S3 E21: My Eclectic Conversation with Fulvio D'Acquisto, PhD: From Carl Rogers to Immuno-Moodulin

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Untangling PANDAS and PANS is a podcast about two little known medical disorders characterized by the sudden and dramatic onset of symptoms such as obsessions and compulsions, vocal or motor ticks, and restricted eating behaviors, and a whole host of other symptoms following a strip or other bacterial or viral infection.
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I have the privilege of interviewing some of the top researchers and clinicians in this rapidly growing area, known by various names such as immune-mediated neuropsychiatric disorders, infection-associated neural immune disorders, and other immune encephalitis, or simply pandas and pants.
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My name is Dr.
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Susan Manthell.
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I am a social psychologist, the executive director of the Alex Mantel Fund, and the mother of Alex Manthov, who died at 26 years old due to pandas.
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A disorder my husband and I knew next to nothing about.
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Certainly not that our daughter could die from it.
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This is episode 21 of Untangling Pandas and Pans, recorded January 22nd, 2026.
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Welcome to Untangling Pandas and Pans, a monthly podcast in which we talk about infection-associated immune-mediated neuropsychiatric disorders.
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I am very fortunate to have as my guest today Dr.
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Fulvio De Quisto.
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He's an immunologist and a psychotherapist, and he is particularly interested in how emotion, personality, living conditions, and lifestyle influence the immune system at the cellular and molecular level.
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He is founder of effective immunology, an area of scientific and translational research focused on establishing a better understanding and appreciation of the immunological basis of mental disorders and the emotional side of immune disorders.
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His academic path began with a PhD in natural substances and pharmacological action at the University of Naples, Federico II, in Italy.
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And that was followed by a postdoc at the Department of Immunobiology in Yale, where he focused his work on cellular and molecular immunology.
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At William Harvey Research Institute, he accepted his first position as a senior lecturer in immunopharmacology.
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Somewhere along the line, he received a master's degree in transpersonal psychotherapy, and a project that examined the dreams of patients with autoimmune disorders was completed.
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Later, he went on to Queen Mary University of London and the University of Roehampton.
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He currently teaches and conducts his research at the University of Teramo in Italy and returns to London on the weekends.
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Dr.
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DeCisto and his teams at Queen Mary University of London and the University of Roehampton recently discovered a very important protein produced by T lymphocytes.
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It connects the immune system and mental health.
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It's called immunomodulin, eye mood for short.
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It's found in the immune cells as opposed to the brain.
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People with OCD have up to six times more eye mood in their immune cells compared to healthy individuals.
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There is a potential for treatments that target the immune system rather than typical treatments that target the brain chemistry.
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Other psychiatric and neuroimmune disorders have been found to have elevated eye mood levels, including pandas and pans.
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Aside from his passion for the emotional and immunological systems, he is especially interested in the work of Carl Rogers and Carl Jung.
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A little known fact about Dr.
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Tequisto is that he is a self-described INPJ, according to the Myers-Briggs type indicator, a personality assessment based on Carl Jung's theory of personality.
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Therefore, he said that he is reluctant to refer to himself as the founder of effective immunology.
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He prefers instead to be called its number one fan.
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I encourage you to look up the different personality types according to Jung and see how well it matches Dr.
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Tequisto's personality.
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Let's go ahead and get started.
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I have with me today Fulvio DeCuisto, and I'm very excited to talk with him.
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You're cooking, and we're having a chat, okay?
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Because I know you like to cook, and I know you like convivial kinds of atmospheres and just talking.
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And so do I, and so does the Alex Manfell Fund.
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You may know that we have an expression, dialogue saves lives.
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And we feel very strongly about that.
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We feel that we will move forward when people talk to one another.
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And that's why we set up our symposia, for example, so that physicians and researchers and counselors and whoever is attending our symposium has this opportunity.
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And we found that as a result of that, people who did not know one another before the symposium are now working together.
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And I think that's really important.
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All right.
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So I'm very attracted to your work for a lot of different reasons.
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And speaking personally, which I'll go in and out of in this talk, what you're interested in is much of what got me interested in psychology.
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Read a lot of the same books.
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And like, for example, Carl Rogers, very drawn to him.
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And when I was teaching, I always talked about Carl Rogers' work in therapy and what he would consider sort of a foundational relationship with unconditional positive regard and empathy and genuineness and the ability to express those things.
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And early on, I and through graduate school, I was also very interested in Carl Jung.
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I mean, who is interested in Carl Jung, and I used uh his Myers-Briggs typology assessment during some of the work I did with businesses.
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And I also read Herman Hasse.
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So uh much maybe never.
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Yeah.
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And I now, though, I'm very interested, was sort of thrown into this field of um the immune system and how it relates to well, infection and the immune system and psychiatric disorders, and of course, in particular, pandas and pans.
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I also I'll just tell you this too, that in my daughter Alex's last few years, I went into her apartment one day, and uh this was a few years before she died.
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But what should I see was on her nightstand were books like Man's Searching for Meaning, Man's Search for Himself.
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She asked me about Herman Husa and which books I would recommend.
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So I think she was beginning to wonder who she was, and I'll get into that a little bit later.
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You commented on wanting to focus some of your work more on how happiness makes you feel good as opposed to the opposite, because in psychiatry there is so much uh focus on on feeling bad.
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I I mean talking about uh mental illness.
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But it would be great if we did have more focus on happiness and what brings purpose and meaning and well-being in life, instead of or in addition to, I'll say, what makes you feel sad, depressed, and generally unhappy.
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So I'm drawn to your work for a number of different reasons, and more recently, your your research.
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What can I say?
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I mean, I wish this podcast or chat lasts forever.
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I mean, we really have so much to talk about.
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I mean, um, obviously, I met you in one of your wonderfully organized meetings, and uh, that was really um an excellent experience for me to meet people like yourself and many other uh like-minded people that come to the Alex Mantle meeting every year.
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And let me start.
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I want to address the cooking part, uh which is quite interesting.
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So, as you might know, I also have a double degree, so I have a master in psychotherapy and I practice as a psychotherapist.
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And one of my placements was for a wonderful association of a charity in London called uh Maitree.
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And this is a respite for suicidal people.
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So very interesting model.
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You you can kind of um enroll in this, you spend four nights and five days, and during these four nights and five days, you have rotational uh volunteer, and usually they're also psychotherapists in training.
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And you know, the the guests they end up talking over and over and over about their narrative and the story, and so at the end of the staying, they kind of change their mind.
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So it's a very interesting model that really fits with your idea that you know talking about it works really well.
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Guess what?
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You know, I did a couple of my ministroni and a couple of other pasta that I know how to do it.
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I just won the place for lunchtime.
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My shift has always been for lunchtime, and um, when we were at the table, you know, you get like five guests and a couple of others volunteer.
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I always found the guests will talk more if they were eating, you know, there is the pleasure of the food, and okay, I'm I'm showing off here a bit.
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But also, there is the I think the idea that you've been fed that kind of foster a welcoming space for you to open up and say things that you want to say or share it with other people.
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So I absolutely believe in what you're saying and uh in aspect, you know, the the convivial, eating together, and also the talking definitely is one one of the main things that I think are very, very important.
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So thank you for that.
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I'm so happy that I say that.
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I always wanted to kind of um thank you know all the people that I met there, and this might be an opportunity for me.
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Thank you.
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I guess my uh yeah, it's it's an obsession really.
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Even uh I think three days ago, uh whenever I have you know some sort of uh I feel unsettled, I just put some video on Jung and immediately I come down and I even went to see his house, Switzerland, then I found out it was closed, and I threw myself into the lake because I really want to see it.
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I have so many things to talk about, but you know, I'll I'll try to be not too much Italian kind of going everywhere, chaotic, um, explosive.
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Uh well no, that's that's what we're here to do, and there is so much you can say on uh coming to the table and and getting together with people, and I'll just provide one other anecdote.
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My husband and I give tours in Provence.
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I know you know we love Provence, can go there frequently, but sometimes we bring along a group of people, never more than eight, just enough to fit around the table.
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And sometimes when those people arrive, because very often they don't know one another, and we wonder at the end of the first day, whoa, are they gonna like one another and talk and have a good time?
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And one of the things we do to bring them together is every night we go to the long table and we have a very nice meal and wine from Provence.
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And I think that that is uh an amazingly successful way of bringing people together.
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And uh I think the sort of milieu therapy, I think that you're describing in the in the group where you do some of the cooking.
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I just think that's great.
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So in my public engagement or patient engagement activity, I used a system which had been taught to me by people in humanities called the long table.
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And that comes from a book of an American going back to France because the mother has died and she inherited the house, and she goes there to sell the house, and every night has one person coming to the table, and then this table becomes bigger and bigger and bigger, and at the end she doesn't sell it anymore and moves to France.
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So again, um, quite interesting.
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There is even a movie, and in my public engagement, you know, we we try and do not have the expert and then the audience, but we have this long table, and everyone comes to the table, the experts and uh the audience, and we facilitate discussion that way to be all the same in the same place.
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That's so interesting.
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I have to give one more example and then we'll get going on the real subject, I suppose.
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But this is setting the stage for our conversation, really.
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In the elementary school where Alex went to school, and I think that that's generally true here in the States, they're discouraged from talking at lunch.
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And in fact, if they talk too much, the the lights are blinked, and I suppose the response by the lunch monitors is elevated if it gets really loud.
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And Alex actually found that very distasteful and had her own little protest for that when she first started going to this elementary school, which was great.
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Otherwise, I love the elementary school.
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When she went to school in France, in the equivalent of an elementary school here, they all talked.
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They were encouraged to talk.
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And she loved that, initially found it, wow, this is really, really strange.
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We can talk, and I don't have to whisper.
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But I think as a society, we're we're losing the fine art of conversation.
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And I'd like to see that changed beginning at the elementary school for the reasons that we're we're talking about.
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All right, let's get started.
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Let's start with your idea that you refer to it as effective immunology, I believe, or that's the broad term.
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So, what is the link as you see it between emotional states and living conditions and the immune system and inflammation?
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So, very good question again.
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Thank you for asking that.
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When I uh teach immunology, you know, as I always say, when man was just starting life, you know, they had dinosaurs, they were chasing them, and they developed the brain as a way to uh fight these very big animals and kind of preserve themselves.
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So, in a way, the brain is the uh introduct of sensing the danger outside and trying to have a strategy to avoid death, if you like.
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But then I move on to a slide where I show lots of other dangers like viruses, bacteria, uh, all sorts of things that we actually do not see.
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You know, we we didn't see COVID.
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We we haven't seen bacteria in the air, but we will never uh do that.
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So, how does the body deal with that type of danger?
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And so, based on that, yeah, I kind of introduced the idea of the immune system as a sensor of the external reality.
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So the immune system is the eyes for something that is very small, very tiny, that you need to be alerted from.
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Now, of course, you know, if you drive in the same car, the brain and the immune system cannot just go everyone on his own accord.
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You know, they need to be communicating with each other, and that's the idea.
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So another clear example that I do, you know, when mice get infected by a certain type of pathogen, there's some very nice scientific video that they show that they actually get closer to a cat, so a predator animal or a cat uh that is leaping, so to speak.
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And that is a way through which an infection push a mouse to do something that is not natural, but is natural for the bacteria or for the pathogen.
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They want the passage from the mouse to the cat and then the cat and so on.
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So there is these things about the sickness behaviour, all this uh sort of evidence that whenever we have an immune dysfunction, somehow the brain has to be in sync with that.
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So, you know, you're fighting an infection that takes a lot of energy, you know, the whole immune system is sucking up.
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The energy, but yet you know you want to go party party and uh you know dance all night, you can't do that, so then you feel miserable and sad, and you just wanna stay home and you know drink chicken broth.
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So the way the two systems are connected to me is a positive, and you know, I'm interested in what you're saying about positive.
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I think this interaction is an interaction that is positive to begin with, as in the goal is the same, the trying to uh save the human body, so to speak.
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In affective immunology, I'm particularly focusing on the idea that we are like this sort of a very fluid biological system.
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So, easy example, water.
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You know, water takes the shape of the container, doesn't have a shape itself.
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If you try to hammer water, you can do that, but then it goes back to normal.
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So there is this plasticity that is very unique to the immune system, and I would argue the brain.
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Now, with that in mind, I think that whatever we do, this conversation right now, I'm sure is doing something to our immune system.
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An hour of laughing or an hour of crying, anything that is very tiny and small in time, or you know, in sort of uh transient, if you like, has a mirror effect on the immune system.
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So if you want to mobilize your immune cells in the body, you know, you just do five flights of stairs in a rush.
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The body feels like, what the hell is going on here?
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Why are you rushing?
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You know, is that a dinosaur chasing or something like that?
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And so immediately you get a flash of uh neutrophils, you know, these innate cells that are there for the infection.
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So as soon as we experience something, the immune system has to match it up.
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So to get ready, and you know, possibly also other systems they work that way.
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But I think there is a very sort of tight connection between what we experience and the response of the immune system.
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Response being kind of adjusting the player in the blood or the type of mediators, and so on and so forth.
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So I'm interested in this small tiny transient event, the sum of which dictate the immune system training.
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While these days, you know, most of the psychoneuroimmunology people, what they tend to do is like, okay, uh, two weeks of meditation, two weeks of uh, you know, keto diet, and uh so that there's this sort of banking idea that you need to accumulate, you need almost to violate um your own previous setup to then see the effect of this new thing.
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I don't think it works that way.
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I think that there is a this very tight connection between the two.
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And so we should be mindful of balancing on a daily basis, you know, the positive and the negative, rather than thinking about okay, I need to do three hours meditation a day for 20 days to then see an effect that's not the way it works.
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And also in experimental animal, that doesn't work because there is habituation.
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So I want to know what is the language between these two people.
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I want to know how you know what I see with my eyes, what I experience with my uh mouth, you know, lips kissing someone, how at the level of biology of you know cells and everything, how that is translated.
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I want to know what are the the tools, if you like, whereby these things are happening, and so that is my specific effect, you know, kind of focus.
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So affects uh, you know, like emotion is something that's a beginning at the end, so it's a pick.
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It affects you, you know.
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That's the the reason why I choose affective immunology rather than emotional immunology.
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They would have been the same, but for me, affecting emotion are different in balance, and affects means that it leaves you with something is stored, you know, in the immune system.
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So yeah, without going into negative uh divorce or being raped, that has immediately on the immune system an effect.
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So there is a very quick way to kind of rearrange everything, and I want to know how that works, and I want to know that works, you know, mainly in a positive way, as in you know, it's interesting you brought up you know the um the positive.
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I don't know if you know Nancy McWilliams.
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She's in US, she's um big in psychoanalysis, she did uh the DSM5 of psychoanalysis.
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Uh, I love her, uh, absolutely amazing person and uh psychologist.
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And you know, she recently laid out you know the 10 rules of emotional wellness.
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So, what do we need to do to keep ourselves healthy?
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Because you know, a state of health is not lack of disease, it's something that you foster it, you know, it's an active process, being healthy and balanced rather than healthy, probably.
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It's something that you fuel, you know, you you do things to keep that way.
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And you know, she has many of the things that we briefly talk about, like sociality, uh, intentionality, very, very interesting point.
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And all of them I can see how they will be linked to the immune system in many ways.
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With my heart as a psychotherapist, and let's take a look at OCD.
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You know, to me, OCD triple inverted comma is healthy.
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What do I mean by that?
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I'm in my house.
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I actually did that, and I imagine that there is a bunch of mice or you know est or of any sort that are outside the house, they're trying to get in, and one manages to get in.
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So a mouse is in my house, I'm trying to chase it and trying to kill it, or trying to well kill it, no, but you know, trap it and get him out, and I'm all stressed because you know maybe he will go this way, this way, this way, this way.
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Now, I'm totally focused on finding the mouse.
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I haven't got the energy to deal with more.
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Now, if you take that aspect of OCD, you have to be hyper-vigilant that not other mice are coming in.
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Interesting.
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So think that symbol makes perfect sense.
00:27:43.359 --> 00:27:55.599
You know, you don't want to get infected more, and therefore you create a reality whereby I'm not touching that, or you know, you start to have very intrusive thoughts about what would happen.
00:27:55.599 --> 00:28:02.319
The whole idea is that mate, as they say in English in England, I'm busy in doing this.
00:28:02.319 --> 00:28:05.920
Can you just stop doing something else?
00:28:05.920 --> 00:28:13.759
And the other point that is very important to me, somehow the brain is stupid.
00:28:13.759 --> 00:28:15.759
What do I mean by that?
00:28:15.759 --> 00:28:21.920
You look at the horror movie, you know, you jump on your chair, or you look at a love movie and you start to cry.
00:28:21.920 --> 00:28:23.599
None of that is happening to you.
00:28:23.839 --> 00:28:24.799
Interesting.
00:28:26.480 --> 00:28:28.400
But then you act it out.
00:28:28.400 --> 00:28:33.759
So if you go strip, you can't find it.
00:28:33.759 --> 00:28:36.799
Is it time to get other infection going on?
00:28:36.799 --> 00:28:56.880
So, in that sense, OCD is triple quadruple inverted, comma, uh, healthy, and probably it is healthy, you know, probably we all are OCD, but then at some point, and I'll come to that, there is no mouse.
00:28:56.880 --> 00:29:15.920
You just set the trauma of the mouse in your head, and you hear something, and you think it's a mouse, so the immune system gets activated without even an infection, and the behavior changes, and that is the psychiatric condition.
00:29:15.920 --> 00:29:28.640
So, you know, the what seems to be healthy to begin with, then it moves on to be distorted, and therefore, you know, that becomes a problem.
00:29:29.839 --> 00:29:39.359
And so there's a limited number of people for whom that happens.
00:29:39.359 --> 00:29:45.200
And why does it happen to some people and not to others?
00:29:45.599 --> 00:29:54.000
Yeah, so within uh, you know, that that cohort of OCD people, why some of them have an infection and some they don't.
00:29:54.000 --> 00:30:02.480
That would be the question marked or you know, kind of um strip positive and strip negative.
00:30:05.039 --> 00:30:17.440
Um it's really in some cases, normal cases of um of um level C Then it's related to your immune system in the case in with some people, okay.
00:30:17.440 --> 00:30:39.759
Some in the research in um in affective immunology, some people call it psychonomal immunomology or immune psychometry, there's there's several different names for it.
00:30:39.759 --> 00:30:48.000
You identified something called immunomodulin.
00:30:48.319 --> 00:30:51.119
Yeah, modulating modulation, yeah.
00:30:51.440 --> 00:30:55.759
Can you tell me about that research?
00:30:56.079 --> 00:30:57.440
Yeah, yeah, yeah.
00:30:57.440 --> 00:31:02.640
So that was a discovery by serendipity, if you want.
00:31:02.640 --> 00:31:07.759
You know, I was studying mice that are prone to autoimmune diseases.
00:31:07.759 --> 00:31:14.640
So I was studying another protein that makes mice prone to develop autoimmune inflammation.
00:31:14.640 --> 00:31:25.200
And the PhD that I had at that time, which is quite fun, used to come to me and say, Oh, those mice are just crazy, they are crazy like you.
00:31:25.200 --> 00:31:30.720
They're just the same craziness that you have, they have it.
00:31:30.720 --> 00:31:33.680
So I don't know what you've done to them, you know, kind of thing.
00:31:33.680 --> 00:31:39.519
And I I probably was curious about finding more about myself, I don't know.
00:31:39.519 --> 00:31:44.079
Uh and I went to see this mice, you know.
00:31:44.079 --> 00:31:52.480
I went to see the mice, and uh, if you go to even the paper that we published, you can see this uh open cage.
00:31:52.480 --> 00:32:06.240
You know, we don't do anything, we just open the cage of the mice, and they are frantically kind of digging the sawdust, they're very scuty, they are very kind of agitated, and I haven't done anything to them, you know.
00:32:06.240 --> 00:32:17.039
Kind of I just opened the cage, and so that was very strange because they had this very um anomalous behavior when they came in contact with someone, so to speak.
00:32:17.039 --> 00:32:20.559
The female line, we had the male and the female line.
00:32:20.559 --> 00:32:27.519
The female line, I couldn't get it to uh to you know make more mice, they were cannibals.
00:32:27.519 --> 00:32:35.680
Uh so as soon as they delivered the baby, they eat them up, and so that is a sign of uh post-neonatal depression.
00:32:35.680 --> 00:32:44.640
And then again, if you go to the speedious, you also see that when I put like four females together, there was a bossy uh sister.
00:32:44.640 --> 00:32:57.599
Uh, they um did heterogrooming that means you know removing the fur from the other sister, so there was a sort of dominance, it was all sorts of very strange behavior.
00:32:57.599 --> 00:33:05.119
And to get that line going, um, I had to administer some antipsychotic at that time.
00:33:05.119 --> 00:33:22.640
So basically, this mice that I generated by changing only the immune system, specifically T cell, they had this very strange behavioral phenotype, and that was something completely unexpected to me.
00:33:22.640 --> 00:33:54.480
And when we then did the sort of uh classical basic science experiment where we took those T cells and we put it in a normal mouse, and we saw that the disease was coming up in there in the hosted mouse, we realized that they might produce something that would uh influence the behavior of the mice, and that's how we ended up discovering this very small protein that is secreted by T lymphocytes.
00:33:54.480 --> 00:34:06.400
And uh, when you just give the combined protein to mice, uh mice show sign of one side or uh kind of repetitive anxious behavior.
00:34:06.400 --> 00:34:27.920
So it started with serendipity, but then uh kind of it developed in something that it made sense to me, especially you know when you look at uh certain type of patients, you know, these are not fixed statistics, but you know, one in four uh multiple sclerosis patients commits suicide.
00:34:27.920 --> 00:34:35.039
They commit suicide when they're actually well, as in they can walk and they can do their things.
00:34:35.039 --> 00:34:45.760
So you can fix the body, but then you get this compensation, and the mind becomes super alerted, and you know, you go in psychiatric condition.
00:34:45.760 --> 00:34:56.480
That to me again makes sense because okay, you fix your neurons and you're now able to do the movement that you can normally do.
00:34:56.480 --> 00:35:10.960
You don't want to go rock climbing, so the psychiatric aspect, if you like, has a protective meaning in a very generic triple inverted comma way.
00:35:10.960 --> 00:35:14.960
So it's another distorted way to balance the two.
00:35:14.960 --> 00:35:26.079
And also when you look at this patient with autoimmunity, when you look back in their records, let's say 10 years before, they hadn't psychotic condition.
00:35:26.079 --> 00:35:32.480
They were diagnosed with some sort of either depression or anxiety or uh borderline.
00:35:32.480 --> 00:35:42.079
So when you put the puzzle all together, you know, I come to life, I live a normal life, and then something goes wrong.
00:35:42.079 --> 00:35:46.960
Could be my family, could be the environment that I live, something goes wrong.
00:35:46.960 --> 00:35:55.519
That to me kind of creates an immune response, and like you know, like you had an infection.
00:35:55.519 --> 00:35:58.719
So the trauma becomes similar to an infection.
00:35:58.719 --> 00:36:04.079
Then the body says, Okay, this is not a place to stay.
00:36:04.079 --> 00:36:08.880
Let's move, let's move, let's move, let's do something.
00:36:08.880 --> 00:36:19.599
So it blocks your behavior, and so you get depression and all of that, because you need to change something, you need to move out, you need to do something else.
00:36:19.599 --> 00:36:22.239
People keep in that loop.
00:36:22.239 --> 00:36:25.039
Okay, you're not listening to me, you're not listening to me.
00:36:25.039 --> 00:36:25.840
You know what?
00:36:25.840 --> 00:36:30.159
I'm blocking your body now, and that's where you get autoimmunity.
00:36:30.159 --> 00:36:35.599
It's a romanticized way, uh, for me, you know.
00:36:35.599 --> 00:36:41.039
Obviously, do I have a hundred papers that support exactly this hypothesis?
00:36:41.039 --> 00:36:41.599
No.
00:36:41.599 --> 00:36:43.840
Do I have bits and basis?
00:36:43.840 --> 00:36:44.960
Yes, we do.
00:36:44.960 --> 00:36:54.800
You know, when you talk to the rheumatologist, you always ask, do you do you ask about your patient about you know psychiatric condition, psychological condition?
00:36:54.800 --> 00:36:56.320
No, no, no, we didn't do that.
00:36:56.320 --> 00:37:00.480
You talk to the psychiatrist, do you know how many neurophemes did they get?
00:37:00.480 --> 00:37:02.960
Do you know if they had an infection?
00:37:02.960 --> 00:37:05.199
No, no, no, we didn't do that.
00:37:05.199 --> 00:37:14.480
But when you find someone that looks at the whole thing, then you get the 3.1 line, more or less.
00:37:14.960 --> 00:37:21.280
So you're trying to further understand that connection.
00:37:21.280 --> 00:37:29.760
I I just to read, I think, the first line from one of your papers on immune mood healing.
00:37:29.760 --> 00:37:52.960
You ruminate them patients suffering from no immune diseases more susceptible to mental disorders, yet the existence of specific salelium or molecular mechanisms behind the comorbidity of these pathologies is far from being fully elucidated.
00:37:52.960 --> 00:37:58.960
I mean, that is really a huge question in this field, isn't it?
00:37:59.840 --> 00:38:20.639
Yeah, and uh I think what I'm about to say next will attract the hatred or not of millions of people, and I'm willing to take the risk because I'm 55, I just uh want to be me for the next 10 years, and actually I do believe in what I say.
00:38:20.639 --> 00:38:26.400
So I am well, yeah, I'm quite an expert in inflammation.
00:38:26.400 --> 00:38:28.400
I always worked on inflammation.
00:38:28.400 --> 00:38:35.840
I teach inflammation not just in my course, also to other universities tomorrow, for instance, I'll do a lecture on inflammation.
00:38:35.840 --> 00:38:44.159
When we study inflammation, we say it's a physiological response to a damage.
00:38:44.159 --> 00:38:49.920
Inflammation, it's a physiological response.
00:38:49.920 --> 00:38:54.800
Without inflammation, we wouldn't be alive.
00:38:54.800 --> 00:39:06.400
You hurt yourself, you have dead skin, you have dead cells, who's gonna take them out of the immune system.
00:39:06.400 --> 00:39:09.039
How to inflammation?
00:39:09.039 --> 00:39:17.599
Your wound there is inflammation there to repair and to attack the bacteria there.
00:39:17.599 --> 00:39:27.360
The job of an inflammatory necrosis is to maintain homeostasis in the body, that means a balanced state.
00:39:27.360 --> 00:39:29.440
Full stop.
00:39:29.440 --> 00:39:35.360
I mean, there is no way anyone can change that and say that inflammation is bad.
00:39:36.960 --> 00:39:39.920
As you said, balance is such a key word.
00:39:40.480 --> 00:39:40.960
Yeah.
00:39:40.960 --> 00:39:50.159
So inflammation becomes bad when it is repetitive or it becomes chronic for no reason.
00:39:50.159 --> 00:39:54.559
So the body is looking for the streptococcus infection.
00:39:54.559 --> 00:39:59.119
Streptococcus infection is not there, chronic inflammation.
00:39:59.119 --> 00:40:02.719
Obviously it's not gonna go anywhere.
00:40:02.719 --> 00:40:13.920
So going back to my metaphor, you can picture me spending one day, two days, a week running around the house trying to find something that is not there.
00:40:13.920 --> 00:40:26.639
What's the outcome of that is that one, I get exhausted, two, I don't solve the problem, right?
00:40:26.639 --> 00:40:43.599
So for me in psychiatry, the height and level of inflammation is accumulation in the brain or something that should be cleaned of all these neurodegenerate diseases.
00:40:43.599 --> 00:40:57.360
So you have something in the brain, that cells and neuronals and that whatever you want to call it, something needs to be clean in the body, in the brain in particular.
00:40:57.360 --> 00:41:02.800
So the brain obviously has to call the immune cells to come there.
00:41:02.800 --> 00:41:09.039
So there has to be an inflammatory process that then drives the immune cells there.
00:41:09.039 --> 00:41:12.000
They go there.
00:41:12.000 --> 00:41:15.519
We have now wonderful signs from Jonathan Kickness.
00:41:15.519 --> 00:41:22.639
Immune cells go in and out the brain all the time to clean up.
00:41:22.639 --> 00:41:24.480
That's the job.
00:41:24.480 --> 00:41:26.400
The job is to go there and clean up.
00:41:26.400 --> 00:41:41.760
However, if you haven't got immune cells because you're stressed and you're immunosuppressed, all you have is the sirens you know to recruit the medical people, but no one is coming.
00:41:41.760 --> 00:41:52.480
So it's a complete to me misunderstanding of the role of inflammation in psychiatry.
00:41:52.480 --> 00:41:57.679
The inflammatory process is not always there as we know.
00:41:57.679 --> 00:42:00.880
Even in depression, it's 50% more or less.
00:42:00.880 --> 00:42:11.840
In those cases, is the body trying to push the immune cells to go there, but there is very little immune cells available.
00:42:11.840 --> 00:42:16.239
And so it's like a constant alarm that doesn't get you anywhere.
00:42:16.239 --> 00:42:26.400
If inflammation was truly, truly the driver of psychiatry, well, I mean, glucocorticoids fantastic.
00:42:26.400 --> 00:42:28.480
Neurofen.
00:42:28.480 --> 00:42:31.440
Plenty of the anti-inflammatory.
00:42:31.440 --> 00:42:41.119
I mean, if there is one overcrowded stack of drugs is anti-inflammatory drugs, we got at least 40 types.
00:42:41.119 --> 00:42:44.880
We know where we know how it works.
00:42:44.880 --> 00:43:00.639
I guess what people with OCD until you know when you go to blog that I love to listen to the patient rather than the scientist, they say, ooh, take a low dose of ibuprofen or neurophen.
00:43:00.639 --> 00:43:05.360
It makes you kind of positive boot.
00:43:05.360 --> 00:43:18.239
So clearly there is something there that is being I'm not saying obviously I'm not God far from it, but I think we've taken away the basic biology.
00:43:18.239 --> 00:43:29.199
I challenge everyone to take a book of pathology in medical school and biomedical science and read to me inflammation is a pathology.
00:43:29.199 --> 00:43:31.760
It is not.
00:43:31.760 --> 00:43:40.000
Inflammation is a physiological response of vascularized tissue.
00:43:40.000 --> 00:43:45.760
It happens in plants, it happens in drosophila, it happens in all sorts of animals.
00:43:45.760 --> 00:43:49.840
They have a vascular system, so a system of communication.
00:43:49.840 --> 00:43:54.880
Where there is communication, there might be a mistake, you need something that fixes.
00:43:54.880 --> 00:44:00.400
You have a house, your pipe gets broken, you get the plumber.
00:44:00.400 --> 00:44:04.800
The air conditioned system doesn't work, the electricity doesn't work.
00:44:04.800 --> 00:44:11.599
All those things are immune cells in inflammatory process.
00:44:11.599 --> 00:44:14.400
They are a fixer.
00:44:14.400 --> 00:44:23.519
We need EU from the Greek good inflammation.
00:44:23.519 --> 00:44:25.519
We need that.
00:44:25.519 --> 00:44:30.559
In fact, I mean when you are stressed, what do you do?
00:44:30.559 --> 00:44:36.320
You may not surprise you haven't got self in your body.
00:44:36.320 --> 00:44:38.639
Maybe you haven't got the soldier.
00:44:38.639 --> 00:44:41.840
Your alarm bell doesn't go anywhere.
00:44:41.840 --> 00:44:44.320
Well of course you're getting blamed.
00:44:44.320 --> 00:44:51.760
How do you fix it?
00:44:51.760 --> 00:44:53.039
Stop.
00:44:53.039 --> 00:45:00.159
Go back to it.
00:45:01.519 --> 00:45:26.079
So what are your thoughts about why for some people one inflammation uh soldier, so to speak, is effective in one person, and yet for another person, well, one one person takes advil in their their their will, another person needs steroids, another person needs uh IVIG.
00:45:26.079 --> 00:45:32.000
What are your thoughts about the underlying mechanisms to explain that?
00:45:32.000 --> 00:45:40.480
I mean, honestly, let me preface that by saying, of course, we don't have all the answers there, but do you have any thoughts on that?
00:45:41.440 --> 00:45:56.400
Well, I mean, let's start from something, you know, the intense code that I found pans and pandas, even in a from scientific point of view, because he helps me so much consolidating lots of questions that like this one that you have.
00:45:56.400 --> 00:46:01.360
Yeah, we we do know that plasmapheresis works in pants and pandas, right?
00:46:01.360 --> 00:46:10.239
So plasma pheresis, you remove anything soluble, allegedly, and you just leave the cells from the blood.
00:46:10.239 --> 00:46:16.000
So clearly there is something soluble that is produced that does something.
00:46:16.000 --> 00:46:24.880
But it is a fact, you know, that if you remove the plasma, the patient gets better.
00:46:24.880 --> 00:46:26.480
So that's number one.
00:46:26.480 --> 00:46:33.519
Now, the plasma must contain something that then causes Tanz and Bandas manifestation.
00:46:33.519 --> 00:46:42.719
Now that as we've seen, and again, I can never be grateful enough uh for giving me the opportunity to come to one of your meetings.
00:46:42.719 --> 00:46:54.559
I learned so much, you know, from obviously I knew Jennifer Frankovich and you know all these other uh kind of pillars of the field, but it's different when you see them all together.
00:46:54.559 --> 00:47:05.519
And you know, you get this picture of well, it's not just OCT, and then there is a bit of uh rheumatoid arthritis, and then there is the dysgraphia, and then there is this and this and that.
00:47:05.519 --> 00:47:10.880
So the way I picture in my mind is that um the disease is like a book.
00:47:10.880 --> 00:47:18.000
So there is a narrative going on, there is this a process with stages, stage one, two, three, four, five.
00:47:18.000 --> 00:47:21.840
The drugs just act at different points.
00:47:21.840 --> 00:47:26.880
Now, if you like enough to go with the right drug at the right stage, it works.
00:47:26.880 --> 00:47:32.719
If it doesn't, then obviously you either too late or too early.
00:47:32.719 --> 00:47:38.400
And that, for instance, in my case, works wonderfully.
00:47:38.400 --> 00:47:43.519
When you think about emot, imode immunomodulin, think about the domino, right?
00:47:43.519 --> 00:47:49.599
So your one domino knocks down, becomes two, two becomes four, four becomes eight.
00:47:49.599 --> 00:47:53.519
So it's a protein that kind of aggregates like dominions.
00:47:53.519 --> 00:48:01.519
So it depends on where you are, you can interrupt that chain of reaction.
00:48:01.519 --> 00:48:07.599
Because then when you have aggregated imod, that's the time we think it goes to the brain.
00:48:07.599 --> 00:48:13.679
When it goes to the brain, then it deposits in hydrils like amyloid and cynuclein.
00:48:13.679 --> 00:48:18.400
So there are different stages, not like what we think.
00:48:18.400 --> 00:48:22.960
You know, there is a receptor and the ligand, and I just block the receptor or the ligand.
00:48:22.960 --> 00:48:27.679
That's a like a love story that focuses on a case.
00:48:27.679 --> 00:48:31.119
There's the whole love story.
00:48:31.119 --> 00:48:36.400
There's the flirting, the meeting, you know, the sex or the fight.
00:48:36.400 --> 00:48:40.000
And you know, the drugs are just acting at different points.
00:48:40.000 --> 00:48:42.320
We don't know what these points are, maybe.
00:48:42.320 --> 00:48:52.079
That's the reason why some works and some not, because we we're just trying our luck and see which one works.
00:48:53.280 --> 00:49:04.159
Yeah, if only we had more personalized medicine so we could see at what stage the individual was more research to do.
00:49:04.800 --> 00:49:16.320
And also, when we had the meeting, you know, we were talking about the auto antibodies in Panzer Pandas, and you know, they were never the same.
00:49:16.320 --> 00:49:22.559
They were all over the place because that is a personalized response.
00:49:22.559 --> 00:49:26.400
So there was no correlation in this is not my work, but you know what I mean?
00:49:26.400 --> 00:49:28.880
For me, that made a lot of sense.
00:49:28.880 --> 00:49:38.159
It's just uh you know, like you know, the experience of a glass of wine for you is different from me, and this is the same thing.
00:49:38.159 --> 00:49:46.320
There are steps in progression, it's not just two points, one line, and then the breakage of the line.
00:49:46.719 --> 00:49:47.199
Mm-hmm.
00:49:47.199 --> 00:49:50.239
It's much more complicated.
00:49:50.239 --> 00:49:53.199
There's a researcher, Dr.
00:49:53.199 --> 00:49:59.440
Lauren Breithop, who was at Harvard Mass General, and we've supported her work.
00:49:59.440 --> 00:50:20.079
Uh she does proteomics, in which she looks for proteins in patients with pandas, with OCD, with ARFID, and with different disorders, and she's really just started to analyze that data.
00:50:20.079 --> 00:50:37.440
She's found she on the basis of certain protein profile, she's able to distinguish pandas from quote-unquote healthy patients with 91% accuracy.
00:50:37.440 --> 00:50:40.079
That's pretty remarkable.
00:50:40.079 --> 00:50:56.079
So, but that doesn't answer, as what what we're talking about, doesn't answer what treatment would be best, but it does show that we can distinguish the two groups.
00:50:56.079 --> 00:51:02.079
And in fact, she and Kyle Williams have applied for a patent for this.
00:51:02.079 --> 00:51:08.639
So there's some movement forward, but all the questions are not answered.
00:51:08.639 --> 00:51:26.880
I think the other interesting observation, and you're right about this too, I think, is it's known that autoimmune disease is um closely related to certain psychiatric disorders, in fact, quite a few of them.
00:51:26.880 --> 00:51:37.599
But um why is it that they're related to more to some psychiatric disorders than to others?
00:51:37.599 --> 00:51:44.079
Like um the relationship between psoriasis and OCD is is pretty strong.
00:51:44.079 --> 00:51:47.760
And that that's a subject I'm I'm really interested in.
00:51:47.760 --> 00:52:12.800
And Kyle Williams from Mass General in Harvard is doing some research on that subject, and he hasn't uh finished the paper yet, but he completed an extensive study of the association of obsessive-compulsive disorder with multiple uh autoimmune conditions.
00:52:12.800 --> 00:52:24.000
And he looked at over a million medical records at Mass General, and so he's looked at OCD and bipolar disorder and schizophrenia and depression and autism.
00:52:24.000 --> 00:52:47.679
And the autoimmune conditions, I think there's probably 20 of them that are listed here: children's, autoimmune thyroid disorders, alopecia, ariana, Addison's butulus disorder, psoriasis, psoriatic arthritis, Crohn's disease, all sorts of colitis lupus, and more.
00:52:47.679 --> 00:53:08.880
And this is just preliminary but he found that OCD show disproportionately high prevalence of inflammatory battle disease and dermatological autoimmune conditions, such as psoriasis, and with IL-17 being the connection there.
00:53:08.880 --> 00:53:21.119
And in contrast, he found diabetes, rheumatoid arthritis, demyelating disease, and myasthenia gravis were more prevalent in mood and psychotic disorders.
00:53:21.119 --> 00:53:35.360
So I find that really interesting that with certain psychiatric disorders, certain uh autoimmune conditions are more likely to be uh identified.
00:53:35.360 --> 00:53:43.280
And it kind of goes back again, supporting the role of, well, this is sort of obvious, but the role of the immune system.
00:53:43.280 --> 00:53:44.320
Right?
00:53:44.320 --> 00:53:45.280
Would you agree?
00:53:45.679 --> 00:53:46.159
Yeah, yeah, yeah.
00:53:46.159 --> 00:53:50.880
And again, I'm gonna give you this is so liberating today.
00:53:50.880 --> 00:53:53.760
I'm saying everything that I want to say.
00:53:53.760 --> 00:53:59.519
Um we'll go into the very hocus focus part of me.
00:54:01.840 --> 00:54:02.480
Oh, good.
00:54:02.480 --> 00:54:04.239
I like the hocus-focus part.
00:54:04.239 --> 00:54:05.119
I like it.
00:54:05.360 --> 00:54:08.639
Very, very philosophical, so to speak.
00:54:08.639 --> 00:54:12.960
So the way Symptom and Symbol famous book in America.
00:54:12.960 --> 00:54:17.440
Uh I don't remember the author, but it's called Symptoms and Symbols.
00:54:17.920 --> 00:54:18.239
Oh, okay.
00:54:19.280 --> 00:54:24.800
The symptoms are symbolic of a certain psychological state or processes.
00:54:24.800 --> 00:54:25.519
Uh-huh.
00:54:25.519 --> 00:54:42.239
So I have OCD, and um, I'm 100% I'm talking as immune system and OCD, and I'm sure that there is some sort of infection that I don't know what it is, and I'm trying to find it and trying to find it.
00:54:42.239 --> 00:54:49.599
So we need to make sure that we don't add more steak, you know, to the barbecue.
00:54:49.599 --> 00:54:55.599
Let's put on some very disgusting kind of something that pushes people away.
00:54:55.599 --> 00:55:02.400
So psoriasis in that sense, you know, it's a visual thing.
00:55:02.800 --> 00:55:03.280
Mm-hmm.
00:55:03.599 --> 00:55:04.480
Absolutely.
00:55:04.480 --> 00:55:10.239
I'm always trying to kind of have a look at that.
00:55:10.239 --> 00:55:16.000
It's a distorted nature, but it's nature.
00:55:16.000 --> 00:55:20.079
So what is this body trying to achieve?
00:55:20.079 --> 00:55:30.239
Theoretically, those should lead to a better survival if this is a strategy for survival, and there's a distorted one.
00:55:30.239 --> 00:55:32.800
So it is a distorted one.
00:55:32.800 --> 00:55:44.880
One thinks that you know there is an infection that is in there, and then because he can't find it, it puts these things out to block the person from doing other things or being approached by other people.
00:55:45.679 --> 00:55:46.880
That's very interesting.
00:55:48.159 --> 00:55:50.960
I try and reason it, if you like.
00:55:50.960 --> 00:56:00.800
Um that would be the link uh for me between um the two.
00:56:00.800 --> 00:56:11.679
And the other more scientific way, I think, when you go to depression, there is more reduced number of immune cells in the blood.
00:56:11.679 --> 00:56:22.159
Like, you know, you're just immunosuppressed by the stress, while you know, in OCD and all these other conditions, there is not much of that going on.
00:56:22.159 --> 00:56:29.039
The cells are there, but they are all over the place, they are doing something which is uncontrolled.
00:56:31.119 --> 00:56:32.960
Yeah, that's really interesting.
00:56:32.960 --> 00:56:54.559
So much of it, I think, has to do with making sure it's uh a correct psychiatric diagnosis, and whether our understanding is sufficient yet, and like in terms of psychosis, what are we talking about?
00:56:54.559 --> 00:56:57.760
And and there's multiple types of schizophrenia.
00:56:57.760 --> 00:57:02.639
In fact, every DSM I think has a different number of the different types.
00:57:02.639 --> 00:57:15.840
And maybe taking a closer look at the diagnosis and whether or not they're accurate and what autoimmune conditions they're associated with might be valuable.
00:57:15.840 --> 00:57:22.800
And I guess what's making me think that is a case that I found myself re-referring to quite a bit.
00:57:22.800 --> 00:57:31.360
Uh, and that was a an article from The New Yorker about a woman that was diagnosed with schizophrenia.
00:57:31.360 --> 00:57:32.800
Her name was Mary.
00:57:32.800 --> 00:57:34.400
Did you read that article?
00:57:34.800 --> 00:57:36.880
No, um, but I heard of it, yeah.
00:57:37.119 --> 00:57:39.280
Okay, I found it really fascinating.
00:57:39.280 --> 00:57:47.199
For listeners who are not familiar with it, it was a woman who in her 40s is diagnosed with schizophrenia.
00:57:47.199 --> 00:57:51.679
And it's a very unusual age to be diagnosed with schizophrenia.
00:57:51.679 --> 00:57:58.719
Most of the time, it's in the late teens or likely the early 20s to early 30s.
00:57:58.719 --> 00:58:03.599
And she lived for 20 years, being pretty treatment resistant.
00:58:03.599 --> 00:58:13.840
I mean, she was in and out of hospitals on multiple different psychiatric drugs and just not responsive in general.
00:58:13.840 --> 00:58:18.639
So you can imagine what happened to her life in 20 years.
00:58:18.639 --> 00:58:31.039
Her family, although her daughters were very supportive, they did not get to enjoy the richness of what those relationships should have been.
00:58:31.039 --> 00:58:37.440
And as I said, she was on so many drugs with many side effects and in and out of hospitals.
00:58:37.440 --> 00:58:50.960
And about 20 years after she was diagnosed, that is again meeting the criteria for schizophrenia, she developed uh cancer, lymphoma.
00:58:50.960 --> 00:59:12.639
And as a result of that, took rituximab, the immune-modulating or immune-pressing drug that's often used to treat pandas and pans, and she suddenly lost all of her symptoms of schizophrenia and was no longer able to diagnose her as having schizophrenia.
00:59:12.639 --> 00:59:27.440
So 20 years ago, I understand why they didn't test for other medical conditions, but had they, perhaps they would have identified the autoimmune condition, which was lupus, and treated her differently.
00:59:27.440 --> 00:59:49.840
I uh I guess I bring that up because we need to know so much more about what autoimmune conditions, well what medical conditions in particular autoimmune conditions need to be tested when we see a psychiatric disorder uh presenting itself.
00:59:50.400 --> 00:59:53.920
So I have two points to make on that, which are very relevant.
00:59:53.920 --> 00:59:55.360
And I'll pick up lupus.
00:59:55.360 --> 00:59:59.760
So lupus is in autoimmune diseases where you have auto antibody against.
00:59:59.760 --> 01:00:01.039
DNA.
01:00:01.039 --> 01:00:03.519
Circulating DNA in the body.
01:00:03.519 --> 01:00:08.559
This is a very generic and very approximate definition of the disease.
01:00:08.559 --> 01:00:14.559
I'm about to publish a study where I simulated fear in mice.
01:00:14.559 --> 01:00:19.920
So basically I spose the mice to a predator order like fox urine.
01:00:19.920 --> 01:00:24.880
You know, you spose the mice to foxurine, they have a fear response.
01:00:24.880 --> 01:00:28.719
And then I induce an inflammatory process.
01:00:28.719 --> 01:00:37.519
What you see is that again the immune cells in this case they explode.
01:00:37.519 --> 01:00:49.199
So the one they've been subjected to fear, the neutrophil, they actually overreact, and by doing that they expel all the inner material, including DNA.
01:00:49.199 --> 01:00:57.280
It is over the last ten years that we've done a connection between neutrophils and lupus.
01:00:57.280 --> 01:01:08.639
So you know, you can see how you just need to be going through a war having sort of social fear and fear.
01:01:08.639 --> 01:01:12.480
Your immune system might have blasted all this DNA out.
01:01:12.480 --> 01:01:15.440
That didn't make sense.
01:01:15.440 --> 01:01:17.599
Generational antipode.
01:01:17.599 --> 01:01:23.280
Yeah, yeah, yeah.
01:01:26.400 --> 01:01:26.800
Uh-huh.
01:01:27.360 --> 01:01:35.280
It's interesting that when I look at FIA, even at the level of the immune system, you know, the neutrophils should be very slow to react and then do their things.
01:01:35.280 --> 01:01:46.000
When I took the mice to have a fearful um condition, they just go ballistic and they it's almost like killing themselves, though.
01:01:46.000 --> 01:01:49.840
They don't even have the time to do their job, they just explode.
01:01:50.239 --> 01:01:50.719
Wow.
01:01:50.960 --> 01:02:02.000
And so tells you so much about you know that one hour window, two-hour window of a cotton piece of cotton with fox urine in it.
01:02:02.000 --> 01:02:11.360
So you can see the idea of the effect, you know, those little things that you think they do nothing, but they do.
01:02:11.360 --> 01:02:13.199
They actually do.
01:02:13.199 --> 01:02:26.239
And if that is repeated, then that's how you get autoimmunity and auto-antibody by resposing to the same antigen or the same protein that it shouldn't be there.
01:02:26.239 --> 01:02:31.519
So repeated exposure causes autoimmunity as well.
01:02:31.519 --> 01:02:43.920
The provocative side of uh going back to pants and all of that, you know, uh here we go the Nobel Prize for medicine in the palating words.
01:02:43.920 --> 01:02:46.800
My approach will be very simple.
01:02:46.800 --> 01:02:54.000
All the OCD tourette, uh, pants and pandas, they should have bone marrow transplantation.
01:02:54.000 --> 01:02:56.960
Like, you know, wipe off their immune system completely.
01:02:56.960 --> 01:03:12.880
You know, when you have cancer, you you remove all your immune cells from the body, and then you transplant with the bone marrow so you the the precursor of immune cells uh of your sister or parents, you know.
01:03:12.880 --> 01:03:22.800
So you basically uh delete from the body all the wrong immune cells, and in that case, in cancer is cancerous cells.
01:03:22.800 --> 01:03:30.559
So immunotherapy, bone marrow transplantation, and then see if disease is still there.
01:03:30.559 --> 01:03:35.280
Because the you know the crazy T cell will not be there.
01:03:35.280 --> 01:03:42.719
In the case of depression, all you need to do, triple invested coma, is to pump more immune cells in the body.
01:03:42.719 --> 01:03:45.599
IL7, GMCSF.
01:03:45.599 --> 01:03:59.119
When you look at this cytokine, what they do in the body, you know, they they stimulate T cell production or they stimulate neutrophil production, so you make more immune cells, and then guess what?
01:03:59.119 --> 01:04:01.360
They all have a behavioral effect.
01:04:03.199 --> 01:04:03.840
Wow.
01:04:03.840 --> 01:04:11.519
So I um see an immediate practical problem, of course, but if we only could do that.
01:04:11.840 --> 01:04:14.400
But we know why this is not happening, right?
01:04:15.039 --> 01:04:16.320
Yes, exactly.
01:04:16.320 --> 01:04:22.000
Insurance companies, cost, which is just so disheartening.
01:04:22.000 --> 01:04:30.400
But you're saying to have a a drug like rituxamab or plasma phoresis.
01:04:30.880 --> 01:04:33.599
Yeah, it really depletes certain cells.
01:04:33.599 --> 01:04:37.440
I'm talking about wiping off completely.
01:04:37.440 --> 01:04:49.840
When you have bone marrow transplant tissue, you basically uh you wipe off completely your immune system and doesn't exist anymore, and then you receive progenitor cells which are in the bone marrow.
01:04:49.840 --> 01:04:52.880
Those are the cells that then give you immune cells.
01:04:52.880 --> 01:05:01.760
So you replace the patient immune system with uh in the immune system or someone in your family that is compatible.
01:05:02.159 --> 01:05:03.280
Really interesting.
01:05:03.280 --> 01:05:04.800
That's really interesting.
01:05:04.800 --> 01:05:12.800
So just so I understand, I mean, would you have something like plasmapheresis first or just go right to uh bone marrow transplant?
01:05:13.039 --> 01:05:22.000
Yeah, I think bone marrow transplantation would be, you know, wiping because at the end the plasma is just a container of what these immune cells have produced, right?
01:05:23.119 --> 01:05:23.440
Wow.
01:05:23.679 --> 01:05:42.159
So if you wipe them off because they are producing an unregulated amount of whatever is causing the disease, then you replace with proper, not sensitized uh immune cells, then is anyone doing that?
01:05:42.159 --> 01:05:43.760
Absolutely not.
01:05:44.000 --> 01:05:45.599
Yeah, yeah.
01:05:46.079 --> 01:05:46.719
Fair enough.
01:05:46.719 --> 01:05:49.519
I've been saying this for over the last five years.
01:05:49.679 --> 01:05:50.000
Uh-huh.
01:05:50.239 --> 01:05:54.880
Uh here and there in some reviews, they start to popping up.
01:05:55.360 --> 01:05:59.440
Talking about having a bone marrow, the value of having a bone marrow transplant.
01:05:59.760 --> 01:06:04.800
Oh, yeah, it's a thing of depression and inflammation is not really connected.
01:06:04.800 --> 01:06:09.679
So, but you know, there are the holder of the truth.
01:06:09.679 --> 01:06:21.840
And until it comes from them, everything else is you know what has to come to certain people.
01:06:21.840 --> 01:06:22.159
Yeah.
01:06:22.159 --> 01:06:24.079
Other people are crazy.
01:06:24.719 --> 01:06:32.320
Sort of harkens back to Similvice's problems in the end of the 19th century, yeah.
01:06:32.320 --> 01:06:36.400
Um, and then he had proof if you looked at his data.
01:06:36.400 --> 01:06:56.800
Doctors who washed their hands with his chlorinated substance and then delivered babies and a reduction in uh the mortality, but there wasn't an explanation by the doctors in Panor, so to speak.
01:06:56.800 --> 01:07:00.000
And in that case, that was in Viennin, and then uh Dr.
01:07:00.000 --> 01:07:09.840
Stimmelweiss was from Hungary, and um maybe he didn't carry the same gravitomas as the other doctors.
01:07:09.840 --> 01:07:11.519
It's very interesting.
01:07:11.519 --> 01:07:14.639
Okay, I just have a couple more questions.
01:07:14.639 --> 01:07:24.960
I want to I want I just want to ask you if you can tell us a little bit about what you're what kind of research you're doing with brain tissue.
01:07:25.760 --> 01:07:26.400
Yeah.
01:07:27.199 --> 01:07:34.320
So as I mentioned to you, immunomodulin is this sort of um uh imagining.
01:07:34.320 --> 01:07:48.800
I don't know if you ever seen those toys with uh magnets, you know, you you have like little sticks of magnets, and then you have other sticks, and then uh if you put them close to each other, they kind of ta-ta-ta-ta-ta-tago.
01:07:48.800 --> 01:07:53.679
So that's IMUD or immunomodulin becoming pathogenic.
01:07:53.679 --> 01:08:02.719
So is the conversion from a single molecule to a cluster of molecules, and then it becomes a fabrible.
01:08:02.719 --> 01:08:08.159
And this process is pretty much what happened in Alzheimer's and Parkinson.
01:08:08.159 --> 01:08:12.079
So there is a class of protein, and IMUD is one of them.
01:08:12.079 --> 01:08:33.119
So then you know you have nuclein, alpha C nuclein in Parkinson or beta-malloid in uh Alzheimer's, so they share certain behavior, they are called intrinsically disordered protein, which means basically they are very flexible, they are very unstable in the structure.
01:08:33.119 --> 01:08:37.680
And on top of that, they tend to aggregate.
01:08:37.680 --> 01:08:45.199
So in Parkinson and Alzheimer's, this protein they aggregate first and then they form fibroults.
01:08:45.199 --> 01:08:52.880
Fibro in the brain then goes cell debt, and then obviously neural damage and the symptoms there we know.
01:08:52.880 --> 01:08:56.640
Where are these protein to begin with?
01:08:56.640 --> 01:08:58.319
In blood.
01:08:58.319 --> 01:09:03.279
So, like, guess what?
01:09:03.279 --> 01:09:10.000
Serotonin is like 100 times more present in blood than in the brain.
01:09:10.000 --> 01:09:11.520
Let's not go there.
01:09:11.520 --> 01:09:25.119
IMUD is in the blood, and then an infarction can happen, or something or traumatic can happen, and then IMUD basically becomes aggregated.
01:09:25.119 --> 01:09:30.079
Once it becomes aggregated, it becomes um lipophilic.
01:09:30.079 --> 01:09:34.800
That means they can cross a lipid bilayer, the brain.
01:09:34.800 --> 01:09:48.800
And then once it gets to the brain, this bubble of aggregated amount, uh, for reasons that we don't know yet, uh, becomes possibly a fibril or a bigger bubble.
01:09:48.800 --> 01:09:56.720
The presence of this bigger bubble or fibrill will impact the way neurons talk to each other.
01:09:56.720 --> 01:10:06.880
I don't know if you ever use one of those foams, you know, when you have a hole in the in the wall and you want to fill it in, and you have that kind of polystyrene expansion thing.
01:10:06.880 --> 01:10:19.119
That's that's Simon, you know, it's basically like polymerize uh gung in the brain that stops you know the two neurons talking to each other.
01:10:19.119 --> 01:10:30.239
The beauty of it, once that is done, is that it's not always there, you can also disassemble and come back in blood.
01:10:30.239 --> 01:10:32.720
Why is that important?
01:10:32.720 --> 01:10:37.840
Because that would display acute phase relapse.
01:10:37.840 --> 01:10:45.520
Yeah, remission relapse, so you get high disease during the infection.
01:10:45.520 --> 01:11:06.319
Infection activate these cells, these produce more IMUD, more immod becomes gunk, gunk in the brain becomes these sort of things they obstruct neural connection, then infection goes away, eye mode goes down in the blood, the one from the brain goes back into circulation.
01:11:06.319 --> 01:11:12.159
So that will give you this waves of psychiatric manifestation.
01:11:12.159 --> 01:11:26.239
Now, I've been lucky enough through you, once again, that I had the chance to opportunity to have access to the brain of a patient from Pants and Pandas and some control.
01:11:26.239 --> 01:11:34.479
And we can see these bubbles of IMUD in many of these sections.
01:11:34.479 --> 01:11:46.880
I haven't got the full picture yet, but I can clearly see that there are some brain tissue that have this bubble of IMUD and some others they don't.
01:11:46.880 --> 01:12:00.479
So the brain is like you know the endpoint of a run, you know, kind of when you when you're running, when you're doing a marathon, that's the finish line.
01:12:00.479 --> 01:12:03.439
So the finish line is the bubble.
01:12:03.439 --> 01:12:07.760
If I see bubble, that means that it's pathogenic.
01:12:07.760 --> 01:12:17.920
And so I need the brain of patient to show that there is a correlation between the formation of these bubbles and the disease.
01:12:17.920 --> 01:12:19.199
Oh my gosh.
01:12:19.199 --> 01:12:22.079
Yeah, yeah, I wouldn't need you know the three things.
01:12:22.079 --> 01:12:24.000
I would need the blood.
01:12:24.000 --> 01:12:32.159
But what is very uh, you know, you were talking about proteomic and with 90% confidence.
01:12:32.159 --> 01:12:47.359
In these other diseases like Alzheimer and Parkinson, where you have two other proteins that have similar behavior to IMUD, so they they have disordered in the form of this bubble and thing.
01:12:47.359 --> 01:12:53.600
They are right now antibody, they are administered in vivo in patient.
01:12:53.600 --> 01:13:00.319
They block the this process of polymerization, they stop the change like you stop the domino.
01:13:00.319 --> 01:13:01.600
They are working.
01:13:01.600 --> 01:13:18.880
Yeah, oh my four drugs from Eli Lilly, you know, they are currently test when you take the plasma of those patients and you trying to reproduce the bubble formation, you can do that in vitro.
01:13:18.880 --> 01:13:25.359
That test is diagnostic with the power of 95% accuracy.
01:13:25.680 --> 01:13:37.439
Wow, that's huge strides in understanding the uh ideology of some of the symptoms and um and the treatment.
01:13:38.000 --> 01:13:42.800
Yeah, yeah, so it's a good sign for immune psychiatry in that sense.
01:13:42.800 --> 01:13:48.800
Because then this neurodegenerative disorder, they've been treated in the periphery.
01:13:48.800 --> 01:13:52.720
Peripherically, in blood, not in the brain.
01:13:52.720 --> 01:13:55.600
You know, the antibody are in blood.
01:13:55.600 --> 01:14:02.399
When you administer IVIG, they stay the majority of it in blood, and that's how they work.
01:14:02.399 --> 01:14:07.520
So they clearly block something that is circulating in the body.
01:14:07.520 --> 01:14:11.439
Antibody cannot go into the brain that easily.
01:14:11.680 --> 01:14:12.000
Okay.
01:14:12.239 --> 01:14:14.079
But it stays in the blood forever.
01:14:14.079 --> 01:14:20.479
The key aspect, I think, is that you have this sensor molecule in the body, right?
01:14:20.479 --> 01:14:23.119
And you have a certain level, you have a healthy level.
01:14:23.119 --> 01:14:26.159
Then something goes wrong, an infection.
01:14:26.159 --> 01:14:38.319
You overcharge the system, and that overcharge causes this sort of chain reaction that then goes to your brain and does something.
01:14:38.720 --> 01:14:39.439
Interesting.
01:14:39.680 --> 01:14:42.720
So again, it's a very homeostatic system, right?
01:14:42.720 --> 01:14:56.560
It's a very sort of uh plastic, movable things that you see also in OCD, you know, and you know, definition of pans and pandas is wax and waning.
01:14:56.880 --> 01:15:07.119
Is the presence of the eye mood and the the clusters of that is do you feel that that's related to flares that have come on?
01:15:07.119 --> 01:15:14.159
And flares that and and not present or not as present when the flares remit.
01:15:14.159 --> 01:15:15.199
Yeah.
01:15:16.000 --> 01:15:21.439
Yeah, I think when you see the symptoms, all the iMod, the gunked IMOT is in the brain.
01:15:21.439 --> 01:15:25.279
Then when the symptom goes down, it's going back into circulation.
01:15:25.279 --> 01:15:29.680
Because the trigger is gone.
01:15:29.680 --> 01:15:34.560
For some other people, you might stay there forever and therefore the symptoms never go.
01:15:36.239 --> 01:15:45.119
So in the limited sample that you had of brain tissue, you were able to see the eye mood evidence of that.
01:15:45.600 --> 01:15:50.399
Yeah, which you know, I I I kept saying to you, you know, when I did the first data.
01:15:50.399 --> 01:16:04.880
So Susan, I need to show you slightly dumb up and down, but you can get time and things and uh uh power, uh power, I must admit, you know, uh is slowing me down.
01:16:04.880 --> 01:16:07.840
But uh, you know, I'm definitely getting there.
01:16:08.000 --> 01:16:10.960
So wow, that gives us a lot to think about.
01:16:10.960 --> 01:16:20.640
We um well, I encourage you to request more tissue from the brain bank to further understand that.
01:16:20.640 --> 01:16:22.640
That's really amazing.
01:16:22.640 --> 01:16:24.800
Maybe that should have been our headline.
01:16:25.439 --> 01:16:31.359
Um but also, you know, just let's forget about emos for a moment.
01:16:31.359 --> 01:16:38.319
Let's, you know, look really at the idea that antibiotic works, IBA works.
01:16:38.319 --> 01:16:41.199
So these are all things that are peripheral.
01:16:41.199 --> 01:16:45.600
When I say peripheral, I mean blood, not in the brain necessarily.
01:16:45.600 --> 01:16:49.039
Plasmapheresis work.
01:16:49.039 --> 01:16:52.159
So clearly, and then that's the other thing.
01:16:52.159 --> 01:16:59.119
I went with fantastic meeting organized by Andre Laguliari Messine about pants and pandas, everyone was there.
01:16:59.119 --> 01:17:03.279
And then it turns out that many people do plasmapheresis.
01:17:03.279 --> 01:17:04.159
And guess what?
01:17:04.159 --> 01:17:06.319
Where is this plasma going?
01:17:06.319 --> 01:17:09.119
Thrown away.
01:17:09.119 --> 01:17:14.960
Why we haven't got the bio bunk for the plasma or the plasmapheresis?
01:17:15.760 --> 01:17:19.279
Wow, well, why now I'm gonna be asking that question.
01:17:19.279 --> 01:17:22.319
Why is that just such an oversight?
01:17:22.319 --> 01:17:32.000
Um all right, and I think I um had better ask you my last question.
01:17:32.000 --> 01:17:38.000
And it's going back to something that we talked about at the very beginning.
01:17:38.000 --> 01:18:00.079
Just this idea of not only learning more of them, just generally speaking, what makes you similar to promised or feeling as if there isn't a purpose for you versus what makes you feel good and um have a purpose and meaning in life.
01:18:00.079 --> 01:18:05.840
And I just want to say, and maybe you can just comment on the minute.
01:18:05.840 --> 01:18:19.439
I told you the minute when I went in Alice's apartment just in a few years before she didn't mind that she had those books on her nightstand of finding purpose, finding meaning.
01:18:19.439 --> 01:18:28.960
There was another one she had afraid to tell you whom I am because if I tell you whom you might not like me.
01:18:28.960 --> 01:18:43.760
So within when I tell you that in one of my conversations with analytics, you probably know that she initially had a fairly mild case and then was highly functioning.
01:18:43.760 --> 01:19:05.039
Um finished Princeton when I went to work in towns on Wall Street and one of her managers that I still speak with who she worked for Morgan's family, said that she remains the best analyst that he's ever worked with.
01:19:05.039 --> 01:19:07.119
So she was functioning very well.
01:19:07.119 --> 01:19:20.239
But she said to me one day on the phone, and I don't remember what prompted it, but she said, you know, Mom, I'm not the same person that I was at 12 South Street.
01:19:20.239 --> 01:19:24.319
12 South Street is where we live and where she grew up.
01:19:24.319 --> 01:19:42.640
And I talked to a neurologist about them, and he said that when someone makes a statement like that, then it really reinforces his belief that the person has a neurological disorder.
01:19:42.640 --> 01:19:50.159
And so I have that in mind, and then I have in mind the patients who do get better.
01:19:50.159 --> 01:19:59.760
And I'm picturing one young woman in my mind right now who'd not been well for a little while, and she went the psychiatric route to begin with, and then finally when she was.
01:19:59.760 --> 01:20:06.319
Was treated for the infection-associated neuroimmune disorder that she had.
01:20:06.319 --> 01:20:08.479
She got amazingly better.
01:20:08.479 --> 01:20:10.880
She's doing remarkably well.
01:20:10.880 --> 01:20:16.640
And I venture to say that she feels more herself.
01:20:16.640 --> 01:20:31.359
She's told her parents that she feels more herself and that she's beginning to reclaim some of her confidence that she had before and her sense of self.
01:20:31.359 --> 01:20:43.920
I guess when I read that you were very interested in that idea of what makes us feel happy and having a purpose and what have you, that that needs more study.
01:20:43.920 --> 01:20:53.199
And I look at what my daughter said and what this young person who's on the other side said, I do think that's really important work.
01:20:53.199 --> 01:21:06.159
Like what happened to her, aside from the obvious fact that she's is not suffering from these symptoms, but I think it goes beyond just not suffering from the symptoms.
01:21:06.159 --> 01:21:09.520
What do you have any thoughts on that?
01:21:10.000 --> 01:21:22.000
So these are again, uh these are very, very, very strong beliefs that I have and which I never share, but you know, I feel so connected with you on that.
01:21:22.000 --> 01:21:32.079
And if I were to write a book about the last hundred years, I think uh this is the century of the disease of belonging.
01:21:32.079 --> 01:21:41.279
The core of everything that we are having health-wise is a crisis of belonging.
01:21:41.279 --> 01:21:46.079
And you know, to try and do in my little word something about it.
01:21:46.079 --> 01:21:49.760
There is a colleague of mine, a psychotherapist, Emanuele Roberti.
01:21:49.760 --> 01:21:52.479
We wanted to launch something called salotto.
01:21:52.479 --> 01:22:00.720
Salotto is you know in Italian means you know, living room, or you know, is where the Italians used to entertain you know artists and poets.
01:22:00.720 --> 01:22:12.960
And uh in Italian we say when you say sta facendo salotto, she's doing salotto, it means that you're having a chat with like-minded people, you know, you're having a stimulating conversation.
01:22:12.960 --> 01:22:20.880
So we decided to do that, to the salotto podcast or something, and then they said, Well, that was the first thing that we want to explore.
01:22:20.880 --> 01:22:24.000
I say, No, let's go for belonging, belonging is very important to me.
01:22:24.000 --> 01:22:25.920
Search in social media.
01:22:25.920 --> 01:22:28.319
People are trying to belong to someone else.
01:22:28.319 --> 01:22:31.439
Loneliness crisis.
01:22:31.439 --> 01:22:53.119
I'm not the same person that you met, is the lack of space or reality to belong to another group of people because we are all scattered.
01:22:53.119 --> 01:23:07.359
So before there was an enforced belonging before social media, so to speak, or you you kind of worked with what you had and you make an effort, and probably it was similar.
01:23:07.359 --> 01:23:21.520
Now we are so scattered that it's very difficult to belong to someone and then to to a group of people to just be something, or just be yourself.
01:23:21.520 --> 01:23:40.479
And uh, when we there was Manuela's son, and uh we made some interviews uh with uh scientific people and psychological people, you know, expert in those fields, and then we asked Manuela's son and said, you know, what's belonging to you?
01:23:40.479 --> 01:23:43.359
And uh he's 12 years old.
01:23:43.359 --> 01:23:48.000
He said, You are mine, you belong to me.
01:23:48.000 --> 01:23:55.680
And that caught us by surprise because you know, we thought, you know, football team or something.
01:23:55.680 --> 01:24:09.039
So that is another key point, you know, the son and the mother, the son and the parents, it's a model of belonging, it's the initial exposure to belonging.
01:24:09.039 --> 01:24:30.960
And then if that is not followed up by an equal model where you leave the home and then you have an equally accepting or not uh environment, then there is a crisis and you don't know who you are, and you start to question who you really are.
01:24:30.960 --> 01:24:33.039
You know, I'm not the same as anymore.
01:24:33.039 --> 01:24:38.880
I haven't got you know, it's like going back to the water example, it's a water without container.
01:24:38.880 --> 01:24:42.479
And the container is made by belonging to something.
01:24:42.479 --> 01:24:57.199
Look at Netflix, you know, Netflix series, you know, the record, world record, you know, there are the people they uh challenge themselves in eating uh the hottest chili, the one they have competition for the hair.
01:24:57.199 --> 01:25:03.039
That is another evidence of well, actually I want to belong somewhere.
01:25:03.039 --> 01:25:07.439
And then you find an excuse to connect.
01:25:07.439 --> 01:25:11.279
And that's the problem.
01:25:11.279 --> 01:25:13.520
That is the problem.
01:25:13.520 --> 01:25:30.640
So if we fix belonging, I'm quite confident that many and fair enough, you know, if you isolate yourself and you stay by yourself and then kind of thing, uh uh immunologically you become weaker.
01:25:30.640 --> 01:25:38.960
The hygiene hypothesis, you know, don't touch that, don't clean everything.
01:25:38.960 --> 01:25:41.600
So being clean is equal, you're a good person.
01:25:41.600 --> 01:25:50.159
You belong to the environment, those bacteria are not there to kill you, they belong to your life.
01:25:50.159 --> 01:25:53.199
You got 20 kilos of bacteria in your guts.
01:25:53.199 --> 01:26:05.840
So at the bottom of it is really a societal issue that just gets manifested in such a powerful and damaging way.
01:26:07.920 --> 01:26:09.920
So a couple things.
01:26:09.920 --> 01:26:16.640
One, as I mentioned at the beginning, I've been a long time fan of uh Carl Rogers.
01:26:16.640 --> 01:26:23.520
So we made a concerted effort to raise Alex with those qualities in her environment.
01:26:23.520 --> 01:26:32.000
And she did have a very good sense of self, a very healthy view of herself.
01:26:32.000 --> 01:26:48.800
And I wonder what there is beyond some of the things that you just talked about where you end up isolating yourself because of the condition, or because you believe there's some stigma attached to it, or what have you.
01:26:48.800 --> 01:26:59.199
What is it about this condition and and other ones that test your empathy?
01:26:59.199 --> 01:27:09.840
I felt she began to lose her ability to empathize at times, and she didn't have as much unconditional positive regard for other people.
01:27:09.840 --> 01:27:15.359
So I think uh I mean, I'd love to see that investigated.
01:27:15.359 --> 01:27:29.039
And then the things that you're talking about, at the risk of being political, I'll just say that in this country at this time, there are uh it is the antithesis of Carl Rogers.
01:27:29.039 --> 01:27:36.960
And I I I'm frightened about what that environment will do to young people who are growing up.
01:27:37.920 --> 01:27:45.279
If I want to console myself, I look at the introduction becoming a person of Carl Rogers.
01:27:45.279 --> 01:27:53.039
It was a big challenge for him to find his place in the world of psychology and to have such a revolutionary idea.
01:27:53.039 --> 01:27:57.920
And you know, that was the America of the sky is the limit.
01:27:57.920 --> 01:28:00.239
That was the dreamland.
01:28:00.239 --> 01:28:03.520
But would you compare his time to our time?
01:28:03.520 --> 01:28:04.560
Clearly not.
01:28:05.920 --> 01:28:06.239
Okay.
01:28:06.239 --> 01:28:14.560
Well, I think we have a lot more to talk about, and this is a good way to end our conversation for now.
01:28:14.560 --> 01:28:40.560
We all need to take the time out of our increasingly crazy busy lives to focus on taking care of ourselves, and maybe as you write, you know, get a massage every once in a while, or listen to music that moves us in some way, or art doodling.
01:28:41.840 --> 01:28:44.319
But look at what you and your husband are doing.
01:28:44.319 --> 01:28:47.760
You are giving us a platform to belong.
01:28:47.760 --> 01:28:50.640
Can you see that?
01:28:53.840 --> 01:28:54.479
Thank you.
01:28:55.520 --> 01:28:58.640
You know, what that has done to all of us.
01:28:58.640 --> 01:29:04.560
And look how enthusiastic we are about doing this.
01:29:06.880 --> 01:29:09.840
I guess we all do feel like we're a part of this.
01:29:10.640 --> 01:29:11.840
Yeah, exactly.
01:29:11.840 --> 01:29:21.119
And that that makes you know that even the research lab, you know, it becomes an inspiration, becomes something exciting, something that gives you meaning.
01:29:21.119 --> 01:29:21.520
Yeah.
01:29:21.520 --> 01:29:25.359
Because you know, you don't have the right people to talk about it, you know.
01:29:25.359 --> 01:29:31.199
You can be happy about you and your discovery, but about the people in the journey with you.
01:29:31.199 --> 01:29:35.039
You know, again, America always led.
01:29:35.039 --> 01:29:43.439
Remember when I was in the US for my postdoc, you know, there was an association, I can't remember now, the Anne Fuller.
01:29:43.439 --> 01:29:47.039
I think uh rheumatoid arthritis charity.
01:29:47.039 --> 01:30:00.800
Once you get the fellowship, the first thing you need to do, you need to go out for a dinner, gala dinner, where you sit in you, and then at the table there are all the donors, you know, all the family of people with the rheumatoid arthritis.
01:30:00.800 --> 01:30:03.279
That is the way to do it.
01:30:03.279 --> 01:30:04.800
That is the way to do it.
01:30:04.800 --> 01:30:08.560
You know, from very early on, I was just 26 or something.
01:30:08.560 --> 01:30:15.439
You know, that's where you need to understand that those plastic tubes that you do in the lab, they mean something.
01:30:15.439 --> 01:30:18.479
They have an impact.
01:30:19.760 --> 01:30:20.079
Absolutely.
01:30:20.319 --> 01:30:20.800
Yeah, of course.
01:30:20.800 --> 01:30:24.000
I mean, I'm not saying the research should be all like this, you know.
01:30:24.000 --> 01:30:36.159
You can also do very basic research just for the fun of the science, but there is an element of meaning and belonging that they should be included in the in the journey, but not probably just in science.
01:30:36.720 --> 01:30:55.520
Well, and maybe the basic researchers need a little more support to meet who it is they're doing this work for that might not be translated right this moment, but when you put it all together, it can be very meaningful.
01:30:55.520 --> 01:31:02.880
And let's hope it doesn't take 17 years to do to go from the the bench to the bed.
01:31:02.880 --> 01:31:05.439
All right, Fulvio, thank you so much.
01:31:05.439 --> 01:31:07.520
What an interesting conversation.
01:31:07.520 --> 01:31:12.560
And I look forward to to more of them, but thank you very much.
01:31:13.680 --> 01:31:19.760
And thank you, Susan, and you know, your family to allow me to be part of the family.
01:31:20.239 --> 01:31:20.880
Absolutely.
01:31:20.880 --> 01:31:23.520
We'll have to come to the table together.
01:31:23.520 --> 01:31:25.359
All right, thank you, Fulvio.
01:31:25.359 --> 01:31:25.920
Bye.
01:31:26.399 --> 01:31:28.239
All right, bye-bye, bye.
01:31:29.680 --> 01:31:35.279
This concludes episode 21 of Untangling Pandas and Pans.
01:31:35.279 --> 01:31:37.600
Thank you for listening.
01:31:37.600 --> 01:31:53.279
For more information about pandas and pans and the Alex Manful Fund, please visit the AlexManfulfund.org.
01:31:53.279 --> 01:32:06.319
The content in this podcast is not a substitute for professional medical advice, diagnosis, or treatment.
01:32:06.319 --> 01:32:13.760
Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.