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Translational Medicine Friday

Translational ImmunoPsychiatry Unit (TIU)  --- U.S. National Institute of Mental Health

9/13/2024

 
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Christopher M Bartley, M.D., Ph.D.
Chief

Translational Immunopsychiatry Unit (TIU)
US National Institute of Mental Health
Research Topics

The Translational Immunopsychiatry Unit (TIU) studies immune processes that contribute to neuropsychiatric illness.he TIU is interested particularly in identifying autoimmune B and T cell reactivities that cause behavioral pathology.

One aim of the lab is to identify rare psychiatric subgroups whose illness is defined by an antigen-specific autoimmune response—thereby helping to parse the staggering heterogeneity of psychiatric illness.

A second aim is to develop technologies that demarcate cells and circuits that are vulnerable to autoimmune responses in the human central nervous system.

A third focus of the TIU is, in collaboration, to study the pathobiological consequences of immune-antigen interactions at different levels of analysis: structure and biochemistry, neurophysiology, and behavior.

The Mental Health System, the Disability System and Microglia

9/13/2024

 
At 1:00 --
The bit that I've been particularly sort of interested in is how we have had these two separate worlds ---  mental health over here  and the disability system ---

And when I went to work in Mental Health I just saw people with almost identical needs to the people I had worked [with] and known in the disability system.

In fact, if you went to some of the less desirable community living alternatives and boarding houses and hostels and all that --- these people were practically indistinguishable almost.
Microglia and cognitive impairment in schizophrenia: translating scientific progress into novel therapeutic interventions  (2023)
Research has demonstrated that microglia, especially those in the gray matter of the brain, are activated in schizophrenia.

Upon activation, microglia release key proinflammatory cytokines and free radicals, which are well-recognized neurotoxic factors contributing to cognitive decline.

Thus, we propose that the inhibition of microglial activation holds potential for the prevention and treatment of cognitive deficits in patients with schizophrenia.

This review identifies potential targets for the development of new treatment strategies and eventually the improvement of care for these patients.

It might also help psychologists and clinical investigators in planning future research.
Microglia in Prenatal Brain Injury  (2021)

Mitigating Cognitive Deficits in Down Syndrome by Managing Microglia Activation (2020)

Microglia in Parkinson's Disease (2022)

The Role of Microglia in Brain Metastases: Mechanisms and Strategies (2024)

Microglia Modulate Neurodevelopment in Autism Spectrum Disorder and Schizophrenia (2023)

Suicide in bipolar disorder patients is associated with hippocampal microglia activation and reduction of lymphocytes-activation gene 3 (LAG3) microglial checkpoint expression (2023)

Former Australian Mental Health Commissioner Eddie Bartnik discusses needs for Inclusion, Citizenship and the need to recognize the often missed commonalities between "Mental Illness" and other types of "Disability."

Bartnik also discusses the need for sustained and inclusive focus on Mental Health such as could be provided by a Mental Health Commission which could drive reform and push for Personalized and Self-Directed services.

The role of microglia in multiple sclerosis (2017)
Summary

Microglia are implicated in all stages of multiple sclerosis (MS).

Microglia alterations are detected by positron emission tomography in people living with MS prior to the formation of structural lesions determined through magnetic resonance imaging. In histological specimens, clusters of microglia form in normal-appearing tissue likely predating the development of lesions.

Features of degeneration-associated/pro-inflammatory states of microglia increase with chronicity of MS.

However, microglia play many beneficial roles including the removal of neurotoxins and in fostering repair.

The protector-gone-rogue microglia in MS is featured herein.

We consider mechanisms of microglia neurotoxicity and discuss factors, including aging, osteopontin, and iron metabolism, that cause microglia to lose their protective states and become injurious. 

. . . The framework of microglia-turned-destroyers may instigate new approaches to counter microglia-driven neurodegeneration in MS.
Microglia NLRP3 Inflammasome and Neuroimmune Signaling in Substance Use Disorders (2023)

Associations of the immune system in aggression traits and the role of microglia as mediators (2024)

"Microglia are innate immune cells of the central nervous system (CNS)"

Vaccines & Vaccination Strategies --- Opening Pandora's Box

9/12/2024

 
Val's Take/Conjecture
  • There are some issues that are such hot button issues that the Conversation goes off the rails before it even gets started.
  • Vaccines is not one of those issues for me, but I have my own hot button issues.
  • I think it is turning out that Vaccines are more complicated than we thought.
  • The analogy that comes to mind that may not be a perfect analogy is FARMING.
  • During the Great Depression and the Dust Bowl, we found out that FARMING was more complicated than we thought.
  • We didn't decide to stop FARMING, but we did modify our FARMING PRACTICES.
One of the things that I wasn't aware of and didn't think about was that people are not the only ones to get vaccinations.

Farm animals get vaccinations.

Further, farm animals can be subject to Maternal Immune Activation.

In the  2022 Study to the right involving chickens, veterinary researchers found that chickens subject to Maternal Immune Activation needed:
  • modified diets, and
  • vaccination strategies

We actually do have modified vaccination strategies or guidelines for some people with known illnesses, such as multiple sclerosis.
That "modified strategy" is generally not --- don't get vaccinated because --- people with compromised immune systems might be more likely to have serious complications or die from the disease or illness the vaccination is meant to protect against.

On the other hand, it is not ignoring that a modification in vaccination strategy needs to be made.
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Transgenerational Effects of Maternal Immune Activation on Specific Antibody Responses in Layer Chickens (2022)
Activation of the maternal immune system may affect innate and adaptive immune responses in the next generation and may therefore have implications for vaccine efficacy and dietary immune modulation by feed additives . . .

Despite variabilities in the outcomes of the two experiments, the observations of both suggest a link between the maternal innate immune system and the immune system of the offspring.
Furthermore, our results may imply that maternal activation of the innate immune system can influence immune modulating dietary interventions and vaccine strategies in the next generation. 
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The Dust Bowl. Image Credit: National Drought Mitigation Center, University of Nebraska

Sensory processing,  ADHD, Autism, Mood Disorders & Immunity

8/31/2024

 
Val's Take/Conjecture
  • I think when there is some kind of serious emotional dysregulation, behind that is often a processing disorder.
    • Serious emotional dysregulation is not rare in this society and maybe a lot of societies.
  • Certainly in Education, there is more and more recognition of processing differences and the need for "Brain Breaks."
These processing disorders do represent another kind of Catch-22 or vicious cycle.
  • Often times this "processing disorder" involves taking in:
    • "More" (not all) information, and
    • It is hitting all at once
  • The person can become overwhelmed --- both mentally and physically.
  • It is taking a lot of Energy, a lot of ATP to try to regulate this.
  • At some point, your body is trying to get Energy from wherever it can, and anger can help to supply that.
    • Many neuro-diverse people are already irritable and most of us try to MASK that.
Further, if you are around people who are irritable and/or "emotionally dysregulated" --- it is taking you a lot of Energy and ATP to both deal with that situation and your own reactions to it.

Severe Irritability and/or Emotional Dysregulation can look a lot of ways, it can look fairly basic or primitive or quite sophisticated.
HERE'S THE CATCH-22
  • You didn't take in ALL information, and to address this situation --- You need to take in more information.
  • That requires more Energy and more ATP.
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Wikipedia:  Positive Feedback Loop
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Transdiagnostic Patterns of Sensory Processing in Autism and ADHD (2024)

Sensory processing abilities are highly variable within and across people diagnosed with autism and attention-deficit/hyperactivity disorder (ADHD).

This study examined the transdiagnostic nature of sensory processing
…
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Autism and mood disorders (2021)

[I]ndividuals with autism, who may present with 'atypical' features (e.g. severe irritability).

Risk factors for mood problems in autism appear to be largely overlapping with those identified in the general population, including shared genetic, environmental, cognitive, physiological/neurobiological mechanisms.
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The intense world theory - a unifying theory of the neurobiology of autism (2010)

The proposed neuropathology is hyper-functioning of local neural microcircuits, best characterized by hyper-reactivity and hyper-plasticity. 
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Sensory neurons: An integrated component of innate immunity (2024)
  • The sensory nervous system possesses the ability to integrate exogenous threats and endogenous signals to mediate downstream effector functions.
  • Sensory neurons have been shown to activate or suppress host defense and immunity against pathogens, depending on the tissue and disease state.
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Inflammation-induced mitochondrial and metabolic disturbances in sensory neurons control the switch from acute to chronic pain (2023)

ADHD, Autism, Sensory neurons, Pain & an intense world

8/31/2024

 
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Transdiagnostic Patterns of Sensory Processing in Autism and ADHD (2024)

Sensory processing abilities are highly variable within and across people diagnosed with autism and attention-deficit/hyperactivity disorder (ADHD).

This study examined the transdiagnostic nature of sensory processing
…
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Inflammation-induced mitochondrial and metabolic disturbances in sensory neurons control the switch from acute to chronic pain (2023)
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The intense world theory - a unifying theory of the neurobiology of autism (2010)

The proposed neuropathology is hyper-functioning of local neural microcircuits, best characterized by hyper-reactivity and hyper-plasticity. 
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Sensory neurons: An integrated component of innate immunity (2024)
  • The sensory nervous system possesses the ability to integrate exogenous threats and endogenous signals to mediate downstream effector functions.
  • Sensory neurons have been shown to activate or suppress host defense and immunity against pathogens, depending on the tissue and disease state.

Autoimmunity and: Neuro-Developmental Disorders, Cancer, Psychiatric Disorders & Dementia

8/30/2024

 
Val's Note:  The focus here is on "Auto-Immunity" and there seem to be numerous associations in areas we might not expect; although more and more we might expect them.

Beyond "Auto-Immunity" there often seem to be "Immune Mechanisms" that are important, this may be true in "Depression" where the evidence for classic "Auto-Immunity" is conflicting but nonetheless seems clear that "Immune Mechanisms" are relevant.

Additionally, it appears that "Immune Mechanisms" are relevant with regard to Substance Use Issues.
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Autoimmunity and Cancer-Two Sides of the Same Coin (2022)
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Immune system-wide Mendelian randomization and triangulation analyses support autoimmunity as a modifiable component in dementia-causing diseases (2022)

Affiliations
  • 1 Broad Institute of the Massachusetts Institute of Technology and Harvard University, The Klarman Cell Observatory, Cambridge, MA, USA.
  • 2 Department of Epidemiology and Public Health, University College London, London, UK.
  • 3 Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.
  • 4 Broad Institute of the Massachusetts Institute of Technology and Harvard University, The Klarman Cell Observatory, Cambridge, MA, USA.
  • 5 Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland.
  • 6 Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.
  • 7 Department of Epidemiology and Public Health, University College London, London, UK.
  • 8 Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France.
  • 9 Research & Development, Biogen Inc., Cambridge, MA, USA.
  • 10 Division of Psychiatry, University College London, London, UK.
  • 11 Camden and Islington NHS Foundation Trust, London, UK.
  • 12 Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA.
  • 13 Boston University School of Public Health, Boston, MA, USA.
  • 14 New York University Grossman School of Medicine, New York, NY, USA.
  • 15 Boston University School of Medicine, Boston, MA, USA.
  • 16 Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • 17 Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • 18 Institute of Cardiovascular Science, University College London, London, UK.
  • 19 University College London, British Heart Foundation Research Accelerator, London, UK.
  • 20 Health Data Research UK, London, UK.
National Institute of Health
Harnessing the Immune System to Protect Against Opioid Addiction and Overdose (2023)
Medical Dialogues
Hidden Mental Health Symptoms in People Living with Long Term Autoimmune Disease
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Role of autoimmunity in Neuronal damage in children with Autism spectrum disorder (2023)
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Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin (2020)
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Association of Maternal Autoimmune Disease With Attention-Deficit/Hyperactivity Disorder in Children (2021)
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Schizophrenia as autoimmune disease: Involvement of Anti-NCAM antibodies (2023)
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The prevalence of bipolar disorder in autoimmune disease: a systematic review and meta-analysis (2021)
Conclusions:

The prevalence of bipolar disorder is markedly higher in patients with autoimmune disease.

Yet, more basic research is needed to verify the special significance of immune mechanisms in bipolar disorder. 
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Subclinical thyroid dysfunction and major depressive disorder (2021)
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Microglia in depression: an overview of microglia in the pathogenesis and treatment of depression (2022)
Microglia are the predominant resident immune cells in the brain and exhibit a critical role in depression.
Val's Take:   Autoimmunity and various Immune Mechanisms are extremely important for understanding human cognition and behavior, the neuro-developmental/psychiatric continuum and relationships to other chronic diseases.
***Physical Health Issues, the Immune System & Mental Health

VIRUSES:  Auto-immunity, Neuro-developmental Disorders, PsychiatrIC Disorders & Cancer

8/30/2024

 
Val's Take/Conjecture
  • The Epstein-Barr Virus is  extremely common, some  estimates are that 95% of people will be infected.
  • However, the responses to Epstein Barr Viruses (and other viruses) can be extremely idiosyncratic.
  • What  factors are driving more serious responses?
Epstein–Barr Viruses: Their Immune Evasion Strategies and Implications for Autoimmune Diseases (2024)

Epstein–Barr virus as a leading cause of multiple sclerosis: mechanisms and implications (2023)

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NIH Director's Blog:

Study Reveals How Epstein-Barr Virus May Lead to Cancer (2023)

Association of Epstein-Barr virus (EBV) with lung cancer: meta-analysis (2023)

Hypothesis: bipolar disorder is an Epstein–Barr virus‐driven chronic autoimmune disease – implications for immunotherapy (2020)

Schizophrenia is Associated With an Aberrant Immune Response to Epstein–Barr Virus (2019)

Atypical Immune Response to Epstein-Barr Virus in Major Depressive Disorder (2020)

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Modulation of human endogenous retroviruses and cytokines expression in peripheral blood mononuclear cells from autistic children and their parents (2022)
Conclusion

Herein we show that autistic children and their mothers share an intrinsic responsiveness to in vitro microenvironmental changes in expressing HERVs [Human Endogenous Retroviruses] and pro-inflammatory cytokines.

Remarkably, the antiretroviral drug Efavirenz restores the expression of specific HERV families to values similar to those of the controls, also reducing the expression of proinflammatory cytokines but keeping the regulatory ones high.

Our findings open new perspectives to study the role of HERVs in the biological mechanisms underlying Autism.
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Endogenous Retroviruses Activity as a Molecular Signature of Neurodevelopmental Disorders (2019)
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Interplay between activation of endogenous retroviruses and inflammation as common pathogenic mechanism in neurological and psychiatric disorders (2023)

Conjecture:  Antibiotics, AlleRgies, Vaccines, Mitochondria & Catch-22s

8/30/2024

 
Val's Take/Conjecture
  • There were more people after the Black Death  that were subject to Auto-Immunity than before the Black Death (1346-1353).

Mother's autoimmune disease is associated with neuro-developmental & psychiatric disorders.
  • Some autoimmune diseases more than others, Maternal Thyroid Disorders are particularly associated with neuro-developmental and psychiatric disorders.
Downs Syndrome is a neuro-developmental disorder and it is associated with pregnant women over 35, according to the Centers for Disease Control.
  • Based on research from the University of Colorado, Down Syndrome is  more and more conceptualized as an Immune Disorder.
    • See also:  Immune Dysregulation in Down Syndrome [proposal that Down Syndrome is a "Cytokinopathy"]
Father's age is important as well:

  • A 2019 study determined that a father's age has a significant impact on a child's health and development.
  • The study found that babies born to older fathers had an increased risk of cleft lip or palate, heart defects, autism, schizophrenia and bipolar disorder.
www.nbcnews.com › health › parenting
Al Pacino expecting a baby at 83: Health risks for children ...
Antibiotic exposures and the development of pediatric autoimmune diseases: a register-based case–control study (2023)

Antimicrobial resistance (World Health Organization 2023)

Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod (2023)
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Insights into new-onset autoimmune diseases after COVID-19 vaccination (China) (2023)
[V]accination implementation is critically significant.

However, growing evidence suggests that COVID-19 vaccination may cause new-onset autoimmune diseases, including autoimmune glomerulonephritis, autoimmune rheumatic diseases, and autoimmune hepatitis.
Nevertheless, the causal relationship between COVID-19 vaccines and these autoimmune diseases remains to be demonstrated.

In this review, we provide evidence that vaccination induces autoimmunity and summarize possible mechanisms of action, such as molecular mimicry, activation by bystanders, and adjuvants.
Our objective is not to refute the importance of vaccines, but to raise awareness about the potential risks of COVID-19 vaccination. In fact, we believe that the benefits of vaccination far outweigh the possible risks and encourage people to get vaccinated.
Our objective is not to refute the importance of vaccines, but to raise awareness about the potential risks of COVID-19 vaccination. In fact, we believe that the benefits of vaccination far outweigh the possible risks and encourage people to get vaccinated.
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Potential health risks of mRNA-based vaccine therapy: A hypothesis (2023)
Susceptible individuals would then expectedly have an increased risk of DNA damage, chronic autoinflammation, autoimmunity and cancer.

In light of the current mass administration of nms-mRNA vaccines, it is essential and urgent to fully understand the intracellular cascades initiated by cellular uptake of synthetic mRNA and the consequences of these molecular events.
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How the Black Death shaped human evolution
  • Another protective variant has been associated with an increased risk of two autoimmune diseases. Thus, the Black Death and other past pandemics may have shaped humans’ immune systems in ways both good and bad.

While we acquired better protection against infections, we became more susceptible to autoimmune diseases.
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Long-term risk of autoimmune diseases after mRNA-based SARS-CoV2 vaccination in a Korean, nationwide, population-based cohort study  (Korea) (2024)
We report that the risk of developing most AI-CTDs  [autoimmune connective tissue diseases] did not increase following mRNA vaccination, except for systemic lupus erythematosus with a 1.16-fold risk in vaccinated individuals relative to controls.

Comparable results were reported in the stratified analyses for age, sex, mRNA vaccine type, and prior history of non-mRNA vaccination.
However, a booster vaccination was associated with an increased risk of some AI-CTDs [autoimmune connective tissue diseases] including alopecia areata, psoriasis, and rheumatoid arthritis.

Overall, we conclude that mRNA-based vaccinations are not associated with an increased risk of most AI-CTDs, although further research is needed regarding its potential association with certain conditions.
Val's Take:      The discussion on vaccines is becoming more sophisticated.

I'm not for banning antibiotics or vaccines, but I do think there are issues, especially over time.

"Mitochondria are flinging their DNA into our brain celLs"

8/29/2024

 
"Mitochondrial DNA behaves like a virus"
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Somatic nuclear mitochondrial DNA insertions are prevalent in the human brain and accumulate over time in fibroblasts (2023)
Combined, our data document spontaneous numtogenesis in human cells and demonstrate an association between brain cortical somatic Numts and human lifespan.

These findings open the possibility that mito-nuclear horizontal gene transfer among human post-mitotic tissues produce functionally-relevant human Numts over timescales shorter than previously assumed.
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University of Michigan School of Medicine
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Colombia University Irving Medical Center
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The insertions are called nuclear-mitochondrial segments—NUMTs ("pronounced new-mites")—and have been accumulating in our chromosomes for millions of years.

"As a result, all of us are walking around with hundreds of vestigial, mostly benign mitochondrial DNA segments in our chromosomes that we inherited from our ancestors," Mills says.
"Mitochondrial DNA insertions are common in the human brain"

"Stress accelerates NUMTogenesis"
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A systematic review on the role of mitochondrial dysfunction/disorders

in neurodevelopmental disorders and psychiatric/behavioral disorders (2024)

How many mental Health Professionals are addressing a lack of immune Homeostasis?

8/25/2024

 
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Maternal immune activation and neuroinflammation in human neurodevelopmental disorders (2021)
Key points

    Human studies are uncovering a role for maternal immune activation (MIA) in the pathogenesis of common neurodevelopmental disorders, such as autism spectrum disorder, attention-deficit/hyperactivity disorder and Tourette syndrome, in the offspring.

    Prenatal, in utero and postnatal embedding of environmental factors in the epigenetic architecture of both the brain and the peripheral immune system can modulate individual susceptibility to neurodevelopmental disorders.

    The effects of MIA, mediated by acute and chronic inflammation in pregnancy, are transduced to the fetus through inflammatory cell signalling pathways and epigenetic mechanisms.

    Pathogen-associated molecular patterns, damage-associated molecular patterns and Toll-like receptors represent a convergent cellular pathway between heterogeneous environmental factors and innate immune activation.

    In conjunction with individual genetic risk, sex-related factors and second ‘immune’ hits during life, MIA-induced aberrant immune programming results in a loss of immune homeostasis, which is associated with behavioural abnormalities in animal models.
Val's Take/Conjecture
  • Researchers began to investigate whether the Immune System had something to do with Mental Illness at least by the beginning of the 20th Century.
  • BUT the biology on this is hugely complicated involving more than one generation, genetics yes but also a highly dysregulated epigenetics, and multiple systems of the body that are impacting each other in multi-directional ways.
  • Even though a significant connection between the Immune System and Mental Illness has been pondered by researchers for over 100 years, they didn't have the evidence, and they certainly didn't have a comprehensive understanding of the mechanisms involved or the ability to get such understanding.
  • Researchers are getting the evidence and are putting together a  profoundly complicated puzzle.
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Neuroscience News

Extra Credit

Ancient DNA Markers Predict Aging with
New Epigenetic Clock


August 19, 2024
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    Translational Medicine Friday

    We're riffing off NPR's Science Friday to create Translational Medicine Friday.

    We'll be collecting Research Article recommendations for Clinicians with regard to Cognitive Disability.

    ​There is much in the RESEARCH JOURNALS and we'll just be SKIMMING THE SURFACE.

    The POINT is to INCREASE FUNDING for TRANSLATIONAL RESEARCH at the Federal Level for the National Institutes of Health, the Centers for Disease Control, the Nation's Research & Teaching Hospitals and possible collaborations with Medicare and Medicaid providers.

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    • THE IMD RULE & ADMIN. ENFORCEMENT OF DISABILITY CIVIL RIGHTS LAWS
    • Medicaid & Supportive Housing & Housing-Related Services
    • CMS' FAILURE TO COVER HOUSING FOR LTC & THE IMD RULE: WHAT THEY HAVE IN COMMON IS DISCRIMINATION
    • National Take
  • Research & Translational Medicine
    • Immunology & Mental Health >
      • Alcoholism & the Immune System & Mental Health
      • Brain Injury, the Immune System & Mental Health
      • Celiac Disease & Sensitivities, the Immune System & Mental Illness
      • Mental Illness & The Immune System
      • Racial Discrimination & the Immune System & Mental Health
      • Trauma & the Immune System & Mental Health
      • ***Physical Health Issues, the Immune System & Mental Health Index
    • University of Chicago: Institute of Translational Medicine
  • Hot Topics
    • What We Want --- SAMHSA Grant Opportunities Due Jan. 22, 2019
    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
      • Personality Disorders -- Unscientific & Vague -- Must Be Reformed
    • Executive Functioning & "Prison Brain" >
      • Job Accommodation Network on Executive Functioning Deficits
    • Medicaid & Medicare Network Adequacy >
      • OIG: STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE (Sept. 2014)
      • OIG: ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE (Dec. 2014)
      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
      • CMS: Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability (April 2017)
    • Medicaid Mental Health & Substance Use Disorder Parity >
      • CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs [Jan. 17, 2017]
      • Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP [CMS October 11, 2017]
    • Olmstead Disability Rights >
      • Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. (2011)
      • Comprehensive Olmstead Planning
      • the Logical Long Term Consequences of our failure to provide Intensive Community MH Treatment
      • Olmstead Nation ---State Pages: How Far to Comply with Olmstead?
  • Take A Walk Around Orchid's Resource Block
  • Colorado Abuse & Neglect Scandals Involving People with Disabilities
  • Mental Health By The Numbers
  • New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW
  • Olmstead & Homelessness
  • Double V
  • " 'Defund the Police" Means 'Invest in the Resources Our Communities Need' " or Don't Cost Shift to the Police
  • VAGUE OLMSTEAD PLANS, EXPENSIVE LITIGATION
  • Updating & Reforming our Understanding & Treatment of "Anti-Social Personality Disorder" Blog
  • Reform of " Anti-Social Personality Disorder" in Criminal Justice
  • CO HB22-1278
  • New Understandings Matter
  • Mental Health, Ethics & Law
  • CO Olmstead Disability Homeless Law & Policy Project
  • Inflammation, the Immune System, Neuro-Developmental Disorders, Psychiatric Disorders, Substance Use Issues & Chronic Disease
  • Microglia and the Brain's Immune System
  • Substance Issues & the Immune System