Utilization of Never-Medicated Bipolar Disorder Patients towards Development and Validation of a Peripheral Biomarker Profile

Abstract

There are currently no biological tests that differentiate patients with bipolar disorder (BPD) from healthy controls. While there is evidence that peripheral gene expression differences between patients and controls can be utilized as biomarkers for psychiatric illness, it is unclear whether current use or residual effects of antipsychotic and mood stabilizer medication drives much of the differential transcription. We therefore tested whether expression changes in first-episode, never-medicated BPD patients, can contribute to a biological classifier that is less influenced by medication and could potentially form a practicable biomarker assay for BPD. We employed microarray technology to measure global leukocyte gene expression in first-episode (n=3) and currently medicated BPD patients (n=26), and matched healthy controls (n=25). Following an initial feature selection of the microarray data, we developed a cross-validated 10-gene model that was able to correctly predict the diagnostic group of the training sample (26 medicated patients and 12 controls), with 89% sensitivity and 75% specificity (p<0.001). The 10-gene predictor was further explored via testing on an independent cohort consisting of three pairs of monozygotic twins discordant for BPD, plus the original enrichment sample cohort (the three never-medicated BPD patients and 13 matched control subjects), and a sample of experimental replicates (n=34). 83% of the independent test sample was correctly predicted, with a sensitivity of 67% and specificity of 100% (although this result did not reach statistical significance). Additionally, 88% of sample diagnostic classes were classified correctly for both the enrichment (p=0.015) and the replicate samples (p<0.001). We have developed a peripheral gene expression biomarker profile, that can classify healthy controls from patients with BPD receiving antipsychotic or mood stabilizing medication, which has both high sensitivity and specificity. Moreover, assay of three first-episode patients who had never received such medications, to first enrich the expression dataset for disease-related genes independent of medication effects, and then to test the 10-gene predictor, validates the peripheral biomarker approach for BPD.

Gene expression alterations related to mania and psychosis in peripheral blood of patients with a first episode of psychosis

“…The majority of studies have focused on schizophrenia-spectrum psychosis, suggesting alterations in genes related to myelination, neurodevelopment and AKT pathway, 14 although affective psychoses studies are under-represented in the literature, particularly early-stage affective psychoses. Very few studies on gene expression of antipsychotic-naive bipolar disorder patients have been conducted, 15 , 16 , 17 , 18 reporting alterations in inflammatory genes, such as TNF , 15 and in genes of AKT1/mTOR pathway. 18 …”

Roles of NUCKS1 in Diseases: Susceptibility, Potential Biomarker, and Regulatory Mechanisms

“…NUCKS1 directly interacts with miR-92a-3p and miR-29b-3p in BD patients [ 62 ]. Meanwhile, in in vitro studies, NUCKS1 is downregulated upon enforced expression of miR-125b in combination with miR-99a and/or miR-100 compared with scrambled control-miR in ALL [ 57 ].…”

Putative biological predictors of treatment response in bipolar disorders

“…A peripheral gene expression biomarker panel was developed based on global leukocyte gene expression changes in first-episode and nevermedicated BPD patients compared to currently medicated BPD patients and matched healthy controls. The 10-gene model exhibited a diagnostic accuracy of 84% (89% sensitivity and 75% specificity; p < 0.001) [239]. Lowthert et al (2012) reported that 127 genes were differentially expressed in lithium responders versus non-responders in depressed BD patients after 8 weeks of treatment, with an upregulation of apoptosis regulatory genes [240].…”