Date:   10/13/2008 3:20:04 PM ( 16 y ago)
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URL:   https://www.curezone.org/forums/fm.asp?i=1276264

http://www.emergingworlds.com/ch_article.cfm?link=Interview_with_Dr._Ian_Lipkin.htm

Questions and Answers: The Nature of Disease

Are infectious agents responsible for more diseases than we currently realize?

NEWSWEEK WEB EXCLUSIVE

http://www.newsweek.com/

A recent study by German researchers reportedly found that the Borna virus, an infection that is known to cause behavioral changes in some animals, was present in up to 100 percent of people experiencing severe mood disorders, but in only 30 percent of people who were healthy. The results prompted new speculation as to whether or not the Borna virus causes depression. 

Neuroscientist Dr. Ian Lipkin, director of the Emerging Diseases Laboratory at the University of California, Irvine, is not convinced that the link between the two has been proven. Still, Lipkin does believe that infections may be at least in part responsible for the development of many diseases. NEWSWEEK's Laura Fording asked Lipkin, who will soon be moving to the Mailman School of Public Health at Columbia University, to elaborate. 

NEWSWEEK: You say that more and more evidence points to environmental triggers for chronic diseases. Can you explain?       

Dr. Ian Lipkin: Chronic diseases affect some 90 million people in the United States alone. Chronic infections have been implicated in some types of cancer and in peptic ulcer disease. Prior to 1984, peptic ulcer disease was attributed to stress. With the recognition of a bacterium called Helicobacter pylori, we now know that the vast majority of peptic ulcer disease is due to infection. This discovery has changed the whole approach to treatment of this disorder, from surgical to antimicrobial. Another example is the role of the Human Papilloma Virus [HPV] in cervical cancer. [I believe] that the same thing is going to pertain to mental illnesses, multiple sclerosis and to a variety of other disorders. They are perhaps due to chronic infections as well.
       
Tell me about how your research with infectious diseases and the central nervous system.      

In the mid '80s I started working with the Borna virus, with the notion that infectious agents might be important in a variety of chronic central-nervous-system disorders, including depression, schizophrenia and autism.... We have continued to develop and expand, [with the hope] that we'll be able to find infectious agents that are going to be important in a wide variety of disorders, ranging from cancer to central-nervous-system disorders. We were also the group that discovered that it was the West Nile virus as opposed to St. Louis encephalitis in the 1999 outbreak in New York City.
       
What have you discovered about mental illnesses in the course of your research?
       

We're trying to develop more sensitive techniques to pick up evidence of infection that occurs during gestation or that occurs at some point during the course of a life span. As we learn more about the development of the nervous system and how it evolves during gestation, we've begun to recognize that there are particular checkpoints. If something goes awry [at a certain time] in gestation or in [early] childhood, there can be very specific consequences. In our case, we're thinking about microbial infections. Disorders that are triggered in the first or second trimester could, 10 or 20 years down the road, cause schizophrenia, depression, Parkinson's disease or something else.
       

 How might a fetus be affected by a mother's infection?
 

Some mothers infected with a microorganism may have very severe responses, while others may have a very mild response. In certain circumstances, it may not even be necessary for the unborn child to be infected. If the mother has a severe infection, her body will release of a whole series of chemicals in her body, called chemokines and cytokines, which can affect the development of the fetus. We tend to be concerned about mothers not smoking, not using drugs and eliminating alcohol intake. We need to be very careful about maternal infections as well. They are extremely important. We've known for many, many years that there are a number of agents that can cause damage in fetuses; for example, some people think that toxoplasmosis may be associated with schizophrenia, and the Cytomegalovirus [CMV] and the herpes virus are also associated with damage to the developing fetus. But when people typically think of birth defects due to infections, they think about very severe diseases. There is more subtle damage that can occur, which might result in later expression of autism or schizophrenia, or perhaps even disorders like depression.
       
So you think that some mental illnesses possibly result from fetal infections rather than later in life.

I think it's likely that there are exposures to infectious agents or toxins at particular points during early development in the fetus or in early childhood that result in schizophrenia and autism.
       

Could the infection in the mother be as minor as a common cold?

We don't know. We are just beginning to explore this. We are trying to develop more sensitive ways to detect infections during the course of pregnancy.... There are a number of ways that infectious agents can cause disease. They can trigger an immune response, which may not become apparent for weeks or months. Or, for example, if you consider that a virus may simply kill a stem cell which is required for central-nervous-system development ... that cell may be lost, but the disease itself may be clinically silent until you go through a normal developmental progression.
       

What about environmental toxins?     

 I'm not discounting environmental pollutants. It's just not my field. We know that mercury can be very toxic to the developing brain and that it's less toxic in an adult. Lead poisoning is similar: An adult can have lead toxicity, but it's not going to be as severe as with a child. The same thing is true for certain types of infections. You are very susceptible to severe disease while your brain and endocrine system are developing and you don't have the ability to build an immune response and to rapidly remove that offending agent.... People have been arguing nature versus nurture for 3,000 years. The fact is it's a combination of the two. You can have a genetic predisposition to a disorder but not show signs of that disorder unless there is an environmental trigger. And the environmental factor is likely to be an infection.
       
So you believe that it's really a complex interaction between genetics and infectious agents.      

Exactly.
       

What kind of work is being done now in this field?       

Developmental neurobiologists have begun to look at where the risk factors are for particular brain structures in animals.... [Some] are looking at influenza virus epidemics, or natural disasters like floods or earthquakes, all of which suggest certain types of stress, infectious or toxic or otherwise. At particular points of development of the human brain, these can result in subtle disease or severe disease.
       
 How might an infection cause damage?

Drugs called serotonin re-uptake inhibitors are used to treat some aspects of autism. They work by raising levels of a particular neurochemical, which results in a more balanced neurochemistry and an improvement in behavior. The same thing is done in depression. So there are a couple of ways in which you can envision an infection causing damage.... The viruses could be knocking out the cells that make those chemicals or they could be knocking out the cells that have receptors.... [To prove this in humans] we need to have very rapid, very sensitive methods for detecting the presence of microbes, and we need to have access to specimens which are collected from pregnant mothers, children and adults so we can look at large populations and find out whether or not infections are correlated with the later presence of these disorders. You've got to do all this in the context of the genomics project too, because, as I've said, some people will have one response to an infectious agent, while others will have a different one. So we need to be able to take all of this information and put it together.
       
In response to the German study of the Borna virus mentioned above, you have said that the fact that you find evidence of infection in one population does not allow you to conclude a causal relationship between virus and disease.       

Yes. First of all, the work of the German researchers has not been replicated. But let's assume it is correct, that 100 percent of the people in the German study who have depression also have immune complexes containing Borna antigens and antibodies to the Borna virus, whereas only 30 percent of healthy people do. What are the potential interpretations for that? Well, one is that the [Borna virus] infection itself is a risk factor for disease. But let's take schizophrenia as another example. If you look at people who are schizophrenic in this country, many of them have a history of homelessness. Because of this, these people are more likely to encounter infectious agents as a result of exposure and poor nutrition. Because of their lifestyle, they may be less healthy. Does this mean that if more of these people have athlete's foot, that athlete's foot causes schizophrenia? No, of course not. That's why I say that it hasn't been proven that the Borna virus causes depression.
       
So what do you believe is the relationship between infections and depression?      

Depression itself is a very common manifestation of common viral infections. You're lethargic, you are exhausted. These are symptoms of cytokine release. So that's not surprising. And it would be perfectly reasonable to think of a situation where some people who are chronically depressed are also chronically infected with a virus. That's not to say that I've identified the virus or that I have any proof this it's possible. I'm just saying it's plausible. But the most compelling story, I think, in terms of the central nervous system is that some sort of environmental trigger during development in utero, either through infection of the mother or infection of the fetus, results in disease that is expressed at a later point, like schizophrenia or autism. I'm absolutely convinced that we are going to find such a linkage. It's just a question of time.
       
Any other examples of infectious diseases affecting the brain?      

PANDAS is a warm and fuzzy term but it's not a warm and fuzzy syndrome. It stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. [I know] of two groups working on this: one at the National Institute for Mental Health [NIMH] and the other at Yale. They've found that there are certain children who have frequent strep infections who develop a variety of disorders, including Obsessive Compulsive Disorder and Attention Deficit/Hyperactivity Disorder.... [After treatment with antibiotics or by other methods] many of these children improve. Other kids may not have this disorder, even though they have the same streptococcal infection, because they don't have a genetic predisposition.
       

What did you talk about at the congressional briefing you attended in Washington D.C. in late June?      

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