統合失調症における抗炎症チャレンジ

実験的：Infliximab

Subjects will be stratified by sex and randomized before this visit in preparation for the infusion. Vitals and safety labs will be drawn at this visit as well as urine testing for drugs of abuse and pregnancy testing for all biological females. Patients will receive breakfast followed by a double-blinded infusion of infliximab (5mg/kg body weight) in the GCSTA Clinical Research Center at Emory University Hospital. The infusion will last 2.5 hours, and subjects will be monitored during the infusion and for one hour after completion for the possible development of anaphylaxis, which occurs in less than 1% of patients receiving an initial dose of infliximab

薬：インフリキシマブ

インフリキシマブは、関節リウマチおよび炎症性腸症候群の治療薬として FDA の承認を受けています。 現在の提案は、脳の報酬回路の変化と特定の症状ドメインの変化につながる炎症プロセスの役割を分析するための実験ツールとしてのインフリキシマブの使用を表しています。

インフリキシマブの二重盲検注入は、エモリー大学病院にあるGCTSA臨床研究センターで実施されます。 独立した薬剤師は、研究薬剤師によって提供されたコンピューター生成のランダム化リストに従って、250mlの生理食塩水バッグにインフリキシマブまたはプラセボのいずれかを調剤します。

プラセボコンパレーター：Placebo

Subjects will be stratified by sex and randomized prior to this visit in preparation for the infusion. Vitals and safety labs will be drawn at this visit as well as urine testing for drugs of abuse and pregnancy testing for all biological females. Patients will receive breakfast followed by a double-blinded infusion of saline in the GCSTA Clinical Research Center at Emory University Hospital. The infusion will last 2- 2.5 hours, and subjects will be monitored during the infusion and for one hour after completion for the possible development of anaphylaxis, which occurs in less than 1% of patients receiving an initial dose of infliximab

薬：プラセボ

生理食塩水の二重盲検注入は、エモリー大学病院にあるGCTSA臨床研究センターで実施されます。 独立した薬剤師は、研究薬剤師によって提供されたコンピューター生成のランダム化リストに従って、250mlの生理食塩水バッグにインフリキシマブまたはプラセボのいずれかを調剤します。

Changes in Monetary Incentive Delay Task (MID)

Change in Bold Oxygen Level Dependent (BOLD) Activation in the Ventral Striatum during "Win" Monetary Incentive Delay (MID) Task between Infliximab and Placebo (time frame:1-3 days before intervention and 2 weeks post intervention (MID occurs during scans). Activation response in ventral striatum in response to reward anticipation: Infliximab (vs placebo)-treated patients will exhibit a) increased activation in ventral striatum in response to reward. Mixed-effects models for repeated measures (MMRM) will first be employed to examine effects of group (infliximab vs. placebo), time and their interaction on blood oxygenation level-dependent (BOLD) signals (an index of regional brain activation) using a Region-of-Interest (ROI) approach.

Changes in Effort Based Decision Making Task (EBDM)

Changes in BOLD Activation response in anterior insula in response to increasing effort between Infliximab and Placebo (time frame:1-3 days before intervention and 2 weeks post intervention (EBDM occurs during scans) ). Activation response in insula in response to increasing effort: Infliximab (vs placebo)-treated patients will exhibit a) decreased activation in anterior insula in response to effort.

Mixed-effects models for repeated measures (MMRM) will first be employed to examine effects of group (infliximab vs. placebo), time and their interaction on BOLD signals (an index of regional brain activation) using a Region-of-Interest (ROI) approach.

Changes in C-Reactive Protein (CRP)

30ml study bloods per visit will be collected by venipuncture into EDTA-containing vacutainer tubes using standard sterile technique. Plasma for the evaluation of plasma concentrations of CRP will be obtained by centrifugation of whole blood at 1000 x g for 10 minutes at 4 C.

Plasma CRP will be assessed with a high sensitivity turbidimetric assay. Assay sensitivity is rated at 0.18 mg/L, range of measure is 0.2 to 80 mg/L and functional sensitivity (at 20% CV) is 0.2 mg/L.

Changes in Brief Negative Symptom Scale (BNSS)

Infliximab (vs placebo) -treated patients will record their performance on the BNSS Motivation and Pleasure domain score.

The BNSS is a 13-item scale designed for research studies in response to the 2005 National Institute of Mental Health (NIMH) consensus development conference on negative symptoms of schizophrenia.The BNSS measures the five commonly accepted domains of negative symptoms: blunted affect, alogia, asociality, anhedonia, and avolition. Items are scored on a 0 to 6 scale, with 0 indicating the symptom is absent and 6 indicating the symptom is severe. Items are summed for a total score that ranges between 0 and 78.

Changes in Performance on the Effort Expenditure for Reward Task (EEfRT)

Infliximab (vs placebo) -treated patients will be evaluated on their performance on the EEfRT.

Assessment of reward motivation will be accomplished using an fMRI-adapted version of the EEfRT task. During each trial, subjects are presented with a choice between two levels of task difficulty, a High Effort option and a Low Effort option, which require different amounts of speeded manual button pressing for differing levels of monetary reward. The reward magnitude for a No Effort option remains constant , while the reward magnitude for the High Effort option will vary between 20%, 50%, 80%, and 100% of the subjects max effort (set for each individual prior to scan). The task will use a rapid event-related design with an exponential jitter between trials drawn in order to optimize hemodynamic response function estimation. Responses will be made using MRI-compatible button-boxes and images will be presented on a rear projection screen visible with a mirror mounted on the head coil.

Changes in Positive and Negative Syndrome Scale (PANSS)

Infliximab (vs placebo) -treated patients will record their performance on the Positive and Negative Syndrome Scale (PANSS) The PANSS is the most commonly used measure of assessing the symptoms of schizophrenia. Seven items measure positive symptoms, seven measure negative symptoms, and sixteen measure general psychopathology symptoms. PANSS items are rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, and 7=extreme); because the absence of symptoms is equal to 1 point, the lowest possible total score on both PANSS scales is 7.

Changes in Motivation and Pleasure Scale (MAPS-SR)

The MAPS-SR is a 15-item self-report scale that has demonstrated good convergent validity with the clinician-rated Motivation and Pleasure scale of the Clinical Assessment Interview for Negative Symptoms (CAINS). The scale has four subscales that include ratings of social pleasure, recreational or work pleasure, feelings and motivations about close, caring relationships, and motivation and effort to engage in activities, corresponding to the CAINS subscales of deficits in motivation and pleasure and deficits of expression.

(MAP-SR) Six items tap consummatory and anticipatory pleasure related to social and recreational or work domains. Six items tap feelings and motivations to be around family, romantic partners, and friends. The remaining six items tap motivation and effort to engage in activities. All items are rated on a 5-point Likert scale; higher scores reflect greater pathology after reverse scoring for items 8, 10, and 12.

Changes in Calgary Depression Scale for Schizophrenia (CDSS)

The CDSS is a clinician-administered, 9-item rating scale designed for the assessment of depressive symptoms in schizophrenia. Depressive symptoms are highly prevalent in patients with schizophrenia and may lead to a higher burden of disease. It is reliable, valid, and able to distinguish depressive symptoms from negative symptoms and extrapyramidal symptoms.

Changes in Inflammatory markers changes: IL-1

Customized Fluorokine MAP Multiplex Human Biomarker Panels (R&D Systems, Minneapolis, MN) will be used to measure plasma Interleukin (IL)-1 receptor antagonist. This inflammatory marker was chosen based on its reliable changes in psychiatric illness and/or their relationship to symptoms of anhedonia and corticostriatal function.

Changes in Inflammatory markers changes: IL-6

Customized Fluorokine MAP Multiplex Human Biomarker Panels (R&D Systems, Minneapolis, MN) will be used to measure plasma IL-10. This inflammatory marker was chosen based on its reliable changes in psychiatric illness and/or their relationship to symptoms of anhedonia and corticostriatal function.

Changes in Inflammatory markers changes: IL-10

Customized Fluorokine MAP Multiplex Human Biomarker Panels (R&D Systems, Minneapolis, MN) will be used to measure plasma IL-10. This inflammatory marker was chosen based on its reliable changes in psychiatric illness and/or their relationship to symptoms of anhedonia and corticostriatal function.

Changes in Inflammatory markers changes: Soluble IL-6R

Customized Fluorokine MAP Multiplex Human Biomarker Panels (R&D Systems, Minneapolis, MN) will be used to measure plasma soluble IL-6R. This inflammatory marker was chosen based on its reliable changes in psychiatric illness and/or their relationship to symptoms of anhedonia and corticostriatal function.

Changes in Inflammatory markers changes: Tumor necrosis factor (TNF)

Customized Fluorokine MAP Multiplex Human Biomarker Panels (R&D Systems, Minneapolis, MN) will be used to measure plasma TNF This inflammatory marker was chosen based on its reliable changes in psychiatric illness and/or their relationship to symptoms of anhedonia and corticostriatal function.

Changes in Inflammatory markers changes: sTNFR2

Customized Fluorokine MAP Multiplex Human Biomarker Panels (R&D Systems, Minneapolis, MN) will be used to measure plasma sTNFR2. This inflammatory marker was chosen based on its reliable changes in psychiatric illness and/or their relationship to symptoms of anhedonia and corticostriatal function.

Changes in Inflammatory markers changes: monocyte chemoattractant protein (MCP)-1

Customized Fluorokine MAP Multiplex Human Biomarker Panels (R&D Systems, Minneapolis, MN) will be used to measure plasma monocyte chemoattractant protein (MCP)-1. This inflammatory marker was chosen based on its reliable changes in psychiatric illness and/or their relationship to symptoms of anhedonia and corticostriatal function.