The molecular mimicry of strep in PANDAS
A study came out on December 4th, 2019 showing how Strep has the uncanny ability to cloak itself from the immune system. Although this isn’t news to those of us with kids who have PANDAS, it sure does paint a pretty picture of what is literally going on inside, doesn’t it? 😳.
Smithsonian Magazine reported:
Various types of harmful bacteria, for example, masquerade as human cells to evade the immune system, blanketing their surfaces with molecules that resemble our own. The clever trick effectively gives the pathogens “cloaks of invisibility,” says David Gonzales, a biochemist and microbiologist at the University of California, San Diego.
Now, Gonzalez and his team have discovered a new form of this microbial mimicry that’s especially macabre. To avoid being snuffed out by the immune system, the bacteria that cause strep throat tear apart red blood cells and then dress themselves in the debris, as reported today in the journal Cell Reports.
When this strategy works, the bacteria, called Group A Streptococcus (group A strep), remain concealed while they wreak havoc on the body, the study’s mouse experiments show. But when a protein in the bacteria responsible for the sanguine disguise is snipped out of the strep genome, the microbes are left exposed, allowing the immune system to attack the pathogens and prevent a potentially deadly infection.
A graphical abstract of pathogen Group A Streptococcus camouflaged as red blood cells. (Dorota Wierzbicki)
So let’s take this a step further. Here we have a bacteria (namely Group A Streptococcus) brilliantly hiding from the immune system, within the immune system, using the immune system to hide. What do you think happens when the immune system sniffs out some of these buggers cloaked in it’s own red blood cells? Well, it’s going to attempt to attack the invader, but without a doubt, the body’s own cells are part of the collateral damage resulting from that war. How could there not be some confusion about which cells are attacked when they are literally intertwined together?
It is natural for the body to send out B and T-cells to clean up the mess from war with an invader, and those cells naturally develop antibodies to anything it’s fighting, in order to ward off the same infection in the future. These cells are tasked with tagging the invader so that the body can recognize and demolish any future sneaky invasions. It’s also totally normal for the body to develop some antibodies against it’s own tissue when it gets hit in the line of fire, this is when our blood cell warriors are sent to clean up the dead cellular debris.
Here’s where the trouble lies. If enough of our own tissue/cells are damaged and our B and T-cells continue to develop antibodies to our own dead tissue, the process can become chronic and is referred to as autoimmunity. And what causes this to become chronic? Ongoing infections, in this case, by Group A Streptococcus.
PANDAS is autoimmunity to the body’s own basal ganglia in the brain, causing symptoms typified by rage, OCD and tics. Strep is known to cross the blood brain barrier and this new study sheds some light on how an autoimmunity response may be occurring.
Wait there’s more?
Clearly, this isn’t ALL that is going on. With the molecular mimicry present causing an autoimmune dance with strep, in both beneficial and pathogenic strains, the body is conditioned to attack all strep, right? I have a theory about another layer that is downstream to the molecular mimicry, and I know this is incredibly simplified, I'm sure there is so much more to it than this:
First, it’s important to understand that the beneficial strains of strep are the microbiome's serotonin producers. In other words, the neurotransmitter serotonin is produced by strains of strep like S. thermophiles in the gut. In strep-induced PANDAS, the body is creating antibodies against strep. So it seems pretty logical that in a PANDAS scenario, when the body senses any strep, it wages war on it...pathogenic AND beneficial strains alike.
Well guess what the result of this war would be? Reduced strep strains and by default, lowered serotonin!! Now, looking at the symptoms of low serotonin, I see PANDAS...compound these with a developing brain!
Serotonin deficiency is thought to be associated with several psychological symptoms, such as:
anxiety
depressed mood
aggression
impulsive behavior
insomnia
irritability
low self-esteem
poor appetite
poor memory
In addition, low serotonin levels are also thought to be associated with several psychological conditions, including:
eating disorders
obsessive-compulsive disorder (OCD)
panic disorder
post-traumatic stress disorder
social anxiety disorder
Now let's talk about the tics, because the most common symptoms typifying PANDAS are rage, OCD and many have tics also. Well, serotonin and dopamine work together in the body so check this out!
Recent family-genetic studies suggest that vocal and motor tics, as well as obsessive-compulsive symptoms, are expressed in the disorder known as Tourette Syndrome. Biochemical and pharmacologic studies suggest that these symptoms are mediated in part by the serotonin and dopamine neurotransmitter systems. For instance, tics respond most reliably to pharmacologic blockade of the dopamine system, while obsessive-compulsive symptoms are most responsive to medications with primary effects on the serotonin system. A number of animal studies have demonstrated neuroanatomical, developmental, biochemical, and behavioral interactions between the dopamine and serotonin systems.
PANDAS=Serotonin deficiency!
In this excerpt from a study, The Gut-Brain Axis: The Missing Link in Depression, we see how certain strains of beneficial bacteria and yeast produce neurotransmitters. When we are deficient in those bacteria, we will inevitably be deficient in their byproducts as well!
“The human gut microbiota contains more than 1,000 species and over 7,000 subspecies. Gut bacteria are able to produce active metabolites for human organ systems. For example; Lactobacillus and Bifidobacterium synthesize gamma-aminobutyric acid (GABA) from monosodium glutamate. Escherichia coli, Bacillus and Saccharomyces produce norepinefrin; Candida, Streptococcus, Escherichia and Enterococcus produce serotonin, and Bacillus and Serratia produce dopamine. When rats were given Bifidobacterium infantis orally, increased plasma tryptophan levels were observed. Lactobacillus acidophilus increases the expression of cannabinoid receptors in the brainstem. Conversely, germ-free rats had high plasma serotonin levels.”
Neurotransmitters are kept in balance by a balanced microbiome. Too much of a good thing can be problematic too! Candida overgrowth comes to mind here!
Did you know that Candida is a normal resident of a healthy microbiome? Like other residents of a healthy microbiome, Candida has a purpose and when part of a balanced ecosystem, it is actually beneficial. One of the roles Candida plays is to keep bad bacteria and toxins in check. It can hold it’s weight in toxins, sequestering them from the bloodstream. It also attempts to manage bacterial infections, so you will notice that a person who has bacterial overgrowth, also has candida overgrowth. They go hand in hand, because Candida is trying to control the bacterial overgrowth. When heavy metals are at play, the Candida will also be elevated because it’s trying to sequester the heavy metals, thereby increasing as the heavy metal load increases. Clearly, we don’t want Candida overgrown, because it can become pathogenic so the goal is to eliminate the need for Candida’s increase. But in a case where Candida is overgrown, knowing that Candida produces serotonin indicates a potential elevation of serotonin due to the imbalance.
An elevated serotonin level is referred to as “serotonin syndrome” which occurs when someone has an excess of serotonin in their nervous system. The condition’s symptoms generally fall into three categories:
Altered mental status (irritability, agitation, restlessness, and anxiety)
Neuromuscular hyperactivity (tremors, shivering, muscle rigidity, and muscle spasms)
Autonomic hyperactivity (rapid heartbeat, high blood pressure, sweating, and fever)
Because serotonin is produced primarily in the gastrointestinal tract, digestive problems like nausea and diarrhea are common. A person experiencing serotonin syndrome may also be confused, dizzy, or disoriented. In severe cases, an individual may develop hallucinations and seizures.
The goal to putting PANDAS into remission is to bring down the inflammation on the brain by reducing the toxic burden overall, because toxins depress the immune system by killing off beneficial strains of bacteria that, as you can see, produce critical byproducts. We take human nature for granted every day by assuming the body will just do what it’s supposed to do regardless of how we treat it, but does your car drive without gasoline? The body needs non-toxic fuel and a healthy environment to thrive in.
Taming inflammation will look different for each person, but everyone should start with dietary considerations (your fuel) and improving gut health by reinoculating it with beneficial bacteria (you must also nurture and feed bacteria, aka - prebiotics). Reducing toxins in your environment can start with baby steps from my “for the home” and “for the body” tips. Remember that if you are gluten, dairy and soy free (which is highly recommended when autoimmunity of any kind is present) you will want to also think about your personal care products like toothpaste, shampoo, hair gel, hairspray, moisturizers and so on. Continuous gentle detoxification is a great way to improve immune system function overall, because it encourages the body to continue purging the onslaught of toxins coming in from all around us (toxins harm our microbiome), but what good is detoxification, if you keep introducing toxins to the body. Living consciously and reducing the incoming toxins not only speeds up healing, it produces more permanent results.
If you are overwhelmed and would like guidance with this journey, for your family, please consider joining my coached community!
Resources
https://www.smithsonianmag.com/science-nature/harmful-bacteria-masquerade-red-blood-cells-evade-immune-system-180973678/#xSS3mPFkr82azh0B.99
Group A Streptococcal S Protein Utilizes Red Blood Cells as Immune Camouflage and Is a Critical Determinant for Immune Evasion, I.H.Wierzbicki, A.Campeau, D.Dehaini,C.N.LaRock, L.Zhang, D.J.Gonzalez
https://www.cell.com/cell-reports/fulltext/S2211-1247(19)31472-X
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662178/?fbclid=IwAR3BCLtC4iWQDrmCgxd747A9t4aQkOfcRLEw4l1xF_DuTUm6mXAg9q20dpg