fashionista# 2: Maasboulevard.

This photoshoot is part of Researchista_fashionista story. The location of our second photoshoot is one of the main streets in Maastricht: Maasboulevard. It is main because it runs through the junction between Stationstraat, a street that takes you from the train station directly to the city centre… and with thee mmm, street itself. Basically, it’s at the cross-road of things. And also! not least important, it flows next to the river bank of the Maas. This is where you can have a promenade and buy a ticket for a boat ride to Belgium..voila! or should I better say, gezellig!

Say hello to Carolin!

Hello, Carolin!

This story is about how the body’s immune system could attack the brain in a way that leads to a “wrong” diagnosis of psychotic disorders such as schizophrenia or bipolar disorder. Let’s start at the beginning:

A self-destructing body

Put simply, autoimmunity is when your body’s immune system attacks your own body. The ‘normal’ healthy function of the immune system is, of course, to recognise and “clean up” foreign structures that do not belong to the inside of the body, such as microbes. The system consists of several components, including white blood cells, some of which are specialised cells (B-cells). These cells produce antibodies that are responsible for recognising the foreign invader – the antigen. Those antibodies can be imagined as red flags with two arms holding on to the antigen and signaling the rest of the crew that what they have found here has to be cleaned up. Unfortunately, it is not uncommon for those antibodies to make a mistake and hold on to something that is actually a (healthy) part of the body. This leads to an immunity attack, possibly inflammation, without any foreign aggressor. This can happen in any part of the body, leading to many different complications. You may have heard of rheumatoid arthritis, a disease where the immune system attacks proteins in the joint. This is caused by such a ‘mistake’, and it leads to the destruction and inflammation of insulin dependent diabetes (Type 1 Diabetes), where the insulin producing beta-cells in the pancreas are destroyed by an autoimmune attack.

The brain on fire

For me, the most fascinating cases are when auto-antibodies are targeting the brain. In particular, I am interested in those autoimmune reactions which lead to psychiatric symptoms. The connection might not be very obvious, but I am studying the role of autoimmunity in psychotic disorders (e.g. schizophrenia or bipolar disorder) and also the pathologic mechanism of the so-called autoimmune encephalitis (brain inflammation).

 A different view on psychotic disorders

Perhaps I should mention that I am coming from a biomedical background, so I have a “special” approach to psychiatric/mental disorders. To me, everything in the body has a biological explanation and what is projected externally (behaviour, personality, indicators of mental state, etc.) has an internal origin in the organs, in this case the brain. I am aware that not everyone might agree with this theory, but the study of the mind (psychology and psychiatry) and the brain/nervous system (neurology) is definitely starting to fuse, and diseases are starting to be called “neuropsychiatric”. In the future, I think that all mental diseases will be explained by neuronal changes and the discipline of (neuro-)psychiatry will be a subspecialty of neurology. This will, therefore, also include psychotic disorders such as schizophrenia and bipolar disorder. Currently, we know very little about the underlying mechanisms of these diseases or, shall I say, “disorders”, “syndromes” or “collection of patients with similar symptoms”. Likely, these cohorts of patients do not all suffer from the same disease. Instead, there are different groups of patients with a different set of genetic and environmental factors leading to neuronal changes via different ways. One mechanism, in a subset of these patients, could be an autoimmune disease, for example.

Latest research on immune factors in psychotic disorders 

This hypothesis of an autoimmune cause in psychosis is not as absurd as it may first seem. It is well accepted that a unsregulated immune system and genes, important for immune regulation, are linked to developing psychotic disorders. A big game-changer was the discovery, within the last 10 years, of several autoimmune diseases, which target neurotransmitter receptors and ion-channels, crucial for functioning and communication of cells in the brain (neurons). This autoimmune inflammation of the brain also leads to symptoms that look very similar to schizophrenia, but commonly co-occur with “neurological” symptoms, such as movement disorders, epileptic seizures, and loss of consciousness. Interestingly, some research groups are starting to find auto-antibodies in blood and cerebrospinal fluid (the liquid around the brain) that potentially bind the brain. My research builds on these findings. Via a  collaboration with many different hospitals all over Europe, I received a large cohort of blood/serum samples from psychotic patients (around 600 samples) and healthy controls (250 samples). These large samples provided me the opportunity to test for the presence of auto-antibodies that attack the brain. It seems that these auto-antibodies are more common in diseased individuals than in the  controls. However, these results are preliminary and I don’t want to give away too much at this point …

Finding signs of inflammation in brains of schizophrenic patients

Another study, that I started recently, may further help us understand the link between autoimmunity and psychotic disorders, this time using brain tissue from post-mortem schizophrenia patients. In this project, we are using methods to ‘colour’ certain cells or structures in the brain. We expect to find markers that point towards a presence of the immune system, such as immune cells and antibodies, and to make a distinction between brains of healthy individuals and individuals with psychotic disorders. Overall, we hope to find ways to identify those patients that might be “misdiagnosed” with a psychotic disorder and be able to treat the biological cause of their disease.

 Treating the cause and not the symptoms

Why we think this is important? Well, it might make a big difference for the patients because they could get a very different treatment. For autoimmune disorders, there are already several possible treatments out there which might also be successful in “autoimmune psychosis”. So, I hope that one day the diagnosis of schizophrenia & co. will be altered, and instead, we can use a diagnosis of diseases so that we can treat the cause and maybe even cure it (let’s dream big)!

So, after the Researchista part, here’s another note on the Fashionista:

If I was at risk for any addiction, it would probably be shopping. I can spend the whole day checking clothes and at times buying many more things than my closet can handle.

This year, I made the resolution to buy less and focus on sustainable, high quality materials. I am making an effort, but there is definitely room for improvement…

I also like sewing my own clothes or recycling old things. For example, the dress I am wearing in the photo-shoot I created from a cotton fabric that my mother brought me from a holiday in Malaysia. Unfortunately, I usually don’t have the time to sew my own clothes… However, in the end, these unique pieces are always worth the effort.

by Carolin Hoffman, PhD student at Department of Neuroscience, School for Mental Health and Neuroscience (FHML), Maastricht University,  Early-Experienced Researcher.

This street was inviting and a good place for exploration and reflection along the river. Here is a little poetic touch out of this reflection on Research developments on body’s immune system on Maasboulevard.

Who is next to share a story on Researchista fashionista? 😉

With love for Research,

Photo credits: Photostique, Peter Mullenberg (A beautiful vespa scooter was provided with the courtesy of Photostique, bedankt!). Editing Credits: Rose Education Consultancy, Claire Willis. Outfits: happy people in a self-made dress by Carolin and Vanilia dress on Researchista.