Pharmacotherapy of schizophrenia: immunological aspects and potential role of immunotherapy

ABSTRACT

Introduction

Schizophrenia is a complex disorder owing to diversity in clinical phenotypes, overlapping symptoms, and heterogeneous clinical presentation. Even after decades of research, the exact causative mechanisms of schizophrenia are not completely known. Recent evidence indicates the role of immune dysfunction in schizophrenia pathogenesis as observed from alteration in immune cells, increased activity of complement cascade, and development of autoantibodies against neurotransmitter receptors. Immunotherapy involving immunosuppressants and cytokine-targeting drugs, have shown promising results in several clinical studies and it demands further research in this area.

Areas covered

Here, the authors review the immunopathogenesis of schizophrenia, limitations of conventional, and atypical antipsychotic drugs and the potential role and limitations of immunotherapeutic drugs in schizophrenia management.

Expert opinion

Schizophrenia is a complex disorder and poses a challenge to the currently available treatment approaches. Nearly 30% schizophrenia patients exhibit minimal response toward conventional and atypical antipsychotic drugs. Immune system dysfunction plays an important part of schizophrenia pathophysiology and existing monoclonal antibody (mAb) drugs targeting specific components of the immune system are being repositioned in schizophrenia. The authors call upon public and private funders to facilitate urgent and rigorous research efforts in exploring potential role of immunotherapy in schizophrenia.

KEYWORDS:

• Autoimmune
• biomarkers
• cytokines
• immunotherapy
• monoclonal antibodies
• schizophrenia

Article highlights

• Schizophrenia is a chronic, debilitating psychiatric illness that poses a challenge to the currently available treatment modalities.

• About 30% schizophrenia patients are resistant to currently available antipsychotic drugs and drug repurposing in schizophrenia appears a reasonable strategy.

• Immune system dysfunction could be one of the possible reasons for ineffectiveness of antipsychotic drugs.

• Inflammatory and immunological phenotypes need to be explored at individual level to maximise the effect of immuno-modulating drugs in schizophrenia.

• Based on the unmet needs with the available antipsychotic drugs, this article focuses on the immune dysfunction aspects of schizophrenia pathogenesis and potential role, drawbacks and safety concerns associated with potential immunotherapeutic drugs.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper is not funded.