Low-dose methotrexate as a potential treatment for schizophrenia via astrocytic and neuroimmune modulation

The reduced life expectancy observed in individuals with schizophrenia (SCZ) underscores the urgent need for novel therapeutic targets. Emerging evidence suggests that astrocytic dysfunction and immune-inflammatory processes contribute to SCZ pathophysiology. Low-dose methotrexate (MTX), an established immunomodulatory drug used for non-neurological conditions, demonstrated antipsychotic potential in early SCZ. However, the underlying mechanisms remain unknown.

This study aimed to identify molecular targets of MTX within SCZ-relevant pathways, focusing on astrocytic and neuroimmune networks using in silico bioinformatics analysis and a rodent model for SCZ.

In silico analysis: A bioinformatics-based approach was employed, integrating cognitive computing-generated knowledge graphs, modular co-expression analysis, and gene-drug interaction databases with a machine learning-based text-mining tool. Rodent model: The NMDA receptor antagonist MK-801-induced mouse model for SCZ was used to assess MTX's therapeutic potential, compared to clozapine. Behavioural outcomes (sociability and cognition) and astrocytic reactivity (GFAP expression in the medial prefrontal cortex, mPFC) were evaluated.

In silico: MTX preferentially targeted hub genes within astrocyte and NFκB modules. In astrocytes, MTX modulated NT5E, a key regulator of adenosine metabolism. In the NFκB module, MTX interacted with IL-6 and STAT3, both involved in immune regulation. Rodent model: MK-801 administration impaired sociability and cognition, accompanied by increased GFAP-positive astrocytes in the prelimbic mPFC, both of which were prevented by MTX. The neuroimmunomodulator effect of MTX was comparable to clozapine in both the in silico and rodent model.

Our findings provide mechanistic insights into the potential antipsychotic-like effects of low-dose MTX in SCZ, involving astrocytic modulation and immune regulation. Further experimental medicine studies in clinical populations stratified by astrocytic and neuroinflammatory biomarkers are warranted to validate these findings.