At first glance, the idea seems bizarre.

September 30, 2018 1:41 PM

"A bone-marrow transplant essentially reboots the immune system. Chemotherapy kills off your old white blood cells, and new ones sprout from the donor’s transplanted blood stem cells. It’s unwise to extrapolate too much from a single case study, and it’s possible it was the drugs the man took as part of the transplant procedure that helped him. But his recovery suggests that his immune system was somehow driving his psychiatric symptoms."

posted by mhoye (24 comments total)

This reminds me of a previous study which identified a candidate allele linking the immune system to schizophrenia. In that case, though, it was a neuron-pruning gene which would have a presumably permanent effect. In this case, it sounds like there might be ongoing immune system involvement which can be turned on or off.

Two of the most complicated systems that we know about - our immune system and our brain - interacting in complicated ways. Fascinating stuff.
posted by clawsoon at 2:01 PM on September 30, 2018 [8 favorites]

Interesting. Speculative of course, but very interesting nonetheless.

Whenever I read stories like this, my main thought is "I am so glad I don't have schizophrenia." I have some risk factors, and of course it's one of those disorders that usually presents later in life, early adulthood. So now that I'm past that age, I breathe a sigh of relief. Such a frightening disorder. I hope one day we find a cure, or better yet a way of identifying it before it presents and preventing it entirely.
posted by Anticipation Of A New Lover's Arrival, The at 2:08 PM on September 30, 2018 [4 favorites]

This boggles my mind and simultaneously makes complete sense. There's been some discussion of the link between the immune system and dementia as well.

There are so many things we do not yet understand about the body. This is why basic science is crucial to fund. Under what conditions does this occur, and why?
posted by sockermom at 2:10 PM on September 30, 2018 [13 favorites]

This was fascinating and may give hope to many. Schizophrenia is a highly debilitating disease with very few treatment options, and the ones available have many side effects are not typically very effective. There is no cure. But this is super hopeful - the science of the micro biome is a revolution in medicine.
posted by bluesky43 at 4:06 PM on September 30, 2018 [3 favorites]

This bit was new to me and fairly boggling:
the Austrian physician Julius Wagner-Jauregg developed a method of deliberate infection of psychiatric patients with malaria to induce fever. Some of his patients died from the treatment, but many others recovered. He won a Nobel Prize in 1927.
posted by doctornemo at 4:49 PM on September 30, 2018 [9 favorites]

This is really interesting. The microbiome seems to be coming up in many areas relating to both mental/cognitive health and the immune system. “Cytokines” is also a word that I had never heard before and I seen several times in the past year. If anyone knows where I can read more about this all in layman terms, I’d love a suggestion or two.
posted by CrazyLemonade at 4:51 PM on September 30, 2018 [2 favorites]

Fascinating stuff - thanks.
posted by parki at 4:56 PM on September 30, 2018

CrazyLemonade: “Cytokines” is also a word that I had never heard before and I seen several times in the past year.

As I understand it, "cytokine" is a bit of a grab-bag of a word for small molecules that are used for intercellular communication, something like "hormone". It seems like "cytokine" could be useful for describing all sorts of intercellular communication molecules, but I've only ever seen it used when talking about the immune system. I think maybe that immunologists came up with the word and haven't been able to convince other biologists to use it for anything outside the immune system.

If anyone knows where I can read more about this all in layman terms, I’d love a suggestion or two.

I found How the Immune System Works by Lauren M. Sompayrac useful. It's not quite layman-level - more like an attempt to keep the attention of tired medical students - but it has short chapters, lots of pictures, understandable analogies, and it at least touches on most of the immune system.
posted by clawsoon at 5:11 PM on September 30, 2018 [4 favorites]

This really moves me. Thank you, fascinating and sobering information.
posted by LansLeFleur at 5:26 PM on September 30, 2018

Immune-mediated psychosis in children
posted by TedW at 5:27 PM on September 30, 2018 [2 favorites]

Somebody close to me has schizophrenia. They’ve found an anti-psychotic that works for them and now appear be “better” - which feels absolutely miraculous coming only a few years after a series of psychotic breaks (including an attempted murder) and a period of institutionalisation. At that point, their condition seemed completely irreversible and it looked like they would spend the rest of their life in their own personal David Lynch-directed nightmare.

They’re pretty comfortable talking go me about “being insane” (their words) and I found this article so interesting that I’m considering sending it to them.
posted by chappell, ambrose at 5:46 PM on September 30, 2018 [3 favorites]

The problem with selecting an immunotherapy for treating schizophrenia is that for the overwhelming majority of cases, there is no definitive way of selecting which patients are likely to benefit. This excepts something like anti-NMDA-receptor encephalitis, which I've seen definitely confirmed in several patients, and which shows neurological signs. It's like finding "cancer" and testing it by selecting a random chemotherapy and sticking with it without any biomarkers to monitor response. Sometimes you just have to try. I've used minocycline, for example, in several occasions without the ability to know if it's likely to benefit. But I'm hopeful we'll get better at being able to identify and select appropriate therapies for specific patients. After all, we managed to figure out which of severely mentally ill had the general paresis of the insane and give them penicillin.
posted by meehawl at 6:05 PM on September 30, 2018 [3 favorites]

Leptin, my pet energy balance hormone, is also a cytokine! It's classified that way because it's involved in inflammatory signaling as well as in energy balance, and seems to have evolved from an ancestral immune system signaling factor to its current energy balance function.

Leptin levels also seem to be implicated in depression, is the interesting thing. I'm fascinated by the way that bodies use signals like these for some unexpected forms of double duty in different contexts.

The metaphor of cancer for phenotypes like schizophrenia seems very apt, honestly.
posted by sciatrix at 7:11 PM on September 30, 2018 [5 favorites]

Have there been any other observations on the effects of bone marrow transplants for other autoimmune diseases?
posted by 1970s Antihero at 8:01 PM on September 30, 2018

This makes complete sense, the brain is an organ

Yes, but it’s an organ that we only just found out is directly hooked up to the immune system. Before meningeal lymphatic vessels were discovered four years ago, it was assumed the central nervous system relied on much less straightforward backdoor methods to repair and defend itself. Turns out the brain is hooked right into the bone marrow of the skull.
posted by Sys Rq at 11:25 PM on September 30, 2018 [12 favorites]

OK, so that was a true story I read in High Times when I was a teenager and has haunted me ever since - about a group of people with access to a mental hospital and they would inject the blood of schizophrenia patients. "blood of a wig" For kicks.
posted by cda at 3:32 AM on October 1, 2018 [1 favorite]

Christ, what a nasty little asshole that man was. You can more or less absolve your horror, though: unless the hapless mental patients were carefully screened to be O negative, the main response would probably be a fever and chills as the immune response to clearly foreign blood set in.

Falling that, antipsychotics don't produce much of a high. Neither is "madness" communicable, even by blood transfusion. Assuming any of this actually happened--doubtful, as I can't imagine anyone being willing to pay for the privilege of a strong induced allergic reaction to incompatible protein, certainly not more than once--the author probably felt vaguely clammy and gave himself permission to behave in a way he associated with the incurably mad.

(For the unwarned: the author of the piece practically revels in casual homophobia and appears to think his misogyny is just edgy honesty, and maybe it was. But you might like to know that going in.)
posted by sciatrix at 5:11 AM on October 1, 2018 [1 favorite]

Every time I think about Toxoplasmosis-driven behavioral changes I try to imagine what the behavioral sciences landscape will look like in the near future. I think within 15 years most of today's treatment modalities - even the decent ones - will look absolutely Victorian (which many of them are, I know). In 50 years, it'll all sound like total Pliny the Elder shit and nobody will believe it was real.
posted by Lyn Never at 9:53 AM on October 1, 2018 [4 favorites]

I found How the Immune System Works by Lauren M. Sompayrac useful.

Thanks, clawsoon, I just ordered the book right now.
posted by CrazyLemonade at 10:30 AM on October 1, 2018

Have there been any other observations on the effects of bone marrow transplants for other autoimmune diseases?

They are experimenting with treating Multiple Sclerosis. I read an essay by an Australian nurse who went to Russia to have it done when I was first diagnosed. Of course, since MS has such a wide spectrum of outcomes, many would not consider the risks to be worth it.
posted by soelo at 11:05 AM on October 1, 2018

This bit was new to me and fairly boggling:
the Austrian physician Julius Wagner-Jauregg developed a method of deliberate infection of psychiatric patients with malaria to induce fever. Some of his patients died from the treatment, but many others recovered. He won a Nobel Prize in 1927.
posted by doctornemo at 19:49 on September 30
[8 favorites +] [!]

For those who are curious, it was specifically for patients with syphilis. After a long period of time syphilis attacks the brain. The high fever caused by malaria killed the syphilis and prevented further brain damage, potentially saving a person's life (but leaving then with the brain damage they'd already suffered).
posted by I paid money to offer this... insight? at 11:52 AM on October 1, 2018 [3 favorites]

A lot of illnesses are being traces to the immune system. Diabetes, of course, but the Nobel for Medicine just went to cancer immunotherapists. Asthma is theorized to be a response to the world being too clean and safe -- the immune system starts attacking dust.

Fun fact, you can cure Type 1 Diabetes -- just kill the immune system, same as in any transplant scenario. It'll reboot and not kill beta cells in the pancreas anymore (they never all die).

Apparently it takes a month and kills 1% of patients (last I checked, this was a few years ago). It's not seriously an option AFAIK.
posted by effugas at 3:12 AM on October 2, 2018 [1 favorite]

just kill the immune system, same as in any transplant scenario
This is specific to stem cell and bone marrow transplants. Other types of transplants, like solid organ transplants, do not reboot the immune system.

And the hygiene hypothesis (less microbial exposure causes asthma) is not supported by evidence.
posted by sockermom at 5:40 PM on October 2, 2018 [1 favorite]

Socket Mom,

I'll see your review from 2006 and raise you a review from 2015. And I'll thank you for reminding me, no really, there are people who spend all day every day working on this and they write all about it, extensively.

I'm adjusting my opinion to "read more about the hypothesis, it appears to be in a process of slow refinement".
posted by effugas at 2:37 AM on October 3, 2018