Advantages of recombinant antibodies-compulsive disorder (OCD) is a common and debilitating mental illness. Treatment resistance is common, and emerging evidence suggests that biological components, such as autoimmune processes, may be implicated in some cases of OCD.
Autoimmunity in OCD was first introduced through the discovery of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS) in which patients develop a sudden-onset of psychiatric symptoms, including OCD and OCD-like behaviors after an infection with group A beta-hemolytic streptococci [22]. It is assumed that these infections trigger the formation of pathogenic antibodies, which cross the blood brain barrier and target basal ganglia tissue. The presence of these antibodies, referred to as anti-basal ganglionic autoantibodies (ABGA), correlates with the rapid-onset of OCD in PANDAS patients and with improved clinical response to standard therapies in those patients.
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A few cross-sectional studies analyzing different autoantibodies have been conducted in OCD patients. However, most of these studies have been performed with small samples and have not replicated the findings of previous reports. A few of these studies have shown elevated levels of ABGA in OCD patients compared to healthy controls, while others did not.
Based on the growing body of evidence, it is possible that a subtype of OCD, referred to as antibody OCD, exists. A structured clinical approach to identify autoimmune OCD and treat these patients, which is analogous to the current diagnostic approaches in PANDAS syndrome, is proposed. In addition, a new red flag criteria for possible, probable, and definite antibody OCD is outlined.