Immunological Characterization of an Italian PANDAS Cohort
RESEARCH IMPACT:
“Immunological Characterization of an Italian PANDAS Cohort” suggests PANDAS may be linked to persistent systemic inflammation rather than just recurrent infections. Elevated TNF-α and IL-17 levels might contribute to ongoing inflammation in PANDAS patients, independent of infection. Given the variability in immune responses, a combination of ASO, anti-DNase B antibodies, and throat cultures is suggested for better diagnosis. This research highlights the need for improved understanding of the immune mechanisms in strep triggered PANDAS, emphasizing the role of inflammation rather than recurrent infections in symptom persistence.
SUMMARY
“Immunological Characterization of an Italian PANDAS Cohort” investigates the immune profiles of children diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) to understand its underlying pathophysiology.
The focus was on identifying potential immune defects that may lead to recurrent Group A β-hemolytic Streptococcus (GABHS) infections and immune dysregulation contributing to systemic inflammation.
Researchers evaluated 26 children diagnosed with PANDAS and 11 control children with recurrent pharyngotonsillitis. Assessments done through immunological analysis, cytokine profiling, and phenotypic characterization, including TNF-α and IL-17 levels, as well as complement component (C3 and C4) levels found no primary immunodeficiencies in either PANDAS patients or controls. However, PANDAS patients showed a trend toward elevated TNF-α and IL-17 levels, indicating a possible role of chronic systemic inflammation in sustaining neuropsychiatric symptoms, along with lower C3 levels compared to controls.
The study found that 53.3% of PANDAS patients had mothers with autoimmune diseases, suggesting a potential genetic predisposition. 76.9% of PANDAS patients exhibited neuropsychiatric symptoms beyond OCD and tics, including emotional instability, depression, irritability, aggression, developmental regression, and school performance issues. Additionally, anti-streptolysin O (ASO) titers were elevated in most patients but did not significantly differ from controls, suggesting limited diagnostic value.
LINK TO PAPER: https://doi.org/10.3389/fped.2023.1216282
CITATION
Leonardi, L., Lorenzetti, G., Carsetti, R., Piano Mortari, E., Guido, C. A., Zicari, A. M., Förster-Waldl, E., Loffredo, L., Duse, M., & Spalice, A. (2024). Immunological characterization of an Italian PANDAS cohort. Frontiers in pediatrics, 11, 1216282. https://doi.org/10.3389/fped.2023.1216282