Updates in Inflammation - Depression, Neurotoxicity/Delirium Lessons from CAR-T to COVID-19, Bio-markers, and Implications for Treatment

The goal of this workshop is to provide an overview of the role of inflammation in Consultation-Liaison Psychiatry, with considerations for both inpatient and outpatient work, and cross-specialty collaborations. Inflammation and its association with depression, anxiety, neuro-toxicity and delirium will be reviewed, as well as presentation of recent data in psycho-oncology on bio-markers for depression and inflammation, and discussions on implications for treatment.


Dr. Saenz - Depression and Inflammation review
Depression is associated with inflammation, and this relationship has been reported in multiple settings. The treatment-refractoriness of depression in medical illness may be a reflection, in part, of the impact of inflammation on treatment response - elevation of inflammatory markers have been shown to predict treatment non-response in ambulatory depressed patients especially to SSRIs. Systemic inflammation tends to deplete mono-amine neurotransmitters in the central nervous system.(53) Both serotonin and dopamine are depleted, as shown by fMRI data.


Dr. Lad - Role of Inflammatory Cytokines - Relating CAR-T Neurotoxicity Experience to COVID-19 Delirium
Pathologically sustained cytokine production (ie IL-6, IL-1, Interferon -γ and Tumor necrosis) has been seen and studied in CAR-T immune therapy in cancer patients and contributes to our knowledge of cytokine release syndrome (CRS). Although the pathophysiology of COVID-19-associated CRS remains poorly understood, it is possible that COVID-19-induced CRS and CAR-T therapy-induced CRS might have similar pathophysiological process. Therefore, suggesting that the lessons learned from CAR-T toxicity can be utilized to better understand COVID-19 patient, especially as CRS may contribute to difficult to manage delirium and neurotoxicity of both.


Dr. McFarland - Updates on Bio-Markers (CRP, albumin,NLR etc)
Pro-inflammatory cytokines (i.e., IL-6, TNF) and the positive acute phase reactant C-reactant protein (CRP) have been most extensively studied in association with depression including in the cancer setting. Albumin, a negative acute phase reactant whose synthesis by the liver is suppressed by systemic inflammation, has been associated with depression in various medical contexts in addition to its association with nutrition. Albumin changed with depression severity to a similar extent as CRP. The neutrophil-lymphocyte ratio (NLR) obtained from the white blood cell differential on a complete blood count measure has also been associated with both inflammation and depression in cancer and other clinical settings.


Dr. Bengtsen - Potential Implications for Treatments
Cancer-related inflammation is a direct byproduct of having cancer through its genomic instability and other cancer-tumor environment interactions and is now used to direct anticancer treatments (i.e., checkpoint inhibitor therapies). Inflammation can predict antidepressant non-response (i.e., treatment resistance) and possibly combination psychopharmacologic treatments for depression that address inflammation are required.