Autoimmunity, neuroinflammation, pathogen load: A decisive crosstalk in neuropsychiatric SLE

Depicting the cellular and molecular bases of the continuous dialogue existing between the peripheral immune and the central nervous systems, as in neurolupus, is fundamental to improve, and better apprehend the role played by immune cells and mediators in the initiation and progression of neurological and psychiatric diseases, which nowadays remain a major public health issue. The relative frequency of neurological symptoms occurring in systemic autoimmunity is particularly worrying as, for example, two-thirds of patients with lupus will eventually experience the disabling effects of neuropsychiatric lupus. Neurolupus is a particularly severe form of lupus with wide-ranging symptoms, which contribute to increased mortality and morbidity in patients. In this context, infections, which suddenly trigger exacerbations of the otherwise mild lupus disease, may drive the progression of neuroinflammation and neurodegeneration via different mechanisms involving a network of effector molecules and cells. The complex interaction of neuroimmunology and neuroinfectiology represents a genuine challenge for basic scientists and clinicians to understand the mechanisms that are implicated, and identify possible biomarkers of severity that might predict the development of this devastating form of lupus. The ultimate goal is to design appropriate, personalised therapeutic strategies to improve the outcome of the disease.