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Eroshchenko NN, Veselov VV, Pirogov AV, Danilova EY, Kirushin AN, Paravyan AL, Cravotto G. Development and validation of a HPLC-MS/MS method for the analysis of fatty acids - in the form of FAME ammonium adducts - in human whole blood and erythrocytes to determine omega-3 index. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1227:123799. [PMID: 37379757 DOI: 10.1016/j.jchromb.2023.123799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
Recent scientific studies in the field of health and nutrition have unanimously affirmed the importance of consuming the omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), because of their cardioprotective properties. Fatty acid profiling in erythrocyte membranes allows the omega-3 index, which is a recognized indicator of the risk of developing cardiovascular disease, to be calculated. One consequence of the upward trend in healthy lifestyles and longevity is an increase in the number of studies into the omega-3 index, which requires a reliable method for the quantitative analysis of fatty acids. This article describes the development and validation of a sensitive and reproducible liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method for the quantitative analysis of 23 fatty acids (in the form of fatty acid methyl esters, FAMEs) in 40 µl of whole blood and erythrocytes. The list of acids includes saturated, omega-9 unsaturated, omega-6 unsaturated and omega-3 unsaturated fatty acids as well as their trans-isomers. The limit of quantitation was 250 ng ml-1 for C12:0, C16:0 and C18:0; and 62.5 ng ml-1 for other FAMEs, including EPA, DHA and trans-isomers of FAME C16:1, C18:1 and C18:2 n-6. Sample preparation for fatty acid (FA) esterification/methylation with boron trifluoride-methanol (BF3) has been optimized. Chromatographic separation has been carried out on a C8 column in gradient mode using a mixture of acetonitrile, isopropanol and water with the addition of 0.1% formic acid and 5 mM ammonium formate. As a result, the problem of separating the cis- and trans-isomers of FAME C16:1, C18:1 and C18:2 n-6 has been solved. The electrospray ionization mass spectrometry (ESI-MS) detection of FAMEs, in the form of ammonium adducts, has been optimized for the first time, which has made the method more sensitive that when the protonated species are used. This method has been applied to 12 samples from healthy subjects that consumed omega-3 supplements and has proven to be a reliable tool for determining the omega-3 index.
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Affiliation(s)
- N N Eroshchenko
- Biomedical Science and Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubetskaya ul, 119991 Moscow, Russia.
| | - V V Veselov
- Biomedical Science and Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubetskaya ul, 119991 Moscow, Russia
| | - A V Pirogov
- Chemistry Department, M.V. Lomonosov Moscow State University, Lenih Hills, d. 1, str. 3., 119991 Moscow, Russia
| | - E Y Danilova
- Chemistry Department, M.V. Lomonosov Moscow State University, Lenih Hills, d. 1, str. 3., 119991 Moscow, Russia
| | - A N Kirushin
- Biomedical Science and Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubetskaya ul, 119991 Moscow, Russia
| | - A L Paravyan
- Biomedical Science and Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubetskaya ul, 119991 Moscow, Russia
| | - G Cravotto
- Department of Drug Science and Technology, University of Turin, Via P. Giuria 9, 10125 Turin, Italy
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Frajerman A, Chaumette B, Farabos D, Despres G, Simonard C, Lamazière A, Krebs MO, Kebir O. Membrane Lipids in Ultra-High-Risk Patients: Potential Predictive Biomarkers of Conversion to Psychosis. Nutrients 2023; 15:2215. [PMID: 37432345 DOI: 10.3390/nu15092215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023] Open
Abstract
Alterations in membrane lipids are reported in schizophrenia. However, no conclusion can be drawn regarding the extended and predictive value of these alterations in persons at ultra-high risk of psychosis (UHR). Recent studies suggested that sterols' impact on psychiatric disorders was underestimated. Here, we simultaneously explored sterols, fatty acids (FA), and phospholipids (PL) in UHR persons for the first time. We analysed erythrocyte membrane lipids in 61 UHR persons, including 29 who later converted to psychosis (UHR-C) and 32 who did not (UHC-NC). We used gas chromatography for FA and liquid chromatography tandem with mass spectrometry for sterols and phospholipids. Among UHR individuals, elevated baseline membrane linoleic acid level was associated with conversion to psychosis (26.1% vs. 60.5%, p = 0.02). Combining sterols, FA, and PL membrane composition improved the prediction of psychosis onset (AUC = 0.73). This is the first report showing that membrane sterol participates, with other membrane lipids, in modulating the risk of psychosis. It suggests that membrane lipids could be used as biomarkers for personalised medicine in UHR patients.
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Affiliation(s)
- Ariel Frajerman
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
| | - Boris Chaumette
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
- Department of Psychiatry, McGill University, Montréal, QC H3A 0G4, Canada
| | - Dominique Farabos
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Gaétan Despres
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Christelle Simonard
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Antonin Lamazière
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Marie-Odile Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
| | - Oussama Kebir
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
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Rosqvist F, Fridén M, Vessby J, Rorsman F, Lind L, Risérus U. Circulating fatty acids from high-throughput metabolomics platforms as potential biomarkers of dietary fatty acids. Clin Nutr 2022; 41:2637-2643. [PMID: 36308982 DOI: 10.1016/j.clnu.2022.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Some fatty acids, i.e. n-3 and n-6 polyunsaturated fatty acids (PUFA), from metabolomics platforms based on nuclear magnetic resonance imaging (NMR) or liquid chromatography mass-spectrometry (LC-MS) are suggested to reflect dietary exposure. NMR and LC-MS are both relatively fast and cheap, however few studies have investigated their validity. Linoleic acid (LA) and docosahexaenoic acid (DHA), measured using gas chromatography (GC), are established biomarkers of dietary n-6 and n-3 PUFA intake, respectively. OBJECTIVE To examine if circulating fatty acids derived from two commonly applied metabolomics platforms (using NMR and LC-MS) provide similar information compared to GC in two pooled population-based cohorts, one patient cohort, and in a randomized controlled trial (RCT). METHODS Spearman rank correlations were conducted between LA and DHA in cholesteryl esters (CE) from GC and whole serum/plasma LA and DHA from the metabolomics platforms in a pooled population-based cohort of men and women (n ˜ 1100) (primary analysis). Secondary correlation analyses included fatty acid classes such as n-3 PUFA, n-6 PUFA, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA) and total PUFA. Additionally, correlations were investigated for LA, DHA and the five fatty acid classes in phospholipids (PL), triacylglycerols (TAG) and non-esterified fatty acids (NEFA) in a RCT of n = 60 as well as in a population with biopsy-verified non-alcoholic fatty liver disease (NAFLD) (n = 59). Misclassification was examined using cross-tabulation and visualized using alluvial plots. RESULTS Moderate to strong correlations (r = 0.51-0.81) were observed for LA and DHA in multiple lipid fractions in all cohorts using the NMR platform. For the pooled cohort, LA (r = 0.67, P < 0.0001) and DHA (r = 0.68, P < 0.0001) assessed in CE were strongly correlated with LA and DHA derived using NMR. Nearly half (49%) were correctly classified into their respective quartiles. Using LC-MS, only DHA (r = 0.44, P < 0.0001) demonstrated moderate correlations with DHA from GC. CONCLUSIONS Unless fatty acid data from GC analysis is available or feasible, NMR-based technology might be a better option than a LC-MS-based platform, at least for certain PUFA. This should be taken into account in future studies aiming to use circulating fatty acids as dietary biomarkers for the investigation of diet-disease relationships.
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Affiliation(s)
- Fredrik Rosqvist
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
| | - Michael Fridén
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Johan Vessby
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
| | - Fredrik Rorsman
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
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Susai SR, Mongan D, Healy C, Cannon M, Cagney G, Wynne K, Byrne JF, Markulev C, Schäfer MR, Berger M, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger GE, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Street R, Thompson A, Ruth Yung A, Nelson B, McGorry PD, Föcking M, Paul Amminger G, Cotter D. Machine learning based prediction and the influence of complement - Coagulation pathway proteins on clinical outcome: Results from the NEURAPRO trial. Brain Behav Immun 2022; 103:50-60. [PMID: 35341915 DOI: 10.1016/j.bbi.2022.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Functional outcomes are important measures in the overall clinical course of psychosis and individuals at clinical high-risk (CHR), however, prediction of functional outcome remains difficult based on clinical information alone. In the first part of this study, we evaluated whether a combination of biological and clinical variables could predict future functional outcome in CHR individuals. The complement and coagulation pathways have previously been identified as being of relevance to the pathophysiology of psychosis and have been found to contribute to the prediction of clinical outcome in CHR participants. Hence, in the second part we extended the analysis to evaluate specifically the relationship of complement and coagulation proteins with psychotic symptoms and functional outcome in CHR. MATERIALS AND METHODS We carried out plasma proteomics and measured plasma cytokine levels, and erythrocyte membrane fatty acid levels in a sub-sample (n = 158) from the NEURAPRO clinical trial at baseline and 6 months follow up. Functional outcome was measured using Social and Occupational Functional assessment Score (SOFAS) scale. Firstly, we used support vector machine learning techniques to develop predictive models for functional outcome at 12 months. Secondly, we developed linear regression models to understand the association between 6-month follow-up levels of complement and coagulation proteins with 6-month follow-up measures of positive symptoms summary (PSS) scores and functional outcome. RESULTS AND CONCLUSION A prediction model based on clinical and biological data including the plasma proteome, erythrocyte fatty acids and cytokines, poorly predicted functional outcome at 12 months follow-up in CHR participants. In linear regression models, four complement and coagulation proteins (coagulation protein X, Complement C1r subcomponent like protein, Complement C4A & Complement C5) indicated a significant association with functional outcome; and two proteins (coagulation factor IX and complement C5) positively associated with the PSS score. Our study does not provide support for the utility of cytokines, proteomic or fatty acid data for prediction of functional outcomes in individuals at high-risk for psychosis. However, the association of complement protein levels with clinical outcome suggests a role for the complement system and the activity of its related pathway in the functional impairment and positive symptom severity of CHR patients.
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Affiliation(s)
- Subash Raj Susai
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - David Mongan
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Colm Healy
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Gerard Cagney
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Kieran Wynne
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland; Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - Jonah F Byrne
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Connie Markulev
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Miriam R Schäfer
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Maximus Berger
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Monika Schlögelhofer
- BioPsyC-Biopsychosocial Corporation - Non-Profit Association for Research Funding, Vienna, Austria
| | - Stefan Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregor E Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zürich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Denmark
| | | | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore
| | - Rebekah Street
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Andrew Thompson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Alison Ruth Yung
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia; School of Health Sciences, University of Manchester, UK
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Melanie Föcking
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - G Paul Amminger
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - David Cotter
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Liu G, Makrides M, Coates P, Lam K, Ranieri E, Mas E, Gibson RA. A rapid method for the screening of fatty acids in lipids in plasma or serum without prior extraction. Prostaglandins Leukot Essent Fatty Acids 2022; 178:102416. [PMID: 35325692 DOI: 10.1016/j.plefa.2022.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/20/2022]
Abstract
Serum or plasma are the commonly used blood fractions to determine the relationship between dietary and circulating fatty acids in health and disease. Most methods available for the measurement of fatty acids in serum or plasma (referred to as serum henceforth) require prior extraction with organic solvents. We have determined that it is possible to directly convert the lipids in aqueous biological samples to fatty acid methyl esters (FAME) without prior extraction, providing that the ratio of serum to transmethylation solvent does not exceed 10%. Our in-vial transmethylation system uses 50uL serum pipetted into 2 mL screw top GC vials containing 1 mL of 1% H2SO4 in methanol at 50 °C and subsequent FAME extracted in the same vial into 300uL heptane. The system yields both compositional and quantitative analysis of the fatty acids of serum identical to conventional standard methods. Evaluation of our new serum assay confirms significant correlations between the fatty acid measures and those obtained from conventional standard assay for all fatty acids (r > 0.99, P<0.0001), including the n-6 (r = 0.998, P<0.0001) and n-3 long chain polyunsaturated fatty acids (r = 0.993, P<0.0001). There were high levels of agreement between methods on Bland -Altman analysis, indicating the interchangeability of the methods. These results establish our new method as reliable for the assessment of fatty acid composition of small volumes of serum useful for high throughput situations that limits the volume of organic solvents and technical input.
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Affiliation(s)
- Ge Liu
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000, Australia; School of Medicine, The University of Adelaide, North Terrace, Adelaide SA 5000, Australia
| | | | - Khoa Lam
- SA Pathology, Frome Rd., Adelaide SA 5000, Australia
| | - Enzo Ranieri
- SA Pathology, Frome Rd., Adelaide SA 5000, Australia
| | - Emilie Mas
- SA Pathology, Frome Rd., Adelaide SA 5000, Australia
| | - Robert A Gibson
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000, Australia; School of Agriculture, Food and Wine, The University of Adelaide, North Terrace, Adelaide SA 5000, Australia.
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6
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Susai SR, Mongan D, Healy C, Cannon M, Nelson B, Markulev C, Schäfer MR, Berger M, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger GE, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, McGorry PD, Föcking M, Cotter D, Amminger GP. The association of plasma inflammatory markers with omega-3 fatty acids and their mediating role in psychotic symptoms and functioning: An analysis of the NEURAPRO clinical trial. Brain Behav Immun 2022; 99:147-156. [PMID: 34624483 DOI: 10.1016/j.bbi.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 12/12/2022] Open
Abstract
There is increasing evidence that dysregulation of polyunsaturated fatty acids (FAs) mediated membrane function plays a role in the pathophysiology of schizophrenia. Even though preclinical findings have supported the anti-inflammatory properties of omega-3 FAs on brain health, their biological roles as anti-inflammatory agents and their therapeutic role on clinical symptoms of psychosis risk are not well understood. In the current study, we investigated the relationship of erythrocyte omega-3 FAs with plasma immune markers in a clinical high risk for psychosis (CHR) sample. In addition, a mediation analysis was performed to examine whether previously reported associations between omega-3 FAs and clinical outcomes were mediated via plasma immune markers. Clinical outcomes for CHR participants in the NEURAPRO clinical trial were measured using the Brief Psychiatric Rating Scale (BPRS), Schedule for the Scale of Assessment of Negative Symptoms (SANS) and Social and Occupational Functioning Assessment Scale (SOFAS) scales. The erythrocyte omega-3 index [eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA)] and plasma concentrations of inflammatory markers were quantified at baseline (n = 268) and 6 month follow-up (n = 146) by gas chromatography and multiplex immunoassay, respectively. In linear regression models, the baseline plasma concentrations of Interleukin (IL)-15, Intercellular adhesion molecule (ICAM)-1 and Vascular cell adhesion molecule (VCAM)-1 were negatively associated with baseline omega-3 index. In addition, 6-month change in IL-12p40 and TNF-α showed a negative association with change in omega-3 index. In longitudinal analyses, the baseline and 6 month change in omega-3 index was negatively associated with VCAM-1 and TNF-α respectively at follow-up. Mediation analyses provided little evidence for mediating effects of plasma immune markers on the relationship between omega-3 FAs and clinical outcomes (psychotic symptoms and functioning) in CHR participants. Our results indicate a predominantly anti-inflammatory relationship of omega-3 FAs on plasma inflammatory status in CHR individuals, but this did not appear to convey clinical benefits at 6 month and 12 month follow-up. Both immune and non-immune biological effects of omega-3 FAs would be resourceful in understanding the clinical benefits of omega-3 FAs in CHR papulation.
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Affiliation(s)
- Subash Raj Susai
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - David Mongan
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Colm Healy
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Connie Markulev
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Miriam R Schäfer
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Maximus Berger
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Monika Schlögelhofer
- BioPsyC-Biopsychosocial Corporation - Non-Profit Association for Research Funding, Austria; Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
| | - Stefan Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregor E Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zürich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Denmark
| | | | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore
| | - Andrew Thompson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Alison Ruth Yung
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia; School of Health Sciences, University of Manchester, UK
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia
| | - Melanie Föcking
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - David Cotter
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - G Paul Amminger
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; Orygen, 35 Poplar Rd, Parkville 3052, Australia; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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7
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Supplementation with the omega-3 long chain polyunsaturated fatty acids: Changes in the concentrations of omega-3 index, fatty acids and molecular phospholipids of people at ultra high risk of developing psychosis. Schizophr Res 2020; 226:52-60. [PMID: 31606244 DOI: 10.1016/j.schres.2019.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 01/03/2023]
Abstract
Omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) are necessary for optimum mental health, with recent studies showing low n-3 LCPUFA in people at ultra-high risk (UHR) of developing psychosis. Furthermore, people at UHR of psychosis had increased erythrocyte sphingomyelin (SM) and reduced phosphatidylethanolamine (PE) concentrations as well as 27 erythrocyte phospholipid species that differed when compared to erythrocytes from age matched people not at UHR of psychosis. The aim of this analysis was to evaluate the effect of n-3 supplementation on the different erythrocyte lipid species (including SM and PE concentrations) in people at UHR of psychosis. Participants were randomly assigned to fish oil (containing 840 mg EPA and 560 mg DHA per day) or placebo (paraffin oil) for 6 months. Fasted blood samples were taken at baseline and post intervention. Mass spectrometry was used to analyse the molecular phospholipids and fatty acid composition of erythrocytes for both groups. The n-3 index was significantly increased from 3.0% to 4.12% after 6 months of receiving n-3 capsules. Fish oil capsules increased the phospholipid molecular species containing n-3 LCPUFA, and concomitant decreases in n-6 LCPUFA species. SM species did not show any significant changes in n-3 LCPUFA group however, three SM species (SM 16:0, SM 18:0, SM 18:1) significantly increased after 6 months of supplementation with placebo. N-3 supplementation for 6 months led to higher n-3 incorporation into erythrocytes, at the expense of n-6 PUFA across all phospholipid classes analyzed and may have prevented the increase in SM seen in the placebo group.
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8
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Alqarni A, Mitchell TW, McGorry PD, Nelson B, Markulev C, Yuen HP, Schäfer MR, Berger M, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger GE, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, Amminger GP, Meyer BJ. Comparison of erythrocyte omega-3 index, fatty acids and molecular phospholipid species in people at ultra-high risk of developing psychosis and healthy people. Schizophr Res 2020; 226:44-51. [PMID: 31301881 DOI: 10.1016/j.schres.2019.06.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 12/12/2022]
Abstract
People classified as ultra-high risk (UHR) of developing psychosis have reduced cellular membrane omega-3 and omega-6 polyunsaturated fatty acids (PUFA). We aimed to compare omega-3 index, fatty acids and molecular phospholipid species from erythrocytes of people with UHR (n = 285) with age-matched healthy controls (n = 120) assessed by mass spectrometry. Lower proportions of PUFA were observed in the UHR group compared to healthy controls; specifically, eicosapentaenoic acid (EPA) was 29.3% lower, docosahexaenoic acid (DHA) was 27.2% lower, arachidonic acid (AA) was 15.8% lower and the omega-3 index was 26.9% lower. The AA to EPA ratio was higher in the UHR group compared to the healthy group. Smoking status had no significant effect on PUFA levels in healthy or the UHR groups. BMI was associated with PUFA levels in the UHR group only and the statistical model only explains 2% of the variance of the PUFA levels. The proportion of nervonic acid was 64.4% higher in the UHR group compared to healthy controls. At a lipid class level, the UHR group had 16% higher concentrations of sphingomyelin (SM) and 46% lower concentrations phosphatidylethanolamine (PE) compared to healthy group. Of the 49 individual molecular phospholipids, twenty-seven phospholipid species were lower in the UHR group. In conclusion, there are clear differences in the proportions of erythrocyte fatty acids and phospholipids between UHR and healthy controls and UHR had higher concentrations of SM and lower concentrations of PE. These differences may represent a promising prodromal risk biomarker in the UHR population to aid clinical diagnosis.
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Affiliation(s)
- Ayedh Alqarni
- School of Medicine, Molecular Horizons, Lipid Research Centre, University of Wollongong, and Illawarra Health & Medical Research Institute, Wollongong, Australia; King Fahad Specialist Hospital, Dammam City, Saudi Arabia
| | - Todd W Mitchell
- School of Medicine, Molecular Horizons, Lipid Research Centre, University of Wollongong, and Illawarra Health & Medical Research Institute, Wollongong, Australia
| | - Patrick D McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Connie Markulev
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Hok Pan Yuen
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miriam R Schäfer
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Maximus Berger
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Nilufar Mossaheb
- Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Smesny
- Department of Psychiatry, University Hospital Jena, Jena, Germany
| | - Ian B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Gregor E Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Dorien H Nieman
- Department of Psychiatry, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | | | | | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore
| | - Andrew Thompson
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England, United Kingdom of Great Britain and Northern Ireland; North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire National Health Service Partnership Trust, Coventry, England, United Kingdom of Great Britain and Northern Ireland
| | - Alison Ruth Yung
- Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, England, United Kingdom of Great Britain and Northern Ireland; Greater Manchester West National Health Service Mental Health Foundation Trust, Manchester, England, United Kingdom of Great Britain and Northern Ireland
| | - G Paul Amminger
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Barbara J Meyer
- School of Medicine, Molecular Horizons, Lipid Research Centre, University of Wollongong, and Illawarra Health & Medical Research Institute, Wollongong, Australia.
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9
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Amminger GP, Nelson B, Markulev C, Yuen HP, Schäfer MR, Berger M, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger GE, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, McGorry PD. The NEURAPRO Biomarker Analysis: Long-Chain Omega-3 Fatty Acids Improve 6-Month and 12-Month Outcomes in Youths at Ultra-High Risk for Psychosis. Biol Psychiatry 2020; 87:243-252. [PMID: 31690495 DOI: 10.1016/j.biopsych.2019.08.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND NEURAPRO was a multicenter, placebo-controlled trial of long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) in 304 individuals at ultra-high risk for psychotic disorders. The study failed to show benefits of n-3 PUFAs over placebo. Although the randomized controlled trial design is placed at the top of the evidence hierarchy, this methodology has limitations in fish oil randomized controlled trials, as not only is the test agent present in the intervention group, but also n-3 fats are present in the diet and the body tissue of all participants. METHODS Analysis of biomarker data (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA], n-3 index, EPA+DHA) collected as part of NEURAPRO was conducted on 218 participants with longitudinal biomarker data to determine if n-3 PUFAs measured in erythrocytes at baseline and month 6 predicted clinical outcomes. RESULTS Increases of the n-3 index, EPA, and DHA predicted less severe psychopathology and better functioning at both follow-up time points. Higher baseline levels and increases of n-3 index also predicted overall clinical improvement at month 6 (n-3 index baseline: adjusted odds ratio [95% confidence interval (CI)] = 1.79 [1.30-2.48]; n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.43 [1.16-1.76]) and at month 12 (n-3 index baseline: adjusted odds ratio [95% CI] = 2.60 [1.71-3.97]; n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.36 [1.06-1.74]). CONCLUSIONS These data suggest that n-3 PUFAs can exert therapeutic effects in ultra-high-risk individuals. This finding has implications for early intervention and treatment guidelines, as n-3 PUFA supplementation can easily and safely be used in a wide variety of settings, from primary care to specialist services.
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Affiliation(s)
- G Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Miriam R Schäfer
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Maximus Berger
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nilufar Mossaheb
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Monika Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Stephan Smesny
- Department of Psychiatry, Jena University Hospital, Jena, Germany
| | - Ian B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Gregor E Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison Ruth Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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10
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Hartmann JA, Schmidt SJ, McGorry PD, Berger M, Berger GE, Chen EY, de Haan L, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma SK, Yuen HP, Yung AR, Amminger GP, Nelson B. Trajectories of symptom severity and functioning over a three-year period in a psychosis high-risk sample: A secondary analysis of the Neurapro trial. Behav Res Ther 2020; 124:103527. [DOI: 10.1016/j.brat.2019.103527] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/31/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
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11
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Berger M, Nelson B, Markulev C, Yuen HP, Schäfer MR, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger GE, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Mitchell TW, Meyer BJ, Thompson A, Yung AR, McGorry PD, Amminger GP. Relationship Between Polyunsaturated Fatty Acids and Psychopathology in the NEURAPRO Clinical Trial. Front Psychiatry 2019; 10:393. [PMID: 31244693 PMCID: PMC6562242 DOI: 10.3389/fpsyt.2019.00393] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Deficiencies in membrane polyunsaturated fatty acids (PUFA) such as omega-3 (n-3) fatty acids are thought to contribute to the pathophysiological processes underlying psychotic disorders. Emerging evidence suggests that the levels of PUFA are related to clinical symptoms but significant heterogeneity exists between studies. Here, we investigated associations of membrane PUFA with clinical symptoms and functioning in a large sample of individuals at ultra-high risk (UHR) for psychosis. Methods: A total of 285 participants of the NEURAPRO clinical trial were investigated for erythrocyte PUFA levels, including the n-3 index, n-6/n-3 PUFA ratio, docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA). Severity of general psychopathology [Brief Psychiatric Rating Scale (BPRS)], psychotic symptoms (BPRS psychosis subscale), negative symptoms [Scale for the Assessment of Negative Symptoms (SANS)], manic symptoms [Young Mania Rating Scale (YMRS)], depressive symptoms [Montgomery Asberg Depression Rating Scale (MADRS)], and functioning [Social and Occupational Functioning Scale (SOFAS), Global Functioning Social (GF-S) and Role (GF-R) scales] were assessed concurrently. Partial correlation taking into account the effects of gender, age, and smoking was used to examine the relationship between PUFAs and symptoms severity. Results: The n-3 index negatively correlated with the severity of general psychopathology, psychotic symptoms, depressive symptoms, and manic symptoms. The n-6/n-3 PUFA ratio positively correlated with severity of psychotic and depressive symptoms. The n-3 PUFA DHA negatively correlated with the severity of general psychopathology, positive, manic, and depressive symptoms. EPA negatively correlated with manic symptoms. Nervonic acid, an n-9 monounsaturated fatty acid, positively correlated with general psychopathology, positive and negative symptoms, depressive symptoms, and manic symptoms. The long-chain saturated fatty acid tetracosanoic acid positively correlated with general psychopathology, positive, manic, and depressive symptoms. Conclusions: Partially consistent with a previous study, psychotic symptoms, depressive symptoms, and symptoms of mania were associated with several classes of FAs in the present study. These findings support the relevance of membrane fatty acids for the onset of psychotic symptoms and indicate that FAs should be further evaluated as biomarkers in the UHR for psychosis group. Clinical Trial Registration: ANZCTR, identifier: 12608000475347.
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Affiliation(s)
- Maximus Berger
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Connie Markulev
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hok Pan Yuen
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Miriam R Schäfer
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Vienna, Austria.,Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Monika Schlögelhofer
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Vienna, Austria
| | - Stefan Smesny
- Department of Psychiatry, University Hospital Jena, Jena, Germany
| | - Ian B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Gregor E Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, Hong Kong
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, Amsterdam, Netherlands
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, Netherlands
| | | | | | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore
| | - Todd W. Mitchell
- School of Medicine and Lipid Research Centre, University of Wollongong, Wollongong, NSW, Australia,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Barbara J. Meyer
- School of Medicine and Lipid Research Centre, University of Wollongong, Wollongong, NSW, Australia,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Andrew Thompson
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alison Ruth Yung
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Patrick D McGorry
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - G Paul Amminger
- Orygen-The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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