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Scott MR, McClung CA. Bipolar Disorder. Curr Opin Neurobiol 2023; 83:102801. [PMID: 38223491 PMCID: PMC10786345 DOI: 10.1016/j.conb.2023.102801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
This review focuses on recent advances made towards understanding the neurobiology of bipolar disorder (BD), a chronic neuropsychiatric illness characterized by altered mood and energy states. The past few years have seen the completion of the largest genetic studies by far, which have emphasized the polygenic nature of BD as well as it's connection to other psychiatric illnesses. Furthermore, the use of inducible pluripotent stem cells has rapidly expanded. These studies support previous work that implicates dysregulation of neurodevelopment, mitochondria, and calcium homeostasis, while also allowing for investigation into the underlying mechanisms of individual responsivity to lithium. Sleep and circadian rhythms have also been heavily implicated in BD, from disruptions in activity patterns to molecular abnormalities.
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Affiliation(s)
- Madeline R Scott
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Colleen A McClung
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Wartchow KM, Scaini G, Quevedo J. Glial-Neuronal Interaction in Synapses: A Possible Mechanism of the Pathophysiology of Bipolar Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1411:191-208. [PMID: 36949311 DOI: 10.1007/978-981-19-7376-5_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Bipolar disorder (BD) is a severe and chronic psychiatric disorder that affects approximately 1-4% of the world population and is characterized by recurrent episodes of mania or hypomania and depression. BD is also associated with illnesses marked by immune activation, such as metabolic syndrome, obesity, type 2 diabetes mellitus, and cardiovascular diseases. Indeed, a connection has been suggested between neuroinflammation and peripheral inflammatory markers in the pathophysiology of BD, which can be associated with the modulation of many dysfunctional processes, including synaptic plasticity, neurotransmission, neurogenesis, neuronal survival, apoptosis, and even cognitive/behavioral functioning. Rising evidence suggests that synaptic dysregulations, especially glutamatergic system dysfunction, are directly involved in mood disorders. It is becoming clear that dysregulations in connection and structural changes of glial cells play a central role in the BD pathophysiology. This book chapter highlighted the latest findings that support the theory of synaptic dysfunction in BD, providing an overview of the alterations in neurotransmitters release, astrocytic uptake, and receptor signaling, as well as the role of inflammation on glial cells in mood disorders. Particular emphasis is given to the alterations in presynaptic and postsynaptic neurons and glial cells, all cellular elements of the "tripartite synapse," compromising the neurotransmitters system, excitatory-inhibitory balance, and neurotrophic states of local networks in mood disorders. Together, these studies provide a foundation of knowledge about the exact role of the glial-neuronal interaction in mood disorders.
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Affiliation(s)
- Krista M Wartchow
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Giselli Scaini
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Abstract
PURPOSE OF REVIEW Due to bipolar disorder clinical heterogeneity, a plethora of studies have provided new genetic, epigenetic, molecular, and cellular findings associated with its pathophysiology. RECENT FINDINGS Genome-wide association studies and epigenetic evidence points to genotype-phenotype interactions associated with inflammation, oxidative stress, abnormalities in signaling pathways, hypothalamic-pituitary-adrenal axis, and circadian rhythm linked to mitochondrial dysfunction in bipolar disorder. Although the literature is constantly increasing, most of the genetic variants proposed as biomarkers remain to be validated by independent groups and use bigger samples and longitudinal approaches to enhance their power and predictive ability. SUMMARY Regardless of which of the mechanisms described here plays a primary or secondary role in the pathophysiology of bipolar disorder, all of these interact to worsen clinical outcomes for patients. Identifying new biomarkers for early detection, prognosis, and response to treatment might provide novel targets to prevent progression and promote general well being.
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Yun Y, Zhang Q, Zhao W, Ma T, Fan H, Bai L, Ma B, Qi S, Wang Z, An H, Yang F. Relationship between the tryptophan-kynurenine pathway and painful physical symptoms in patients with major depressive disorder. J Psychosom Res 2022; 163:111069. [PMID: 36335711 DOI: 10.1016/j.jpsychores.2022.111069] [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] [Received: 07/15/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the relationship between the tryptophan-kynurenine (TRP-KYN) pathway and painful physical symptoms (PPS) in major depressive disorder (MDD). METHODS Eighty-four patients with MDD (40 patients with PPS and 44 without PPS) and forty-six healthy controls (HC) were recruited. The serum levels of tryptophan (TRP), kynurenine(KYN), kynurenic acid (KA), quinolinic acid (QA), 3-hydroxy-kynurenine (3-HK), serotonin (5-HT) were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Depression, anxiety and pain were assessed using Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Short-form McGill pain questionnaire (SFMPQ) respectively. RESULTS Patients in the MDD group exhibited significantly lower KA and 5-HT levels than HC, whereas MDD patients with PPS showed higher KYN and QA levels, and a higher KYN/TRP ratio than those without. There was a positive correlation between the scores of SFMPQ and QA levels and a negative correlation between the scores of SFMPQ and TRP levels or KA/QA ratios in MDD patients with PPS group. Stepwise multiple regression analysis showed that the KYN/TRP ratios, the KA/QA ratios, and the HAMD scores were significant predictor factors for SFMPQ scores. CONCLUSIONS These results demonstrated that the TRP-KYN pathway may play a role in the pathophysiology of pain in patients with major depressive disorder, suggesting that further studies of this pathway as a potential biomarker or therapeutic target are required.
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Affiliation(s)
- Yajun Yun
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Qi Zhang
- Wuxi Mental Health Center, Wuxi, China
| | - Wenxuan Zhao
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Ting Ma
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Luyuan Bai
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Botao Ma
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Siyuan Qi
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Huimei An
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
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Bartoli F, Cioni RM, Cavaleri D, Callovini T, Crocamo C, Misiak B, Savitz JB, Carrà G. The association of kynurenine pathway metabolites with symptom severity and clinical features of bipolar disorder: An overview. Eur Psychiatry 2022; 65:e82. [PMID: 36366795 PMCID: PMC9724221 DOI: 10.1192/j.eurpsy.2022.2340] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The balance between neurotoxic and neuroprotective effects of kynurenine pathway (KP) components has been recently proposed as a key element in the pathophysiology of bipolar disorder (BD) and related mood episodes. This comprehensive overview explored the link of KP with symptom severity and other clinical features of BD. METHODS We searched Medline, Embase, and PsycInfo electronic databases for studies assessing the association of peripheral and/or central concentrations of KP metabolites with putative clinical features, including symptom severity and other clinical domains in BD. RESULTS We included the findings of 13 observational studies investigating the possible variations of KP metabolites according to symptom severity, psychotic features, suicidal behaviors, and sleep disturbances in BD. Studies testing the relationship between KP metabolites and depression severity generated mixed and inconsistent findings. No statistically significant correlations with manic symptoms were found. Moreover, heterogeneous variations of the KP across different clinical domains were shown. Few available studies found (a) higher levels of cerebrospinal fluid kynurenic acid and lower of plasma quinolinic acid in BD with psychotic features, (b) lower central and peripheral picolinic acid levels in BD with suicide attempts, and (c) no significant correlations between KP metabolites and BD-related sleep disturbances. CONCLUSIONS An imbalance of KP metabolism toward the neurotoxic branches is likely to occur in people with BD, though evidence on variations according to specific clinical features of BD is less clear. Additional research is needed to clarify the role of KP in the etiopathogenesis of BD and related clinical features.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Riccardo M Cioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Błażej Misiak
- Department of Psychiatry, Wrocław Medical University, Wrocław, Poland
| | - Jonathan B Savitz
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, USA
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Psychiatry, University College London, London, United Kingdom
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