Clinical Scorecard: Neuroimaging Insights into Immune Changes in Schizophrenia and the Impact of a Therapeutic Antibody
At a Glance
Category
Detail
Condition
Schizophrenia with first-episode psychosis
Key Mechanisms
Elevated 18 kDa translocator protein (TSPO) expression indicating neuroinflammation, primarily involving microglia and astrocytes
Target Population
Patients with first-episode psychosis symptomatic despite antipsychotic treatment
Care Setting
Specialized psychiatric and neuroimaging research centers
Key Highlights
Baseline TSPO levels in grey matter, especially temporal lobe, are elevated in first-episode psychosis patients compared to healthy controls.
Natalizumab, a monoclonal antibody, crosses the blood–brain barrier and is well tolerated in schizophrenia patients.
Natalizumab treatment modestly improves symptoms but does not significantly alter TSPO PET binding, suggesting TSPO elevation may reflect non-microglial cell expression.
Guideline-Based Recommendations
Diagnosis
Use 18F-DPA-714 PET imaging to quantify TSPO levels as a biomarker of neuroinflammation in first-episode psychosis.
Assess symptom severity with the Positive and Negative Syndrome Scale (PANSS).
Management
Consider natalizumab as an add-on treatment for patients with inadequate response to antipsychotics, noting modest symptom improvement.
Continue standard antipsychotic treatment alongside investigational immune-targeted therapies.
Monitoring & Follow-up
Perform baseline and follow-up TSPO PET imaging to evaluate neuroinflammation status.
Monitor clinical symptoms using PANSS at baseline and after treatment.
Observe for adverse events related to natalizumab, although serious events were not reported.
Risks
Natalizumab was well tolerated with no serious treatment-related adverse events in this study.
The functional relevance of TSPO changes remains unclear; lack of TSPO reduction despite symptom improvement suggests complexity in immune involvement.
Patient & Prescribing Data
First-episode psychosis patients with persistent symptoms despite antipsychotic treatment
Natalizumab crosses the blood–brain barrier and leads to modest symptom improvement without significant changes in TSPO PET binding.
Clinical Best Practices
Use TSPO PET imaging to identify neuroinflammatory status in schizophrenia research settings.
by Yuya Mizuno, Ines Carreira Figueiredo, Toby Pillinger, Guy Hindley, Luke Baxter, Sita Parmar, Maria C Lobo, Jacek G Donocik, Ivana Rosenzweig, Anish Gupta, Ilaria Callegari, Sami Jeljeli, Joel T Dunn, Alexander Hammers, Ramla Awais, Kerstin Sander, Erik Årstad, Marios Politis, Julia J Schubert, Mattia Veronese, Federico E Turkheimer, Tiago Reis Marques, Oliver D Howes
