Increased microglial synapse elimination in patient-specific models of schizophrenia

Schizophrenia patients display decreased synaptic density in postmortem studies, suggesting aberrant microglial synapse elimination during neurodevelopment. Here, we use cellular reprogramming to create patient-specific in vitro models of microglia-mediated synapse engulfment that demonstrate increased synapse elimination in schizophrenia-derived models compared to healthy controls. We show that excessive synaptic pruning in schizophrenia reflects abnormalities in microglia-like cells as well as synaptic structures. Further, we find that schizophrenia risk-associated variants within the complement component 4 locus contribute to the increased uptake in schizophrenia models. Finally, we demonstrate that the antibiotic minocycline reduces microglia-mediated synapse uptake and show that minocycline treatment for acne is associated with a reduction in incident schizophrenia risk compared to other treatments in a cohort of more than 9,000 young adults drawn from health records. Specific pharmacological interventions targeting excessive pruning merit further study for their capacity to delay or prevent the onset of schizophrenia in high-risk individuals.