Unveiling the Interconnected Realm: Inflammation, Auto-Immunity, and PANS/PANDAS Amid COVID-19
The convergence of inflammation, auto-immunity, and the onset or worsening of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) comes to the forefront during the COVID-19 pandemic. This interaction highlights the significant impact of systemic immune responses on neuropsychiatric conditions in children, opening avenues for better understanding and management of these disorders during these challenging times. Amid the pandemic, we aim to delve into these connections, to address the challenges and explore potential therapeutic approaches for managing PANS and PANDAS.
Inflammation and Autoimmune Response:
COVID-19 triggers an inflammatory and autoimmune response, leading to aberrant and excessive inflammation. The immune response against the virus triggers neuropsychiatric abnormalities, as evidenced by increased levels of pro-inflammatory cytokines like IL-6, IL-2, IL-17, and TNF, which can induce neuroinflammatory reactions, compromise the blood-brain barrier, and disrupt neurotransmission.
The abnormal immune response to SARS-CoV-2, especially in individuals with a history of autoimmune illnesses or allergies, may lead to autoimmunity, causing secondary nervous system damage. This includes the phenomenon of “molecular mimicry,” where host antibodies or lymphocytes become cross-reactive with both viral antigens and self-antigens, potentially initiating autoimmunity.
Interaction with Basal Ganglia:
Pro-inflammatory cytokines can affect basal ganglia GABAergic transmission, which is particularly relevant for PANS as the basal ganglia’s functioning is already disrupted in these conditions.
COVID-19 as a Trigger for PANS/PANDAS:
COVID-19 may act as a trigger for new onset or exacerbation of PANS/PANDAS symptoms. It could reactivate Epstein–Barr Virus (EBV), which has been identified as a potential trigger for PANS.
Impact of Social Isolation:
Social isolation during the pandemic, even without infection, may lead to increased levels of inflammatory markers like IL-6 and CRP, potentially exacerbating PANS/PANDAS symptoms.
Treatments like Intravenous Immunoglobulin (IVIG), commonly prescribed for PANDAS, have also shown efficacy in critically ill COVID-19 patients, highlighting a potential intersection in the immune profiles of PANS/PANDAS and COVID-19 patients.
The summary encapsulates the role of inflammation and auto-immunity in PANS and PANDAS, especially in the context of COVID-19, and underscores the complex interplay between systemic inflammation, auto-immunity, and neuropsychiatric symptoms in affected individuals.