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Schizophrenia and Autism: Both Shared and Disorder-Specific Pathogenesis Via Perinatal Inflammation?
Open accessAbstract
Prenatal exposure to infection and subsequent inflammatory responses have been implicated in the etiology of schizophrenia and autism. In this review, we summarize current evidence from human and animal studies supporting the hypothesis that the pathogenesis of these two disorders is linked via exposure to inflammation at early stages of development. Moreover, we propose a hypothetical model in which inflammatory mechanisms may account for multiple shared and disorder-specific pathological characteristics of both entities. In essence, our model suggests that acute neuroinflammation during early fetal development may be relevant for the induction of psychopathological and neuropathological features shared by schizophrenia and autism, whereas postacute latent and persistent inflammation may contribute to schizophrenia- and autism-specific phenotypes, respectively.
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“Multiple animal models of prenatal infection have found evidence of diverse neurobehavioral abnormalities, whether through direct exposure of pregnant mice or rodents to influenza virus, or through non-infectious activation of the maternal immune system (e.g., using RNA poly(I:C) to stimulate an antiviral inflammatory response or lipopolysaccharide to stimulate a bacterial inflammatory response) (”
From Maternal hospitalization with infection during pregnancy and risk of autism spectrum disorders (2015) · cites this paper as Meyer et al., 2011
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Self-citationTransforming the understanding of brain immunity
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Tertiary mechanisms of brain damage: a new hope for treatment of cerebral palsy?
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“The emerging consensus among leaders in the field is that prenatal infection may be relevant to a number of CNS diseases and restricting interpretation to a specific human disorder may limit the utility and relevance of the MIA model (38, 39).”
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“, using RNA poly(I:C) to stimulate an antiviral inflammatory response or lipopolysaccharide to stimulate a bacterial inflammatory response) (Brown and Derkits, 2010; Deverman and Patterson, 2009; Meyer et al., 2011; Miller et al., 2013; Patterson, 2011).”
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“This is particularly true between child onset schizophrenia and autism (Meyer et al., 2011; Rapoport et al., 2009).”
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Developmental neuroinflammation and schizophrenia
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“Exposure to acute fetal inflammation may further induce latent neuroinflammatory abnormalities that can be unmasked by exposure to certain environmental stimuli throughout postnatal life (Meyer et al., 2011a).”
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Long-term Risk of Neuropsychiatric Disease After Exposure to Infection In Utero
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“hit").(15, 53) An adaptive, evolutionary perspective further suggests potential survival advantages of the observed brain phenotypes.”
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“…and cellularmechanisms remain to be identified, it has been suggested that enhanced pro-inflammatory activity in general, andmicroglia over-activation in particular, may play a role in precipitating such progressive brain changes in schizophrenia (van Berckel et al., 2008; Meyer et al., 2011).”
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Self-citationNeurologic Consequences of Preterm Birth
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Evolution, human-microbe interactions, and life history plasticity
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“(79) Similarly inflammation during pregnancy, from any cause, increases the risk of autism and schizophrenia in the child.((80)) It is hypothesized that diminished immunoregulation can increase this risk further.”
BackgroundMicrobial ‘Old Friends’, immunoregulation and stress resilience
Rook, G. A. W., Lowry, C. A., & Raison, C. L. (2013) · Evolution Medicine and Public Health · doi:10.1093/emph/eot004 · Cited by 258
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“Both can involve auditory and visual hallucinations (Meyer et al., 2011; Barneveld et al., 2011), abnormalities of serotonergic, dopaminergic and glutamatergic systems (Brown et al., 2013; Shimmura et al., 2013; Sodhi and Sanders-Bush., 2004) and shared genetic causes (de Lacy and King, 2013;…”
Microbiome, inflammation, epigenetic alterations, and mental diseases
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Evidence for a Dysregulated Immune System in the Etiology of Psychiatric Disorders
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“linked to prenatal stress [122,123].”
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“IL-6, however, is a member of pro-infl ammatory cytokines involved in MIA and the development of neurodevelopmental disorders (Meyer et al. 2011).”
BackgroundChorioamnionitis and neonatal outcomes
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“An early example is the use of improved phenotyping in 1971 to recognize that autism spectrum disorder was a different disease than schizophrenia 2 .”
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“This approach has proved fruitful given there are significant similarities between the disorders, with a recent article even suggesting that it may be neuroinflammatory events during early fetal development which result in this shared pathogenesis (Meyer et al., 2011).”
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“Cytokines such as TNF-α released during intrauterine inflammation are a possible cause of brain damage observed in animal studies linking preterm birth and periventricular white matter damage (61,85,94).”
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“Cognitive deficits often precede the onset of other symptoms and are associated with poor medication compliance and a higher tendency for relapse in first episode psychosis (Meyer et al, 2011b).”
Cytokines and the neurodevelopmental basis of mental illness
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“…in the brain that predisposes an individual, perhaps already at risk due to genetic and environmental influences, to develop the neuropathology and behavioral and cognitive impairments observed in major disorders such as schizophrenia and autism (Rehn and Rees, 2005; Meyer et al., 2011).”
BackgroundMaternal immune activation in nonhuman primates alters social attention in juvenile offspring
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“, 2013; Patterson, 2011), schizophrenia (Meyer et al., 2011; Miller et al., 2013; Patterson, 2009), and cerebral palsy (Yoon et al.”
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“This is relevant as there are both clinical and biological links between autism and schizophrenia (Meyer et al., 2011).”
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“More speculatively, perinatal inflammation is suggested to play a critical role in the pathogenesis of autism and schizophrenia [157–159].”
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“There has been increasing interested in and evidence for an important contribution of prenatal exposure to infection and/or inflammation in the etiology of developmental brain disorders (Brown and Derkits, 2010; Meyer et al., 2011; Patterson, 2011).”
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“Although there is a wide range of environmental risk factors linked to SZ, the most compelling risk factor to date is maternal infection (4, 26, 95, 96), which has been estimated to account for up to one-third of cases (25).”
BackgroundPosttraumatic stress disorder: does the gut microbiome hold the key?
Leclercq, S., Forsythe, P., & Bienenstock, J. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716635535 · Cited by 121
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Abdallah, M. W., Larsen, N., Grove, J., Nørgaard‐Pedersen, B., Thorsen, P., Mortensen, E. L., & HOUGAARD, D. M. (2011) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2011.09.003 · Cited by 126
“Also, increased levels of a neutrophil attractant chemokine (IL-8) were reported to be associated with other neurodevelopmental disorder, namely schizophrenia (Brown et al., 2004), which is hypothesized to share a common etiologic pathway with autism during pregnancy (Meyer et al., 2011).”
Prenatal maternal immune activation causes epigenetic differences in adolescent mouse brain
Basil, P., Li, Q., Dempster, E. L., Mill, J., Sham, P.-C., Wong, C. C. Y., & McAlonan, G. M. (2014) · Translational Psychiatry · doi:10.1038/tp.2014.80 · Cited by 116
Microbiota, immunoregulatory old friends and psychiatric disorders
Rook, G. A. W., Raison, C. L., & Lowry, C. A. (2014) · Advances in Experimental Medicine and Biology · doi:10.1007/978-1-4939-0897-4_15 · Cited by 117
Cattane, N., Richetto, J., & Cattaneo, A. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.07.001 · Cited by 129
Vuillermot, S., Luan, W., Meyer, U., & Eyles, D. W. (2017) · Molecular Autism · doi:10.1186/s13229-017-0125-0 · Cited by 116
“has accumulated to suggest that prenatal infection also is a risk factor for autism spectrum disorder (ASD) [3, 4].”
BackgroundSelf-citationPrata, J., Santos, S. G., Almeida, M. I., Coelho, R., & Barbosa, M. A. (2017) · Journal of Neuroinflammation · doi:10.1186/s12974-017-0938-y · Cited by 115
Hygiene and other early childhood influences on the subsequent function of the immune system
Rook, G. A. W., Lowry, C. A., & Raison, C. L. (2015) · Brain Research · doi:10.1016/j.brainres.2014.04.004 · Cited by 109
“In view of the significant epidemiological association with familial allergic disorder, where the birth order effect is clear, this is of great interest (discussed in Meyer et al., 2011; Onore et al., 2012).”
InfluentialGuma, E., Plitman, E., & Chakravarty, M. M. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.06.020 · Cited by 108
Neuro-Inflammation, Blood-Brain Barrier, Seizures and Autism
Theoharides, T. C., & Zhang, B. (2011) · Journal of Neuroinflammation · doi:10.1186/1742-2094-8-168 · Cited by 108
Immune system gene dysregulation in autism and schizophrenia
Michel, M., Schmidt, M. J., & Mirnics, K. (2012) · Developmental Neurobiology · doi:10.1002/dneu.22044 · Cited by 107
“Autism spectrum disorder (ASD) is characterized by symptoms in the domains of social interaction, communication, and restricted and repetitive interests and behaviors (Meyer et al., 2011; Noterdaeme, 2011; Ratajczak, 2011).”
Samsam, M. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i29.9942 · Cited by 113
Kirsten, T. B., Lippi, L. L., Bevilacqua, E. M. A. F., & Bernardi, M. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0082244 · Cited by 111
“[4-7].”
Sullivan, S. A., Rai, D., Golding, J., Zammit, S., & Steer, C. D. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.05.010 · Cited by 104
Lim, C. K., Essa, M. M., Martins, R. D. P., Lovejoy, D. B., BILGIN, A. A. B., Waly, M. I., Al-Farsi, Y. M., Al‐Sharbati, M. M., Al‐Shaffae, M. A., & Guillemin, G. J. (2015) · Autism Research · doi:10.1002/aur.1565 · Cited by 100
Cataldo, I., Azhari, A., & Esposito, G. (2018) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2018.00027 · Cited by 97
“…infection, either through direct exposure of preganant mice to viruses, or via activation of maternal immune response in the absence of an infectious agent, led to atypical behaviors in the resulting pups (Brown and Derkits, 2010; Meyer et al., 2011; Patterson, 2011; Miller V. M. et al., 2013).”
BackgroundMaternal Immune Activation Disrupts Dopamine System in the Offspring
Luchicchi, A., Lecca, S., Melis, M., Felice, M. D., Cadeddu, F., Frau, R., Muntoni, A. L., Fadda, P., Devoto, P., & Pistis, M. (2016) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyw007 · Cited by 105
“This is not surprising when considering the similarities between schizophrenia and autismrelated disorders, which might also share a neuroinflammatory pathogenesis during early fetal development (Meyer et al., 2011).”
BackgroundInflammation impairs social cognitive processing: A randomized controlled trial of endotoxin
Moieni, M., Irwin, M. R., Jevtic, I., Breen, E. C., & Eisenberger, N. I. (2015) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2015.03.002 · Cited by 95
“It has been hypothesized that prenatal exposure to infection, including the subsequent maternal proinflammatory response, can alter the development of the fetal brain (Fineberg and Ellman, 2013; Meyer et al., 2009, 2011; Michel et al., 2012; Onore et al., 2012; Patterson, 2009).”
InfluentialToward an immune-mediated subtype of autism spectrum disorder
McDougle, C. J., Landino, S. M., Vahabzadeh, A., O’Rourke, J., Zurcher, N. R., Finger, B. C., Palumbo, M. L., Helt, J., Mullett, J. E., Hooker, J. M., et al. (2015) · Brain Research · doi:10.1016/j.brainres.2014.09.048 · Cited by 95
Abdallah, M. W., Larsen, N., Mortensen, E. L., Atladóttir, H. Ó., Nørgaard-Pedersen, B., Bonefeld-Jørgensen, E. C., Grove, J., & Hougaard, D. M. (2012) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2012.07.013 · Cited by 94
“An additional case group, OCPD, was introduced, comprising the subset of controls who had at least one childhood psychiatric disorder other than ASD.”
InfluentialEissa, N., Sadeq, A. S., Sasse, A., & Sadek, B. S. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.00886 · Cited by 99
“Social cognitive impairments are hallmark behavioral deficits in both, ASD and SCH (Couture et al., 2006; Meyer et al., 2011).”
BackgroundInfluentialElmer, B. M., Estes, M. L., Barrow, S. L., & McAllister, A. K. (2013) · The Journal of Neuroscience · doi:10.1523/jneurosci.2366-13.2013 · Cited by 88
“Because MIA is a risk factor for both ASD and SZ (Atladóttir et al., 2010, 2012; Meyer et al., 2011; Brown, 2012), the MHCIMEF2 signaling pathway identified here may be critical for the pathogenesis of these disorders.”
BackgroundHarvey, L., & Boksa, P. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2011.11.022 · Cited by 94
Trevisan, D. A., Foss‐Feig, J. H., Naples, A. J., Srihari, V. H., Anticevic, A., & McPartland, J. C. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00548 · Cited by 95
Anderson, G., & Maes, M. (2012) · Metabolic Brain Disease · doi:10.1007/s11011-012-9307-9 · Cited by 105
“Developmental neuroinflammation caused by maternal prenatal infections is pathophysiologically relevant and may contribute to progressive brain changes and thus progression of schizophrenia (Meyer et al. 2011).”
Klocke, C., Allen, J. L., Sobolewski, M., Mayer-Pröschel, M., Blum, J. L., Lauterstein, D., Zelikoff, J. T., & Cory-Slechta, D. A. (2017) · Toxicological Sciences · doi:10.1093/toxsci/kfx010 · Cited by 87
Jyonouchi, H., Geng, L., & Davidow, A. L. (2014) · Journal of Neuroinflammation · doi:10.1186/s12974-014-0187-2 · Cited by 87
“Mounting evidence indicates that in other neuropsychiatric conditions such as schizophrenia, inflammatory cytokines such as IL-1β and IL-6 have a role in onset and progress of neuropsychiatric symptoms [27-31].”
BackgroundEhrlich, K. B., Ross, K. M., Chen, E., & Miller, G. E. (2016) · Development and Psychopathology · doi:10.1017/s0954579416000845 · Cited by 84
Fetal programming of schizophrenia: Select mechanisms
Debnath, M., Venkatasubramanian, G., & Berk, M. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2014.12.003 · Cited by 89
“This "second hit" due to stress, immune re-exposure or even peripubertal sex hormonal changes might potentially unmask and exacerbate the hitherto latent inflammatory processes with resultant onset of clinical symptoms (Meyer et al., 2011; Knickmeyer et al., 2010) .”
BackgroundEffects of inflammation on social processes and implications for health
Moieni, M., & Eisenberger, N. I. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13864 · Cited by 89
Innate Immune Regulation by Toll-Like Receptors in the Brain
Mallard, C. E. (2012) · ISRN Neurology · doi:10.5402/2012/701950 · Cited by 82
“Several studies have been performed to mimic viral infections during pregnancy by giving TLR3 ligands as models for developmentally induced psychiatric disorders [141, 142].”
BackgroundParker, W., Hornik, C. D., Bilbo, S. D., Holzknecht, Z. E., Gentry, L., Rao, R., Lin, S. S., Herbert, M. R., & Nevison, C. D. (2017) · Journal of International Medical Research · doi:10.1177/0300060517693423 · Cited by 87
Ardalan, M., Chumak, T., Vexler, Z. S., & Mallard, C. E. (2019) · International Journal of Molecular Sciences · doi:10.3390/ijms20092270 · Cited by 83
“Moreover, dysregulation of immune-related genes has been shown in the brains of patients with neuropsychiatric disorders such as schizophrenia [244], raising the possibility that immune-induced inflammation increases vulnerability of the brain that already is at risk due to genetic influences [245,246].”
BackgroundDoenni, V. M., Gray, J. M., Song, C. M., Patel, S., Hill, M. N., & Pittman, Q. J. (2016) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2016.07.152 · Cited by 80
“…changes occurring in the placenta Inflammation, particularly during the prenatal period, has been associated with increased incidence of disorders such as autism (Patterson, 2011) and schizophrenia (reviewed in Green and Nolan, 2014; Meyer et al., 2011; Miller et al., 2013) in the offspring.”
Metadata
- Authors
- MEYER, U., FELDON, J., & DAMMANN, O.
- Affiliations
- ETH Zurich (CH)
- Tufts Medical Center (US)
- Corresponding author
- MEYER, URS
- Venue
- Pediatric Research
- Published
- 2011-05
- Volume
- 69
- Issue
- 5 Part 2
- Pages
- 26R-33R
- ISSN
- 0031-3998 (ISSN-L)
- PMC
- PMC3086802
- OpenAlex
- W2011183628
- Cited by
- 357
- References
- 86
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 14 · 2023: 20 · 2022: 13 · 2021: 18 · 2020: 19 · 2019: 22 · 2018: 30 · 2017: 31 · 2016: 30 · 2015: 36 · 2014: 32 · 2013: 32 · 2012: 30
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pediatric Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Science Foundation
- National Alliance for Research on Schizophrenia and Depression
- European Commission (LSHM‐CT‐2006‐036534, 241778)
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (116719, 100309)
- Eidgenössische Technische Hochschule Zürich (11 07/03)
- National Institutes of Health
- National Eye Institute (R21EY019253)
- Topics
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- schizophrenia, autism spectrum disorder, perinatal inflammation, prenatal infection, neuroinflammation, fetal development, shared pathogenesis, chronic inflammation, psychopathology, neuropathology
- MeSH terms
- Autistic Disorder, Female, Humans, Inflammation, Models, Theoretical, Pregnancy, Pregnancy Complications, Schizophrenia
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