Brain Behav Immun. 2026 Jan 16. pii: S0889-1591(26)00024-3. [Epub ahead of print]
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BACKGROUND: Increased microglial/macrophage transcripts are found in the midbrains of cases with neuroinflammatory subtype of schizophrenia. However, it is unknown in which immune cell population these transcripts are mostly expressed, nor do we know if transcriptional changes in microglial/macrophage markers are also found in the midbrains of neuroinflammatory bipolar disorder subgroups.
METHODS: Here, we determined the extent of microglial/macrophage changes in the ventral midbrain (at the level of the oculomotor nerve exit) of a larger cohort of people with schizophrenia and bipolar disorder, defined as low or high-inflammation, compared to controls. We aimed to confirm in which cell cluster our transcripts were expressed (microglia vs macrophages). First, we mapped the cellular expression of putative microglial/macrophage markers via snRNA-seq. Then, mRNA levels of 11 microglial/macrophage markers were measured and compared via RT-PCR from human post-mortem midbrains of 61 healthy controls, 63 schizophrenia cases, and 33 bipolar disorder cases.
RESULTS: 7/11 mRNAs (IBA1, CD11B, CX3CR1, P2RY12, CD64, CD40, &TMEM119) were mainly expressed in microglial cell clusters; 2 mRNAs in the macrophage cell cluster (CD32C, CD86); 1 mRNA was broadly expressed (HEXB), and the CD68 mRNA cluster location appeared to vary according to diagnosis. Across groups, transcripts associated with microglia activation and motility were significantly increased in high-inflammation schizophrenia (IBA1, CD11B; all p ≤ 0.001) and significantly decreased in high-inflammation bipolar disorder (P2RY12, CX3CR1; all p ≤ 0.01) compared to low-inflammation controls. Transcripts associated with microglial and macrophage activation via FcγR-IgG/Immune complex antigen binding were significantly increased in high-inflammatory schizophrenia (CD64 &CD32C) and high-inflammatory bipolar disorder (CD32C) (all p ≤ 0.01). Transcripts associated with increased cytokine response (CD40 & CD86) and phagocytosis (CD68) were significantly increased in high-inflammatory schizophrenia and divergently changed in high-inflammatory bipolar disorder (CD40 increased/CD86 decreased) (all p ≤ 0.05). Overall, the number of CD68 + cells with reactive-like morphology was increased in high-inflammation schizophrenia compared to all the low-inflammation groups (all p ≤ 0.05).
CONCLUSION: Our findings strengthen the contention that microglia and macrophages are activated in schizophrenia and disrupted in bipolar disorder midbrains of high-inflammatory subgroups. This suggests that optimal immune-based treatments targeting schizophrenia and bipolar disorder patients may differ when restoring microglial function during inflammation.
Keywords: Bipolar Disorder; Macrophage; Microglia; Midbrain; Schizophrenia; mRNA