1
|
Drago A. Genetic signatures of suicide attempt behavior: insights and applications. Expert Rev Proteomics 2024; 21:41-53. [PMID: 38315076 DOI: 10.1080/14789450.2024.2314143] [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: 09/21/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Every year about 800,000 complete suicide events occur. The identification of biologic markers to identify subjects at risk would be helpful in targeting specific support treatments. AREA COVERED A narrative review defines the meta-analytic level of current evidence about the biologic markers of suicide behavior (SB). The meta-analytic evidence gathered so far indicates that the hypothesis-driven research largely failed to identify the biologic markers of suicide. The most consistent and replicated result was reported for: 1) 5-HTR2A T102C, associated with SB in patients with schizophrenia (OR = 1.73 (1.11-2.69)) and 2) BDNF Val66Met (rs6265), with the Met-Val + Val-Val carriers found to be at risk for suicide in the Caucasian population (OR: 1.96 (1.58-2.43)), while Val-Val vs. Val-Met + Met carriers found to be at risk for suicide in the Asian populations (OR: 1.36 (1.04-1.78)). GWAS-based meta-analyses indicate some positive replicated findings regarding the DRD2, Neuroligin gene, estrogen-related genes, and genes involved in gene expression. EXPERT OPINION Most consistent results were obtained when analyzing sub-samples of patients. Some promising results come from the implementation of the polygenic risk score. There is no current consensus about an implementable biomarker for SB.
Collapse
Affiliation(s)
- Antonio Drago
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
2
|
Wang W, Du J, Li S, Xie G, Xu J, Ren Y. Demographic, clinical and biochemical correlates of the length of stay for different polarities in Chinese inpatients with bipolar disorder: A real-world study. Front Hum Neurosci 2023; 17:1135403. [PMID: 36936616 PMCID: PMC10014706 DOI: 10.3389/fnhum.2023.1135403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction: Many patients with bipolar disorder (BD) need hospitalization, while the number of hospital beds for these patients is limited. Managing the length of stay (LOS) is an effective solution to this issue. Research on LOS and its influencing factors in BD is limited in China. This study aimed to identify the factors relevant to LOS in different polarities in Chinese patients with BD. Method: This was a real-world, cross-sectional study. Data were obtained from the electronic medical record system. Patients admitted to Beijing Anding Hospital between Jan 2014 and Dec 2017 and diagnosed with BD were included. Demographic information, clinical characteristics, and biochemical variables were collected. Patients were classified into short and long LOS groups based on a cutoff value. A univariate study and a multivariate logistic regression analysis were performed to identify variables related to LOS in various BD polarities. The receiver operating characteristic (ROC) analysis was utilized to evaluate the discrimination accuracy of the regression model. Result: Four thousand six hundred and seventy-five visits from 4,451 individuals were included in the analysis. For the whole sample, unmarried status, psychotic features, and family history of mental disorders were positively associated with long LOS (all p < 0.05). There was an additive interaction between a family history of mental disorders and polarities (p < 0.05). For manic episodes, unmarried status, psychotic features, and family history of mental disorders were positively associated with long LOS (all p < 0.05). For depressive episodes, psychotic features and high-density lipoprotein cholesterol (HDLC) levels were positively associated with long LOS (all p < 0.05). For mixed states, unmarried status was positively associated with long LOS, while low-density lipoprotein cholesterol (LDLC) levels were negatively associated with LOS (all p < 0.05). The area under the curve (AUC) values for depressive episodes, manic episodes, and mixed states in the combined model were 0.587, 0.553, and 0.619, respectively (all p < 0.05). Discussion: The findings suggested that LOS correlates differed by polarity, with marital status, psychotic features, a family history of mental disorders, and lipid levels strongly linked with LOS in patients with BD.
Collapse
Affiliation(s)
- Wei Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing Du
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sheng Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gaoming Xie
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jinjie Xu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jinjie Xu Yanping Ren
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- *Correspondence: Jinjie Xu Yanping Ren
| |
Collapse
|
3
|
De Giorgi R, Cowen PJ, Harmer CJ. Statins in depression: a repurposed medical treatment can provide novel insights in mental health. Int Rev Psychiatry 2022; 34:699-714. [PMID: 36786109 DOI: 10.1080/09540261.2022.2113369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Depression has a large burden, but the development of new drugs for its treatment has proved difficult. Progresses in neuroscience have highlighted several physiopathological pathways, notably inflammatory and metabolic ones, likely involved in the genesis of depressive symptoms. A novel strategy proposes to repurpose established medical treatments of known safety and to investigate their potential antidepressant activity. Among numerous candidates, growing evidence suggests that statins may have a positive role in the treatment of depressive disorders, although some have raised concerns about possible depressogenic effects of these widely prescribed medications. This narrative review summarises relevant findings from translational studies implicating many interconnected neurobiological and neuropsychological, cardiovascular, endocrine-metabolic, and immunological mechanisms by which statins could influence mood. Also, the most recent clinical investigations on the effects of statins in depression are presented. Overall, the use of statins for the treatment of depressive symptoms cannot be recommended based on the available literature, though this might change as several larger, methodologically robust studies are being conducted. Nevertheless, statins can already be acknowledged as a driver of innovation in mental health, as they provide a novel perspective to the physical health of people with depression and for the development of more precise antidepressant treatments.
Collapse
Affiliation(s)
- Riccardo De Giorgi
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| |
Collapse
|
4
|
Stenzel C, Dalkner N, Unterrainer HF, Birner A, Bengesser SA, Fellendorf FT, Fink A, Fleischmann E, Lenger M, Maget A, Platzer M, Queissner R, Schönthaler E, Tmava-Berisha A, Reininghaus EZ. Effects of metabolic syndrome and obesity on suicidality in individuals with bipolar disorder. J Affect Disord 2022; 311:1-7. [PMID: 35580694 DOI: 10.1016/j.jad.2022.05.062] [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: 12/30/2021] [Revised: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The prevalence of metabolic syndrome and overweight/obesity is increased in bipolar disorder (BD) compared to the general population and is related to suicidality. The aim of this study was to examine the association between both the rate of suicidal ideation and suicide attempts and metabolic variables in individuals with BD. METHODS Anthropometric measures, socio-demographic data, suicide history and serum lipid levels were measured in 215 individuals with BD. Individuals were divided into normal weight, overweight and obese according to their body mass index (BMI), and metabolic syndrome was assessed using "The International Diabetes Federation"-criteria. RESULTS Of the 215 individuals studied, 80.9% reported suicidal ideation, 35.3% reported at least one suicide attempt and 30.7% were diagnosed with metabolic syndrome. Both metabolic syndrome and BMI were not related to suicide attempts. However, individuals with normal weight had more suicidal ideation than overweight individuals, while obese individuals did not differ from either group. Furthermore, there was no association between suicide attempts or suicidal ideation and serum lipid levels. LIMITATIONS The cross-sectional design of the study, a non-standardized questionnaire for suicidality, and not controlling the medication intake are limiting factors. CONCLUSION Contrary to expectations, a difference was found in the BMI categories and suicidal ideation, but not suicide attempts. Serum lipid levels were found to be unsuitable as possible biomarkers for suicidality in individuals with BD. Special attention should be paid to suicidal ideation and BMI rather than metabolic syndrome or lipid values when treating suicidal individuals with BD.
Collapse
Affiliation(s)
- Christoph Stenzel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.
| | - Human-Friedrich Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria; Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria; Institute of Religious Studies, University of Vienna, Vienna, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Andreas Fink
- Institute of Psychology, University of Graz, Graz, Austria
| | - Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Elena Schönthaler
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| |
Collapse
|
5
|
Johnston JN, Campbell D, Caruncho HJ, Henter ID, Ballard ED, Zarate CA. Suicide Biomarkers to Predict Risk, Classify Diagnostic Subtypes, and Identify Novel Therapeutic Targets: 5 Years of Promising Research. Int J Neuropsychopharmacol 2022; 25:197-214. [PMID: 34865007 PMCID: PMC8929755 DOI: 10.1093/ijnp/pyab083] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/02/2021] [Accepted: 11/30/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Suicide is a global health crisis. However, no objective biomarkers of suicide risk currently exist, and self-reported data can be unreliable, which limits prediction, diagnostic, and treatment efforts. Reliable biomarkers that can differentiate between diagnostic subgroups, predict worsening symptoms, or suggest novel therapeutic targets would be extremely valuable for patients, researchers, and clinicians. METHODS MEDLINE was searched for reports published between 2016 and 2021 using search terms (suicid*) AND (biomarker*) OR (indicat*). Reports that compared biomarkers between suicidal ideation, suicide attempt, death from suicide, or any suicide subgroup against other neuropsychiatric disorders were included. Studies exclusively comparing suicidal behavior or death from suicide with healthy controls were not included to ensure that biomarkers were specific to suicide and not other psychopathology. RESULTS This review summarizes the last 5 years of research into suicide-associated biomarkers and provides a comprehensive guide for promising and novel biomarkers that encompass varying presentations of suicidal ideation, suicide attempt, and death by suicide. The serotonergic system, inflammation, hypothalamic-pituitary-adrenal axis, lipids, and endocannabinoids emerged as the most promising diagnostic, predictive, and therapeutic indicators. CONCLUSIONS The utility of diagnostic and predictive biomarkers is evident, particularly for suicide prevention. While larger-scale studies and further in-depth research are required, the last 5 years of research has uncovered essential biomarkers that could ultimately improve predictive strategies, aid diagnostics, and help develop future therapeutic targets.
Collapse
Affiliation(s)
- Jenessa N Johnston
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Darcy Campbell
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Hector J Caruncho
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| |
Collapse
|
6
|
Zhou CH, Xue F, Shi QQ, Xue SS, Zhang T, Ma XX, Yu LS, Liu C, Wang HN, Peng ZW. The Impact of Electroacupuncture Early Intervention on the Brain Lipidome in a Mouse Model of Post-traumatic Stress Disorder. Front Mol Neurosci 2022; 15:812479. [PMID: 35221914 PMCID: PMC8866946 DOI: 10.3389/fnmol.2022.812479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
The neuroprotective effect of electroacupuncture (EA) treatment has been well studied; growing evidence suggests that changes in lipid composition may be involved in the pathogenesis of post-traumatic stress disorder (PTSD) and may be a target for treatment. However, the influence of early EA intervention on brain lipid composition in patients with PTSD has never been investigated. Using a modified single prolonged stress (mSPS) model in mice, we assessed the anti-PTSD-like effects of early intervention using EA and evaluated changes in lipid composition in the hippocampus and prefrontal cortex (PFC) using a mass spectrometry-based lipidomic approach. mSPS induced changes in lipid composition in the hippocampus, notably in the content of sphingolipids, glycerolipids, and fatty acyls. These lipid changes were more robust than those observed in the PFC. Early intervention with EA after mSPS ameliorated PTSD-like behaviors and partly normalized mSPS-induced lipid changes, notably in the hippocampus. Cumulatively, our data suggest that EA may reverse mSPS-induced PTSD-like behaviors due to region-specific regulation of the brain lipidome, providing new insights into the therapeutic mechanism of EA.
Collapse
Affiliation(s)
- Cui-Hong Zhou
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
- Department of Toxicology, Shaanxi Key Lab of Free Radical Biology and Medicine, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi’an, China
| | - Fen Xue
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
- Department of Toxicology, Shaanxi Key Lab of Free Radical Biology and Medicine, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi’an, China
| | - Qing-Qing Shi
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Shan-Shan Xue
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Tian Zhang
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Xin-Xu Ma
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Li-Sheng Yu
- Department of General Medicine, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Chuang Liu
- Department of Obstetrics, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
- Department of Toxicology, Shaanxi Key Lab of Free Radical Biology and Medicine, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi’an, China
- *Correspondence: Hua-Ning Wang,
| | - Zheng-Wu Peng
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi’an, China
- Zheng-Wu Peng,
| |
Collapse
|
7
|
Zhang Q, Zhao S, Liu Z, Luo B, Yang Y, Shi Y, Geng F, Xia L, Zhang K, Liu H. Association of thyroid-stimulating hormone and lipid levels with suicide attempts among adolescents with major depressive disorder in China. Front Psychiatry 2022; 13:1031945. [PMID: 36733417 PMCID: PMC9887045 DOI: 10.3389/fpsyt.2022.1031945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Evidence suggested that thyroid-stimulating hormone (TSH) and lipid levels were associated with major depressive disorder (MDD). However, its role in suicide attempts in adolescents with MDD was unclear. This investigation was to probe into the relationship between TSH, lipid levels, and attempted suicide in adolescents with MDD. METHODS A total of 179 adolescents with MDD were included from January 2021 to January 2022. Socio-demographic data and clinical data were obtained through self-made questionnaires. TSH and lipid levels were analyzed by a recognized laboratory. The Epidemiological Studies Depression Scale (CES-D) was used to assess the severity of depression. Questions about whether there was a behavior of suicide attempts were completed through conversation interviews. RESULTS Results showed that the CES-D total score, TSH, and low-density lipoprotein cholesterol (LDL-C) of suicide attempters were significantly higher than those of non-suicide attempters. Ordinary family relationships were more likely to attempt suicide than good family relationships. The CES-D total score, ordinary family relationships, TSH and LDL-C were still significant in binary logistic regression, with an adjusted odds ratio (OR) of 1.04, 3.42, 5.14, and 1.76, respectively. The area under the receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) ranged from 0.60 to 0.74. CONCLUSION Suicide attempts are common among adolescents with MDD and were associated with CES-D total score, ordinary family relationships, TSH, and LDL-C. Given the association between suicide attempts and TSH and LDL-C, the dynamic changes in TSH and LDL-C levels should be detected regularly.
Collapse
Affiliation(s)
- Qing Zhang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Shuyi Zhao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Zhichun Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Bei Luo
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yingying Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yudong Shi
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Feng Geng
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Kai Zhang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| |
Collapse
|
8
|
González-Castro TB, Genis-Mendoza AD, León-Escalante DI, Hernández-Díaz Y, Juárez-Rojop IE, Tovilla-Zárate CA, López-Narváez ML, Marín-Medina A, Nicolini H, Castillo-Avila RG, Ramos-Méndez MÁ. Possible Association of Cholesterol as a Biomarker in Suicide Behavior. Biomedicines 2021; 9:biomedicines9111559. [PMID: 34829788 PMCID: PMC8615563 DOI: 10.3390/biomedicines9111559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Suicides and suicidal behavior are major causes of mortality and morbidity in public health and are a global problem. Various authors have proposed changes in lipid metabolism (total cholesterol decrease) as a possible biological marker for suicidal behavior. The objective of this study was to review the studies that have demonstrated a relationship between serum cholesterol levels and suicidal behavior and to describe the possible pathophysiological mechanisms that associate changes in cholesterol concentration and suicidal behavior. Relevant literature related to serum cholesterol levels and suicidal behavior was identified through various database searches. The data from the existing literature present the findings that relate low cholesterol levels and possible pathophysiological mechanisms (neuroinflammation, serotonergic neurotransmission), genes related to cholesterol synthesis, pharmacological treatments that alter lipid metabolism and the possible participation in suicidal behavior. Nevertheless, future research is required to describe how serum cholesterol affects cholesterol metabolism in the CNS to establish and understand the role of cholesterol in suicidal behavior.
Collapse
Affiliation(s)
- Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86205, Tabasco, Mexico; (T.B.G.-C.); (Y.H.-D.)
| | - Alma Delia Genis-Mendoza
- Departamento de Genética Psiquiátrica, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico;
| | - Dulce Ivannia León-Escalante
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86650, Tabasco, Mexico;
| | - Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86205, Tabasco, Mexico; (T.B.G.-C.); (Y.H.-D.)
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico; (I.E.J.-R.); (R.G.C.-A.); (M.Á.R.-M.)
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86650, Tabasco, Mexico;
- Correspondence: (C.A.T.-Z.); (H.N.); Tel.: +52-9933581500 (ext. 6900) (C.A.T.-Z.); +52-53501900 (ext. 1197) (H.N.)
| | - María Lilia López-Narváez
- Secretaría de Salud de Chiapas, Hospital Chiapas Nos Une “Dr. Gilberto Gómez Maza”, Tuxtla Gutiérrez 29045, Chiapas, Mexico;
| | | | - Humberto Nicolini
- Departamento de Genética Psiquiátrica, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico;
- Correspondence: (C.A.T.-Z.); (H.N.); Tel.: +52-9933581500 (ext. 6900) (C.A.T.-Z.); +52-53501900 (ext. 1197) (H.N.)
| | - Rosa Giannina Castillo-Avila
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico; (I.E.J.-R.); (R.G.C.-A.); (M.Á.R.-M.)
| | - Miguel Ángel Ramos-Méndez
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico; (I.E.J.-R.); (R.G.C.-A.); (M.Á.R.-M.)
| |
Collapse
|
9
|
Chen S, Lee J, Truong TM, Alhassen S, Baldi P, Alachkar A. Age-Related Neurometabolomic Signature of Mouse Brain. ACS Chem Neurosci 2021; 12:2887-2902. [PMID: 34283556 DOI: 10.1021/acschemneuro.1c00259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Neurometabolites are the ultimate gene products in the brain and the most precise biomolecular indicators of brain endophenotypes. Metabolomics is the only "omics" that provides a moment-to-moment "snapshot" of brain circuits' biochemical activities in response to external stimuli within the context of specific genetic variations. Although the expression levels of neurometabolites are highly dynamic, the underlying metabolic processes are tightly regulated during brain development, maturation, and aging. Therefore, this study aimed to identify mouse brain metabolic profiles in neonatal and adult stages and reconstruct both the active metabolic network and the metabolic pathway functioning. Using high-throughput metabolomics and bioinformatics analyses, we show that the neonatal mouse brain has its distinct metabolomic signature, which differs from the adult brain. Furthermore, lipid metabolites showed the most profound changes between the neonatal and adult brain, with some lipid species reaching 1000-fold changes. There were trends of age-dependent increases and decreases among lipids and non-lipid metabolites, respectively. A few lipid metabolites such as HexCers and SHexCers were almost absent in neonatal brains, whereas other non-lipid metabolites such as homoarginine were absent in the adult brains. Several molecules that act as neurotransmitters/neuromodulators showed age-dependent levels, with adenosine and GABA exhibiting around 100- and 10-fold increases in the adult compared with the neonatal brain. Of particular interest is the observation that purine and pyrimidines nucleobases exhibited opposite age-dependent changes. Bioinformatics analysis revealed an enrichment of lipid biosynthesis pathways in metabolites, whose levels increased in adult brains. In contrast, pathways involved in the metabolism of amino acids, nucleobases, glucose (glycolysis), tricarboxylic acid cycle (TCA) were enriched in metabolites whose levels were higher in the neonatal brains. Many of these pathways are associated with pathological conditions, which can be predicted as early as the neonatal stage. Our study provides an initial age-related biochemical directory of the mouse brain and warrants further studies to identify temporal brain metabolome across the lifespan, particularly during adolescence and aging. Such neurometabolomic data may provide important insight about the onset and progression of neurological/psychiatric disorders and may ultimately lead to the development of precise diagnostic biomarkers and more effective preventive/therapeutic strategies.
Collapse
Affiliation(s)
- Siwei Chen
- Department of Computer Science, School of Information and Computer Sciences, University of California—Irvine, Irvine, California 92697, United States
- Institute for Genomics and Bioinformatics, School of Information and Computer Sciences, University of California—Irvine, Irvine, California 92697, United States
| | - Justine Lee
- Department of Pharmaceutical Sciences, School of Pharmacy, University of California—Irvine, Irvine, California 92697, United States
| | - Tri Minh Truong
- Department of Pharmaceutical Sciences, School of Pharmacy, University of California—Irvine, Irvine, California 92697, United States
| | - Sammy Alhassen
- Department of Pharmaceutical Sciences, School of Pharmacy, University of California—Irvine, Irvine, California 92697, United States
| | - Pierre Baldi
- Department of Computer Science, School of Information and Computer Sciences, University of California—Irvine, Irvine, California 92697, United States
- Institute for Genomics and Bioinformatics, School of Information and Computer Sciences, University of California—Irvine, Irvine, California 92697, United States
| | - Amal Alachkar
- Institute for Genomics and Bioinformatics, School of Information and Computer Sciences, University of California—Irvine, Irvine, California 92697, United States
- Department of Pharmaceutical Sciences, School of Pharmacy, University of California—Irvine, Irvine, California 92697, United States
| |
Collapse
|
10
|
Kułak-Bejda A, Bejda G, Lech M, Waszkiewicz N. Are Lipids Possible Markers of Suicide Behaviors? J Clin Med 2021; 10:jcm10020333. [PMID: 33477435 PMCID: PMC7830691 DOI: 10.3390/jcm10020333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 01/26/2023] Open
Abstract
Suicides and suicidal behaviors are very important causes of mortality and morbidity and have become a serious global problem. More than 800,000 people die from suicide every year. Previous researches have established that lipids play an important role in the pathogenesis of suicide. Moreover, lipid levels might be a biological marker of suicide. A lot of researchers have tried to identify biological markers that might be related to depressive disorder, bipolar disorder or schizophrenia and suicidal behavior. It was also important to consider the usefulness of an additional tool for prevention actions. Metabolic deregulation, particularly low total cholesterol and low-density lipoproteins-cholesterol levels may cause higher suicide risk in patients with these psychiatric disorders.
Collapse
Affiliation(s)
- Agnieszka Kułak-Bejda
- Department of Psychiatry, Medical University of Bialystok, 16-070 Choroszcz, Poland; (M.L.); (N.W.)
- Correspondence:
| | - Grzegorz Bejda
- Faculty of General Medicine, School of Medical Science in Bialystok, 15-875 Bialystok, Poland;
| | - Magdalena Lech
- Department of Psychiatry, Medical University of Bialystok, 16-070 Choroszcz, Poland; (M.L.); (N.W.)
| | - Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Bialystok, 16-070 Choroszcz, Poland; (M.L.); (N.W.)
| |
Collapse
|
11
|
Fusar-Poli L, Amerio A, Cimpoesu P, Natale A, Salvi V, Zappa G, Serafini G, Amore M, Aguglia E, Aguglia A. Lipid and Glycemic Profiles in Patients with Bipolar Disorder: Cholesterol Levels Are Reduced in Mania. ACTA ACUST UNITED AC 2020; 57:medicina57010028. [PMID: 33396922 PMCID: PMC7824186 DOI: 10.3390/medicina57010028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Bipolar disorder (BD) is a severe mental condition with a lifetime prevalence estimated around 2% among the general population. Due to risk factors, etiological mechanisms, and the chronic use of psychotropic medications, people with BD are frequently affected by medical comorbidities, such as metabolic syndrome (MetS), associated with altered blood levels of glucose, cholesterol, and triglycerides. Moreover, the lipid concentration may be associated with the severity of psychiatric symptoms. Materials and Methods: Five hundred and forty-two in- and outpatients (418 affected by BD and 124 affected by schizophrenia) were recruited in two Italian university hospitals. A blood examination assessing the fasting glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides was performed. Results: No significant differences were found in the lipid and glycemic profiles between patients with BD and schizophrenia. When considering only the BD sample, we found that patients experiencing a manic episode had significantly lower total cholesterol, HDL, and LDL than euthymic patients. Moreover, the total and LDL cholesterol levels were significantly lower in (hypo)manic than depressed patients. Mood episodes did not influence the triglyceride and glucose levels in our sample. Conclusions: Clinicians should pay attention to blood cholesterol levels in patients with BD, as differences in concentrations may predispose them to severe medical conditions and can be associated with the onset of mood episodes.
Collapse
Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
- Correspondence: ; Tel.: +39-095-378-2470
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, MA 02111, USA
| | - Patriciu Cimpoesu
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
| | - Virginio Salvi
- Department of Clinical Neurosciences, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Guendalina Zappa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| |
Collapse
|
12
|
The biology of aggressive behavior in bipolar disorder: A systematic review. Neurosci Biobehav Rev 2020; 119:9-20. [DOI: 10.1016/j.neubiorev.2020.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 01/04/2023]
|
13
|
Xue SS, Zhou CH, Xue F, Liu L, Cai YH, Luo JF, Wang Y, Tan QR, Wang HN, Peng ZW. The impact of repetitive transcranial magnetic stimulation and fluoxetine on the brain lipidome in a rat model of chronic unpredictable stress. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109946. [PMID: 32325156 DOI: 10.1016/j.pnpbp.2020.109946] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/18/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
The antidepressant effect of repetitive transcranial magnetic stimulation (rTMS) has been extensively studied; growing evidence suggests that changes in lipid composition may be involved in the pathogenesis of depression and may be a targeted mechanism for treatment. However, the influence of rTMS on lipid composition and the differences between these effects compared to antidepressants like fluoxetine (Flx) have never been investigated. Using a chronic unpredictable stress (CUS) model in rats, we assessed the antidepressive effects of rTMS and Flx treatments and evaluated changes in lipid composition in the hippocampus and prefrontal cortex (PFC) using a mass spectrometry-based lipidomic approach. Both rTMS and Flx treatments ameliorated depressive-like behaviors induced by CUS. Moreover, changes in lipid composition, especially glycerophospholipids, sphingolipids, and glycerolipids induced by CUS in the hippocampus were more robust than those observed in the PFC. CUS led to decreased levels of 20 carbon-containing fatty acyls and polyunsaturated fatty acyls in the PFC, and decreased levels of acyl carnitines (AcCa) in both the hippocampus and PFC. Notably, rTMS treatment had higher impact than Flx on composition of glycerophospholipids and sphingolipids in the hippocampus that were altered by CUS, while Flx attenuated CUS-induced changes in the PFC to a greater extent than rTMS. However, neither was able to restore fatty acyls and AcCa to baseline levels. Altogether, modulation of the brain lipidome may be involved in the antidepressant action of rTMS and Flx, and the degree to which these treatments induce changes in lipid composition within the hippocampus and PFC might explain their differential antidepressant effects.
Collapse
Affiliation(s)
- Shan-Shan Xue
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; Department of Toxicology, Shaanxi Key Lab of Free Radical Biology and Medicine, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an 710032, China
| | - Cui-Hong Zhou
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; Department of Toxicology, Shaanxi Key Lab of Free Radical Biology and Medicine, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an 710032, China
| | - Fen Xue
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Ling Liu
- Institute of Neuroscience, Fourth Military Medical University, Xi'an 710032, China
| | - Yan-Hui Cai
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Jian-Feng Luo
- Department of Pediatrics, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Ying Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Qing-Rong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Zheng-Wu Peng
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; Department of Toxicology, Shaanxi Key Lab of Free Radical Biology and Medicine, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an 710032, China.
| |
Collapse
|
14
|
Bartoli F, Misiak B, Crocamo C, Carrà G. Glial and neuronal markers in bipolar disorder: A meta-analysis testing S100B and NSE peripheral blood levels. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109922. [PMID: 32171903 DOI: 10.1016/j.pnpbp.2020.109922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 01/11/2023]
Abstract
S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE) might be peripheral markers reflecting glia and neuronal abnormalities in subjects with bipolar disorder. We carried out a systematic review and meta-analysis, searching for studies indexed in main electronic databases, to clarify whether S100B and NSE blood levels might be increased in bipolar disorder. Eleven studies met eligibility criteria, with data on S100B levels and/or NSE levels in subjects with bipolar disorder and healthy controls, respectively. Random-effects meta-analysis estimated higher levels of S100B in bipolar disorder (standardized mean difference [SMD] = 0.81; p < .001), with some inconsistency across studies (I2 = 81.7%). Findings were confirmed by relevant sensitivity analyses. Meta-regression analyses did not estimate any effect for tested covariates. On the other hand, no differences in NSE levels between individuals with bipolar disorder and healthy controls were estimated (SMD = -0.32; p = .374), with high heterogeneity across studies (I2 = 89.9%). Meta-regression analyses showed that the effect size was influenced by both mean age (p < .001) and illness duration (p = .001) of subjects with bipolar disorders. Our findings support the hypothesis of a possible role of glial abnormalities in the pathophysiology of bipolar disorder.
Collapse
Affiliation(s)
- Francesco Bartoli
- Department of Mental Health and Addiction, ASST Nord Milano, Milano, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Wroclaw, Poland
| | - Cristina Crocamo
- Department of Mental Health and Addiction, ASST Nord Milano, Milano, Italy
| | - Giuseppe Carrà
- Department of Mental Health and Addiction, ASST Nord Milano, Milano, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Division of Psychiatry, University College London, London, UK
| |
Collapse
|
15
|
González-Castro TB, Almeida de la O PDLA, Tovilla-Zárate CA, López-Narváez ML, Genis Mendoza AD, Juárez-Rojop IE, Pérez-Hernández N, Rodriguez-Perez JM. Evaluation of leptin levels in serum as a biomarker for suicide behavior: systematic review and meta-analysis. Int J Neurosci 2020; 131:49-55. [PMID: 32083967 DOI: 10.1080/00207454.2020.1733558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: We conducted a meta-analysis of case-control studies to determine whether leptin levels in serum contribute to the pathogenesis of suicide behavior.Methods: PubMed, EBSCO and Science Direct databases were used to search for relevant articles published before January 2020. The systematic review included nine case-control studies that measured leptin levels. The standardized mean difference (d) and 95% confidence intervals were calculated in a fixed-effects model and a random-effects model when appropriate.Results: The results of our meta-analysis indicated that individuals with suicide behavior presented reduced levels of leptin (d: -1.80, 95% CI: -2.21 to -01.38 ng/ml, I2 = 0, p(Q) = 0.59). Sensitivity and publication bias analyses confirmed these results.Conclusions: The current meta-analysis suggests that leptin levels might be associated with an increased risk of suicide behavior. However, more studies including larger sample sizes are needed to reach conclusive result.
Collapse
Affiliation(s)
| | | | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. Manuel Velasco Suarez", Secretaría de Salud, Yajalón, Chiapas, México
| | - Alma Delia Genis Mendoza
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - José Manuel Rodriguez-Perez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| |
Collapse
|
16
|
Abstract
In the search for biomarkers and modifiable risk factors for suicide, lipid status has garnered considerable interest, although the lipid-suicide connection is not without controversy. Major categories of lipids that have been reported as germane to suicide include sterols and polyunsaturated fatty acids (PUFAs). Research concerning lipid effects on mood and suicide risk includes epidemiologic approaches, cohort studies, and clinical trials. In general, current evidence suggests that higher n-3 relative to n-6 PUFA intake may have beneficial effects on depression and suicide risk, particularly in women, while low cholesterol may be detrimental in both sexes. Additionally, low estrogen in women has been associated with suicide attempts, whereas high androgen loads may contribute to the higher suicide completion rate in men. Basic and translational research provides strong evidence for several potential mechanisms that have been implicated in depression and suicide. Firstly, PUFAs, cholesterol, and estrogen can interact to influence structure and function of membrane microdomains ("lipid rafts"), with potential regulatory effects on inflammation and signal transduction, including monoaminergic signaling. Secondly, PUFAs bind to and activate peroxisome proliferator-activated receptors (PPARs), nuclear receptors that regulate gene expression, with resultant effects on inflammation and bioenergetics. Thirdly, PUFAs are both a target for and a hormetic regulator of oxidative stress. Critical to a greater understanding of lipid status as a suicide risk predictor and treatment target will be studies that map genomic and phenotypic characteristics of individuals whose emotional state is affected most by lipid status. Also important will be a more nuanced understanding of lipid-lipid interactions and the differential roles of lipid subclasses on suicide risk.
Collapse
Affiliation(s)
- M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA.
| |
Collapse
|
17
|
Abstract
Suicide is a relevant worldwide public health problem. Many studies have shown that different demographic and clinical factors are potentially associated with suicidal behavior. Other studies have reported data about the role of biomarkers in the onset of suicidal behaviors. Specifically, researchers have found that suicidal risk may be increased by abnormalities in serotonergic system, hypothalamic-pituitary-adrenal axis, lipid metabolism, immune system and neuronal plasticity. The identification of specific biological parameters associated with self-harm may be helpful to implement prevention strategies and also to detect new therapeutic strategies. In this review, we summarize and analyze the results of main studies about neurobiological mechanisms related to suicidal behavior, also exploring the possible interconnection between the different biological systems.
Collapse
|
18
|
Su M, Li E, Tang C, Zhao Y, Liu R, Gao K. Comparison of blood lipid profile/thyroid function markers between unipolar and bipolar depressed patients and in depressed patients with anhedonia or suicidal thoughts. Mol Med 2019; 25:51. [PMID: 31747876 PMCID: PMC6865003 DOI: 10.1186/s10020-019-0119-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/05/2019] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to investigate the differences in the serum levels of glucose, lipid, and thyroid function markers between unipolar and bipolar depressed patients, as well as the effect of anhedonia and suicidal thoughts on the levels of these biochemical parameters. Methods A total of 287 unmedicated depressed patients from January 2016 to December 2017 were included in this study, including 92 bipolar depressions and 195 unipolar depressions. Anhedonia was determined using the item 32 of Symptom Checklist (SCL-90). Suicide ideation was assessed by item 15 of SCL-90. Results The bipolar group had significantly lower lipid levels (including triglycerides, cholesterol, low-density lipoprotein cholesterol [LDL], very low-density lipoprotein cholesterol [VLDL]) and insulin resistance index but higher levels of prolactin, low triiodothyronine (T3) and free T3 (FT3) as well as higher incidence of anhedonia as compared with the unipolar group. Depressed patients with anhedonia had significantly higher LDL level than those without anhedonia. Depressed patients with suicidal thoughts had cholesterol and high-density lipoprotein cholesterol (HDL) level. The above-mentioned differences were confirmed by logistic regression analysis. Receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve (AUC) ranged from 0.546 to 0.685. Conclusion Triglycerides, cholesterol, LDL, VLDL T3, FT3 levels were significantly different between unipolar and bipolar depressed patients, which might have the potential to be the markers for differential diagnosis. Patients with anhedonia had lower LDL level, while patients with suicidal thoughts had higher levels of cholesterol and HDL as compared with the corresponding control groups.
Collapse
Affiliation(s)
- Meilei Su
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China.
| | - Enze Li
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Chong Tang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Yongzhi Zhao
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
| | - Ruqing Liu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Keming Gao
- Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry, Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
19
|
Ma YJ, Wang DF, Yuan M, Zhang XJ, Long J, Chen SB, Wu QX, Wang XY, Patel M, Verrico CD, Liu TQ, Zhang XY. The prevalence, metabolic disturbances and clinical correlates of recent suicide attempts in Chinese inpatients with major depressive disorder. BMC Psychiatry 2019; 19:144. [PMID: 31077181 PMCID: PMC6509770 DOI: 10.1186/s12888-019-2131-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/30/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Metabolic disturbances have been correlated with suicidality, but little is known about the association between suicide risk and metabolic disturbances among individuals with depression. This study was to evaluate the prevalence and clinical correlations, especially cardio-metabolic associated factors of recent suicide attempts in Chinese patients with major depressive disorder (MDD). METHODS A total of 288 MDD inpatients were recruited. Their clinical and demographic data together with plasma glucose, lipid and thyroid function parameters were collected. Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) and Eysenck Personality Questionnaire (EPQ) were rated for most of the patients. RESULTS Of these MDD inpatients, 20.14% had attempted suicide during the past 1 month. Compared to those who had not attempted suicide, the suicide attempters had a significantly longer duration of illness, lower low-density lipoprotein (LDL) cholesterol, lower total cholesterol, and more psychotic symptoms. However, all these significant results did not survive after the bonferroni correction (all p > 0.05). A logistic regression analysis indicated that suicide attempts were associated with the lower total cholesterol and more psychotic symptoms. CONCLUSIONS Our findings support the hypothesis of the association of low plasma cholesterol level and recent suicidal attempts in patients with MDD.
Collapse
Affiliation(s)
- Yue-Jiao Ma
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Dong-Fang Wang
- Psychosomatic Health Institute of the Third Xiangya Hospital, Central South University, Changsha, Hunan People’s Republic of China
| | - Ming Yuan
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Xiao-Jie Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Jiang Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Shu-Bao Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Qiu-Xia Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Xu-Yi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Marguerite Patel
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - Christopher D. Verrico
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - Tie-Qiao Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Xiang-Yang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX 77054 USA
| |
Collapse
|
20
|
Capuzzi E, Bartoli F, Crocamo C, Malerba MR, Clerici M, Carrà G. Recent suicide attempts and serum lipid profile in subjects with mental disorders: A cross-sectional study. Psychiatry Res 2018; 270:611-615. [PMID: 30384279 DOI: 10.1016/j.psychres.2018.10.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/20/2018] [Accepted: 10/21/2018] [Indexed: 12/14/2022]
Abstract
Peripheral biomarkers for suicide have been studied generating mixed results. We investigated the association between serum lipid levels and suicide attempts in subjects with different mental disorders. We conducted a cross-sectional study, including 593 inpatients with schizophrenia spectrum, bipolar, major depressive, and personality disorders, hypothesizing that subjects with lower total cholesterol levels would have higher rates of recent suicide attempts. Contrary to our hypothesis, individuals with lower total cholesterol levels (<160 mg/dL) showed lower rates also of suicide attempts (OR adjusted for age and gender: 0.56; one-tailed p = 0.03). Further logistic regression models failed to estimate any association of continuous levels between total/low-density lipoprotein (LDL) cholesterol/ triglycerides, and suicide attempts, also considering diagnosis and suicide methods. An association between lipid profile and suicide attempts in subjects with mental disorders is not fully supported. Further research is needed to clarify the role of biomarkers in suicidal behaviors.
Collapse
Affiliation(s)
- Enrico Capuzzi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza (MB) 20900, Italy.
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza (MB) 20900, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza (MB) 20900, Italy
| | - Maria Rosaria Malerba
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza (MB) 20900, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza (MB) 20900, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza (MB) 20900, Italy; Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| |
Collapse
|
21
|
Liang Y, Yang M, Zhao G, Mao Y, Zhang L, Hu Z. Relationship between mortality in people with mental disorders and suicide mortality in China during 2000 to 2014: An observational study. Medicine (Baltimore) 2018; 97:e13359. [PMID: 30544403 PMCID: PMC6310536 DOI: 10.1097/md.0000000000013359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Suicide is one of the top 10 causes of death in many countries. Although there are many studies on mental disorders, few studies have examined mortality in suicide population and mentally ill population. This study examined the association between mortality and mental disorders using data on suicides and mental disorders in China. Data from China's Health and Family Planning Statistical Yearbook for 2000 to 2014 were used to analyze the relationship between mortality associated with suicide and mental disorders. The analyses found that mortality among people with mental disorders dropped from 5.42/10 million in 2000 to 2.68/10 million in 2014, decreased more among females than males, and differed between urban and rural areas; that suicide mortality dropped from 10.79/10 million in 2000 to 6.79/10 million in 2014; the decrease was greater in women than in men, with suicide being highest among male residents of cities; and no significant correlation was found between mortality among persons with mental disorders and suicide mortality. There was no correlation between suicide mortality and mental-disorder mortality during 2000 to 2014; however, overall mortality decreased more among females than males during this period.
Collapse
Affiliation(s)
- Yundan Liang
- Department of Pathology and Pathophysiology, Chengdu Medical College
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan
| | - Gaofeng Zhao
- Mental Health Hospital of Jining, Jining, Shandong
| | - Yuanyi Mao
- Department of Forensic Psychiatry, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lushun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College
| | - Zeqing Hu
- Department of Forensic Psychiatry, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
22
|
Berardelli I, Corigliano V, Hawkins M, Comparelli A, Erbuto D, Pompili M. Lifestyle Interventions and Prevention of Suicide. Front Psychiatry 2018; 9:567. [PMID: 30459660 PMCID: PMC6232529 DOI: 10.3389/fpsyt.2018.00567] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/18/2018] [Indexed: 12/26/2022] Open
Abstract
Over the past years, there has been a growing interest in the association between lifestyle psychosocial interventions, severe mental illness, and suicide risk. Patients with severe mental disorders have higher mortality rates, poor health states, and higher suicide risk compared to the general population. Lifestyle behaviors are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. The current article provides a comprehensive review of the literature on lifestyle interventions, mental health, and suicide risk in the general population and in patients with psychiatric disorders. For this purpose, we investigated lifestyle behaviors and lifestyle interventions in three different age groups: adolescents, young adults, and the elderly. Several lifestyle behaviors including cigarette smoking, alcohol use, and sedentary lifestyle are associated with suicide risk in all age groups. In adolescents, growing attention has emerged on the association between suicide risk and internet addiction, cyberbullying and scholastic and family difficulties. In adults, psychiatric symptoms, substance and alcohol abuse, weight, and occupational difficulties seems to have a significant role in suicide risk. Finally, in the elderly, the presence of an organic disease and poor social support are associated with an increased risk of suicide attempt. Several factors may explain the association between lifestyle behaviors and suicide. First, many studies have reported that some lifestyle behaviors and its consequences (sedentary lifestyle, cigarette smoking underweight, obesity) are associated with cardiometabolic risk factors and with poor mental health. Second, several lifestyle behaviors may encourage social isolation, limiting the development of social networks, and remove individuals from social interactions; increasing their risk of mental health problems and suicide.
Collapse
Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentina Corigliano
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michael Hawkins
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anna Comparelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
23
|
Gómez-Peralta TG, González-Castro TB, Fresan A, Tovilla-Zárate CA, Juárez-Rojop IE, Villar-Soto M, Hernández-Díaz Y, López-Narváez ML, Ble-Castillo JL, Pérez-Hernández N, Rodríguez-Pérez JM. Risk Factors and Prevalence of Suicide Attempt in Patients with Type 2 Diabetes in the Mexican Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1198. [PMID: 29880751 PMCID: PMC6025580 DOI: 10.3390/ijerph15061198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND It has been proposed that the risk of death by suicide is higher in patients with diabetes than in the general population. Therefore, it is necessary to investigate the risk factors of suicidal behavior in patients with type 2 diabetes. The aim of the present study was to analyze the prevalence of suicide attempt and determine the risk factors of suicide attempt, in patients with type 2 diabetes in a Mexican population. METHODS Clinic characteristics, anthropometric measurements, biochemical levels, depression, and suicidal behavior were evaluated in 185 Mexican patients with type 2 diabetes. A multivariate logistic regression analysis was performed to find predictive factors of suicide attempt. RESULTS 11.4% of patients reported previous suicide attempts n = 21). Younger patients (OR: 3.63, 95% CI: 1.29⁻10.19), having depression (OR: 3.33, 95% CI: 1.13⁻9.76) and normal BMI (OR: 3.14, 95% CI: 1.11⁻8.83), were predictive factors of suicide attempt. No other variables in the study showed statistical significance. CONCLUSIONS Our results showed a high prevalence of suicidal behavior in patients with type 2 diabetes. We found that younger age, depression and normal BMI could be risk factors of suicide attempt in these patients. Therefore, psychiatric interventions to prevent depression and suicidal behavior in this population are necessary. New studies using larger samples are necessary to replicate and confirm these results.
Collapse
Affiliation(s)
- Tania Guadalupe Gómez-Peralta
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86025, Tabasco, Mexico.
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86200, Tabasco, Mexico.
| | - Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de Mexico 14370, Mexico.
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86025, Tabasco, Mexico.
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86140, Tabasco, Mexico.
| | - Mario Villar-Soto
- Hospital de Alta Especialidad "Gustavo A. Rovirosa Pérez", Secretaría de Salud, Villahermosa 86140, Tabasco, Mexico.
| | - Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86200, Tabasco, Mexico.
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. Manuel Velasco Suarez", Secretaría de Salud, Yajalón 29930, Chiapas, Mexico.
| | - Jorge L Ble-Castillo
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86140, Tabasco, Mexico.
| | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico 14080, Mexico.
| | - José Manuel Rodríguez-Pérez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico 14080, Mexico.
| |
Collapse
|