Association of choroid plexus enlargement with cognitive, inflammatory, and structural phenotypes across the psychosis spectrum

Paulo Lizano, Olivia Lutz, George Ling, Adam M. Lee, Seenae Eum, Jeffrey R. Bishop, Sinead Kelly, Ofer Pasternak, Brett Clementz, Godfrey Pearlson, John A. Sweeney, Elliot Gershon, Carol Tamminga, Matcheri Keshavan

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Objective: The choroid plexus is an important physiological barrier and produces CSF and neurotrophic, angiogenic, and inflammatory factors involved in brain development. Choroid plexus abnormalities have been implicated in both schizophrenia and bipolar disorder. A previous choroid plexus transcriptomic analysis of schizophrenia identified an upre-gulation of immune and inflammatory genes that correlated with peripheral inflammatory markers. The purpose of this study was to examine choroid plexus volume in probands across the psychosis spectrum and in their first-degree and axis II cluster A relatives, as well as choroid plexus familiality and choroid plexus covariance with clinical, cognitive, brain, and peripheral marker measures. Methods: Choroid plexus volume was quantified (using FreeSurfer) in psychosis probands, their first-degree and axis II cluster A relatives, and healthy control subjects, organized by DSM-IV-TR diagnosis. Analyte, structural connectivity, and genotype data were collected from a subset of study subjects. Results: Choroid plexus volume was significantly larger in probands compared with first-degree relatives or healthy control subjects; first-degree relatives had intermediate enlargement compared with healthy control subjects; and total choroid plexus volume was significantly heritable. Larger volume was associated with worse cognition, smaller total gray matter and amygdala volume, larger lateral ventricle volume, and lower structural connectivity in probands. Associations between larger volume and higher levels of interleukin 6 in probands was also observed. Conclusions: These findings suggest the involvement of the choroid plexus across the psychosis spectrum with a potential pathophysiological mechanism involving the neuroimmune axis, which functions in maintaining brain homeostasis and interacting with the peripheral immune and inflammatory system. The choroid plexus may be an important target in future research.

Original languageEnglish (US)
Pages (from-to)564-572
Number of pages9
JournalAmerican Journal of Psychiatry
Issue number7
StatePublished - 2019

Bibliographical note

Funding Information:
Previously presented at the 29th annual meeting of the American Neuropsychiatric Association, Boston, March 21–24, 2018. Supported in part by NIMH grants MH-077851 (to Dr. Tamminga), MH-078113 (to Dr. Keshavan), MH-077945 (to Dr. Pearlson), MH-077852 (to Dr. Thaker), and MH-077862 (to Dr. Sweeney); the Commonwealth Research Center (grant SCDMH82101008006 to Dr. Keshavan); the NIH’s National Center for Advancing Translational Sciences (grant UL1TR000114 to Dr. Bishop); and a Livingston Award from Harvard Medical School (to Dr. Lizano). The authors thank the families at each recruitment site who took part in this study, as well as the scientific participants at each site.

Publisher Copyright:
© 2019 American Psychiatric Association. All rights reserved.


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