Suicide mostly occurs in association with neuropsychiatric disorders characterized by neuroinflammation (brain inflammation). Neuroinflammation often results from perturbations of the brain-gut axis, with pro-inflammatory immune signaling from the gut to the brain. An important study just published in Psychiatry Research offers data showing the connection between biomarkers of gastrointestinal inflammation and recent suicide attempt. The authors were motivated by the intent to validate biomarkers to help assess, treat and prevent suicide attempts.
Most attempting suicide have an illness associated with neuroinflammation
“Psychological autopsy and epidemiological studies indicate that more than 90% of people who die by suicide have a diagnosable psychiatric illness, particularly major depression, bipolar disorder, or schizophrenia…The identiﬁcation of blood-based markers would provide for more personalized methods for the assessment and treatment, and ultimately prevention, of suicide attempts.”
It is an urgent clinical need to identify causes that promote dysregulated activation of the immune system against the neuronal antigens.
The GI tract is often the source of immune activation against the brain
Biomarkers of gastrointestinal inflammation are frequently increased in neuropsychiatric disorders.
“Many individuals with schizophrenia and mood disorders have evidence of immune activation suggesting that immune dysregulation may be part of the etiopathology of these disorders. Studies by our group and others indicate that the gastrointestinal tract is often the primary source of this immune activation as evidenced by increased levels of markers of gastrointestinal inﬂammation in individuals with serious mental illness.”
IBD (inflammatory bowel disease) and celiac disease appear to increase risk for suicide.
“Furthermore, increased rates of suicide and suicide attempts have been found in some populations of individuals with celiac disease or inﬂammatory bowel diseases.”
But previous studies have focused on a lifetime history rather than attempts, so the authors set out to:
“…examine the association between levels of markers of gastrointestinal inﬂammation and a recent suicide attempt in individuals with schizophrenia, bipolar disorder or major depressive disorder in comparison with non-psychiatric controls.”
Interleukin-6 (IL-6), a key pro-inflammatory cytokine which can arise from the GI tract, is associated.
“Results from other investigators indicate that inﬂammation may be associated not only with a proclivity for a psychiatric disorder, but speciﬁcally with suicidal behavior. Studies have found an association between a suicide attempt history and the level of cytokines such as IL-6 which are cell signaling molecules involved in the immune response and which can arise from inﬂammation from many sources, including the gastrointestinal tract”
Gluten and brain inflammation
Neuroinflammation triggered by non-celiac gluten sensitivity is also implicated:
“Gliadin is a component of gluten, found in wheat and related cereals. Antibody response to dietary gliadin is associated with celiac disease, an immune-mediated enteropathy, and with non-celiac wheat sensitivity and is thought to indicate intestinal inﬂammation and/or intestinal barrier dysfunction. We have found increased levels of antibodies to gliadin in individuals with schizophrenia and with bipolar disorder and in individuals with acute mania during a hospital stay…”
Additionally, loss of tolerance to a commensal yeast may promote neuroinflammation.
“We also have studied the antibody response to yeast mannans represented by antibodies to Saccharomyces cerevisiae (ASCA), a commensal organism present in some foods and in the intestinal tract of many individuals. Elevated ASCA levels are associated with increased intestinal inﬂammation. We have previously found increased levels of ASCA in individuals with mood disorders.”
Pathogens and loss of immune tolerance
Various pathogens present at low levels can elicit a persistent cross-reaction to self-antigens, including brain antigens, in individuals disposed to loss of immune tolerance.
“An association between elevated antibodies to Toxoplasma gondii, an apicomplexan parasite, and suicide attempts have also been reported. In a recent study, we found that individuals with serious mental illness who had a lifetime history of a suicide attempt had elevated levels of IgM class antibodies to Toxoplasma gondii and Cytomegalovirus (CMV); we also found an association between the levels of these antibodies and the number of suicide attempts.”
Significant link found
The authors examined data for 282 participants: 90 with schizophrenia, 72 with bipolar disorder, 48 with major depressive disorder, and 72 non-psychiatric controls; who were enrolled in ongoing studies of the role the immune response to infections in individuals with serious psychiatric disorders. Biomarkers measured included IgA antibody to yeast mannan from Saccharomyces cerevisiae (ASCA), IgG antibody to gliadin, IgA antibody to bacterial lipopolysaccharide (LPS) from E. coli O111:B4, Pseudomonas aeruginosa, and Klebsiella pneumoniae, and levels of C-Reactive protein.
“We found a statistically signiﬁcant diﬀerence between the recent attempters and the control group in levels of IgA ASCA; the level in the recent attempt group was signiﬁcantly higher…We also found that the level of IgG antibodies to gliadin was signiﬁcantly higher in the recent attempters vs. the control group…We also found that the level of IgA antibodies to bacterial lipopolysaccharide (LPS) was signiﬁcantly higher in the recent attempters vs. the control group…In terms of CRP, we found that there was a signiﬁcantly higher level in the past attempter group.”
Predicting risk and protecting patients
These findings offer a valuable opportunity for clinicians to gauge and ameliorate risk of suicide in patients with serious neuropsychiatric disorders.
“The markers of gastrointestinal inﬂammation are of interest because they can be readily measured in blood samples. In addition, some of the markers studied here may be an attractive target for therapeutic intervention since intestinal inﬂammation can be modulated by dietary interventions as well as the administration of available prebiotic, probiotic, and antibiotic medications.”
The authors conclude:
“Suicide, for which a previous suicide attempt is the greatest risk factor, is a major cause of death worldwide and is highly prevalent in patients with serious mental illness. Unfortunately, the ability to predict suicide remains limited and no reliable biological markers are available. The identiﬁcation of blood-based markers should provide for more personalized methods for the assessment and treatment, and ultimately prevention, of suicide attempts in individuals with serious mental illnesses.”
For additional categories of importance in evaluating neuropsychiatric risk see The Parents’ Guide to Brain Health.