171. Immunotherapy in Schizophrenia: What are the Next Steps?

Abstract

Overall Abstract: Recent studies indicate that immune dysregulation plays a major role in the pathogenesis of schizophrenia. These fndings have led to quite a number of different treatment trials of compounds affecting the immune system. Previous studies have focused on broadly reacting com-pounds such as NSAIDs and Cox-2 inhibitors. However, the recent devel-opment of monoclonal antibodies and other agents directed at specifc immune targets offer new opportunities in this area. The current workshop aims to briefy review the studies already performed and intends to encourage discussion regarding future directions for immu-notherapy in schizophrenia. Many of the new compounds offer advantages in terms of specifcity and low toxicity. However, many of the new compounds are also very expensive. Hence the co-operation of the pharmaceutical industry is essential in terms of developing immunotherapies applicable to individuals with schizophrenia. Dr. Yolken will discuss recent advances in terms of understanding the human microbiome and how these impact strategies for schizophrenia treatment. Dr. Weiser will present data on a recently completed RCT administering aspirin to patients with schizophrenia with high plasma CRP, and another study on naproxen for schizophrenia, showing negative results. Dr. Kahn will present PET studies examining the role of microglia in schizophrenia, as well as novel postmortem studies including the use of brain organoids to study involvement of microglia in schizophrenia. He will also present studies using simvastatine and prednisone in the treatment of psychosis. Dr. Fleischhacker will discuss some of the methodological pitfalls of designing and interpreting clinical trials in schizophrenia in general and immunotherapies in particular. Dr. Miller will present data on relationships between blood cytokines, psy-chopathology, and cognition in patients with schizophrenia and will discuss 2 ongoing RCTs of adjunctive anti-interleukin-6 monoclonal antibody immunotherapy. Dr. Muller will present data on the effects and potential mechanisms of the use of cyclooxygenase 2 inhibitors and NSAIDs in schizophrenia with a special focus on cognition. Dr. Sperner-Unterweger will build the bridge between immunotherapy trials in affective disorders and schizophrenia based on the recently completed "moodinfame" study. Dr. Gopal and Dr. Saad will present data from a recently completed long-term controlled study of paliperidone palmitate in which serum cytokines were collected longitudinally in a subset of patients. The relationship between changes in levels of infammatory markers (IL6R, IL6, TNF-alpha, CRP, IL10, gp130, mature BDNF, IGF1, leptin, adiponectin, cor-tisol, and IL1RA) and symptom relapse as measured by the PANSS will be presented.