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Reininghaus EZ, Lenger M, Schönthaler EMD, Fellendorf FT, Stross T, Schwarz M, Moll N, Reininghaus B, Dalkner N. Changes in tryptophan breakdown associated with response to multimodal treatment in depression. Front Psychiatry 2024; 15:1380620. [PMID: 38974918 PMCID: PMC11224482 DOI: 10.3389/fpsyt.2024.1380620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Background Research on depression showed that dysregulations in tryptophan (TRP), kynurenine (KYN), and its KYN pathway metabolites are key aspects in the development and maintenance of depressive symptoms. In our previous reports, we described sex-specific changes in TRP breakdown as well as changes in KYN and KYN/TRP in association with treatment response and inflammatory and metabolic parameters. However, results of treatment effects on KYN pathway metabolites as well as how pathway changes are related to treatment response remain sparse. Objective We investigated potential changes of KYN and KYN pathway metabolites in association with therapeutic response of individuals with depression during a six-week multimodal psychiatric rehabilitation program. Methods 87 participants were divided into treatment responders and non-responders (48 responders, 39 non-responders; 38 male, 49 female; M age = 51.09; SD age = 7.70) using scores of psychological questionnaires. KYN pathway metabolites serum concentrations as well as their ratios were collected using high performance liquid chromatography. Changes over time (time of admission (t1) vs. time of discharge (t2)) were calculated using repeated measure analyses of (co)variance. Results Non-responders exhibited higher levels of 3-Hydroxyanthralinic acid (3-HAA), nicotinic acid (NA), and 3-HAA/KYN, independently of measurement time. NA levels decreased, while 3-HAA levels increased over time in both groups, independently of treatment response. 3-HK/KYN levels decreased, while KYN levels increased in non-responders, but not in responders over time. Discussion The results indicate that some compounds of the KYN pathway metabolites can be altered through multimodal long-term interventions in association with treatment response. Especially the pathway degrading KYN further down to 3-HAA and 3-HK/KYN might be decisive for treatment response in depression.
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Affiliation(s)
- Eva Z. Reininghaus
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Elena M. D. Schönthaler
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T. Fellendorf
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Tatjana Stross
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Markus Schwarz
- Institute of Laboratory Medicine, University Hospital, Ludwig-Maximilian University (LMU), Munich, Munich, Germany
| | - Natalie Moll
- Institute of Laboratory Medicine, University Hospital, Ludwig-Maximilian University (LMU), Munich, Munich, Germany
| | - Bernd Reininghaus
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Birner A, Mairinger M, Elst C, Maget A, Fellendorf FT, Platzer M, Queissner R, Lenger M, Tmava-Berisha A, Bengesser SA, Reininghaus EZ, Kreuzthaler M, Dalkner N. Machine-based learning of multidimensional data in bipolar disorder - pilot results. Bipolar Disord 2024; 26:364-375. [PMID: 38531635 DOI: 10.1111/bdi.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Owing to the heterogenic picture of bipolar disorder, it takes approximately 8.8 years to reach a correct diagnosis. Early recognition and early intervention might not only increase quality of life, but also increase life expectancy as a whole in individuals with bipolar disorder. Therefore, we hypothesize that implementing machine learning techniques can be used to support the diagnostic process of bipolar disorder and minimize misdiagnosis rates. MATERIALS AND METHODS To test this hypothesis, a de-identified data set of only demographic information and the results of cognitive tests of 196 patients with bipolar disorder and 145 healthy controls was used to train and compare five different machine learning algorithms. RESULTS The best performing algorithm was logistic regression, with a macro-average F1-score of 0.69 [95% CI 0.66-0.73]. After further optimization, a model with an improved macro-average F1-score of 0.75, a micro-average F1-score of 0.77, and an AUROC of 0.84 was built. Furthermore, the individual amount of contribution per variable on the classification was assessed, which revealed that body mass index, results of the Stroop test, and the d2-R test alone allow for a classification of bipolar disorder with equal performance. CONCLUSION Using these data for clinical application results in an acceptable performance, but has not yet reached a state where it can sufficiently augment a diagnosis made by an experienced clinician. Therefore, further research should focus on identifying variables with the highest amount of contribution to a model's classification.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Marco Mairinger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Clemens Elst
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Markus Kreuzthaler
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Li Y, Wang L, Huang J, Zhang P, Zhou Y, Tong J, Chen W, Gou M, Tian B, Li W, Luo X, Tian L, Hong LE, Li CSR, Tan Y. Serum neuroactive metabolites of the tryptophan pathway in patients with acute phase of affective disorders. Front Psychiatry 2024; 15:1357293. [PMID: 38680780 PMCID: PMC11046465 DOI: 10.3389/fpsyt.2024.1357293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Background Many studies showed disrupted tryptophan metabolism in patients with affective disorders. The aims of this study were to explore the differences in the metabolites of tryptophan pathway (TP) and the relationships between TP metabolites and clinical symptoms, therapeutic effect in patients with bipolar disorder with acute manic episode (BD-M), depressive episode (BD-D) and major depressive disorder (MDD). Methods Patients with BD-M (n=52) and BD-D (n=39), MDD (n=48) and healthy controls (HCs, n=49) were enrolled. The serum neuroactive metabolites levels of the TP were measured by liquid chromatography-tandem mass spectrometry. Hamilton Depression Scale-17 item (HAMD-17) and Young Mania Rating Scale (YMRS) were used to evaluate depressive and manic symptoms at baseline and after 8 weeks of antidepressants, mood stabilizers, some also received antipsychotic medication. Results The levels of tryptophan (TRP) and kynurenic acid (KYNA) were significantly lower and the ratios of tryptophan/kynurenine (TRP/KYN), 5-hydroxytryptamine/tryptophan (5-HT/TRP), quinolinic acid/kynurenic acid (QUIN/KYNA) were higher in BD-M, BD-D, MDD vs. HC. The levels of QUIN and the ratios of QUIN/KYNA were higher in BD-M than in BD-D, MDD, and HCs. The 5-hydroxyindoleacetic acid (5-HIAA) levels of patients with MDD were significantly higher than those in BD-M and BD-D. Binary logistic regression analysis showed the lower peripheral KYNA, the higher the QUIN level, and the higher the risk of BD-M; the lower peripheral KYNA and the higher KYN/TRP and 5-HT/TRP, the higher the risk of BD-D; and the lower the peripheral KYNA level and the higher the KYN/TRP and 5-HT/TRP, the higher the risk of MDD. Correlation analysis, showing a significant association between tryptophan metabolites and improvement of clinical symptoms, especially depression symptoms. Conclusions Patients with affective disorders had abnormal tryptophan metabolism, which involved in 5-HT and kynurenine pathway (KP) sub-pathway. Tryptophan metabolites might be potential biomarkers for affective disorders and some metabolites have been associated with remission of depressive symptoms.
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Affiliation(s)
- Yanli Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Leilei Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Ping Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Yanfang Zhou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Wenjin Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Mengzhuang Gou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Wei Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Li Tian
- Institute of Biomedicine and Translational Medicine, Department of Physiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - L. Elliot Hong
- Louis A. Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan, Hospital, Beijing, China
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Tassan Mazzocco M, Pisanu C, Russo L, Acconcia C, Cambiaghi M, De Girolamo S, Squassina A, Cherchi L, Monzani E, Scebba F, Angeloni D, De Gregorio D, Nasini S, Dall'Acqua S, Sut S, Suprani F, Garzilli M, Guiso B, Pulcinelli V, Iaselli MN, Pinna I, Somaini G, Arru L, Corrias C, Paribello P, Pinna F, Gobbi G, Valtorta F, Carpiniello B, Manchia M, Comai S. Melatonin MT 1 receptors as a target for the psychopharmacology of bipolar disorder: A translational study. Pharmacol Res 2023; 198:106993. [PMID: 37972722 DOI: 10.1016/j.phrs.2023.106993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
The treatment of bipolar disorder (BD) still remains a challenge. Melatonin (MLT), acting through its two receptors MT1 and MT2, plays a key role in regulating circadian rhythms which are dysfunctional in BD. Using a translational approach, we examined the implication and potential of MT1 receptors in the pathophysiology and psychopharmacology of BD. We employed a murine model of the manic phase of BD (Clock mutant (ClockΔ19) mice) to study the activation of MT1 receptors by UCM871, a selective partial agonist, in behavioral pharmacology tests and in-vivo electrophysiology. We then performed a high-resolution Nuclear Magnetic Resonance study on isolated membranes to characterize the molecular mechanism of interaction of UCM871. Finally, in a cohort of BD patients, we investigated the link between clinical measures of BD and genetic variants located in the MT1 receptor and CLOCK genes. We demonstrated that: 1) UCM871 can revert behavioral and electrophysiological abnormalities of ClockΔ19 mice; 2) UCM871 promotes the activation state of MT1 receptors; 3) there is a significant association between the number of severe manic episodes and MLT levels, depending on the genetic configuration of the MT1 rs2165666 variant. Overall, this work lends support to the potentiality of MT1 receptors as target for the treatment of BD.
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Affiliation(s)
- Margherita Tassan Mazzocco
- IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Claudia Pisanu
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, Cagliari, Italy
| | - Luigi Russo
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Clementina Acconcia
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Marco Cambiaghi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sofia De Girolamo
- IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Alessio Squassina
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, Cagliari, Italy
| | - Laura Cherchi
- IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Elena Monzani
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Scebba
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Via G. Moruzzi, 56124 Pisa, Italy
| | - Debora Angeloni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Via G. Moruzzi, 56124 Pisa, Italy; The Institute of Biorobotics, Scuola Superiore Sant'Anna, Via G. Moruzzi, 56124 Pisa, Italy
| | - Danilo De Gregorio
- IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Sofia Nasini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Stefano Dall'Acqua
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Stefania Sut
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Mario Garzilli
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Beatrice Guiso
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Vittoria Pulcinelli
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Maria Novella Iaselli
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Ilaria Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Laura Arru
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Flavia Valtorta
- IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
| | - Stefano Comai
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy; Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Biomedical Sciences, University of Padua, Padua, Italy.
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Sapienza J, Spangaro M, Guillemin GJ, Comai S, Bosia M. Importance of the dysregulation of the kynurenine pathway on cognition in schizophrenia: a systematic review of clinical studies. Eur Arch Psychiatry Clin Neurosci 2023; 273:1317-1328. [PMID: 36460745 DOI: 10.1007/s00406-022-01519-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/15/2022] [Indexed: 12/04/2022]
Abstract
Schizophrenia is a chronic psychotic disease burdened by cognitive deficits which hamper daily functioning causing disability and costs for society. Biological determinants underlying cognitive impairment are only partially understood and there are no convincing pharmacological targets able to improve cognitive outcome. Mounting evidence has shown the involvement of the kynurenine pathway in the pathophysiology of schizophrenia, also concerning cognitive symptoms. Therefore, the action of specific metabolites of kynurenine could affects cognition in schizophrenia. To evaluate the impact of the metabolites of kynurenine pathway on cognitive functions in schizophrenia spectrum disorders, with a focus on the modulating role of gender, to identify predictors of cognitive functioning and hypothetical pharmacological targets able to resize disability by improving cognition, thus functioning and quality of life. A systematic review was performed in PubMed/MEDLINE and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All studies measuring the direct impact of kynurenine metabolites on cognitive performances in living individuals with schizophrenia spectrum disorders were included in the review. Six studies were included. The activation of the kynurenine pathway resulted associated with greater cognitive deficits in patients with schizophrenia and both elevations and reduction of metabolites seemed able to affect cognitive outcome. No modulating role of sex emerged. This systematic review provides evidence that the activation of the kynurenine pathway affects cognition in patients with schizophrenia and highlights this pathway as a possible future target for developing novel drugs toward this still unmet clinical need. However, evidence is still limited and future studies are needed to further clarify the relationship between kynurenine pathway and cognition in schizophrenia.
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Affiliation(s)
| | | | - Gilles J Guillemin
- Neuroinflammation Group, Macquarie Medicine School, Macquarie University, Sydney, NSW, Australia
| | - Stefano Comai
- IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy.
- Department of Biomedical Sciences, University of Padua, Padua, Italy.
| | - Marta Bosia
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita Salute San Raffaele University, Milan, Italy
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Paribello P, Squassina A, Pisanu C, Meloni A, Dall'Acqua S, Sut S, Nasini S, Bertazzo A, Congiu D, Garzilli M, Guiso B, Suprani F, Pulcinelli V, Iaselli MN, Pinna I, Somaini G, Arru L, Corrias C, Pinna F, Carpiniello B, Comai S, Manchia M. Probing the Association between Cognition, Suicidal Behavior and Tryptophan Metabolism in a Sample of Individuals Living with Bipolar Disorder: A Secondary Analysis. Brain Sci 2023; 13:brainsci13040693. [PMID: 37190658 DOI: 10.3390/brainsci13040693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Background and Objectives: Alterations in hot cognition and in the tryptophan metabolism through serotonin (5-HT) and kynurenine (KYN) pathways have been associated with an increased risk of suicidal behavior. Here, we aim at probing the association between Stroop test performances and tryptophan pathway components in a sample of individuals with bipolar disorder (BD). Materials and Methods: We explored the association between the Emotion Inhibition Subtask (EIS) performances of the Brief Assessment of Cognition for Affective Disorders (BAC-A) and plasmatic levels of 5-hydroxytriptophan (5-HTP), 5-HT, KYN, 3-hydroxykynurenine (3-HK), quinolinic acid (QA), and kynurenic acid (KYNA) among subjects reporting lifetime suicide ideation (LSI) vs. non-LSI and subjects reporting lifetime suicide attempts (LSA) vs. non-LSA. Results: In a sample of 45 subjects with BD, we found a statistically significant different performance for LSA vs. non-LSA in the color naming (CN) and neutral words (NW) EIS subtasks. There was a significant association between CN performances and plasma 5-HTP levels among LSI and LSA subjects but not among non-LSI or non-LSA. Conclusions: In our sample, patients with LSA and LSI presented lower performances on some EIS subtasks compared to non-LSA and non-LSI. Moreover, we found an inverse correlation between plasma 5-HTP concentration and some EIS performances in LSA and LSI but not among non-LSA or non-LSI. This may represent an interesting avenue for future studies probing this complex association.
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Affiliation(s)
- Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Alessio Squassina
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, 09042 Cagliari, Italy
| | - Claudia Pisanu
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, 09042 Cagliari, Italy
| | - Anna Meloni
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, 09042 Cagliari, Italy
| | - Stefano Dall'Acqua
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Stefania Sut
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Sofia Nasini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Antonella Bertazzo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Donatella Congiu
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, 09042 Cagliari, Italy
| | - Mario Garzilli
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Beatrice Guiso
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Vittoria Pulcinelli
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Maria Novella Iaselli
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Ilaria Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Laura Arru
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
| | - Stefano Comai
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
- San Raffaele Scientific Institute, 20132 Milano, Italy
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 0A2, Canada
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Pisanu C, Squassina A, Paribello P, Dall’Acqua S, Sut S, Nasini S, Bertazzo A, Congiu D, Meloni A, Garzilli M, Guiso B, Suprani F, Pulcinelli V, Iaselli MN, Pinna I, Somaini G, Arru L, Corrias C, Pinna F, Carpiniello B, Comai S, Manchia M. Investigation of Genetic Variants Associated with Tryptophan Metabolite Levels via Serotonin and Kynurenine Pathways in Patients with Bipolar Disorder. Metabolites 2022; 12:1127. [PMID: 36422266 PMCID: PMC9694761 DOI: 10.3390/metabo12111127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/20/2023] Open
Abstract
The kynurenine pathway (KP) may play a role in the pathophysiology of bipolar disorder (BD). We conducted a genome-wide association study (GWAS) to identify genetic variants associated with the plasma levels of the metabolites of tryptophan (TRP) via the serotonin (5-HT) and kynurenine (KYN) pathways in 44 patients with BD and 45 healthy controls. We assessed whether variants that were differentially associated with metabolite levels based on the diagnostic status improved the prediction accuracy of BD using penalized regression approaches. We identified several genetic variants that were significantly associated with metabolites (5-HT, 5-hydroxytryptophan (5-HTP), TRP, and quinolinic acid (QA) or metabolite ratios (5-HTP/TRP and KYN/TRP) and for which the diagnostic status exerted a significant effect. The inclusion of genetic variants led to increased accuracy in the prediction of the BD diagnostic status. Specifically, we obtained an accuracy of 0.77 using Least Absolute Shrinkage and Selection Operator (LASSO) regression. The predictors retained as informative in this model included body mass index (BMI), the levels of TRP, QA, and 5-HT, the 5-HTP/TRP ratio, and genetic variants associated with the levels of QA (rs6827515, rs715692, rs425094, rs4645874, and rs77048355) and TRP (rs292212) or the 5-HTP/TRP ratio (rs7902231). In conclusion, our study identified statistically significant associations between metabolites of TRP via the 5-HT and KYN pathways and genetic variants at the genome-wide level. The discriminative performance of penalized regression models incorporating clinical, genetic, and metabolic predictors warrants a follow-up analysis of this panel of determinants.
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Affiliation(s)
- Claudia Pisanu
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy
| | - Alessio Squassina
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy
| | - Pasquale Paribello
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Stefano Dall’Acqua
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Stefania Sut
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Sofia Nasini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Antonella Bertazzo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Donatella Congiu
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy
| | - Anna Meloni
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy
| | - Mario Garzilli
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Beatrice Guiso
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Federico Suprani
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Vittoria Pulcinelli
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Maria Novella Iaselli
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Ilaria Pinna
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Giulia Somaini
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Laura Arru
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Carolina Corrias
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Federica Pinna
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Bernardo Carpiniello
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Stefano Comai
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
- San Raffaele Scientific Institute, 20132 Milano, Italy
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada
| | - Mirko Manchia
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, 09121 Cagliari, Italy
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 0A2, Canada
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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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