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- 16 October 2021

The connection between PANS-PANDAS and the gut microbiota

Scientific research has shown a potential connection between PANS-PANDAS and the gut microbiota, suggesting that streptococcal infections can alter intestinal bacterial communities, contributing to the onset of PANS-PANDAS symptoms.

Read this article to learn more.

What are PANS and PANDAS?

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) define a group of complex pediatric-onset conditions that impair the normal neurological function of children's brains, triggering psychiatric disorders such as:

The intricate nature of these syndromes has raised significant questions among researchers. Scientific investigation has recently begun to explore the potential connections between these disorders and specific alterations in the gut microbiota.

The role of the Gut MicrobiotaAn interesting connection

What is gut microbiota?

Gut microbiota refers to the collection of microorganisms, mainly bacteria, residing in the gut, with a higher concentration within its latter portion: the large intestine. These microorganisms play an important role in gut and brain health. For this reason, psychiatric research in recent years has also turned its attention to this "new organ" that translates what we eat into important messenger molecules for our brains.

The connection between PANS-PANDAS and Gut Microbiota

A recent study has revealed an alteration in the structure of gut microbiota in people with PANS-PANDAS, suggesting that streptococcal infections can disrupt intestinal bacterial communities, promoting the onset of PANS-PANDAS symptoms.

The following is what is reported within the Abstract of the article:

«Pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections syndrome (PANDAS) are conditions that impair brain normal neurologic function, resulting in the sudden onset of tics, obsessive-compulsive disorder, and other behavioral symptoms. Recent studies have emphasized the crosstalk between gut and brain, highlighting how gut composition can influence behavior and brain functions. Thus, the present study investigates the relationship between PANS/PANDAS and gut microbiota ecology. The gut composition of a cohort of 30 patients with PANS/PANDAS was analyzed and compared to control subjects using 16S rRNA-based metagenomics. Data were analyzed for their α- and β-diversity; differences in bacterial distribution were detected by Wilcoxon and LEfSe tests, while metabolic profile was predicted via PICRUSt software. These analyses demonstrate the presence of an altered bacterial community structure in PANS/PANDAS patients with respect to controls. In particular, ecological analysis revealed the presence of two main clusters of subjects based on age range. Thus, to avoid age bias, data from patients and controls were split into two groups: 4–8 years old and >9 years old. The younger PANS/PANDAS group was characterized by a strong increase in Bacteroidetes; in particular, Bacteroides, Odoribacter, and Oscillospira were identified as potential microbial biomarkers of this composition type. Moreover, this group exhibited an increase of several pathways concerning the modulation of the antibody response to inflammation within the gut as well as a decrease in pathways involved in brain function (i.e., SCFA, D-alanine and tyrosine metabolism, and the dopamine pathway). The older group of patients displayed a less uniform bacterial profile, thus impairing the identification of distinct biomarkers. Finally, Pearson’s analysis between bacteria and anti-streptolysin O titer revelead a negative correlation between genera belonging to Firmicutes phylum and anti-streptolysin O while a positive correlation was observed with Odoribacter. In conclusion, this study suggests that streptococcal infections alter gut bacterial communities leading to a pro-inflammatory status through the selection of specific bacterial strains associated with gut inflammation and immune response activation. These findings highlight the possibility of studying bacterial biomarkers associated with this disorder and might lead to novel potential therapeutic strategies

Clinical Implications

Certainly, further studies are needed to confirm the results obtained in this study and gain a better understanding of the underlying mechanism linking PANS-PANDAS and gut microbiota. However, the findings from this research carry significant clinical implications:

  1. Firstly, they suggest that bacterial biomarkers could be employed for diagnosing PANS-PANDAS.

  2. Secondly, they propose that interventions aimed at rebalancing the gut microbiota's structure could be utilized for treating PANS and PANDAS.

The discovery

The connection between PANS-PANDAS and the gut microbiota

Gut Microbiota Profiling and Gut-Brain Crosstalk in Children Affected by Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections

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