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Monistrol-Mula A, Diaz-Torres S, Felez-Nobrega M, Haro JM, Medland SE, Mitchell BL. Genetic analyses point to alterations in immune-related pathways underpinning the association between psychiatric disorders and COVID-19. Mol Psychiatry 2024:10.1038/s41380-024-02643-0. [PMID: 38956374 DOI: 10.1038/s41380-024-02643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Current literature suggests that people with psychiatric disorders have a higher risk of COVID-19 infection and a worse prognosis of the disease. We aimed to study the genetic contribution to these associations across seven psychiatric disorders as well as a general psychopathology factor (P-factor) and determine whether these are unique or shared across psychiatric disorders using statistical genetic techniques. Using the largest available genome-wide association studies (GWAS), we found a significant genetic overlap between depression, ADHD, PTSD, and the P-factor with both COVID-19 infection and hospitalization, and between anxiety and COVID-19 hospitalization. We used pairwise GWAS to examine this overlap on a fine-grained scale and identified specific regions of the genome shared between several psychiatric disorders, the P-factor, and COVID-19. Gene-based analysis in these genomic regions suggested possible links with immune-related pathways such as thyroid homeostasis, inflammation, and stress response. Finally, we show preliminary evidence for causal associations between depression, ADHD, PTSD, and the P-factor, and higher COVID-19 infection and hospitalization using Mendelian Randomization and Latent Causal Variable methods. Our results support the hypothesis that the relationship between psychiatric disorders and COVID-19 risk is likely due to shared alterations in immune-related pathways and is not a result of environmental factors alone, shedding light on potentially viable therapeutic targets.
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Affiliation(s)
- Anna Monistrol-Mula
- Group of Epidemiology of Psychiatric disorders and Ageing, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
- Department of Medicine, University of Barcelona, Barcelona, Spain.
- Mental Health and Neuroscience program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Santiago Diaz-Torres
- Mental Health and Neuroscience program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Mireia Felez-Nobrega
- Group of Epidemiology of Psychiatric disorders and Ageing, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Maria Haro
- Group of Epidemiology of Psychiatric disorders and Ageing, Sant Joan de Déu Research Institute, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Sarah E Medland
- Mental Health and Neuroscience program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Brittany L Mitchell
- Mental Health and Neuroscience program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
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Neupane SP, Daray FM, Ballard ED, Galfalvy H, Itzhaky L, Segev A, Shelef A, Tene O, Rizk MM, Mann JJ, Zalsman G. Immune-related biomarkers and suicidal behaviors: A meta-analysis. Eur Neuropsychopharmacol 2023; 75:15-30. [PMID: 37356288 DOI: 10.1016/j.euroneuro.2023.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Abstract
Biomarkers that can differentiate between psychiatric disorders with and without suicidal behavior history from each other and from healthy volunteers may explain part of the pathogenesis of suicidal behavior. We conducted the hitherto largest meta-analysis comparing immune biomarkers between subjects with and without suicide attempt history or death by suicide. The study protocol was registered with PROSPERO, CRD42020212841. Standardized mean differences (SMD) were pooled with random-effects models. Heterogeneity between studies was assessed with the I2-statistic and publication bias was evaluated by the Egger test and funnel plots. Data were based on 36 studies including 2679 persons with suicidal behaviors and 6839 comparison subjects, and four immune-related biomarkers (CRP, IL-6, TNF-α and IL-1β). Suicidal behavior was associated with higher CRP blood levels compared with: healthy controls (SMD [95%CI] = 1.42[0.85-1.98]); patients with depression alone (SMD [95%CI] = 1.23[0.20-2.26]); and patients with any psychiatric disorders (SMD [95%CI] = 0.39[0.22-0.55]). IL-6 blood level was higher in patients with suicidal behaviors compared with healthy controls (SMD [95%CI] = 1.13[0.45-1.82]) and when compared with psychiatric patients without suicidal behaviors (SMD [95%CI] = 0.22 [0.11-0.33]). Meta-regression and subgroup analyses revealed that increased CRP in suicidal behavior is primarily driven by recent suicidal behavior. These results implicate the immune system and inflammatory response in suicidal behavior independent of a relationship to major psychiatric disorders, and that these biological measures are predominantly state-dependent markers. Future studies are needed to determine the cause-and-effect relationship of these immune system biomarkers with suicidal behavior, and their potential predictive properties.
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Affiliation(s)
- Sudan Prasad Neupane
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Building 12, 2nd floor. N-0372 Oslo, Norway.
| | - Federico M Daray
- Institute of Pharmacology, School of Medicine, University of Buenos Aires, Paraguay 2155, Piso9, Ciudad Autónoma de Buenos Aires, C1121ABG, Argentina
| | - Elizabeth D Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Hanga Galfalvy
- Departments of Psychiatry and Biostatistics, Columbia University, New York, NY, United States of America
| | - Liat Itzhaky
- Department of Psychiatry, Columbia University, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States
| | - Aviv Segev
- Shalvata Mental Health Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Shelef
- Lev-Hasharon Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Tene
- Psychiatric Division, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Mina M Rizk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States
| | - J John Mann
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, 10032, NY, United States of America; Division of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, 10032, NY, United States of America; Department of Radiology, Columbia University, 622 West 168th St, New York, 10032, NY, United States of America
| | - Gil Zalsman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University NY, NY, United States of America
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Hernández-Díaz Y, Genis-Mendoza AD, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez ML, Nicolini H. Association and Genetic Expression between Genes Involved in HPA Axis and Suicide Behavior: A Systematic Review. Genes (Basel) 2021; 12:1608. [PMID: 34681002 PMCID: PMC8536196 DOI: 10.3390/genes12101608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Suicide behavior (SB) has been highly associated with the response to stress and the hypothalamic-pituitary-adrenal (HPA) axis. The aim of this study was to summarize the results obtained in genetic studies that analyzed the HPA axis-stress pathway and SB through a systematic review. METHODS We performed an online search in PubMed, EBSCO, Web of Science, Scopus, and PsycoInfo databases up to May 2021. We followed the PRISMA guidelines for systematic reviews. We included case-control and expression studies that provided data on mRNA expression and single-nucleotide polymorphisms of genes associated with SB. RESULTS A total of 21,926 individuals participated across 41 studies (not repeats); 34 studies provided data on single-nucleotide polymorphisms in 21,284 participants and 11 studies reported data on mRNA expression in 1034 participants. Ten genes were identified: FKBP5, CRH, CRHBP, CRHR1, CRHR2, NR3C1, NR3C2, SKA2, MC2R, and POMC. CONCLUSIONS Our findings suggest that key stress pathway genes are significantly associated with SB and show potential as biomarkers for SB.
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Affiliation(s)
- Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86205, Tabasco, Mexico; (Y.H.-D.); (T.B.G.-C.)
| | - Alma Delia Genis-Mendoza
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico;
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86205, Tabasco, Mexico; (Y.H.-D.); (T.B.G.-C.)
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86650, Tabasco, Mexico
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86150, Tabasco, Mexico;
| | | | - Humberto Nicolini
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico;
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Are alterations in estradiol, cortisol, and inflammatory cytokines associated with depression during pregnancy and postpartum? An exploratory study. Brain Behav Immun Health 2021; 16:100309. [PMID: 34589801 PMCID: PMC8474549 DOI: 10.1016/j.bbih.2021.100309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/14/2021] [Accepted: 07/24/2021] [Indexed: 01/11/2023] Open
Abstract
Background Pregnant veterans are a subpopulation known to be at elevated risk of developing mental health symptoms, such as depression and suicidal ideation. Inflammation has been associated with depression, specifically during the perinatal period. Critical changes in estradiol, cortisol, and inflammatory cytokines are necessary for the progression of a healthy pregnancy, which are then rapidly altered in the postpartum period. We explored changes in estradiol, cortisol, and pro-inflammatory cytokines relative to depressive symptoms and suicidal thoughts across pregnancy and postpartum in this pilot and feasibility study. Methods We measured estradiol, cortisol, and the inflammatory cytokines IL-1β, IL-6, IL-8, IFN-γ, and TNF-α in 18 pregnant veterans and analyzed the data using descriptive statistics, dependent t-tests, and correlation analyses. We assessed depression severity with the Edinburgh Postnatal Depression Scale and suicidality with the Columbia-Suicide Severity Rating Scale. Thirteen of the women repeated assessments in the early postpartum period at an average of 6.7 weeks after birth. Results As anticipated, estradiol (t(12) = 12.47, p < .001) and cortisol (t(12) = 9.43, p < .001) significantly decreased from pregnancy to postpartum. There were no differences in the means of gestational and postpartum IL-1β, IL-6, TNF-α, or IFN-γ, but IL-8 was significantly increased from pregnancy to postpartum (t(12) = -4.60, p = .001). Estradiol during pregnancy was positively correlated with IL-6 levels both during pregnancy (r p = .656, p = .008) and postpartum (r = 0.648, p = .023). Elevated IL-1β was associated with suicidal thoughts during pregnancy (r = 0.529, p = .029). Although not statistically significant, depressive symptom severity trended towards a positive association with larger increases in IL-1β (r = 0.535, p = .09) and TNF-α (r = 0.501, p = .08) from pregnancy to postpartum. Conclusion This preliminary study suggests the feasibility of our approach for exploring a complex interplay between hormonal and pro-inflammatory changes from pregnancy to postpartum, and their relationship with depressive symptoms. Given our small sample and the relatively exploratory nature of our analyses, additional investigation focusing on hormonal and inflammatory changes and their potential associations with perinatal mental health is necessary to confirm and extend our preliminary findings and examine additional potential covariates.
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González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez ML, Pérez-Hernández N, Rodríguez-Pérez JM, Genis-Mendoza AD. The role of gene polymorphisms, and analysis of peripheral and central levels of interleukins in suicidal behavior: A systematic review. J Affect Disord 2021; 279:398-411. [PMID: 33099055 DOI: 10.1016/j.jad.2020.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/10/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
In terms of the physiological characteristics of suicidal behavior (SB) disorder, an increase inflammation response has been reported in these individuals. Therefore, the pro-inflammatory and anti-inflammatory activities of interleukins are adequate markers to research in order to understand the pathogenesis of SB. For that reason, the aim of this systematic review was to evaluate the role of interleukins in individuals with suicidal behavior disorder. A systematic search was performed in PubMed, Scopus and EBSCO databases up to July 2019. We used the words "interleukin" AND "suicide", "interleukin" AND "suicidal", and "IL-". Articles where interleukins concentrations were measured in individuals with SB and/or genetic studies addressing interleukins genes variants as possible markers to SB were included. A total of 54 articles were included. Articles that measured interleukin levels comprised 1111 cases and 1588 controls; whereas the genetic studies comprised 3082 cases and 5148 controls. These studies evaluated the concentrations of IL-1β, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8, IL-10, sIL-2R in serum, plasma. The pro-inflammatory interleukins concentrations were higher in cases than in controls; however, we observed heterogeneity in the measurements and sample sources. Whereas, 9 polymorphisms of IL-1α, IL-1β, IL-6, IL-1β-8 genes were analyzed in association with suicide behavior disorder, though no conclusive outcomes were attained. Our results suggest that individuals with suicide risk undergo continuous stress that could trigger the release and circulation of pro-inflammatory interleukins and therefore their concentration in plasma. However, more studies are necessary in order to reach conclusively outcomes.
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Affiliation(s)
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México..
| | - Isela Esther Juárez-Rojop
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México.
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. Manuel Velazco Siles", Secretaría de Salud. Yajalón, Chiapas, México..
| | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México..
| | - José Manuel Rodríguez-Pérez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México..
| | - Alma Delia Genis-Mendoza
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México, México..
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An increase in IL-6 levels at 6-month follow-up visit is associated with SSRI-emergent suicidality in high-risk children and adolescents treated with fluoxetine. Eur Neuropsychopharmacol 2020; 40:61-69. [PMID: 32747326 DOI: 10.1016/j.euroneuro.2020.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/14/2020] [Accepted: 07/16/2020] [Indexed: 01/22/2023]
Abstract
Major depressive disorder (MDD) is associated with alterations in circulatory cytokines, in adults as well as in children and adolescents. Administration of selective serotonin reuptake inhibitors (SSRIs) to MDD pediatric patients modifies cytokine levels. However, most studies only assessed changes over a short time period. In this study, we evaluated long-term effects of the SSRI fluoxetine (FLX) in children and adolescents treated for anxiety and/or MDD, including a high-risk group with pre-treatment suicidality. The study group included ninety-two patients (35 boys and 57 girls) with MDD and/or anxiety disorders, aged 13.90 ± 2.41 years. All patients were treated with FLX and followed for 6 months. The study group included children with pretreatment suicidality (high-risk group;N = 62) and without pretreatment suicidality (N = 30) according to the Columbia Suicide Severity Rating Scale. Plasma concentrations of TNFα, IL-6, and IL-1β were measured by enzyme linked immunosorbent assays before and after six months of treatment. IL-6 and IL-1β significantly increased as a factor of time after 6 months of treatment. The elevation was statistically significant confined to children with pretreatment suicidality. Within the children with pretreatment suicidality, IL-6 levels increased significantly after 6 months only in the children who developed SSRI-associated suicidality. To summarize, an increase in IL-6 levels after 6 months of treatment may be associated with SSRI-emergent suicidality in children with pretreatment suicidality. Further studies are needed to clarify the role and mechanism(s) of IL-6 in the pathogenesis of this life-threatening adverse event.
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Application of antidepressants in depression: A systematic review and meta-analysis. J Clin Neurosci 2020; 80:169-181. [PMID: 33099342 DOI: 10.1016/j.jocn.2020.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The type and quantities of antidepressants are increasing, but the efficacy and safety of first-line and emerging drugs vary between studies. In this article, we estimated the efficacy and safety of first-line and emerging antidepressants (anti-inflammatory drugs and ketamine). METHOD ystematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the depression, depressive symptoms, antidepressants, fluoxetine (Prozac), paroxetine, escitalopram, sertraline, fluvoxamine, venlafaxine, duloxetine, NSAIDs, anti-cytokine drugs or pioglitazone published before May 1st, 2019. Information on study characteristics, depression or depressive symptoms, antidepressants and the descriptive statistics (including efficacy and safety of antidepressants) was extracted independently by 2 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. The response and remission of antidepressants were used as clinical evaluation indicators, and the evaluation criteria were clinical depression scales. OR value of antidepressants as assessed by meta-analysis. RESULTS The literature search retrieved 5529 potentially relevant articles of which 49 studies were finally included. We compared the efficacy of antidepressants (seven first-line antidepressants (fluoxetine, paroxetine, escitalopram, sertraline, fluvoxamine, venlafaxine, duloxetine), there kinds of anti-inflammatory drugs(NASIDs, cytokine-inhibitor, pioglitazone) and ketamine) by comparing the OR values. CONCLUSION The three drugs with the highest OR value in response were NASID (OR = 3.62(1.58, 8.32)), venlafaxin (OR = 3.50(1.83, 6.70)) and ketamine (OR = 3.28(1.89, 5.68)), while the highest OR value in remission were NASID (OR = 3.17(1.60, 6.29)), ketamine (OR = 2.99(1.58, 5.67)) and venlafaxin (OR = 2.55(1.72, 3.78)). Through reading the literature, we found 69 SNPs associated with depression. Major depression was a debilitating disorder that could ultimately lead to enormous societal and economical challenge [1]. The number of person which affected by depression was up to 16% of the population worldwide. More than 300 million individuals were estimated to suffer depression these days [1,2]. Therefore, it is apparent that safety and effective treatments for depression are necessary. In the 1930 s, the first drug for schizophrenia was discovered. This finding was a landmark for the emerging of biological psychiatry. In the 1950 s, pharmacologists had stumbled upon the antidepressant effect of imipramine. Since then, every 30 years, the use of antidepressants had made a pulsatile leap. Selective serotonin reuptake inhibitors (SSRIs) are the most widely-prescribed psychiatric drugs for the treatment of depression. However, the efficacy was variable and incomplete: 60%-70% of the patients do not experience remission, while 30%-40% do not show a significant response [3,4]. Nevertheless, SSRIs, SNRIs (selective serotonin-norepinephrine reuptake inhibitors, which can block norepinephrine at the same time) and NaSSAs (norepinephrine and selective serotonin receptor agonist), constituted the first-line clinical drugs. Nearly 30 years after the outbreak of SSRIs, antidepressants have ushered in a new chapter. It has been found that anti-inflammatory drugs could also have the small and moderate antidepressant effect and it's widely discussed [5]. More than 40 anti-inflammatory drugs have been certificated to have antidepressant effects in preclinical and clinical studies [6]. The antidepressant that has been approved for use recently is ketamine. There is no comprehensive comparison of the efficacy of all these drugs. In this review, we tried to estimate the efficacy and safety of first-line antidepressants, anti-inflammatory drugs and ketamine. On the other hand, with the development of GWAS, SNPs related to depression have been reported, and the corresponding mechanisms have been elaborated, respectively. However, patients with these SNPs have not been treated with individualized drugs according to the mechanisms. We hope to push this process forward through the summary of this article. METHODS Search Strategy and Study Eligibility.
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Coryell W, Wilcox H, Evans SJ, Pandey GN, Jones-Brando L, Dickerson F, Yolken R. Latent infection, inflammatory markers and suicide attempt history in depressive disorders. J Affect Disord 2020; 270:97-101. [PMID: 32339111 DOI: 10.1016/j.jad.2020.03.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/17/2019] [Accepted: 03/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Numerous reports have described increased rates of exposure to Toxoplasma gondii levels in individuals with a history of suicide attempts in comparison with well controls, or psychiatrically ill individuals, with no suicide attempt history. Such findings suggest that the behavioral effects this parasite exerts on rodent hosts extends to humans though few studies have searched for underlying mechanisms. METHODS The present study compared 96 patients with an active depressive disorder and a history of at least two suicide attempts to 126 depressed patients with no history of suicide attempts by IgG and IgM levels of Toxoplasma gondii and cytomegalovirus (CMV). The groups were also compared by IL_1b, TNF-alpha, CRP, IL_6, and IL_1ra titers. RESULTS Toxoplasma gondii IgM levels were higher, and seropositivity more likely, in the suicide attempt group. CMV IgG levels were also higher among suicide attempters. Several of these immunoglobulin measures were more robustly associated with the number of suicide attempts than with the dichotomy of suicide attempter and non-attempter. These two antibody levels were also additive in their association with suicide attempter status. IL_1a levels were lower in suicide attempters and correlated negatively with levels of antibodies to Toxoplasma gondii and CMV. LIMITATIONS These include a sample size insufficient to explore differences across mood disorder diagnoses or demographic groupings. CONCLUSIONS These results indicate that exposure to common infectious agents such as Toxoplasma gondii and CMV are associated with increased risk of suicide attempts but the mechanism of association does not appear to involve the activation of cytokines. Elucidation of the mechanisms which define the relationship between infections and suicide attempts may lead to new methods for the prediction and prevention of suicide attempts.
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Affiliation(s)
- William Coryell
- Psychiatry Research, University of Iowa Carver College of Medicine, 500 Newton Road, 2-205 MEB, Iowa City, IA, 52242-1000, USA.
| | | | | | | | | | | | - Robert Yolken
- Stanley Division of Developmental Neurovirology, USA
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Segura AG, Mitjans M, Jiménez E, Fatjó-Vilas M, Ruiz V, Saiz PA, García-Portilla MP, González-Blanco L, Bobes J, Vieta E, Benabarre A, Arias B. Association of childhood trauma and genetic variability of CRH-BP and FKBP5 genes with suicidal behavior in bipolar patients. J Affect Disord 2019; 255:15-22. [PMID: 31195252 DOI: 10.1016/j.jad.2019.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Around 8% of bipolar disorder (BD) patients die by suicide every year, accounting for the highest rate among the psychiatric population. Suicidal behavior (SB) is mediated by an intertwining system of extrinsic and intrinsic factors. Childhood trauma (CT) and gene variants of the stress-management hypothalamic-pituitary-adrenal (HPA) axis have been reported as risk factors for SB. The aim of this study was to elucidate the association of CT and HPA axis genetic variants with SB. METHODS 135 BD patients were recruited for clinical assessment of CT and SB by means of the Childhood Trauma Questionnaire (CTQ) and the Columbia Suicide Severity Rating Scale (C-SSRS), respectively. A total of 28 single nucleotide polymorphisms (SNPs) from 8 HPA axis genes (POMC, NR3C2, CRH-BP, NR3C1, FKBP5, CRHR2, CRHR1, and MC2R) were genotyped. RESULTS The analyses showed an association of total CTQ score (p = 0.003), emotional abuse (p = 0.001), sexual abuse (p = 0.005) and emotional neglect (p = 0.005) with SB. CRH-BP rs7728378-C carriers (p = 0.004; OR = 3.05), FKBP5 rs3777747-AA (p = 0.039; OR = 0.34) and FKBP5 rs2766533-GG genotypes (p = 0.001; OR = 2.93) were associated with SB although only rs2766533 survived multiple test correction. No gene-environment interaction was found. LIMITATIONS The relatively small sample size limits the statistical power to detect smaller environmental and genetic effects. Cross-sectional data collection in psychometric assessments can yield biased data. CONCLUSIONS The present study characterizes novel SB risk factors and replicates previous findings in BD patients. CT and variability in CRH-BP and FKBP5 genes should be further studied for a better understanding of SB and ultimately help in suicide prevention.
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Affiliation(s)
- A G Segura
- Departament Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, IBUB, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - M Mitjans
- Departament Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, IBUB, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - E Jiménez
- Bipolar Disorder Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Fatjó-Vilas
- Departament Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, IBUB, University of Barcelona, CIBERSAM, Barcelona, Spain; FIDMAG Germanes Hospitalaries Research Foundation, CIBERSAM, Barcelona, Spain
| | - V Ruiz
- Institut Clínic de Neurociencies, Hospital Clínic, Barcelona, Spain
| | - P A Saiz
- Department of Psychiatry, School of Medicine, University of Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - M P García-Portilla
- Department of Psychiatry, School of Medicine, University of Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - L González-Blanco
- Department of Psychiatry, School of Medicine, University of Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - J Bobes
- Department of Psychiatry, School of Medicine, University of Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - E Vieta
- Bipolar Disorder Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Benabarre
- Bipolar Disorder Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Arias
- Departament Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, IBUB, University of Barcelona, CIBERSAM, Barcelona, Spain.
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10
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Li C, Sun X, Dong D, Zhong X, Wang X, Yao S. Effect of corticotropin-releasing hormone receptor1 gene variation on psychosocial stress reaction via the dorsal anterior cingulate cortex in healthy adults. Brain Res 2018; 1707:1-7. [PMID: 30447186 DOI: 10.1016/j.brainres.2018.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE It has been proposed that the common intronic CRHR1 SNP rs110402 is associated with anxiety and cortisol response patterns and plays a key role in vulnerability to certain mental disorders. The current study explored the effect of rs110402 genotype on psychological stress processing in healthy adults. METHODS The Montreal Imaging Stress Task (MIST) was administered to 140 healthy adults (34 C carriers and 106 TT homozygotes) during functional magnetic resonance imaging. Between-group differences in self-reported stress level, whole brain activation, and cortisol levels were assessed. RESULTS The rs110402 genotype groups differed in stress-induced cortisol response and bilateral dorsal anterior cingulate cortex (dACC) activity. The TT homozygotes showed greater stress-induced activation in the bilateral dACC compared to C carriers. Interestingly, dACC activity during MIST was negatively correlated with cortisol response in healthy adults. State anxiety, trait anxiety, and mental resilience did not differ between genotypes. CONCLUSIONS CRHR1 SNP rs110402 genotype plays a role in psychosocial neural processing and cortisol response in healthy adults. The activity in dACC may mediate effect of rs110402 on psychosocial stress processing in the healthy population. Moreover, level of dACC activation may be associated with stress vulnerability.
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Affiliation(s)
- Chuting Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China
| | - Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China
| | - Xue Zhong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China.
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11
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Coryell W, Wilcox H, Evans SJ, Pandey GN, Jones-Brando L, Dickerson F, Yolken R. Aggression, impulsivity and inflammatory markers as risk factors for suicidal behavior. J Psychiatr Res 2018; 106:38-42. [PMID: 30261413 DOI: 10.1016/j.jpsychires.2018.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Increased inflammatory markers have been linked to suicidal behavior in numerous studies. Measures of aggression and of impulsivity also comprise risks factors for suicidal behavior and there is evidence that inflammatory markers correlate with these traits. The following analyses compare suicide attempters and non-attempters to determine whether inflammatory markers mediate relationships between aggression or impulsivity and proclivities to suicidal behavior. METHODS Investigators at three academic centers recruited patients in major depressive episodes who had a history of two or more suicide attempts (n = 79), or who had no history of suicide attempts (n = 123). Analyses compared these groups by five inflammatory marker levels and by measures of aggression and of impulsivity. RESULTS These results did not confirm the hypotheses that cytokine levels would explain relationships between aggressive behavior and suicide attempt history. However, scores for aggressive behavior and for impulsivity were significantly higher among suicide attempters. One of five of the inflammatory markers, (IL-1β), distinguished the two groups with lower values in the suicide attempt group. IL-1β levels correlated inversely with measures of aggression but neither impulsivity or aggressive behavior appear to explain the association between IL-1β levels and suicide attempt status. CONCLUSION These results identify recent aggressive behavior, higher levels of impulsivity, and lower levels of IL-1β as risk factors for a history of multiple suicide attempts in a group suffering from major depressive episodes. These measures appear to be additive in their effects.
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Affiliation(s)
| | | | | | | | | | | | - Robert Yolken
- Stanley Division of Developmental Neurovirology, USA
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