Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy.
Vita-Salute San Raffaele University, Milano, Italy; Mood Disorder Unit, Scientific Institute Ospedale San Raffaele, Milano, Italy.
Brain Behav Immun. 2024 May;118:52-68. doi: 10.1016/j.bbi.2024.02.019. Epub 2024 Feb 15.
Immune-inflammatory mechanisms are promising targets for antidepressant pharmacology. Immune cell abnormalities have been reported in mood disorders showing a partial T cell defect. Following this line of reasoning we defined an antidepressant potentiation treatment with add-on low-dose interleukin 2 (IL-2). IL-2 is a T-cell growth factor which has proven anti-inflammatory efficacy in autoimmune conditions, increasing thymic production of naïve CD4 + T cells, and possibly correcting the partial T cell defect observed in mood disorders. We performed a single-center, randomised, double-blind, placebo-controlled phase II trial evaluating the safety, clinical efficacy and biological responses of low-dose IL-2 in depressed patients with major depressive (MDD) or bipolar disorder (BD). 36 consecutively recruited inpatients at the Mood Disorder Unit were randomised in a 2:1 ratio to receive either aldesleukin (12 MDD and 12 BD) or placebo (6 MDD and 6 BD). Active treatment significantly potentiated antidepressant response to ongoing SSRI/SNRI treatment in both diagnostic groups, and expanded the population of T regulatory, T helper 2, and percentage of Naive CD4+/CD8 + immune cells. Changes in cell frequences were rapidly induced in the first five days of treatment, and predicted the later improvement of depression severity. No serious adverse effect was observed. This is the first randomised control trial (RCT) evidence supporting the hypothesis that treatment to strengthen the T cell system could be a successful way to correct the immuno-inflammatory abnormalities associated with mood disorders, and potentiate antidepressant response.
免疫炎症机制是抗抑郁药理学的有前途的靶点。情绪障碍患者存在免疫细胞异常,表现为 T 细胞部分缺陷。基于这一推理思路,我们定义了一种抗抑郁药物增效治疗方法,即添加低剂量白细胞介素 2(IL-2)。IL-2 是一种 T 细胞生长因子,已被证明在自身免疫性疾病中具有抗炎疗效,可增加胸腺产生幼稚 CD4+T 细胞,并可能纠正情绪障碍中观察到的部分 T 细胞缺陷。我们进行了一项单中心、随机、双盲、安慰剂对照的 II 期临床试验,评估了低剂量 IL-2 在患有重度抑郁症(MDD)或双相情感障碍(BD)的抑郁症患者中的安全性、临床疗效和生物学反应。36 名连续招募的住院患者在心境障碍科被随机分为 2:1 组,分别接受白细胞介素(12 例 MDD 和 12 例 BD)或安慰剂(6 例 MDD 和 6 例 BD)治疗。在两个诊断组中,活性治疗均显著增强了正在进行的 SSRI/SNRI 治疗的抗抑郁反应,并扩大了 T 调节、T 辅助 2 和幼稚 CD4+/CD8+免疫细胞的比例。细胞频率的变化在治疗的前五天迅速诱导,并预测了抑郁严重程度的后期改善。未观察到严重不良事件。这是第一项支持以下假设的随机对照试验(RCT)证据,即治疗增强 T 细胞系统可能是纠正与心境障碍相关的免疫炎症异常并增强抗抑郁反应的有效方法。