Alterações imunoinflamatórias em pacientes com transtorno de personalidade borderline e sua associação com episódio depressivo agudo

Abstract

Borderline personality disorder (BPD) is a serious mental illness that affects up to 6% of population and that it is associated with suicide rates around 50 times higher than general populational indicators. In addition, there is also a high comorbidities prevalence related to other mental disorders, including depression. There are still no effective pharmacological treatments for BPD, what offers a poor prognosis and an impairment of life activities. This study intends to analyze the association between clinical and serum biological parameters - oxidative markers, pro- and anti-inflammatory cytokines and neurotrophins - in patients with BPD accompanied or not by acute depressive episode. For this goal, 26 patients with BPD were interviewed using a structured psychiatric interview - 13 had an acute depressive episode and 13 were euthymic according to the HAMILTON scale 17 – and compared to results given by 8 healthy patients that composed a control group. Both groups were tested using TPB and global functionality (FAST) scales. Meanwhile, serum samples were collected to determine cytokine levels (IL-1b, TNF-α, IL-6, MCP-1, IL-12, IFN-γ, IL-17, IL-2, IL-4 ), brain-derived neurotrophic factor (BDNF) and oxidative markers (nitrite, reduced glutathione and malondialdehyde). In the results, it was found that patients with BPD accompanied or not by depression have significantly higher scores on BPD scale, especially in the emotional dysregulation item, compared to controls (P<0.001). Both groups of TPB patients had significantly lower scores on the FAST scale compared to healthy controls (P<0.001). Regarding biological markers, TPB group with depression had significantly reduced levels of MCP-1 compared to controls (P=0.008). Furthermore, in both TPB groups, it was seen increased levels of IL-6 (P=0.096) and IL1β (P=0.081) in relation to control group, but not significant. Thus, understanding links between clinical and biological parameters becomes a strategy for a better knowledge of BPD, including its development and treatment. The results suggest a participation of neuroimmune mechanisms in the genesis of BPD and a use of serum MCP-1 levels as a promising biomarker predictor of acute depressive symptoms in those patients.