Medicine and Evolution
Understanding of psychiatric pathology from an evolutionary perspective. Inheritance and environment interaction
Physicians, biologists and clinical psychologists attended the VIII Conference on Evolutionary Medicine on 28/11/2017. This day was characterized by being very specific on this occasion since it was concerned with the understanding of psychiatric pathology by looking at adaptation and environment.
It started with a presentation by Maria José Trujillo-Tiebas who tried to contextualize the theme to be treated evolutionarily. She spoke of biological mechanisms that underlie behavior, both genetic (hereditary) and epigenetic aspects (mechanisms modulated by the environment that can also be transmitted to descendants) and current studies in highly analyzed pathologies such as schizophrenia and the most recent ones about Borderline Personality Disorder (BPD). She explained concepts such as heritability and twin studies that are carried out. She presented many examples of endophenotypes, behavioral traits, curiosities and proposed an established relationship with the immune system. She left us many questions to reflect on our current way of life and the expression of these pathologies in the vital context that we have had to live.
Elena Guerrero explained what the BPD is, how it manifests itself, how heterogeneous and unknown it is and how it is treated from the psychological point of view. Likewise, she highlighted that signs of co-morbidity such as addictions and the clear association with traumatic events in childhood and attachment problems usually appear. She showed us illustrative videos that helped to understand the disease, considered as serious from the psychiatric point of view.
Antonio Gil Mingoarranz told us about the similarities and differences of the BPD with Bipolar Disorder, emphasizing that they are not the same although they can come together and that people usually confuse the symptoms. Bipolar disorder has a greater genetic component than BPD that seems to have a more environmental component.
Fernando Sánchez gave us the keys to understanding BPD explaining the theoretical approaches from the psychological point of view of this disorder such as 1) the failure in the maturational mechanism of the self that leads to the borderline borderline state (pseudoself, immaturity / weakness of self and distortion of identity) and 2) of the structural dissociation of personality caused by complex trauma due to abuse (such as neglect-abandonment, physical violence, or sexual abuse).
Silvia Vallejo gave a presentation on the psychiatric aspects of childhood trauma and suicidal behavior. She spoke about how early adverse experiences in life, can be adaptive for the individual, but when traumatic events are severe and / or sustained over time, alterations in the epigenetic mechanisms occur in the regulation of the expression of the genes causing the risk of developing psychiatric pathology in adult life, such as anxiety, impulsivity, aggressiveness, as well as cognitive alterations. She told us about the most current investigations carried out in Dr. Gustavo Tureki's laboratory where she was trained.
Manuel Faraco Favieres put the finishing touch to the Meeting talking about his specialty, Eating Disorders. His presentation on anorexia nervosa, bulimia and binge eating disorders, more common in women, as well as orthorexia and vigorexia (more common in males). He explained with very novel evolutionary hypotheses. Reproductive suppression, intra-sexual competition and flight from the famine are among the most prominent hypotheses.
Some of these talks are published in our IV Volume in Evolutionary Medicine
Under the title "Commitments and compensations in evolution and disease" on December 1, 2015 took place the VII. Meeting of Evolutionary Medicine at the Universidad Universitaria de la Princesa. In front of an audience of diverse health sciences related professions, which included general practitioners, specialists in different areas, biologists, psychologists, nurses and students seven again multidisciplinary talks were presented. The presentations focused on the biological concept of "trade-off", a principle that describes the inability to invest or improve an advantageous feature without paying a price for it.
AlvaroDaschner, from the Allergy Service of that hospital and together with Maria Jose Trujillo Tiebas and Jose-Luis Gomez Perez coordinators of the MedEvo platform, performed the introduction to the concept of "trade-off" referring to the evidence that even if medicine and public health measures are able to control or eradicate diseases (especially infectious), other ailments, such as chronic inflammatory diseases are on the rise especially in developed countries.
The following contribution by biologists Juan Carlos Alvarez Ruiz and Angel Perez Menchero, focused in the impossibility of an "optimal design" in evolution, the result of a constantly changing environment and the necessary evolution of the characters.
Juan Moreno Klemming, form the National Museum of Natural Sciences, described the reasons of aging, mainly concluding that aging would be a trait not actively influenced by mechanisms of natural selection.
Maria-Jose Trujillo Tiebas, geneticist at the Fundación Jimenez Diaz gave many examples of hereditary diseases where the frequency of recessive alleles in populations remain because they confer adaptive advantages of heterozygous individuals at the expense of maintaining individuals who suffer lethal diseases. She centered the attention to the fact that the Jewish Ashkenazy population has emerged a 29% of Nobel prize despite being only 0.25% of the world population. Interestingly, this population carries several hereditary diseases with neurological condition, especially affecting sphingolipids deposition involving the major component of myelin protein that covers neuronal axons and allows fast transmission of nerve impulses.
In the second part of the meeting Ana Barabash, from the Laboratorio de Endocrinología of the Hospital Univeristario San Carlos, explained several hypothesis of possible antagonistic pleiotropy at the ApoE4 allele, an important risk factor for Alzheimer's disease and cardiovascular disease, and which could explain the significant prevalence in populations through selective advantages in reproductive age.
The psychiatrist Eduardo Barbudo form the Hospital unive rsitario San Carlos, also showed obesity and hyperactivity disorder (ADHD) in a context of possible inherited advantages at other levels.
Finally Francisco Abad, from the Servicio de Farmacología of the inviting hospital, discussed the methodology of clinical trials to open a debate on the possible improvement of these tool to assess the effects of drugs.
During the discussions, it became clear that the current role of certain biological traits, should be assessed also in different settings, such as in ancestral history of populations or other environments because this could identify their possible origin in order to explain certain symptoms or diseases which are major focus of modern medicine. In addition, it became clear that medical practice attempts to provide solutions to an individual, but evolutionary interpretation takes into account the population level as a whole.
On 20.th January 2015 we organized our VI. Meeting in Evolutionary Medicine:
Personality and behavior. The boundaries between normality and disease. An evolutionary approach
Our VI. thematic meeting on Evolutionary Medicine with the title "Personality and behavior: The boundaries between normality and disease. An evolutionary approach" dealt with neurological and psychiatric diseases of genetic or environmental origin and the significant impact on the quality of life of individuals and their families.
The meeting began with the conference "Neurodegenerative Diseases in the evolutionary debate", given by Victor Volpini, who talked about how these diseases affect individuals in adulthood in post-reproductive periods. He centralized his presentation on ataxias and involved genes and explained the concept of sprandels, which is a term introduced by Stephen Jay Gould and Richard Lewontin in 1979, and employed in evolutionary biology, referring to those features or elements that have not evolved as a result of biological adaptation, but as a result of the emergence of other adaptations through natural selection. He concluded that neurodegenerative diseases are characteristic of longevity, which in earlier times would be infrequent and longevity in men may have started as a sprandel, meiotically inherited by having a possible adaptive value in women.
Juan José Carballo's and Clara Isabel Gomez communication "Is hyperactivity a modern disease?" deepened into the epidemiology, aetiology and heritability of hiperactivity, as well as the adaptive advantages of this entity. Given the high prevalence (5-10%) and extension of ADHD worldwide, it is unlikely that a "disorder" can be so prevalent in the human species if not positively selected.
The 7-DRD4 allele whose gene is the D4 dopamine receptor, the most studied candidate gene in ADHD, has been described as the positively selected allelic form. The presence of this allele has been associated with the personality trait of novelty seeking, and his presence confers a genetic risk between 25-50% of developing ADHD. Individuals with these features in a sedentary population becomes marginal, whereas in nomadic populations individuals are successful. It has been found that there is a positive correlation if we look at the current geographical distribution of allele DRD4-7R, which is low in the more stable populations and Asia, but high in populations with high migration influence as in America.
Antonio José Cabranes in his speech "Obesity? Biology, nutrients and emotions" reviewed how the biological system attempts to maintain weight and how specific genetic and environmental factors may influence it. He spoke of the heritability of obesity and involved genes and how stress early in life can influence the development of the HPA (hypothalamic-pituitary-adrenal) axis and also the the regulation of hormones related hunger / satiety and alter behavior of intake on the long term. In his reflections we noted the existence of a "critical" link between stressors and obesity induced by ingestion. So he exhibited e.g. excessive intake of "palatable" foods in an environment of reward when there is no possibility for the typical reaction of "fight or flight" to a danger stimulus.
After the break Pedro García Ruiz-Tang intervened with a lecture entitled "Mor-phologicl evolutionary brain changes and movement disorders. What have we achieved and at what price? ". He explored the changes of the human brain in the last thousands years and how these changes may be related to movement disorders, such as deficits in neurotransmitter (Parkinson) or by excess (dystonia). Many of these disorders are only human and related to the specific evolutionary development, such as Parkinson's disease, with a high prevalence (1% in those over 70 years) or the cultural environment such as in dystonias. Parkinson's disease, in which there is a deficiency of the neurotransmitter dopamine, may be related to the substantia nigra, which did not raise enough in size, but has evolved innervation to other areas to a much greater degree. The distonías are characterized by muscle contractions in abnormal postures. A highly repetitive action can lead to occupational dystonia. It is estimated that one in ten musicians develop occupational dystonia that prevents them to continue their profession.
In the next lecture Estrella Gomez Tortosa with her communication "Clinical and genetic correlations in degenerative dementias" defined the concept of dementia as a global and acquired decline of intellectual faculties, and also indicated that between 30 and 50% of the degenerative dementias, such as Alzheimer's disease, have a hereditary character with a bout twenty known genes whose alterations have been associated with different phenotypes of dementia. Again, human longevity appears as a risk factor for the occurrence of such diseases.
Finally Enrique Baca García with a presentation entitled "Mood Disorders. Evolutionary advantages vs. disadvantages " talked about depression (which can be a claim of care from other people to the depressed individual) and costs (10% of lost work hours for depression), on anxiety and its possible adaptive value, as well as certain types of seasonal depressions that in past periods could have been advantageous for the population as it lowered the activity level of the individual in periods of shortage.
During the debates the assistants to the meeting discussed that evolutionary medicine could be a possible way to establish new lines of research and that certain diseases could be mismatches to the current environment. Cephalization (one of the distinctive evolutionary traits of the human species) along with longevity (which allows efficient transmission of culture, also characteristic of the genus Homo sapiens) pay somehow the success they have assumed in our species. Some clinical examples emerged and opened the discussion of the possible practical applicability of the proposed ideas in the different presentations, such as the positive effect of preventive measures of some neurodegenerative diseases through exercise or adequate nutrition.
In the year 2014 we organized our V. Season of Seminars in Evolutionary Medicine
and have now edited our second volume of
Medicina Evolucionista: Aportaciones pluridisciplinares
(Evolutionary medicine: pluri-disciplinary contributions)
On 3rd of December 2013, the V. Conference meeting on Evolutionary Medicine was held in Madrid (Spanish):
Challenging Evolutionary Medicine: Adaptation levels and disease
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On 4th of December 2012, the IV. Conference meeting on Evolutionary Medicine was organized with the title “Disease and biological fitness”. Like in previous years the multidisciplinar team, formed by allergist Alvaro Daschner from the University Hospital La Princesa, anthropologist José-Luis Gómez Pérez and geneticist Maria-José Trujillo Tiebas from Fundación Jiménez Díaz in Madrid, invited speakers of different disciplines to speak about the interplay between genetic variation, epigenetics, the immune system and the environment, searching for answers for the appearance of disease from an evolutionary point of view. For more information and abstract viewing (in Spanish) clic on MORE
On november 29, 2011 our III. Meeting on Evolutionary Medicine had the title "Infections as motor of evolution". Speakers came from a broad spectrum of disciplines, where in the first part general aspects were approached on the topic of infections, their history and evolution. In the second part practical examples were offered, applying evolution theory in medicine with a special emphasis on infections. Speakers from the fields of microbiology, immunology, veterinary science and parasitology showed the usefulness of a multidisciplinary approach in this field. In spite of the more monographic topic of this meeting edition, the attending audience was even greater than in previous editions.
Second Meeting on Evolutionary Medicine 2010:
From Paleopathology to evolutionary aspects of Medicine
Summary from the 2009 Meeting:
The opening scientific meeting on Evolutionary Medicine with the title: "Application in Allergy and Immunology" on 2. december 2009 at the University Hospital La Princesa in Madrid has been welcomed wih a net interest. 120 professionals of Biology and Medicine of different specialities came to listen to 8 speakers, who have explained their scientific work and the evolutionary context of various aspects:
José Enrique Campillo Álvarez, author of "El mono obeso" spoke of the metabolic syndrome and its relationship with the thrifty genotype. José Luis Gómez Pérez worked out basic concepts of evolutionary mechanisms. Labib Drak spoke about the evolution of the genus homo and about some findings in paleopathology. Maria-José Trujillo Tiebas gave several examples of genetic disease, which could have evolved by heterocygote advantage.
During the second part of the meeting Silvia Sánchez-Ramón spoke about the evolutionary perspective of the immunologic recognition and the task of the adaptive immunity as an answer to the advantages of microorganims when adapting to new environments. Alvaro Daschner explained the existing hypotheses with respect to allergic disorders and especially the revised hygiene hypothesis in a world without worms. He added his own view on the possible advantage of the acute allergic reaction (urticaria, anaphylaxis) in the context of the acute parasitism by Anisakis simplex (Gastro-allergic Anisakiasis). Carmen Cuéllar del Hoyo spoke about co-evolution of parasites and the human being and explained a whole battery of evasion mechanims by parasites. The final talk was performed by Teresa Alarcón Cavero, who explained in very comprehensible terms the evolutionary aspects of the actual swine flu virus H1N1.
Both debates have been rather enriching due to the best teaching faculty of all speakers who were able to induce the interest and curiosity of the audience.
One of the aims of this meeting was to investigate the possibility of interest for future meetings of this kind. This aim has been achievd not only due to the high number of professionals coming to the meeting, but also by the patent interest during the debates. Thus we will search for future topics and speakers in Evolutionary Medicine.
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Alvaro Daschner