PANS and PANDAS: Mechanisms, Biomarkers, and Integrated Therapeutic Strategies

Pediatric acute-onset neuropsychiatric syndromes (such as PANS and PANDAS) represent a complex interplay of neuro and behavioural immunological, metabolic, genetic, microbiotal, nutritional, factors. These conditions illustrate how inflammatory triggers, including infections, psychosocial stress, and other immune-activating events, together with immune dysregulation, metabolic and mitochondrial dysfunction, and behavioral influences converge to produce sudden-onset neuropsychiatric symptoms in predisposed pediatric individuals. Although interest in these disorders is increasing, research remains fragmented and is often limited to individual disciplines or single treatment approaches.This Research Topic aims to create a comprehensive and multidisciplinary collection of articles integrating basic science, clinical research, and translational perspectives. The goal is to establish a multisystem paradigm for understanding acute-onset pediatric neuropsychiatric syndromes, emphasizing not only underlying mechanisms but also clinical interpretation, predictive biomarkers, and integrated therapeutic strategies. By framing PANS/PANDAS as a paradigmatic model rather than a limiting focus, this Research Topic aims to provide an integrated scientific framework that unites researchers and clinicians across disciplines. It also aims to move beyond reductionist or polarized narratives by encouraging critical appraisal of competing hypotheses, promoting interdisciplinary integration, addressing reproducibility and methodological rigor, clarifying therapeutic evidence levels, and identifying gaps that require high-quality prospective research. Contributions will emphasize the connection between biological mechanisms, clinical interpretation, and therapeutic decision-making, while highlighting areas of both consensus and controversy, particularly regarding antibiotic interventions. In this way, the collection is intended to serve as a reference framework for clinicians and researchers worldwide, supporting both clinical practice and future research innovation.We welcome contributions in the form of any article type accepted by the journal in the following domains:· Neuroimmune mechanisms of post-infectious and autoimmune processes, including biomarkers and mechanistic studies · Genetic and epigenetic susceptibility influencing individual responses to triggers· Gut microbiota and nutritional modulation in symptom control and immune resilience· Gut microbiota composition, host epigenetic changes and antibiotic treatment· Identification of previously unknown bacterial or viral triggers through metagenomics· Metabolic and mitochondrial pathways as mediators of cerebral vulnerability and systemic stress· Clinical presentation and diagnostic frameworks, including assessment tools and differential diagnosis· Behavioral and psychological interactions influencing disease progression, resilience, and response to interventions· Integrated therapeutic strategies, encompassing immunomodulation, targeted antibiotic therapy, nutrition, behavioral interventions, and multi-disciplinary management· Future directions and translational research, including identification of predictive biomarkers, precision medicine approaches, and novel clinical trial designs Topic editors: Alberto Spalice, Cristiana Alessia Guido, Claudia Brogna, Mariarosaria Matera, Cristiana Alessia Guido Source: https://www.frontiersin.org/research-topics/79492/pans-and-pandas-mechanisms-biomarkers-and-integrated-therapeutic-strategies