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Kaiser J, Nay K, Horne CR, McAloon LM, Fuller OK, Muller AG, Whyte DG, Means AR, Walder K, Berk M, Hannan AJ, Murphy JM, Febbraio MA, Gundlach AL, Scott JW. CaMKK2 as an emerging treatment target for bipolar disorder. Mol Psychiatry 2023; 28:4500-4511. [PMID: 37730845 PMCID: PMC10914626 DOI: 10.1038/s41380-023-02260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
Current pharmacological treatments for bipolar disorder are inadequate and based on serendipitously discovered drugs often with limited efficacy, burdensome side-effects, and unclear mechanisms of action. Advances in drug development for the treatment of bipolar disorder remain incremental and have come largely from repurposing drugs used for other psychiatric conditions, a strategy that has failed to find truly revolutionary therapies, as it does not target the mood instability that characterises the condition. The lack of therapeutic innovation in the bipolar disorder field is largely due to a poor understanding of the underlying disease mechanisms and the consequent absence of validated drug targets. A compelling new treatment target is the Ca2+-calmodulin dependent protein kinase kinase-2 (CaMKK2) enzyme. CaMKK2 is highly enriched in brain neurons and regulates energy metabolism and neuronal processes that underpin higher order functions such as long-term memory, mood, and other affective functions. Loss-of-function polymorphisms and a rare missense mutation in human CAMKK2 are associated with bipolar disorder, and genetic deletion of Camkk2 in mice causes bipolar-like behaviours similar to those in patients. Furthermore, these behaviours are ameliorated by lithium, which increases CaMKK2 activity. In this review, we discuss multiple convergent lines of evidence that support targeting of CaMKK2 as a new treatment strategy for bipolar disorder.
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Affiliation(s)
- Jacqueline Kaiser
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
- St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - Kevin Nay
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
| | - Christopher R Horne
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
| | - Luke M McAloon
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
- St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - Oliver K Fuller
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
| | - Abbey G Muller
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
| | - Douglas G Whyte
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - Anthony R Means
- Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ken Walder
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, 3052, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Anthony J Hannan
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3052, Australia
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - James M Murphy
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Mark A Febbraio
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
| | - Andrew L Gundlach
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia
- St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3052, Australia
- Department of Anatomy and Physiology, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - John W Scott
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, 3052, Australia.
- St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia.
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3052, Australia.
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2
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Li HJ, Goff A, Rudzinskas SA, Jung Y, Dubey N, Hoffman J, Hipolito D, Mazzu M, Rubinow DR, Schmidt PJ, Goldman D. Altered estradiol-dependent cellular Ca 2+ homeostasis and endoplasmic reticulum stress response in Premenstrual Dysphoric Disorder. Mol Psychiatry 2021; 26:6963-6974. [PMID: 34035477 PMCID: PMC8613306 DOI: 10.1038/s41380-021-01144-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 02/04/2023]
Abstract
Premenstrual Dysphoric Disorder (PMDD) is characterized by debilitating mood symptoms in the luteal phase of the menstrual cycle. Prior studies of affected women have implicated a differential response to ovarian steroids. However, the molecular basis of these patients' differential response to hormone remains poorly understood. We performed transcriptomic analyses of lymphoblastoid cell lines (LCLs) derived from women with PMDD and asymptomatic controls cultured under untreated (steroid-free), estradiol-treated (E2), and progesterone-treated (P4) conditions. Weighted gene correlation network analysis (WGCNA) of transcriptomes identified four gene modules with significant diagnosis x hormone interactions, including one enriched for neuronal functions. Next, in a gene-level analysis comparing transcriptional response to hormone across diagnoses, a generalized linear model identified 1522 genes differentially responsive to E2 (E2-DRGs). Among the top 10 E2-DRGs was a physically interacting network (NUCB1, DST, GCC2, GOLGB1) involved in endoplasmic reticulum (ER)-Golgi function. qRT-PCR validation reproduced a diagnosis x E2 interaction (F(1,24)=7.01, p = 0.014) for NUCB1, a regulator of cellular Ca2+ and ER stress. Finally, we used a thapsigargin (Tg) challenge assay to test whether E2 induces differences in Ca2+ homeostasis and ER stress response in PMDD. PMDD LCLs had a 1.36-fold decrease in Tg-induced XBP1 splicing response compared to controls, and a 1.62-fold decreased response (p = 0.005), with a diagnosis x treatment interaction (F(3,33)=3.51, p = 0.026) in the E2-exposed condition. Altered hormone-dependent in cellular Ca2+ dynamics and ER stress may contribute to the pathophysiology of PMDD.
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Affiliation(s)
- Howard J. Li
- grid.47100.320000000419368710Dept. of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT USA ,grid.416868.50000 0004 0464 0574Section on Behavioral Endocrinology, National Institute of Mental Health, NIH, Bethesda, MD USA
| | - Allison Goff
- grid.420085.b0000 0004 0481 4802Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, NIH, Bethesda, MD USA
| | - Sarah A. Rudzinskas
- grid.416868.50000 0004 0464 0574Section on Behavioral Endocrinology, National Institute of Mental Health, NIH, Bethesda, MD USA
| | - Yonwoo Jung
- grid.420085.b0000 0004 0481 4802Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, NIH, Bethesda, MD USA
| | - Neelima Dubey
- grid.416868.50000 0004 0464 0574Section on Behavioral Endocrinology, National Institute of Mental Health, NIH, Bethesda, MD USA
| | - Jessica Hoffman
- grid.416868.50000 0004 0464 0574Section on Behavioral Endocrinology, National Institute of Mental Health, NIH, Bethesda, MD USA
| | - Dion Hipolito
- grid.420085.b0000 0004 0481 4802Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, NIH, Bethesda, MD USA
| | - Maria Mazzu
- grid.416868.50000 0004 0464 0574Section on Behavioral Endocrinology, National Institute of Mental Health, NIH, Bethesda, MD USA
| | - David R. Rubinow
- grid.410711.20000 0001 1034 1720Dept. of Psychiatry, University of North Carolina, Chapel Hill, NC USA
| | - Peter J. Schmidt
- grid.416868.50000 0004 0464 0574Section on Behavioral Endocrinology, National Institute of Mental Health, NIH, Bethesda, MD USA
| | - David Goldman
- grid.420085.b0000 0004 0481 4802Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, NIH, Bethesda, MD USA
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3
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Atkinson LZ, Colbourne L, Smith A, Harmer CH, Nobre AC, Rendell J, Jones H, Hinds C, Mould A, Tunbridge EM, Cipriani A, Geddes JR, Saunders KEA, Harrison PJ. The Oxford study of Calcium channel Antagonism, Cognition, Mood instability and Sleep (OxCaMS): study protocol for a randomised controlled, experimental medicine study. Trials 2019; 20:120. [PMID: 30755265 PMCID: PMC6373140 DOI: 10.1186/s13063-019-3175-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023] Open
Abstract
Background The discovery that voltage-gated calcium channel genes such as CACNA1C are part of the aetiology of psychiatric disorders has rekindled interest in the therapeutic potential of L-type calcium channel (LTCC) antagonists. These drugs, licensed to treat hypertension and angina, have previously been used in bipolar disorder, but without clear results. Neither is much known about the broader effects of these drugs on the brain and behaviour. Methods The Oxford study of Calcium channel Antagonism, Cognition, Mood instability and Sleep (OxCaMS) is a high-intensity randomised, double-blind, placebo-controlled experimental medicine study on the effect of the LTCC antagonist nicardipine in healthy young adults with mood instability. An array of cognitive, psychiatric, circadian, physiological, biochemical and neuroimaging (functional magnetic resonance imaging and magnetoencephalography) parameters are measured during a 4-week period, with randomisation to drug or placebo on day 14. We are interested in whether nicardipine affects the stability of these measures, as well as its overall effects. Participants are genotyped for the CACNA1C risk polymorphism rs1006737. Discussion The results will clarify the potential of LTCC antagonists for repurposing or modification for use in psychiatric disorders in which cognition, mood and sleep are affected. Trial registration ISRCTN, ISRCTN33631053. Retrospectively registered on 8 June 2018 (applied 17 May 2018). Electronic supplementary material The online version of this article (10.1186/s13063-019-3175-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren Z Atkinson
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK
| | - Lucy Colbourne
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK
| | - Alexander Smith
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Catherine H Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK
| | - Anna C Nobre
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK.,Department of Experimental Psychology, University of Oxford, New Radcliffe House, Oxford, UK
| | - Jennifer Rendell
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Helen Jones
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Big Data Institute, University of Oxford, Old Road Campus, Oxford, UK
| | - Arne Mould
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Elizabeth M Tunbridge
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK. .,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK.
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4
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Tecelão D, Mendes A, Martins D, Fu C, Chaddock CA, Picchioni MM, McDonald C, Kalidindi S, Murray R, Prata DP. The effect of psychosis associated CACNA1C, and its epistasis with ZNF804A, on brain function. GENES BRAIN AND BEHAVIOR 2018; 18:e12510. [PMID: 30079586 DOI: 10.1111/gbb.12510] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/23/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
CACNA1C-rs1006737 and ZNF804A-rs1344706 polymorphisms are among the most robustly associated with schizophrenia (SCZ) and bipolar disorder (BD), and recently with brain phenotypes. As these patients show abnormal verbal fluency (VF) and related brain activation, we asked whether the latter was affected by these polymorphisms (alone and in interaction)-to better understand how they might induce risk. We recently reported effects on functional VF-related (for ZNF804A-rs1344706) and structural (for both) connectivity. We genotyped and fMRI-scanned 54 SCZ, 40 BD and 80 controls during VF. With SPM, we assessed the main effect of CACNA1C-rs1006737, and its interaction with ZNF804A-rs1344706, and their interaction with diagnosis, on regional brain activation and functional connectivity (psychophysiological interactions-PPI). Using public data, we reported effects of CACNA1C-rs1006737 and diagnosis on brain expression. The CACNA1C-rs1006737 risk allele was associated with increased activation, particularly in the bilateral prefronto-temporal cortex and thalamus; decreased PPI, especially in the left temporal cortex; and gene expression in white matter and the cerebellum. We also found unprecedented evidence for epistasis (interaction between genetic polymorphisms) in the caudate nucleus, thalamus, and cingulate and temporal cortical activation; and CACNA1C up-regulation in SCZ and BD parietal cortices. Some effects were dependent on BD/SCZ diagnosis. All imaging results were whole-brain, voxel-wise, and familywise-error corrected. Our results support evidence implicating CACNA1C and ZNF804A in BD and SCZ, adding novel imaging evidence in clinical populations, and of epistasis-which needs further replication. Further scrutiny of the inherent neurobiological mechanisms may disclose their potential as putative drug targets.
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Affiliation(s)
- Diogo Tecelão
- Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Mendes
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa
| | - Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cynthia Fu
- School of Psychology, The University of East London, London, UK
| | - Christopher A Chaddock
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marco M Picchioni
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,St. Andrew's Academic Department, St Andrew's Healthcare, Northampton, UK
| | - Colm McDonald
- Centre for Neuroimaging and Cognitive Genomics (NICOG) & NCBES Galway Neuroscience Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Sridevi Kalidindi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Diana P Prata
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Lisbon, Portugal
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5
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Michels S, Ganjam GK, Martins H, Schratt GM, Wöhr M, Schwarting RKW, Culmsee C. Downregulation of the psychiatric susceptibility gene Cacna1c promotes mitochondrial resilience to oxidative stress in neuronal cells. Cell Death Discov 2018; 4:54. [PMID: 29760952 PMCID: PMC5945680 DOI: 10.1038/s41420-018-0061-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022] Open
Abstract
Affective disorders such as major depression and bipolar disorder are among the most prevalent forms of mental illness and their etiologies involve complex interactions between genetic and environmental risk factors. Over the past ten years, several genome wide association studies (GWAS) have identified CACNA1C as one of the strongest genetic risk factors for the development of affective disorders. However, its role in disease pathogenesis is still largely unknown. Vulnerability to affective disorders also involves diverse environmental risk factors such as perinatal insults, childhood maltreatment, and other adverse pathophysiological or psychosocial life events. At the cellular level, such environmental influences may activate oxidative stress pathways, thereby altering neuronal plasticity and function. Mitochondria are the key organelles of energy metabolism and, further, highly important for the adaptation to oxidative stress. Accordingly, multiple lines of evidence including post-mortem brain and neuro-imaging studies suggest that psychiatric disorders are accompanied by mitochondrial dysfunction. In this study, we investigated the effects of Cacna1c downregulation in combination with glutamate-induced oxidative stress on mitochondrial function, Ca2+ homeostasis, and cell viability in mouse hippocampal HT22 cells. We found that the siRNA-mediated knockdown of Cacna1c preserved mitochondrial morphology, mitochondrial membrane potential, and ATP levels after glutamate treatment. Further, Cacna1c silencing inhibited excessive mitochondrial reactive oxygen species formation and calcium influx, and protected the HT22 cells from oxidative cell death. Overall, our findings suggest that the GWAS-confirmed psychiatric risk gene CACNA1C plays a major role in oxidative stress pathways with particular impact on mitochondrial integrity and function.
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Affiliation(s)
- Susanne Michels
- 1Institute of Pharmacology and Clinical Pharmacy, Philipps-University, Marburg, Germany.,2Center for Mind, Brain and Behavior, Philipps-University, Marburg, Germany
| | - Goutham K Ganjam
- 1Institute of Pharmacology and Clinical Pharmacy, Philipps-University, Marburg, Germany.,2Center for Mind, Brain and Behavior, Philipps-University, Marburg, Germany
| | - Helena Martins
- 2Center for Mind, Brain and Behavior, Philipps-University, Marburg, Germany.,3Department of Health Sciences and Technology, Systems Neuroscience, ETH Zurich, Zurich, Switzerland
| | - Gerhard M Schratt
- 2Center for Mind, Brain and Behavior, Philipps-University, Marburg, Germany.,3Department of Health Sciences and Technology, Systems Neuroscience, ETH Zurich, Zurich, Switzerland
| | - Markus Wöhr
- 2Center for Mind, Brain and Behavior, Philipps-University, Marburg, Germany.,4Department of Experimental and Biological Psychology, Behavioral Neuroscience, Philipps-University, Marburg, Germany
| | - Rainer K W Schwarting
- 2Center for Mind, Brain and Behavior, Philipps-University, Marburg, Germany.,4Department of Experimental and Biological Psychology, Behavioral Neuroscience, Philipps-University, Marburg, Germany
| | - Carsten Culmsee
- 1Institute of Pharmacology and Clinical Pharmacy, Philipps-University, Marburg, Germany.,2Center for Mind, Brain and Behavior, Philipps-University, Marburg, Germany
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6
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Harrison PJ, Cipriani A, Harmer CJ, Nobre AC, Saunders K, Goodwin GM, Geddes JR. Innovative approaches to bipolar disorder and its treatment. Ann N Y Acad Sci 2017; 1366:76-89. [PMID: 27111134 PMCID: PMC4850752 DOI: 10.1111/nyas.13048] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 12/29/2022]
Abstract
All psychiatric disorders have suffered from a dearth of truly novel pharmacological interventions. In bipolar disorder, lithium remains a mainstay of treatment, six decades since its effects were serendipitously discovered. The lack of progress reflects several factors, including ignorance of the disorder's pathophysiology and the complexities of the clinical phenotype. After reviewing the current status, we discuss some ways forward. First, we highlight the need for a richer characterization of the clinical profile, facilitated by novel devices and new forms of data capture and analysis; such data are already promoting a reevaluation of the phenotype, with an emphasis on mood instability rather than on discrete clinical episodes. Second, experimental medicine can provide early indications of target engagement and therapeutic response, reducing the time, cost, and risk involved in evaluating potential mood stabilizers. Third, genomic data can inform target identification and validation, such as the increasing evidence for involvement of calcium channel genes in bipolar disorder. Finally, new methods and models relevant to bipolar disorder, including stem cells and genetically modified mice, are being used to study key pathways and drug effects. A combination of these approaches has real potential to break the impasse and deliver genuinely new treatments.
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Affiliation(s)
- Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Anna C Nobre
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Oxford Centre for Human Brain Activity, Warneford Hospital, Oxford, United Kingdom
| | - Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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7
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Probing the lithium-response pathway in hiPSCs implicates the phosphoregulatory set-point for a cytoskeletal modulator in bipolar pathogenesis. Proc Natl Acad Sci U S A 2017; 114:E4462-E4471. [PMID: 28500272 DOI: 10.1073/pnas.1700111114] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The molecular pathogenesis of bipolar disorder (BPD) is poorly understood. Using human-induced pluripotent stem cells (hiPSCs) to unravel such mechanisms in polygenic diseases is generally challenging. However, hiPSCs from BPD patients responsive to lithium offered unique opportunities to discern lithium's target and hence gain molecular insight into BPD. By profiling the proteomics of BDP-hiPSC-derived neurons, we found that lithium alters the phosphorylation state of collapsin response mediator protein-2 (CRMP2). Active nonphosphorylated CRMP2, which binds cytoskeleton, is present throughout the neuron; inactive phosphorylated CRMP2, which dissociates from cytoskeleton, exits dendritic spines. CRMP2 elimination yields aberrant dendritogenesis with diminished spine density and lost lithium responsiveness (LiR). The "set-point" for the ratio of pCRMP2:CRMP2 is elevated uniquely in hiPSC-derived neurons from LiR BPD patients, but not with other psychiatric (including lithium-nonresponsive BPD) and neurological disorders. Lithium (and other pathway modulators) lowers pCRMP2, increasing spine area and density. Human BPD brains show similarly elevated ratios and diminished spine densities; lithium therapy normalizes the ratios and spines. Consistent with such "spine-opathies," human LiR BPD neurons with abnormal ratios evince abnormally steep slopes for calcium flux; lithium normalizes both. Behaviorally, transgenic mice that reproduce lithium's postulated site-of-action in dephosphorylating CRMP2 emulate LiR in BPD. These data suggest that the "lithium response pathway" in BPD governs CRMP2's phosphorylation, which regulates cytoskeletal organization, particularly in spines, modulating neural networks. Aberrations in the posttranslational regulation of this developmentally critical molecule may underlie LiR BPD pathogenesis. Instructively, examining the proteomic profile in hiPSCs of a functional agent-even one whose mechanism-of-action is unknown-might reveal otherwise inscrutable intracellular pathogenic pathways.
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8
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Cipriani A, Saunders K, Attenburrow MJ, Stefaniak J, Panchal P, Stockton S, Lane TA, Tunbridge EM, Geddes JR, Harrison PJ. A systematic review of calcium channel antagonists in bipolar disorder and some considerations for their future development. Mol Psychiatry 2016; 21:1324-32. [PMID: 27240535 PMCID: PMC5030455 DOI: 10.1038/mp.2016.86] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/01/2016] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
Abstract
l-type calcium channel (LTCC) antagonists have been used in bipolar disorder for over 30 years, without becoming an established therapeutic approach. Interest in this class of drugs has been rekindled by the discovery that LTCC genes are part of the genetic aetiology of bipolar disorder and related phenotypes. We have therefore conducted a systematic review of LTCC antagonists in the treatment and prophylaxis of bipolar disorder. We identified 23 eligible studies, with six randomised, double-blind, controlled clinical trials, all of which investigated verapamil in acute mania, and finding no evidence that it is effective. Data for other LTCC antagonists (diltiazem, nimodipine, nifedipine, methyoxyverapamil and isradipine) and for other phases of the illness are limited to observational studies, and therefore no robust conclusions can be drawn. Given the increasingly strong evidence for calcium signalling dysfunction in bipolar disorder, the therapeutic candidacy of this class of drugs has become stronger, and hence we also discuss issues relevant to their future development and evaluation. In particular, we consider how genetic, molecular and pharmacological data can be used to improve the selectivity, efficacy and tolerability of LTCC antagonists. We suggest that a renewed focus on LTCCs as targets, and the development of 'brain-selective' LTCC ligands, could be one fruitful approach to innovative pharmacotherapy for bipolar disorder and related phenotypes.
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Affiliation(s)
- A Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - K Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - M-J Attenburrow
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - J Stefaniak
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - P Panchal
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - S Stockton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - T A Lane
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - E M Tunbridge
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - J R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - P J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Plant N. Can a systems approach produce a better understanding of mood disorders? Biochim Biophys Acta Gen Subj 2016; 1861:3335-3344. [PMID: 27565355 DOI: 10.1016/j.bbagen.2016.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/29/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND One in twenty-five people suffer from a mood disorder. Current treatments are sub-optimal with poor patient response and uncertain modes-of-action. There is thus a need to better understand underlying mechanisms that determine mood, and how these go wrong in affective disorders. Systems biology approaches have yielded important biological discoveries for other complex diseases such as cancer, and their potential in affective disorders will be reviewed. SCOPE OF REVIEW This review will provide a general background to affective disorders, plus an outline of experimental and computational systems biology. The current application of these approaches in understanding affective disorders will be considered, and future recommendations made. MAJOR CONCLUSIONS Experimental systems biology has been applied to the study of affective disorders, especially at the genome and transcriptomic levels. However, data generation has been slowed by a lack of human tissue or suitable animal models. At present, computational systems biology has only be applied to understanding affective disorders on a few occasions. These studies provide sufficient novel biological insight to motivate further use of computational biology in this field. GENERAL SIGNIFICANCE In common with many complex diseases much time and money has been spent on the generation of large-scale experimental datasets. The next step is to use the emerging computational approaches, predominantly developed in the field of oncology, to leverage the most biological insight from these datasets. This will lead to the critical breakthroughs required for more effective diagnosis, stratification and treatment of affective disorders.
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Affiliation(s)
- Nick Plant
- School of Bioscience and Medicine, Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7XH, UK.
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10
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Hui Poon S, Sim K, Baldessarini RJ. Pharmacological Approaches for Treatment-resistant Bipolar Disorder. Curr Neuropharmacol 2016; 13:592-604. [PMID: 26467409 PMCID: PMC4761631 DOI: 10.2174/1570159x13666150630171954] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/06/2014] [Accepted: 12/06/2014] [Indexed: 01/11/2023] Open
Abstract
Bipolar disorder is prevalent, with high risks of disability, substance abuse and premature
mortality. Treatment responses typically are incomplete, especially for depressive components, so that
many cases can be considered “treatment resistant.” We reviewed reports on experimental treatments
for such patients: there is a striking paucity of such research, mainly involving small incompletely
controlled trials of add-on treatment, and findings remain preliminary. Encouraging results have been reported by adding
aripiprazole, bupropion, clozapine, ketamine, memantine, pramipexole, pregabalin, and perhaps tri-iodothyronine in
resistant manic or depressive phases. The urgency of incomplete responses in such a severe illness underscores the need
for more systematic, simpler, and better controlled studies in more homogeneous samples of patients.
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Affiliation(s)
| | | | - Ross J Baldessarini
- Department of General Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore 539747
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11
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Sharma AN, Fries GR, Galvez JF, Valvassori SS, Soares JC, Carvalho AF, Quevedo J. Modeling mania in preclinical settings: A comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry 2016; 66:22-34. [PMID: 26545487 PMCID: PMC4728043 DOI: 10.1016/j.pnpbp.2015.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/29/2015] [Accepted: 11/03/2015] [Indexed: 12/17/2022]
Abstract
The current pathophysiological understanding of mechanisms leading to onset and progression of bipolar manic episodes remains limited. At the same time, available animal models for mania have limited face, construct, and predictive validities. Additionally, these models fail to encompass recent pathophysiological frameworks of bipolar disorder (BD), e.g. neuroprogression. Therefore, there is a need to search for novel preclinical models for mania that could comprehensively address these limitations. Herein we review the history, validity, and caveats of currently available animal models for mania. We also review new genetic models for mania, namely knockout mice for genes involved in neurotransmission, synapse formation, and intracellular signaling pathways. Furthermore, we review recent trends in preclinical models for mania that may aid in the comprehension of mechanisms underlying the neuroprogressive and recurring nature of BD. In conclusion, the validity of animal models for mania remains limited. Nevertheless, novel (e.g. genetic) animal models as well as adaptation of existing paradigms hold promise.
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Affiliation(s)
- Ajaykumar N. Sharma
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Gabriel R. Fries
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Juan F. Galvez
- Department of Psychiatry, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia
| | - Samira S. Valvassori
- Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Jair C. Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - André F. Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Joao Quevedo
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA; Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA; Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil.
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12
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Leo RJ, Singh J. Migraine headache and bipolar disorder comorbidity: A systematic review of the literature and clinical implications. Scand J Pain 2016; 11:136-145. [PMID: 28850455 DOI: 10.1016/j.sjpain.2015.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/21/2015] [Accepted: 12/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Psychiatric disorders, e.g., depression, are often comorbid with, and can complicate the treatment of, patients with migraine headache. Although empirical work has increasingly focused on the association between migraine and bipolar disorder, this topic has received little attention in the pain literature. Bipolar disorder is a chronic and recurrent mood disorder characterized by cyclic occurrence of elevated (i.e., manic or hypomanic) and depressed mood states. Bipolar I disorder is diagnosed when patients present with at least one abnormally and persistently elevated manic episode; bipolar II disorder is characterized by the presence of hypomanic episodes. Bipolar disorder warrants attention as depressive phases of the disorder can prevail and are often misconstrued by the unwary clinician as unipolar depression. However, treatment for bipolar disorder is distinct from that of unipolar depression and use of antidepressants, which are often invoked in migraine prophylaxis as well as the treatment of depression, may precipitate significant mood changes among bipolar disorder patients. A systematic review of the literature addressing the co-occurrence of bipolar disorder and migraine was conducted. The treatment of dually affected patients is also discussed. METHODS In order to review the literature to date on migraine and bipolar disorder co-occurrence, a comprehensive search of MEDLINE, EMBASE, PubMed, PsycINFO, Web of Science, and CINAHL for clinic-based and epidemiological studies was conducted using terms related to migraine and bipolar disorder. Studies were selected for review if they included subjects meeting validated diagnostic criteria for bipolar disorder as well as migraine headache and if a quantitative description of prevalence rates of comorbid bipolar disorder and migraine were reported. Weighted means of the prevalence rates were calculated to compare with general epidemiological prevalence trends for migraine and bipolar disorder, respectively. RESULTS Eleven studies met inclusion criteria. Although findings were constrained by methodological limitations and several low quality studies, clinic- and epidemiological cross-sectional investigations demonstrated a high rate of comorbidity between bipolar disorder and migraine. The weighted mean prevalence rate for migraine headache among bipolar disorder patients was 30.7%; for bipolar disorder among migraineurs, the weighted mean prevalence rates were 9% and 5.9% in clinic-based and epidemiological studies, respectively. The association between bipolar disorder and migraine was most notable among women and patients with the bipolar II disorder subtype. CONCLUSIONS High rates of comorbidity exist between migraine and bipolar disorder, exceeding estimated prevalence rates for those conditions in the general population. Comorbidity may portend a more serious clinical course for dually afflicted individuals. IMPLICATIONS Clinicians need to structure treatment approaches to address concurrent migraine and bipolar disorder in dually afflicted individuals. Although further evidence-based investigation is warranted to inform optimal treatment approaches for both conditions concurrently, anticonvulsants (e.g., valproate, lamotrigine and topiramate); atypical antipsychotics (e.g., olanzapine or quetiapine); and calcium channel blockers (e.g., verapamil) may be considered.
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Affiliation(s)
- Raphael J Leo
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Joshna Singh
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Gershon ES, Alliey-Rodriguez N, Grennan K. Ethical and public policy challenges for pharmacogenomics. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25733960 PMCID: PMC4336925 DOI: 10.31887/dcns.2014.16.4/egershon] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is timely to consider the ethical and social questions raised by progress in pharmacogenomics, based on the current importance of pharmacogenomics for avoidance of predictable side effects of drugs, and for correct choice of medications in certain cancers. It has been proposed that the entire population be genotyped for drug-metabolizing enzyme polymorphisms, as a measure that would prevent many untoward and dangerous drug reactions. Pharmacologic treatment targeting based on genomics of disease can be expected to increase greatly in the coming years. Policy and ethical issues exist on consent for large-scale genomic pharmacogenomic data collection, public vs corporate ownership of genomic research results, testing efficacy and safety of drugs used for rare genomic indications, and accessibility of treatments based on costly research that is applicable to relatively few patients. In major psychiatric disorders and intellectual deficiency, rare and de novo deletion or duplication of chromosomal segments (copy number variation), in the aggregate, are common causes of increased risk. This implies that the policy problems of pharmacogenomics will be particularly important for the psychiatric disorders.
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Affiliation(s)
- Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience; Department of Human Genetics; University of Chicago, Illinois, USA
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience; University of Chicago, Illinois, USA
| | - Kay Grennan
- Department of Psychiatry and Behavioral Neuroscience; University of Chicago, Illinois, USA
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14
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Rare variants in neuronal excitability genes influence risk for bipolar disorder. Proc Natl Acad Sci U S A 2015; 112:3576-81. [PMID: 25730879 DOI: 10.1073/pnas.1424958112] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We sequenced the genomes of 200 individuals from 41 families multiply affected with bipolar disorder (BD) to identify contributions of rare variants to genetic risk. We initially focused on 3,087 candidate genes with known synaptic functions or prior evidence from genome-wide association studies. BD pedigrees had an increased burden of rare variants in genes encoding neuronal ion channels, including subunits of GABAA receptors and voltage-gated calcium channels. Four uncommon coding and regulatory variants also showed significant association, including a missense variant in GABRA6. Targeted sequencing of 26 of these candidate genes in an additional 3,014 cases and 1,717 controls confirmed rare variant associations in ANK3, CACNA1B, CACNA1C, CACNA1D, CACNG2, CAMK2A, and NGF. Variants in promoters and 5' and 3' UTRs contributed more strongly than coding variants to risk for BD, both in pedigrees and in the case-control cohort. The genes and pathways identified in this study regulate diverse aspects of neuronal excitability. We conclude that rare variants in neuronal excitability genes contribute to risk for BD.
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15
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Yoshimizu T, Pan JQ, Mungenast AE, Madison JM, Su S, Ketterman J, Ongur D, McPhie D, Cohen B, Perlis R, Tsai LH. Functional implications of a psychiatric risk variant within CACNA1C in induced human neurons. Mol Psychiatry 2015; 20:162-9. [PMID: 25403839 PMCID: PMC4394050 DOI: 10.1038/mp.2014.143] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 08/19/2014] [Accepted: 09/10/2014] [Indexed: 12/13/2022]
Abstract
Psychiatric disorders have clear heritable risk. Several large-scale genome-wide association studies have revealed a strong association between susceptibility for psychiatric disorders, including bipolar disease, schizophrenia and major depression, and a haplotype located in an intronic region of the L-type voltage-gated calcium channel (VGCC) subunit gene CACNA1C (peak associated SNP rs1006737), making it one of the most replicable and consistent associations in psychiatric genetics. In the current study, we used induced human neurons to reveal a functional phenotype associated with this psychiatric risk variant. We generated induced human neurons, or iN cells, from more than 20 individuals harboring homozygous risk genotypes, heterozygous or homozygous non-risk genotypes at the rs1006737 locus. Using these iNs, we performed electrophysiology and quantitative PCR experiments that demonstrated increased L-type VGCC current density as well as increased mRNA expression of CACNA1C in iNs homozygous for the risk genotype, compared with non-risk genotypes. These studies demonstrate that the risk genotype at rs1006737 is associated with significant functional alterations in human iNs, and may direct future efforts at developing novel therapeutics for the treatment of psychiatric disease.
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Affiliation(s)
- Takao Yoshimizu
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, 02139
- Department of Brain and Cognitive Sciences, MIT, Cambridge, Massachusetts, 02139
| | - Jen Q. Pan
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA 02142
| | - Alison E. Mungenast
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, 02139
- Department of Brain and Cognitive Sciences, MIT, Cambridge, Massachusetts, 02139
| | - Jon M. Madison
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA 02142
| | - Susan Su
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, 02139
- Department of Brain and Cognitive Sciences, MIT, Cambridge, Massachusetts, 02139
| | - Josh Ketterman
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA 02142
| | - Dost Ongur
- McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Donna McPhie
- McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Cohen
- McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Roy Perlis
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA 02142
- Bipolar Clinic and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114
| | - Li-Huei Tsai
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, 02139
- Department of Brain and Cognitive Sciences, MIT, Cambridge, Massachusetts, 02139
- Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge, MA 02139
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16
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Erk S, Meyer-Lindenberg A, Schmierer P, Mohnke S, Grimm O, Garbusow M, Haddad L, Poehland L, Mühleisen TW, Witt SH, Tost H, Kirsch P, Romanczuk-Seiferth N, Schott BH, Cichon S, Nöthen MM, Rietschel M, Heinz A, Walter H. Hippocampal and frontolimbic function as intermediate phenotype for psychosis: evidence from healthy relatives and a common risk variant in CACNA1C. Biol Psychiatry 2014; 76:466-75. [PMID: 24411473 DOI: 10.1016/j.biopsych.2013.11.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/21/2013] [Accepted: 11/22/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Variation in CACNA1C has consistently been associated with psychiatric disease in genome-wide association studies. We have previously shown that healthy carriers of the CACNA1C rs1006737 risk variant exhibit hippocampal and perigenual anterior cingulate (pgACC) dysfunction during episodic memory recall. To test whether this brain systems-level abnormality is a potential intermediate phenotype for psychiatric disorder, we studied unaffected relatives of patients with bipolar disorder, major depression, and schizophrenia. METHODS The study population comprised 188 healthy first-degree relatives of patients with bipolar disorder (n=59), major depression (n=73), and schizophrenia (n=56) and 110 comparison subjects from our discovery study who were genotyped for rs1006737 and underwent functional magnetic resonance imaging while performing an episodic memory task and psychological testing. Group comparisons were analyzed using SPM8 and PASW Statistics 20. RESULTS Similar to risk allele carriers in the discovery sample, relatives of index patients exhibited hippocampal and pgACC dysfunction as well as increased scores in depression and anxiety measures, correlating negatively with hippocampal activation. Carrying the rs1006737 risk variant resulted in a stronger decrease of hippocampal and pgACC activation in relatives, indicating an additive effect of CACNA1C variation on familial risk. CONCLUSIONS Our findings implicate abnormal perigenual and hippocampal activation as a promising intermediate phenotype for psychiatric disease and suggest a pathophysiologic mechanism conferred by a CACNA1C variant being implicated in risk for symptom dimensions shared among bipolar disorder, major depression, and schizophrenia.
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Affiliation(s)
- Susanne Erk
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte; Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Campus Mitte.
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim
| | - Phöbe Schmierer
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte; Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Campus Mitte; Berlin School of Mind and Brain, Humboldt University of Berlin, Berlin
| | - Sebastian Mohnke
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte; Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Campus Mitte
| | - Oliver Grimm
- Department of Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim
| | - Maria Garbusow
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte
| | - Leila Haddad
- Department of Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim
| | - Lydia Poehland
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte
| | - Thomas W Mühleisen
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn; Institute of Human Genetics, University of Bonn, Bonn; Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology, Central Institute of Mental Health, University of Heidelberg, Mannheim
| | - Heike Tost
- Department of Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim
| | - Peter Kirsch
- Department of Psychology, Central Institute of Mental Health, University of Heidelberg, Mannheim
| | | | - Björn H Schott
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte; Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Campus Mitte
| | - Sven Cichon
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Markus M Nöthen
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn; Institute of Human Genetics, University of Bonn, Bonn
| | - Marcella Rietschel
- Department of Genetic Epidemiology, Central Institute of Mental Health, University of Heidelberg, Mannheim
| | - Andreas Heinz
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte
| | - Henrik Walter
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Mitte; Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Campus Mitte; Berlin School of Mind and Brain, Humboldt University of Berlin, Berlin; Department of Psychiatry, University of Bonn, Bonn
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A rare mutation of CACNA1C in a patient with bipolar disorder, and decreased gene expression associated with a bipolar-associated common SNP of CACNA1C in brain. Mol Psychiatry 2014; 19:890-4. [PMID: 23979604 PMCID: PMC4151967 DOI: 10.1038/mp.2013.107] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 07/07/2013] [Accepted: 07/10/2013] [Indexed: 12/15/2022]
Abstract
Timothy Syndrome (TS) is caused by very rare exonic mutations of the CACNA1C gene that produce delayed inactivation of Cav1.2 voltage-gated calcium channels during cellular action potentials, with greatly increased influx of calcium into the activated cells. The major clinical feature of this syndrome is a long QT interval that results in cardiac arrhythmias. However, TS also includes cognitive impairment, autism and major developmental delays in many of the patients. We observed the appearance of bipolar disorder (BD) in a patient with a previously reported case of TS, who is one of the very few patients to survive childhood. This is most interesting because the common single-nucleotide polymorphism (SNP) most highly associated with BD is rs1006737, which we show here is a cis-expression quantitative trait locus for CACNA1C in human cerebellum, and the risk allele (A) is associated with decreased expression. To combine the CACNA1C perturbations in the presence of BD in this patient and in patients with the common CACNA1C SNP risk allele, we would propose that either increase or decrease in calcium influx in excitable cells can be associated with BD. In treatment of BD with calcium channel blocking drugs, we would predict better response in patients without the risk allele, because they have increased CACNA1C expression.
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18
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Erk S, Meyer-Lindenberg A, Linden DE, Lancaster T, Mohnke S, Grimm O, Degenhardt F, Holmans P, Pocklington A, Schmierer P, Haddad L, Mühleisen TW, Mattheisen M, Witt SH, Romanczuk-Seiferth N, Tost H, Schott BH, Cichon S, Nöthen MM, Rietschel M, Heinz A, Walter H. Replication of brain function effects of a genome-wide supported psychiatric risk variant in the CACNA1C gene and new multi-locus effects. Neuroimage 2014; 94:147-154. [DOI: 10.1016/j.neuroimage.2014.03.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/09/2014] [Accepted: 03/09/2014] [Indexed: 12/12/2022] Open
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19
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Vik A, Ravindran A, Shiah IS, Wong H, Walji N, Lam RW, Yatham LN. A double-blind, placebo-controlled study of adjunctive calcitonin nasal spray in acute refractory mania. Bipolar Disord 2013; 15:359-64. [PMID: 23551803 DOI: 10.1111/bdi.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 11/29/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Calcitonin, a neuropeptide, has been shown in preliminary double-blind trials to reduce agitation in patients with acute mania. Given that it has effects similar to those of lithium and anticonvulsants on modulation of second-messenger signaling pathways and stabilization of neuronal membranes, this study examined the efficacy of calcitonin nasal spray in treating acute manic symptoms in patients with treatment-resistant mania using a double-blind, placebo-controlled design. METHODS A total of 46 hospitalized patients experiencing either a manic or a mixed episode, who were refractory to treatment with adequate doses of either a mood stabilizer or an antipsychotic, or a mood stabilizer/antipsychotic combination, and had a score of ≥16 on the Young Mania Rating Scale (YMRS), were randomized to receive adjunctive nasal calcitonin 200 IU (n = 24) or saline (n = 22) spray for three weeks. The primary efficacy measure was the change in YMRS scores using the last observation carried forward (LOCF) method. RESULTS The clinical and demographic characteristics were similar between the groups. Patients had a mean YMRS score of 26 in the placebo group and a mean score of 25 in the calcitonin group. There were no significant differences in YMRS scores or percentage responders at three weeks between patients who received calcitonin and those who received placebo. There were also no significant differences in change scores on any other scales. Few patients experienced any adverse events. CONCLUSIONS This study does not support the use of nasal calcitonin in the treatment of treatment-resistant mania.
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Affiliation(s)
- Astrid Vik
- Department of Psychiatry, University of British Columbia, Vancouver, BC
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Souppart C, Gardin A, Greig G, Balez S, Batard Y, Krebs-Brown A, Appel-Dingemanse S. Pharmacokinetics of Licarbazepine in Healthy Volunteers: Single and Multiple Oral Doses and Effect of Food. J Clin Pharmacol 2013; 48:563-9. [DOI: 10.1177/0091270007313323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Abstract
P/Q-type calcium channels are high-voltage-gated calcium channels contributing to vesicle release at synaptic terminals. A number of neurological diseases have been attributed to malfunctioning of P/Q channels, including ataxia, migraine and Alzheimer's disease. To date, only two specific P/Q-type blockers are known: both are peptides deriving from the spider venom of Agelenopsis aperta, ω-agatoxins. Other peptidic calcium channel blockers with activity at P/Q channels are available, albeit with less selectivity. A number of low molecular weight compounds modulate P/Q-type currents with different characteristics, and some exhibit a peculiar bidirectional pattern of modulation. Interestingly, there are a number of therapeutics in clinical use, which also show P/Q channel activity. Because selectivity as well as the exact mode of action is different between all P/Q-type channel modulators, the interpretation of clinical and experimental data is complicated and needs a comprehensive understanding of their target profile. The situation is further complicated by the fact that information on potency varies vastly in the literature, which may be the result of different experimental systems, conditions or the splice variants of the P/Q channel. This review attempts to provide a comprehensive overview of the compounds available that affect the P/Q-type channel and should help with the interpretation of results of in vitro experiments and animal models. It also aims to explain some clinical observations by implementing current knowledge about P/Q channel modulation of therapeutically used non-selective drugs. Chances and challenges of the development of P/Q channel-selective molecules are discussed.
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Affiliation(s)
- V Nimmrich
- Neuroscience Research, GPRD, Abbott, Ludwigshafen, Germany
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22
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Bhat S, Dao DT, Terrillion CE, Arad M, Smith RJ, Soldatov NM, Gould TD. CACNA1C (Cav1.2) in the pathophysiology of psychiatric disease. Prog Neurobiol 2012; 99:1-14. [PMID: 22705413 PMCID: PMC3459072 DOI: 10.1016/j.pneurobio.2012.06.001] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/27/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
One of the most consistent genetic findings to have emerged from bipolar disorder genome wide association studies (GWAS) is with CACNA1C, a gene that codes for the α(1C) subunit of the Ca(v)1.2 voltage-dependent L-type calcium channel (LTCC). Genetic variation in CACNA1C have also been associated with depression, schizophrenia, autism spectrum disorders, as well as changes in brain function and structure in control subjects who have no diagnosable psychiatric illness. These data are consistent with a continuum of shared neurobiological vulnerability between diverse-Diagnostic and Statistical Manual (DSM) defined-neuropsychiatric diseases. While involved in numerous cellular functions, Ca(v)1.2 is most frequently implicated in coupling of cell membrane depolarization to transient increase of the membrane permeability for calcium, leading to activation and, potentially, changes in intracellular signaling pathway activity, gene transcription, and synaptic plasticity. Ca(v)1.2 is involved in the proper function of numerous neurological circuits including those involving the hippocampus, amygdala, and mesolimbic reward system, which are strongly implicated in psychiatric disease pathophysiology. A number of behavioral effects of LTCC inhibitors have been described including antidepressant-like behavioral actions in rodent models. Clinical studies suggest possible treatment effects in a subset of patients with mood disorders. We review the genetic structure and variation of CACNA1C, discussing relevant human genetic and clinical findings, as well as the biological actions of Ca(v)1.2 that are most relevant to psychiatric illness.
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Affiliation(s)
- Shambhu Bhat
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - David T. Dao
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | | | - Michal Arad
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Robert J. Smith
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | | | - Todd D. Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
- Program in Neuroscience, University of Maryland, Baltimore, MD, United States
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
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23
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Poon SH, Sim K, Sum MY, Kuswanto CN, Baldessarini RJ. Evidence-based options for treatment-resistant adult bipolar disorder patients. Bipolar Disord 2012; 14:573-84. [PMID: 22938165 DOI: 10.1111/j.1399-5618.2012.01042.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Many patients diagnosed with bipolar disorder (BD) respond incompletely or unsatisfactorily to available treatments. Given the potentially devastating nature of this prevalent disorder, there is a pressing need to improve clinical care of such patients. METHODS We performed a literature review of the research findings related to treatment-resistant BD reported through February 2012. RESULTS Therapeutic trials for treatment-resistant bipolar mania are uncommon, and provide few promising leads other than the use of clozapine. Far more pressing challenges are the depressive-dysthymic-dysphoric-mixed phases of BD and long-term prophylaxis. Therapeutic trials for treatment-resistant bipolar depression have assessed anticonvulsants, modern antipsychotics, glutamate [N-methyl-D-aspartate (NMDA)] antagonists, dopamine agonists, calcium-channel blockers, and thyroid hormones, as well as behavioral therapy, sleep deprivation, light therapy, electroconvulsive therapy (ECT), transcranial magnetic stimulation, and deep brain stimulation-all of which are promising but limited in effectiveness. Several innovative pharmacological treatments (an anticholinesterase, a glutamine antagonist, a calcium-channel blocker, triiodothyronine, olanzapine and topiramate), ECT, and cognitive-behavior therapy have some support for long-term treatment of resistant BD patients, but most of trials of these treatments have been methodologically limited. CONCLUSIONS Most studies identified were small, involved supplementation of typically complex ongoing treatments, varied in controls, randomization, and blinding, usually involved brief follow-up, and lacked replication. Clearer criteria for defining and predicting treatment resistance in BD are needed, as well as improved trial design with better controls, assessment of specific clinical subgroups, and longer follow-up.
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Affiliation(s)
- Shi Hui Poon
- Department of General Psychiatry, Institute of Mental Health, 10 Buangkok ViewSingapore 539747
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24
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Sinclair LI, Dineen PT, Malizia AL. Modulation of ion channels in clinical psychopharmacology: adults and younger people. Expert Rev Clin Pharmacol 2012; 3:397-416. [PMID: 22111619 DOI: 10.1586/ecp.10.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This review focuses on the use of Na(+), Ca(2+) and Cl(-) channel modulators in psychiatric disease. Drugs that modulate ion channels have been used in psychiatry for more than a century, and in this review we critically evaluate clinical research that reports the therapeutic effects of drugs acting on GABA(A), voltage-gated Na(+) and voltage-gated Ca(2+) channels in pediatric and adult patients. As in other fields, the evidence underpinning the use of medicines in younger people is far less robust than for adults. In addition, we discuss some current developments and highlight clinical disorders in which current molecules could be further tested. Notable success stories, such as benzodiazepines (in sleep and anxiety disorders) and antiepileptics (in bipolar disorder), have been the result of serendipitous discoveries or refinements of serendipitous discoveries, as in all other major treatments in psychiatry. Genomic, high-throughput screening and molecular pharmacology discoveries may, however, guide further developments in the future. This could include increased research in promising targets that have been perceived as commercially risky, such as selective α-subunit GABA(A) receptors.
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Affiliation(s)
- Lindsey I Sinclair
- Psychopharmacology Unit, Department of Community Based Medicine, University of Bristol, Bristol, UK
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25
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Sklar P, Ripke S, Scott LJ, Andreassen OA, Cichon S, Craddock N, Edenberg HJ, Nurnberger JI, Rietschel M, Blackwood D, Corvin A, Flickinger M, Guan W, Mattingsdal M, Mcquillin A, Kwan P, Wienker TF, Daly M, Dudbridge F, Holmans PA, Lin D, Burmeister M, Greenwood TA, Hamshere ML, Muglia P, Smith EN, Zandi PP, Nievergelt CM, Mckinney R, Shilling PD, Schork NJ, Bloss CS, Foroud T, Koller DL, Gershon ES, Liu C, Badner JA, Scheftner WA, Lawson WB, Nwulia EA, Hipolito M, Coryell W, Rice JP, Byerley W, McMahon FJ, Schulze TG, Berrettini W, Lohoff FW, Potash JB, Mahon PB, Mcinnis MG, Zöllner S, Zhang P, Craig DW, Szelinger S, Barrett TB, Breuer R, Meier S, Strohmaier J, Witt SH, Tozzi F, Farmer A, McGuffin P, Strauss J, Xu W, Kennedy JL, Vincent JB, Matthews K, Day R, Ferreira MD, O'Dushlaine C, Perlis R, Raychaudhuri S, Ruderfer D, Hyoun PL, Smoller JW, Li J, Absher D, Thompson RC, Meng FG, Schatzberg AF, Bunney WE, Barchas JD, Jones EG, Watson SJ, Myers RM, Akil H, Boehnke M, Chambert K, Moran J, Scolnick E, Djurovic S, Melle I, Morken G, Gill M, Morris D, Quinn E, Mühleisen TW, Degenhardt FA, Mattheisen M, Schumacher J, Maier W, Steffens M, Propping P, Nöthen MM, Anjorin A, Bass N, Gurling H, Kandaswamy R, Lawrence J, Mcghee K, Mcintosh A, Mclean AW, Muir WJ, Pickard BS, Breen G, St Clair D, Caesar S, Gordon-Smith K, Jones L, Fraser C, Green EK, Grozeva D, Jones IR, Kirov G, Moskvina V, Nikolov I, O'Donovan MC, Owen MJ, Collier DA, Elkin A, Williamson R, Young AH, Ferrier IN, Stefansson K, Stefansson H, Porgeirsson P, Steinberg S, Gustafsson O, Bergen SE, Nimgaonkar V, hultman C, Landén M, Lichtenstein P, Sullivan P, Schalling M, Osby U, Backlund L, Frisén L, Langstrom N, Jamain S, Leboyer M, Etain B, Bellivier F, Petursson H, Sigur Sson E, Müller-Mysok B, Lucae S, Schwarz M, Schofield PR, Martin N, Montgomery GW, Lathrop M, Oskarsson H, Bauer M, Wright A, Mitchell PB, Hautzinger M, Reif A, Kelsoe JR, Purcell SM. Large-scale genome-wide association analysis of bipolar disorder identifies a new susceptibility locus near ODZ4. Nat Genet 2011; 43:977-83. [PMID: 21926972 PMCID: PMC3637176 DOI: 10.1038/ng.943] [Citation(s) in RCA: 1009] [Impact Index Per Article: 77.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/23/2011] [Indexed: 12/11/2022]
Abstract
We conducted a combined genome-wide association study (GWAS) of 7,481 individuals with bipolar disorder (cases) and 9,250 controls as part of the Psychiatric GWAS Consortium. Our replication study tested 34 SNPs in 4,496 independent cases with bipolar disorder and 42,422 independent controls and found that 18 of 34 SNPs had P < 0.05, with 31 of 34 SNPs having signals with the same direction of effect (P = 3.8 × 10(-7)). An analysis of all 11,974 bipolar disorder cases and 51,792 controls confirmed genome-wide significant evidence of association for CACNA1C and identified a new intronic variant in ODZ4. We identified a pathway comprised of subunits of calcium channels enriched in bipolar disorder association intervals. Finally, a combined GWAS analysis of schizophrenia and bipolar disorder yielded strong association evidence for SNPs in CACNA1C and in the region of NEK4-ITIH1-ITIH3-ITIH4. Our replication results imply that increasing sample sizes in bipolar disorder will confirm many additional loci.
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Affiliation(s)
- Pamela Sklar
- Division of Psychiatric Genomics
Mount Sinai School of MedicineDepartment of Psychiatry, New York,US
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
| | - Stephan Ripke
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Laura J. Scott
- Department of Biostatistics and Center for Statistical Genetics
School of public healthUniversity of MichiganAnn Arbor, Michigan,US
| | - Ole A. Andreassen
- Institute of Clinical Medicine
European Network of Bipolar Research Expert Centers (ENBREC) GroupUniversity of OsloOslo,NO
- Division of Mental Health and Addiction
Oslo University HospitalOslo,NO
| | - Sven Cichon
- Department of Genomics, Life and Brain Center
Bonn Universität - University of BonnBonn,DE
- Institute of Human Genetics
Université de BonnBonn,DE
- INM-1, Institute of Neuroscience and Medicine
Research Center JuelichJuelich,DE
| | - Nick Craddock
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - Howard J. Edenberg
- Department of Biochemistry and Molecular Biology, Department of Medical and Molecular Genetics
Indiana University School of MedicineIndianapolis, Indiana,US
| | - John I. Nurnberger
- Department of Psychiatry, Indiana
Indiana University School of MedicineIndianapolis, Indiana 46202,US
- Department of Medical and Molecular Genetics
Indiana University School of MedicineIndianapolis, Indiana,US
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry
Central Institute of Mental Health MannheimUniversity of HeidelbergMannheim,DE
| | - Douglas Blackwood
- Division of Psychiatry
University of EdinburghRoyal Edinburgh HospitalEdinburgh,GB
- Medical Genetics Section
University of EdinburghWestern General HospitalMolecular Medicine Centre, Edinburgh,GB
| | - Aiden Corvin
- Neuropsychiatric Genetics Research Group
Trinity College DublinDepartment of Psychiatry and Institute of Molecular Medicine, Dublin,IE
| | - Matthew Flickinger
- Department of Biostatistics and Center for Statistical Genetics
School of public healthUniversity of MichiganAnn Arbor, Michigan,US
| | - Weihua Guan
- Department of Biostatistics and Center for Statistical Genetics
School of public healthUniversity of MichiganAnn Arbor, Michigan,US
| | - Morten Mattingsdal
- Institute of Clinical Medicine
European Network of Bipolar Research Expert Centers (ENBREC) GroupUniversity of OsloOslo,NO
- Sorlandet Hospital HF
Sorlandet Hospital HFKristiansand,NO
| | - Andrew Mcquillin
- Molecular Psychiatry Laboratory
University College LondonResearch Department of Mental Health Sciences, Rockefeller Building, London,GB
| | - Phoenix Kwan
- Department of Biostatistics and Center for Statistical Genetics
School of public healthUniversity of MichiganAnn Arbor, Michigan,US
| | - Thomas F. Wienker
- Institute of Medical Biometry, Informatics and Epidemiology
Bonn Universität - University of BonnBonn,DE
| | - Mark Daly
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Frank Dudbridge
- London School of Hygiene and Tropical Medicine
University of LondonLondon,GB
| | - Peter A. Holmans
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
- Biostatistics and Bioinformatics Unit
Cardiff University School of MedicineCardiff,GB
| | - Danyu Lin
- Department of Biostatistics
University of North CarolinaChapel Hill, North Carolina,US
| | - Margit Burmeister
- Department of Human Genetics, Department of Psychiatry
Molecular and Behavioral Neuroscience InstituteUniversity of MichiganAnn Arbor, Michigan,US
| | - Tiffany A. Greenwood
- Department of Psychiatry
University of California San DiegoLa Jolla, California,US
| | - Marian L. Hamshere
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
- Neurosciences Centre of Excellence in Drug Discovery
GlaxoSmithKline Research and DevelopmentVerona,IT
| | - Pierandrea Muglia
- Neurosciences Centre of Excellence in Drug Discovery
GlaxoSmithKline Research and DevelopmentVerona,IT
| | - Erin N. Smith
- The Scripps Translational Science Institute and Scripps Health
The Scripps Translational Science Institute and Scripps HealthLa jolla, California,US
| | - Peter P. Zandi
- Department of Mental Health
Johns Hopkins University and HospitalBaltimore, Maryland,US
| | | | - Rebecca Mckinney
- Department of Psychiatry
University of California San DiegoLa Jolla, California,US
| | - Paul D. Shilling
- Department of Psychiatry
University of California San DiegoLa Jolla, California,US
| | - Nicholas J. Schork
- The Scripps Translational Science Institute and The Scripps Research Institute
The Scripps Translational Science Institute and The Scripps Research InstituteLa Jolla, California,US
| | - Cinnamon S. Bloss
- The Scripps Translational Science Institute and Scripps Health
The Scripps Translational Science Institute and Scripps HealthLa jolla, California,US
| | - Tatiana Foroud
- Department of Psychiatry, Indiana
Indiana University School of MedicineIndianapolis, Indiana 46202,US
| | - Daniel L. Koller
- Department of Psychiatry, Indiana
Indiana University School of MedicineIndianapolis, Indiana 46202,US
| | | | - Chunyu Liu
- Department of Psychiatry
University of ChicagoChicago, Illinois,US
| | - Judith A. Badner
- Department of Psychiatry
University of ChicagoChicago, Illinois,US
| | - William A. Scheftner
- Rush University Medical Center
Rush University Medical CenterChicago, Illinois,US
| | - William B. Lawson
- Department of Psychiatry and Behavioral Sciences
Howard University College of MedicineWashington, DC,US
| | - Evaristus A. Nwulia
- Department of Psychiatry and Behavioral Sciences
Howard University College of MedicineWashington, DC,US
| | - Maria Hipolito
- Department of Psychiatry and Behavioral Sciences
Howard University College of MedicineWashington, DC,US
| | | | - John P. Rice
- Washington University School of Medicine
Washington University School of MedicineSt Louis, Missouri,US
| | - William Byerley
- Department of Psychiatry
University of California San Francisco School of MedicineSan Francisco, California,US
| | | | - Thomas G. Schulze
- Department of Genetic Epidemiology in Psychiatry
Central Institute of Mental Health MannheimUniversity of HeidelbergMannheim,DE
- National Institute of Mental Health
NIHBethesda, Maryland,US
- Department of Psychiatry and Psychotherapy
Universität GöttingenGöttingen,DE
| | - Wade Berrettini
- Department of Psychiatry
University of PennsylvaniaPhiladelphia, Pennsylvania,US
| | - Falk W. Lohoff
- Department of Psychiatry
University of PennsylvaniaPhiladelphia, Pennsylvania,US
| | - James B. Potash
- Department of Mental Health
Johns Hopkins University and HospitalBaltimore, Maryland,US
| | - Pamela B. Mahon
- Department of Mental Health
Johns Hopkins University and HospitalBaltimore, Maryland,US
| | - Melvin G. Mcinnis
- Department of Psychiatry
University of MichiganAnn Arbor, Michigan,US
| | - Sebastian Zöllner
- Department of Psychiatry
University of MichiganAnn Arbor, Michigan,US
| | - Peng Zhang
- Department of Psychiatry
University of MichiganAnn Arbor, Michigan,US
| | - David W. Craig
- The Translational Genomics Research Institute
The Translational Genomics Research InstitutePhoenix, Arizona,US
| | - Szabocls Szelinger
- The Translational Genomics Research Institute
The Translational Genomics Research InstitutePhoenix, Arizona,US
| | - Thomas B. Barrett
- Portland Veterans Affairs Medical Center
Portland Veterans Affairs Medical CenterPortland, Oregon,US
| | - René Breuer
- Department of Genetic Epidemiology in Psychiatry
Central Institute of Mental Health MannheimUniversity of HeidelbergMannheim,DE
| | - Sandra Meier
- Department of Genetic Epidemiology in Psychiatry
Central Institute of Mental Health MannheimUniversity of HeidelbergMannheim,DE
| | - Jana Strohmaier
- Department of Genetic Epidemiology in Psychiatry
Central Institute of Mental Health MannheimUniversity of HeidelbergMannheim,DE
| | - Stephanie H. Witt
- Department of Genetic Epidemiology in Psychiatry
Central Institute of Mental Health MannheimUniversity of HeidelbergMannheim,DE
| | - Federica Tozzi
- Neurosciences Centre of Excellence in Drug Discovery
GlaxoSmithKline Research and DevelopmentVerona,IT
| | - Anne Farmer
- SGDP, Social, Genetic and Developmental Psychiatry Centre
King's College LondonThe Institute of Psychiatry, De Crespigny Park Denmark Hill, London,GB
| | - Peter McGuffin
- SGDP, Social, Genetic and Developmental Psychiatry Centre
King's College LondonThe Institute of Psychiatry, De Crespigny Park Denmark Hill, London,GB
| | - John Strauss
- Molecular Neuropsychiatry and Development Laboratory
Centre for Addiction and Mental HealthToronto, Ontario,CA
| | - Wei Xu
- Department of Biostatistics
Princess Margaret HospitalToronto, Ontario,CA
| | - James L. Kennedy
- Psychiatric Neurogenetics Section
Centre for Addiction and Mental HealthToronto, Ontario,CA
| | - John B. Vincent
- Molecular Neuropsychiatry and Development Laboratory
Centre for Addiction and Mental HealthToronto, Ontario,CA
| | - Keith Matthews
- University of Dundee School of Medicine
University of DundeeNethergate, Dundee,GB
| | - Richard Day
- School of Neurology, Neurobiology and Psychiatry
Royal Victoria InfirmaryNewcastle upon Tyne,GB
| | - Manuel D.C. Ferreira
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
- Queensland Institute of Medical Research
Queensland Institute of Medical ResearchBrisbane,AU
| | - Colm O'Dushlaine
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Roy Perlis
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Soumya Raychaudhuri
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Douglas Ruderfer
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Phil L. Hyoun
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
| | - Jordan W. Smoller
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Jun Li
- Department of Human Genetics, Department of Psychiatry
Molecular and Behavioral Neuroscience InstituteUniversity of MichiganAnn Arbor, Michigan,US
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology
HudsonAlpha Institute for BiotechnologyHuntsville, Alabama,US
| | - Robert C. Thompson
- Department of Psychiatry and Human Behavior
University of California, IrvineCalifornia,US
| | - Fan Guo Meng
- Department of Psychiatry
Weill Medical CollegeCornell UniversityNew York, New York,US
| | - Alan F. Schatzberg
- Psychiatry and Behavioral Science
Stanford University School of MedicinePalo Alto, California,US
| | - William E. Bunney
- Department of Psychiatry and Human Behavior
University of California, IrvineCalifornia,US
| | - Jack D. Barchas
- Department of Psychiatry
Weill Medical CollegeCornell UniversityNew York, New York,US
| | - Edward G. Jones
- Department of Psychiatry and Behavioral Sciences
Center for neuroscienceUniversity of California, Davis-LivermoreCalifornia,US
| | - Stanley J. Watson
- Molecular and Behavioral Neuroscience Institute
University of MichiganAnn Arbor, Michigan,US
| | - Richard M. Myers
- HudsonAlpha Institute for Biotechnology
HudsonAlpha Institute for BiotechnologyHuntsville, Alabama,US
| | - Huda Akil
- Molecular and Behavioral Neuroscience Institute
University of MichiganAnn Arbor, Michigan,US
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics
School of public healthUniversity of MichiganAnn Arbor, Michigan,US
| | - Kim Chambert
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Jennifer Moran
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Ed Scolnick
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Srdjan Djurovic
- Institute of Clinical Medicine
European Network of Bipolar Research Expert Centers (ENBREC) GroupUniversity of OsloOslo,NO
- Deparment of Medical Genetics
Oslo University HospitalOslo,NO
| | - Ingrid Melle
- Institute of Clinical Medicine
European Network of Bipolar Research Expert Centers (ENBREC) GroupUniversity of OsloOslo,NO
- Division of Mental Health and Addiction
Oslo University HospitalOslo,NO
| | - Gunnar Morken
- Department of Psychiatry
St Olavs HospitalTrondheim,NO
- Department of Neuroscience
Norwegian University of Science and TechnologyTrondeheim,NO
| | - Michael Gill
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
- Neuropsychiatric Genetics Research Group
Trinity College DublinDepartment of Psychiatry and Institute of Molecular Medicine, Dublin,IE
| | - Derek Morris
- Neuropsychiatric Genetics Research Group
Trinity College DublinDepartment of Psychiatry and Institute of Molecular Medicine, Dublin,IE
| | - Emma Quinn
- Division of Psychiatric Genomics
Mount Sinai School of MedicineDepartment of Psychiatry, New York,US
- Neuropsychiatric Genetics Research Group
Trinity College DublinDepartment of Psychiatry and Institute of Molecular Medicine, Dublin,IE
| | - Thomas W. Mühleisen
- Department of Genomics, Life and Brain Center
Bonn Universität - University of BonnBonn,DE
- Institute of Human Genetics
Université de BonnBonn,DE
| | - Franziska A. Degenhardt
- Department of Genomics, Life and Brain Center
Bonn Universität - University of BonnBonn,DE
- Institute of Human Genetics
Université de BonnBonn,DE
| | - Manuel Mattheisen
- Institute of Human Genetics
Université de BonnBonn,DE
- Institute of Medical Biometry, Informatics and Epidemiology
Bonn Universität - University of BonnBonn,DE
| | | | - Wolfgang Maier
- Department of Psychiatry
Bonn Universität - University of BonnBonn,DE
| | - Michael Steffens
- Institute of Medical Biometry, Informatics and Epidemiology
Bonn Universität - University of BonnBonn,DE
| | | | - Markus M. Nöthen
- Department of Genomics, Life and Brain Center
Bonn Universität - University of BonnBonn,DE
- Institute of Human Genetics
Université de BonnBonn,DE
| | - Adebayo Anjorin
- Molecular Psychiatry Laboratory
University College LondonResearch Department of Mental Health Sciences, Rockefeller Building, London,GB
| | - Nick Bass
- Molecular Psychiatry Laboratory
University College LondonResearch Department of Mental Health Sciences, Rockefeller Building, London,GB
| | - Hugh Gurling
- Molecular Psychiatry Laboratory
University College LondonResearch Department of Mental Health Sciences, Rockefeller Building, London,GB
| | - Radhika Kandaswamy
- Molecular Psychiatry Laboratory
University College LondonResearch Department of Mental Health Sciences, Rockefeller Building, London,GB
| | - Jacob Lawrence
- Molecular Psychiatry Laboratory
University College LondonResearch Department of Mental Health Sciences, Rockefeller Building, London,GB
| | - Kevin Mcghee
- Division of Psychiatry
University of EdinburghRoyal Edinburgh HospitalEdinburgh,GB
- Medical Genetics Section
University of EdinburghWestern General HospitalMolecular Medicine Centre, Edinburgh,GB
| | - Andrew Mcintosh
- Division of Psychiatry
University of EdinburghRoyal Edinburgh HospitalEdinburgh,GB
- Medical Genetics Section
University of EdinburghWestern General HospitalMolecular Medicine Centre, Edinburgh,GB
| | - Alan W. Mclean
- Division of Psychiatry
University of EdinburghRoyal Edinburgh HospitalEdinburgh,GB
- Medical Genetics Section
University of EdinburghWestern General HospitalMolecular Medicine Centre, Edinburgh,GB
| | - Walter J. Muir
- Division of Psychiatry
University of EdinburghRoyal Edinburgh HospitalEdinburgh,GB
- Medical Genetics Section
University of EdinburghWestern General HospitalMolecular Medicine Centre, Edinburgh,GB
| | - Benjamin S. Pickard
- Division of Psychiatry
University of EdinburghRoyal Edinburgh HospitalEdinburgh,GB
- Medical Genetics Section
University of EdinburghWestern General HospitalMolecular Medicine Centre, Edinburgh,GB
| | - Gerome Breen
- SGDP, Social, Genetic and Developmental Psychiatry Centre
King's College LondonThe Institute of Psychiatry, De Crespigny Park Denmark Hill, London,GB
- Institute of Medical Sciences
University of AberdeenForesterhill, Aberdeen,GB
| | - David St Clair
- Institute of Medical Sciences
University of AberdeenForesterhill, Aberdeen,GB
| | - Sian Caesar
- Department of Psychiatry, School of Clinical and Experimental Medicine
Birmingham UniversityBirmingham,GB
| | - Katherine Gordon-Smith
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
- Department of Psychiatry, School of Clinical and Experimental Medicine
Birmingham UniversityBirmingham,GB
| | - Lisa Jones
- Department of Psychiatry, School of Clinical and Experimental Medicine
Birmingham UniversityBirmingham,GB
| | - Christine Fraser
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - Elaine K. Green
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - Detelina Grozeva
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - Ian R. Jones
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - George Kirov
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - Valentina Moskvina
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
- Neurosciences Centre of Excellence in Drug Discovery
GlaxoSmithKline Research and DevelopmentVerona,IT
| | - Ivan Nikolov
- Division of Psychiatric Genomics
Mount Sinai School of MedicineDepartment of Psychiatry, New York,US
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - Michael C. O'Donovan
- Division of Psychiatric Genomics
Mount Sinai School of MedicineDepartment of Psychiatry, New York,US
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - Michael J. Owen
- Centre for Neuropsychiatric Genetics and Genomics
Medical Research CouncilCardiff UniversityHenry Wellcome Building, School of Medicine, Heath Park, Cardiff,GB
| | - David A. Collier
- SGDP, Social, Genetic and Developmental Psychiatry Centre
King's College LondonThe Institute of Psychiatry, De Crespigny Park Denmark Hill, London,GB
| | - Amanda Elkin
- SGDP, Social, Genetic and Developmental Psychiatry Centre
King's College LondonThe Institute of Psychiatry, De Crespigny Park Denmark Hill, London,GB
| | - Richard Williamson
- SGDP, Social, Genetic and Developmental Psychiatry Centre
King's College LondonThe Institute of Psychiatry, De Crespigny Park Denmark Hill, London,GB
| | - Allan H. Young
- University of Dundee School of Medicine
University of DundeeNethergate, Dundee,GB
- Institute of Mental Health
University of British Columbia (UBC)Vancouver, British Columbia,CA
| | - I Nicol Ferrier
- University of Dundee School of Medicine
University of DundeeNethergate, Dundee,GB
| | | | | | | | | | | | - Sarah E. Bergen
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
| | - Vishwajit Nimgaonkar
- Department of Human Genetics
University of PittsburghPittsburgh, Pennsylvania,US
| | - Christina hultman
- MEB, Department of Medical Epidemiology and Biostatistics
Karolinska InstitutetKarolinska Institutet SE-171 77 Stockholm,SE
| | - Mikael Landén
- MEB, Department of Medical Epidemiology and Biostatistics
Karolinska InstitutetKarolinska Institutet SE-171 77 Stockholm,SE
- Insitute of Neuroscience and Physiology
University of GothenburgUniversity of Gothenburg, Sweden, Box 100, S-405 30 Gothenburg,SE
| | - Paul Lichtenstein
- MEB, Department of Medical Epidemiology and Biostatistics
Karolinska InstitutetKarolinska Institutet SE-171 77 Stockholm,SE
| | - Patrick Sullivan
- Medstar Research Institute
Medstar Research InstituteBaltimore, Maryland,US
| | - Martin Schalling
- Department of Molecular Medicine
Karolinska InstitutetStockholm,SE
| | - Urban Osby
- Department of Molecular Medicine
Karolinska InstitutetStockholm,SE
| | - Lena Backlund
- Department of Clinical Neuroscience
Karolinska InstitutetStockholm,SE
| | - Louise Frisén
- Department of Molecular Medicine
Karolinska InstitutetStockholm,SE
| | - Niklas Langstrom
- Insitute of Neuroscience and Physiology
University of GothenburgUniversity of Gothenburg, Sweden, Box 100, S-405 30 Gothenburg,SE
| | - Stéphane Jamain
- Institut Mondor de Recherche Biomédicale
INSERM : U955Université Paris-Est Créteil Val-de-Marne (UPEC)IFR108 rue du Général Sarrail, 94010 Créteil,FR
- Service de psychiatrie
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Henri MondorHôpital Albert ChenevierCréteil,FR
- ENBREC, European Network of Bipolar Research Expert Centres
ENBRECCréteil,FR
| | - Marion Leboyer
- Institut Mondor de Recherche Biomédicale
INSERM : U955Université Paris-Est Créteil Val-de-Marne (UPEC)IFR108 rue du Général Sarrail, 94010 Créteil,FR
- Service de psychiatrie
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Henri MondorHôpital Albert ChenevierCréteil,FR
- ENBREC, European Network of Bipolar Research Expert Centres
ENBRECCréteil,FR
| | - Bruno Etain
- Institut Mondor de Recherche Biomédicale
INSERM : U955Université Paris-Est Créteil Val-de-Marne (UPEC)IFR108 rue du Général Sarrail, 94010 Créteil,FR
- Service de psychiatrie
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Henri MondorHôpital Albert ChenevierCréteil,FR
- ENBREC, European Network of Bipolar Research Expert Centres
ENBRECCréteil,FR
| | - Frank Bellivier
- Institut Mondor de Recherche Biomédicale
INSERM : U955Université Paris-Est Créteil Val-de-Marne (UPEC)IFR108 rue du Général Sarrail, 94010 Créteil,FR
- Service de psychiatrie
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Henri MondorHôpital Albert ChenevierCréteil,FR
- ENBREC, European Network of Bipolar Research Expert Centres
ENBRECCréteil,FR
| | - Hannes Petursson
- Division of Psychiatry
Landspitali University HospitalUniversity of IcelandReykjavik,IS
| | - Engilbert Sigur Sson
- Division of Psychiatry
Landspitali University HospitalUniversity of IcelandReykjavik,IS
| | | | - Susanne Lucae
- Max Planck Institute of Psychiatry
Max Planck Institute of PsychiatryMunich,FR
| | - Markus Schwarz
- Psychiatric Center Nordbaden
Psychiatric Center NordbadenWiesloch,DE
| | - Peter R. Schofield
- Prince of Wales Medical Institute
Prince of Wales Medical InstituteSydney,AU
- University of New south Wales
University of New South WalesSydney,AU
| | - Nick Martin
- Queensland Institute of Medical Research
Queensland Institute of Medical ResearchBrisbane,AU
| | - Grant W. Montgomery
- Queensland Institute of Medical Research
Queensland Institute of Medical ResearchBrisbane,AU
| | - Mark Lathrop
- CNG, Centre National de Génotypage
CEA : DSV/IGCentre National de Génotypage 2 rue Gaston Crémieux CP5721 91057 EVRY Cedex,FR
| | | | - Michael Bauer
- Department of Psychiatry and Psychotherapy, ENBREC Group
University Hospital Carl Gustav CarusDresden,DE
| | - Adam Wright
- School of Psychiatry
University of New South WalesBlack Dog InstituteSydney, New South Wales,AU
| | - Philip B. Mitchell
- School of Psychiatry
University of New South WalesBlack Dog InstituteSydney, New South Wales,AU
| | - Martin Hautzinger
- Department of Clinical and Developmental Psychology
University of TubingenInstitute of Psychology, Tubingen,DE
| | - Andreas Reif
- Department of Psychiatry
University of WürzburgWürzburg,DE
| | - John R. Kelsoe
- Department of Psychiatry
University of California San DiegoLa Jolla, California,US
- Department of Psychiatry, Special Treatment and Evaluation Program (STEP)
Veterans Affairs San Diego Healthcare SystemSan Diego, California,US
| | - Shaun M. Purcell
- Center for Human Genetic Research
Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts,US
- Stanley Center for Psychiatric Research
Broad Institute of MIT and HarvardCambridge, Massachusetts,US
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Casamassima F, Hay AC, Benedetti A, Lattanzi L, Cassano GB, Perlis RH. L-type calcium channels and psychiatric disorders: A brief review. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:1373-90. [PMID: 20886543 DOI: 10.1002/ajmg.b.31122] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 07/28/2010] [Indexed: 01/11/2023]
Abstract
Emerging evidence from genome-wide association studies (GWAS) support the association of polymorphisms in the alpha 1C subunit of the L-type voltage-gated calcium channel gene (CACNA1C) with bipolar disorder. These studies extend a rich prior literature implicating dysfunction of L-type calcium channels (LTCCs) in the pathophysiology of neuropsychiatric disorders. Moreover, calcium channel blockers reduce Ca(2+) flux by binding to the α1 subunit of the LTCC and are used extensively for treating hypertension, preventing angina, cardiac arrhythmias and stroke. Calcium channel blockers have also been studied clinically in psychiatric conditions such as mood disorders and substance abuse/dependence, yielding conflicting results. In this review, we begin with a summary of LTCC pharmacology. For each category of disorder, this article then provides a review of animal and human data. In particular, we extensively focus on animal models of depression and clinical trials in mood disorders and substance abuse/dependence. Through examining rationale and study design of published clinical trials, we provide some of the possible reasons why we still do not have definitive evidence of efficacy of calcium-channel antagonists for mood disorders. Refinement of genetic results and target phenotypes, enrollment of adequate sample sizes in clinical trials and progress in physiologic and pharmacologic studies to synthesize tissue and isoform specific calcium channel antagonists, are all future challenges of research in this promising field. © 2010 Wiley-Liss, Inc.
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Pedrosa E, Shah A, Tenore C, Capogna M, Villa C, Guo X, Zheng D, Lachman HM. β-catenin promoter ChIP-chip reveals potential schizophrenia and bipolar disorder gene network. J Neurogenet 2010; 24:182-93. [PMID: 20615089 DOI: 10.3109/01677063.2010.495182] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Therapeutic concentrations of lithium salts inhibit glycogen synthase kinase 3 beta (GSK3β) and phosphoinositide (PI) signaling suggesting that abnormal activation of these pathways could be a factor in the pathophysiology of bipolar disorder (BD). Involvement of these pathways is also supported by recent genome-wide association studies (GWASs). One way investigators have investigated the molecular basis of BD and the therapeutic action of lithium is by microarray expression studies, since both GSK3β- and PI-mediated signal transduction pathways are coupled to transcriptional activation and inhibition. However, expression profiling has some limitations and investigators cannot use the approach to analyze fetal brain tissue, arguably the most relevant biological structure related to the development of genetically based psychiatric disorders. To address these shortcomings, the authors have taken a novel approach using chromatin immunoprecipitation-enriched material annealed to microarrays (ChIP-chip) targeting genes in fetal brain tissue bound by β-catenin, a transcription factor that is directly regulated by GSK3β. The promoters for 640 genes were found to be bound by β-catenin, many of which are known schizophrenia (SZ), autism spectrum disorder (ASD), and BD candidates, including CACNA1B, NRNG, SNAP29, FGFR1, PCDH9, and nine others identified in recently published GWASs and genome-wide searches for copy number variants (CNVs). The findings suggest that seemingly disparate candidate genes for SZ and BD can be incorporated into a common molecular network revolving around GSK3β/β-catenin signaling. In addition, the finding that a putative lithium-responsive pathway may influence a subgroup of SZ and ASD candidate genes could have therapeutic implications.
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Affiliation(s)
- Erika Pedrosa
- Department of Psychiatry and Behavioral Sciences, Division of Basic Research, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Nyholt DR. Letter to the editor: Further evidence is required to confirm association between CACNA1C gene variants and bipolar affective disorder. Psychol Med 2010; 40:702-704. [PMID: 20132581 DOI: 10.1017/s0033291710000012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Keers R, Farmer AE, Aitchison KJ. Extracting a needle from a haystack: reanalysis of whole genome data reveals a readily translatable finding. Psychol Med 2009; 39:1231-1235. [PMID: 19215628 DOI: 10.1017/s0033291708005084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is significant unmet need for more effective treatments for bipolar disorder. The drug discovery process is becoming prohibitively expensive. Hence, biomarker clues to assist or shortcut this process are now widely sought. Using the publicly available data from the whole genome association study conducted by the Wellcome Trust Case Control Consortium, we sought to identify groups of genetic markers (single nucleotide polymorphisms) in which each marker was independently associated with bipolar disorder, with a less stringent threshold than that set by the original investigators (p< or =1 x 10(-4)). We identified a group of markers occurring within the CACNA1C gene (encoding the alpha subunit of the calcium channel Cav1.2). We then ascertained that this locus had been previously associated with the disorder in both a smaller and a whole genome study, and that a number of drugs blocking this channel (including verapamil and diltiazem) had been trialled in the treatment of bipolar disorder. The dihydropyridine-based blockers such as nimodipine that bind specifically to Cav1.2 and are more penetrant to the central nervous system have shown some promising early results; however, further trials are indicated. In addition, migraine is commonly seen in affective disorder, and calcium channel antagonists are successfully used in the treatment of migraine. One such agent, flunarizine, is structurally related to other first-generation derivatives of antihistamines such as antipsychotics. This implies that flunarizine could be useful in the treatment of bipolar disorder, and, furthermore, that other currently licensed drugs should be investigated for antagonism of Cav1.2.
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Affiliation(s)
- R Keers
- MRC SGDP Centre, Institute of Psychiatry at King's College London, 16 De Crespigny Park, Denmark Hill, London, UK.
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Mallinger AG, Thase ME, Haskett R, Buttenfield J, Luckenbaugh DA, Frank E, Kupfer DJ, Manji HK. Verapamil augmentation of lithium treatment improves outcome in mania unresponsive to lithium alone: preliminary findings and a discussion of therapeutic mechanisms. Bipolar Disord 2008; 10:856-66. [PMID: 19594501 PMCID: PMC3387673 DOI: 10.1111/j.1399-5618.2008.00636.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Attenuation of protein kinase C (PKC) is a mechanism common to both established (lithium, valproate) and some novel (tamoxifen) antimanic agents. Verapamil, although primarily known as a calcium channel blocker, also has PKC inhibitory activity. Verapamil has shown antimanic activity in some but not all studies. Therefore, we investigated verapamil, used alone or as an adjunctive treatment, in manic patients who did not respond to an initial adequate trial of lithium. METHODS Each study phase lasted three weeks. Subjects were treated openly with lithium in Phase 1 (n = 45). Those who failed to respond were randomly assigned to double-blind treatment in Phase 2 with either verapamil (n = 10) or continued-lithium (n = 8). Phase 2 nonresponders (n = 10) were assigned to combined verapamil/lithium in Phase 3. RESULTS Response in Phase 2 did not differ significantly between verapamil and continued-lithium. During Phase 3, response to combined treatment was significantly better than overall response to monotherapy in Phase 2 (Fisher's Exact test, p = 0.043). Mania ratings improved during combined treatment in Phase 3 by 88.2% (linear mixed model analysis, F = 4.34, p = 0.013), compared with 10.5% improvement during Phase 2. CONCLUSIONS In this preliminary investigation, verapamil monotherapy did not demonstrate antimanic efficacy. By contrast, the combination of verapamil plus lithium was highly efficacious. Our findings thus suggest that verapamil may have potential utility as an adjunct to lithium. This effect may be mediated by additive actions on PKC inhibition, which may be an important mechanism for antimanic agents in general.
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Affiliation(s)
- Alan G Mallinger
- Mood and Anxiety Disorders Program, National Institutes of Health Intramural Research Program, Building 10, Room 3N210, MSC 1290, Bethesda, MD 20892, USA.
| | - Michael E Thase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Roger Haskett
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
| | - Joan Buttenfield
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
| | - David A Luckenbaugh
- Mood and Anxiety Disorders Program, National Institutes of Health Intramural Research Program, Bethesda, MD
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
| | - David J Kupfer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
| | - Husseini K Manji
- Mood and Anxiety Disorders Program, National Institutes of Health Intramural Research Program, Bethesda, MD
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Bocchieri E, Thys-Jacobs S. Role of calcium metabolism in premenstrual syndrome. Expert Rev Endocrinol Metab 2008; 3:645-655. [PMID: 30290409 DOI: 10.1586/17446651.3.5.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Premenstrual syndrome has been the subject of many myths and misconceptions over the centuries. It is a very common problem affecting millions of young women during their reproductive lives and is characterized by numerous recurrent, cyclical emotional and physical symptoms during the luteal phase of the menstrual cycle. The etiology of this disorder has remained poorly understood until only recently. Alterations in calcium homeostasis have long been associated with many affective disorders. Cyclical fluctuations of the ovarian steroid hormones across the menstrual cycle influence calcium metabolism, affect intestinal calcium absorption and modulate 1,25-dihydroxyvitamin D synthesis. Evidence now strongly suggests that abnormalities in calcium and vitamin D metabolism, specifically calcium and vitamin D deficiency, are responsible for these luteal-phase symptoms. Calcium and vitamin D supplementation may offer a simple solution to millions of women affected with premenstrual syndrome.
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Affiliation(s)
- Elisa Bocchieri
- a Division of Endocrinology, St Luke's - Roosevelt Hospital, College of Physicians & Surgeons, Columbia University, NY, USA
| | - Susan Thys-Jacobs
- b Division of Endocrinology, St Luke's - Roosevelt Hospital, College of Physicians & Surgeons, Columbia University, 343 West 58th Street, Suite 11, New York, NY 10019, USA.
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Sklar P, Smoller JW, Fan J, Ferreira MAR, Perlis RH, Chambert K, Nimgaonkar VL, McQueen MB, Faraone SV, Kirby A, de Bakker PIW, Ogdie MN, Thase ME, Sachs GS, Todd-Brown K, Gabriel SB, Sougnez C, Gates C, Blumenstiel B, Defelice M, Ardlie KG, Franklin J, Muir WJ, McGhee KA, MacIntyre DJ, McLean A, VanBeck M, McQuillin A, Bass NJ, Robinson M, Lawrence J, Anjorin A, Curtis D, Scolnick EM, Daly MJ, Blackwood DH, Gurling HM, Purcell SM. Whole-genome association study of bipolar disorder. Mol Psychiatry 2008; 13:558-69. [PMID: 18317468 PMCID: PMC3777816 DOI: 10.1038/sj.mp.4002151] [Citation(s) in RCA: 521] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 12/13/2007] [Accepted: 12/14/2007] [Indexed: 01/17/2023]
Abstract
We performed a genome-wide association scan in 1461 patients with bipolar (BP) 1 disorder, 2008 controls drawn from the Systematic Treatment Enhancement Program for Bipolar Disorder and the University College London sample collections with successful genotyping for 372,193 single nucleotide polymorphisms (SNPs). Our strongest single SNP results are found in myosin5B (MYO5B; P=1.66 x 10(-7)) and tetraspanin-8 (TSPAN8; P=6.11 x 10(-7)). Haplotype analysis further supported single SNP results highlighting MYO5B, TSPAN8 and the epidermal growth factor receptor (MYO5B; P=2.04 x 10(-8), TSPAN8; P=7.57 x 10(-7) and EGFR; P=8.36 x 10(-8)). For replication, we genotyped 304 SNPs in family-based NIMH samples (n=409 trios) and University of Edinburgh case-control samples (n=365 cases, 351 controls) that did not provide independent replication after correction for multiple testing. A comparison of our strongest associations with the genome-wide scan of 1868 patients with BP disorder and 2938 controls who completed the scan as part of the Wellcome Trust Case-Control Consortium indicates concordant signals for SNPs within the voltage-dependent calcium channel, L-type, alpha 1C subunit (CACNA1C) gene. Given the heritability of BP disorder, the lack of agreement between studies emphasizes that susceptibility alleles are likely to be modest in effect size and require even larger samples for detection.
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Affiliation(s)
- P Sklar
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA.
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Williams S, Wynn G, Cozza K, Sandson NB. Cardiovascular Medications. PSYCHOSOMATICS 2007; 48:537-47. [DOI: 10.1176/appi.psy.48.6.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
Despite the remarkable increase in medications validated as effective in bipolar disorder, treatment is still plagued by inadequate response in acute manic or depressive episodes or in long-term preventive maintenance treatment. Established first-line treatments include lithium, valproate and second-generation antipsychotics (SGAs) in acute mania, and lithium and valproate as maintenance treatments. Recently validated treatments include extended release carbamazapine for acute mania and lamotrigine, olanzapine and aripiprazole as maintenance treatments. For treatment-resistant mania and as maintenance treatments, a number of newer anticonvulsants, and one older one, phenytoin, have shown some promise as effective. However, not all anticonvulsants are effective and each agent needs to be evaluated individually. Combining multiple agents is the most commonly used clinical strategy for treatment resistant bipolar patients despite a relative lack of data supporting its use, except for acute mania (for which lithium or valproate plus an SGA is optimal treatment). Other approaches that may be effective for treatment-resistant patients include high-dose thyroid augmentation, clozapine, calcium channel blockers and electroconvulsive therapy (ECT). Adjunctive psychotherapies show convincing efficacy using a variety of different techniques, most of which include substantial attention to education and enhancing coping strategies. Only recently, bipolar depression has become a topic of serious inquiry with the dominant controversy focusing on the place of antidepressants in the treatment of bipolar depression. Other than mood stabilizers alone or the combination of mood stabilizers and antidepressants, most of the approaches for treatment-resistant bipolar depression are relatively similar to those used in unipolar depression, with the possible exception of a more prominent place for SGAs, prescribed either alone or in combination with antidepressants. Future work in the area needs to explore the treatments commonly used by clinicians with inadequate research support, such as combination therapy and the use of antidepressants as both acute and adjunctive maintenance treatments for bipolar disorder.
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Affiliation(s)
- M Gitlin
- Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Sun W, Park KW, Choe J, Rhyu IJ, Kim IH, Park SK, Choi B, Choi SH, Park SH, Kim H. Identification of novel electroconvulsive shock-induced and activity-dependent genes in the rat brain. Biochem Biophys Res Commun 2005; 327:848-56. [PMID: 15649423 DOI: 10.1016/j.bbrc.2004.12.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Indexed: 11/16/2022]
Abstract
Electroconvulsive shock (ECS) has been used as an effective treatment for patients suffering from major depression disorders and schizophrenia. However, the exact mechanisms underlying the action of ECS are poorly understood. Using high-density oligonucleotide microarrays, we identified 60 ECS-induced genes whose gene products are involved in the neuronal signaling, neuritogenesis and tissue remodeling. In situ hybridization and depolarization-dependent expression assay were performed to characterize 4 genes (lysyl oxidase, Ab1-046, SOX11, and T-type calcium channel 1G subunit) which have not yet been reported to be induced by ECS. Interestingly, the induction of these genes was observed mainly in the dentate gyrus of hippocampal formation and piriform cortex, where ECS-induced neural activation is highlighted, and depolarization of cultured cortical neurons also induced the expression of these genes. Taken together, our results suggest that therapeutic actions of ECS may be manifested by the activity-dependent induction of genes related to the plastic changes of the brain such as neuronal signaling neuritogenesis, and tissue remodeling.
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Affiliation(s)
- Woong Sun
- Department of Anatomy, Korea 21 Biomedical Science, Korea University College of Medicine, 126-1, 5-Ka, Anam-Dong, Seongbuk-Gu, Seoul 136-705, Republic of Korea
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Machado-Vieira R, Kapczinski F, Soares JC. Perspectives for the development of animal models of bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:209-24. [PMID: 14751416 DOI: 10.1016/j.pnpbp.2003.10.015] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bipolar disorder (BD) has been a particularly challenging illness for the development of adequate animal models for neurobiological studies. These difficulties are largely related to the peculiar clinical characteristics of this illness, with an intriguing alternation of mania, depression, euthymia, and mixed states. The etiology and brain mechanisms involved in this several mental illness remain unknown. Preclinical studies with animal models of mania or depression have been developed to evaluate the potential efficacy of new psychotropic drugs and generate information concerning the biochemical effects of these drugs on specific targets. These models try to mimic the behavioral components of mania and depression in human subjects and examine the pharmacological responses and mechanisms of action of potentially new therapeutic agents. The main limitation is that there is currently no model that would mimic mood cyclicity, which is a hallmark feature of BD. Thus, these models do not represent valid paradigms for the study of this illness, because they do not address key questions regarding cyclicity. In this review, we propose that new genetics approaches involving potential animal models of BD are a promising new area for further development.
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Affiliation(s)
- Rodrigo Machado-Vieira
- Laboratory of Experimental Psychiatry, Hospital de Clínicas de Porto Alegre, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Abstract
Mood stabilizers have evolved considerably over the past decade. Lithium, divalproex, and olanzapine are currently Food and Drug Administration-approved for the treatment of acute mania. A number of new and traditional medications have also been tested and are commonly used in clinical practice. Several strategies for managing treatment-resistant mania have been suggested, but few have been rigorously tested. Emphases on rapid stabilization and fewer side effects have raised the bar for what is expected from mood stabilizers and the successful treatment of mania involves a delicate balance between swiftness, short-term tolerability, and long-term safety.
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Affiliation(s)
- Paul E Holtzheimer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Gnanadesikan M, Freeman MP, Gelenberg AJ. Alternatives to lithium and divalproex in the maintenance treatment of bipolar disorder. Bipolar Disord 2003; 5:203-16. [PMID: 12780874 DOI: 10.1034/j.1399-5618.2003.00032.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The role of lithium carbonate in the maintenance treatment of bipolar disorder is well established. Unfortunately, many patients fail to respond adequately to this agent or are unable to tolerate its adverse effects. Divalproex has become a commonly used alternative to lithium, but it also is ineffective or poorly tolerated in many patients. This article attempts to review the available data on maintenance therapy in bipolar disorder with a variety of anticonvulsants and antipsychotics (both conventional and novel), with reference to relevant studies in acute mania and bipolar depression as well. METHODS Evidence on maintenance therapy and relevant acute-phase data were collected using MEDLINE database searches. RESULTS Data on maintenance therapy with agents other than lithium and divalproex are sparse, and often derived from open, uncontrolled studies. Implications and flaws of available data are discussed. CONCLUSIONS Other than lithium, there are few robust double-blind data to support the use of a variety of agents in the maintenance phase. However, uncontrolled data suggest that a number of agents merit further study.
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Koch JM, Kell S, Hinze-Selch D, Aldenhoff JB. Changes in CREB-phosphorylation during recovery from major depression. J Psychiatr Res 2002; 36:369-75. [PMID: 12393305 DOI: 10.1016/s0022-3956(02)00056-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
For decades psychiatrists have been looking for biological state markers measurable by easy blood test in order to follow up and predict early on treatment response in patients with major depression. In the present study we investigated whether or not measuring CREB (cAMP-response-element-binding-protein) phosphorylation in peripheral blood T lymphocytes is a state marker of treatment response. CREB is an ubiquitous key-element of intracellular signal transduction cascades and its transcriptional activity depends on phosphorylation at Ser-133. Several studies in animals demonstrated that the transcriptional activity of CREB is up-regulated by antidepressant treatment. Therefore, it has been hypothesized that antidepressant treatment exerts its therapeutic effect by this mechanism. In the present study, we investigated CREB-phosphorylation in T-lymphocytes of 20 patients before and in the end of week one and two of either psychopharmacological or psychotherapeutic treatment. After two weeks, 15 patients fulfilled the criteria of treatment response (i.e. 30% reduction in HAMD score compared to baseline), whereas five patients did not. In the end of week two, the responders showed a significant increase in CREB-phosphorylation (P = 0.018) compared to the non-responders. This was true for all patients with either treatment regimen. In conclusion, these results indicate for the first time that the increase in CREB-phosphorylation might be a molecular state marker for the response to antidepressant treatment.
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Affiliation(s)
- Jakob M Koch
- Department of Psychiatry, Christian-Albrechts-University, Niemannsweg 147, D-24105 Kiel, Germany.
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Abstract
Bipolar, or manic-depressive, disorder is a frequent, severe, mostly recurrent mood disorder associated with great morbidity. The lifetime prevalence of bipolar disorder is 1.3 to 1.6%. The mortality rate of the disease is two to three times higher than that of the general population. About 10-20% of individuals with bipolar disorder take their own life, and nearly one third of patients admit to at least one suicide attempt. The clinical manifestations of the disease are exceptionally diverse. They range from mild hypomania or mild depression to severe forms of mania or depression accompanied by profound psychosis. Bipolar disorder is equally prevalent across sexes, with the exception of rapid cycling, a severe and difficult to treat variant of the disorder, which arises mostly in women. Because of the high risk of recurrence and suicide, long-term prophylactic pharmacological treatment is indicated. Lithium salts are the first choice long-term preventive treatment for bipolar disorder. They also possess well documented antisuicidal effects. Second choice prophylactic treatments are carbamazepine and valproate, although evidence of their effectiveness is weaker.
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Affiliation(s)
- Bruno Müller-Oerlinghausen
- Department of Psychiatry, Research Group of Clinical Psychopharmacology, Freie Universität Berlin, Berlin,
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