The Pharmacogenomics of Bipolar Disorder study (PGBD): identification of genes for lithium response in a prospective sample

BMC Psychiatry

Study Protocol

Ketil J. Oedegaard¹  Joseph R. Calabrese²  Keming Gao²  Julie Garnham³  Martin Alda³  Cynthia V. Calkin³  Katherine E. Burdick⁴  Kristen J. Brennand⁴  John Nurnberger⁵  Yokesh Balaraman⁵  Anit Anand⁵  Mark Frye⁶  Adam X. Maihofer⁷  Paul D. Shilling⁷  Abesh Bhattacharjee⁸  John R. Kelsoe⁸  Caroline M. Nievergelt⁸  Tatyana Shekhtman⁸  Anna DeModena⁸  Michael J. McCarthy⁸  Elliot Gershon⁹  Peter P. Zandi^1,10  William H. Coryell^1,11  Bruce Tarwater^1,11  Melvin G. McInnis^1,12  Wade H. Berrettini^1,13  Susan G. Leckband^1,14  Petter Jakobsen^1,15  Jerome Mertens^1,16  Fred H. Gage^1,16  Son Pham^1,16  Jun Yao^1,16  Ole A. Andreassen^1,17  Szabolcs Szelinger^1,18  Ana Claasen^1,18  David Craig^1,18  Gunnar Morken^1,19  Helle Schoeyen^2,20 

[1] Department of Clinical Medicine, Section for Psychiatry, Faculty of Medicine, University of Bergen, Bergen, Norway;Division of Psychiatry, Haukeland University Hospital, Bergen, Norway;Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA;Department of Psychiatry, Dalhousie University, Halifax, Canada;Department of Psychiatry, Icahn School of Medicine at Mt Sinai, 1 Gustave L. Levy Pl, 10029, New York, NY, USA;Department of Neuroscience, Icahn School of Medicine at Mt Sinai, 1 Gustave L. Levy Pl, 10029, New York, NY, USA;Department of Psychiatry, Indiana University, Indianapolis, IN, USA;Department of Psychiatry, The Mayo Clinic, Rochester, MN, USA;Department of Psychiatry, University of California San Diego, 92093, La Jolla, CA, USA;Department of Psychiatry, University of California San Diego, 92093, La Jolla, CA, USA;Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA;Department of Psychiatry, University of Chicago, Chicago, IL, USA;Department of Psychiatry, University of Chicago, Chicago, IL, USA;Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA;Department of Psychiatry, University of Iowa, Iowa City, IA, USA;Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA;Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA;Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA, USA;Division of Psychiatry, Haukeland University Hospital, Bergen, Norway;Laboratory of Genetics, The Salk Institute for Biological Studies, La Jolla, CA, USA;NORMENT, KB Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway;Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, AZ, USA;St. Olav University Hospital of Trondheim and Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;University of Bergen, Faculty of Medicine and Dentistry, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;

关键词: Bipolar disorder;    Lithium;    Mood stabilizer;    Pharmacogenetics;    GWAS;    Prospective trial;    Personalized medicine;    Precision medicine;   

DOI  :  10.1186/s12888-016-0732-x

 received in 2015-12-30, accepted in 2016-02-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundBipolar disorder is a serious and common psychiatric disorder characterized by manic and depressive mood switches and a relapsing and remitting course. The cornerstone of clinical management is stabilization and prophylaxis using mood-stabilizing medications to reduce both manic and depressive symptoms. Lithium remains the gold standard of treatment with the strongest data for both efficacy and suicide prevention. However, many patients do not respond to this medication, and clinically there is a great need for tools to aid the clinician in selecting the correct treatment. Large genome wide association studies (GWAS) investigating retrospectively the effect of lithium response are in the pipeline; however, few large prospective studies on genetic predictors to of lithium response have yet been conducted. The purpose of this project is to identify genes that are associated with lithium response in a large prospective cohort of bipolar patients and to better understand the mechanism of action of lithium and the variation in the genome that influences clinical response.Methods/DesignThis study is an 11-site prospective non-randomized open trial of lithium designed to ascertain a cohort of 700 subjects with bipolar I disorder who experience protocol-defined relapse prevention as a result of treatment with lithium monotherapy. All patients will be diagnosed using the Diagnostic Interview for Genetic Studies (DIGS) and will then enter a 2-year follow-up period on lithium monotherapy if and when they exhibit a score of 1 (normal, not ill), 2 (minimally ill) or 3 (mildly ill) on the Clinical Global Impressions of Severity Scale for Bipolar Disorder (CGI-S-BP Overall Bipolar Illness) for 4 of the 5 preceding weeks. Lithium will be titrated as clinically appropriate, not to exceed serum levels of 1.2 mEq/L. The sample will be evaluated longitudinally using a wide range of clinical scales, cognitive assessments and laboratory tests. On relapse, patients will be discontinued or crossed-over to treatment with valproic acid (VPA) or treatment as usual (TAU). Relapse is defined as a DSM-IV manic, major depressive or mixed episode or if the treating physician decides a change in medication is clinically necessary. The sample will be genotyped for GWAS. The outcome for lithium response will be analyzed as a time to event, where the event is defined as clinical relapse, using a Cox Proportional Hazards model. Positive single nucleotide polymorphisms (SNPs) from past genetic retrospective studies of lithium response, the Consortium on Lithium Genetics (ConLiGen), will be tested in this prospective study sample; a meta-analysis of these samples will then be performed. Finally, neurons will be derived from pluripotent stem cells from lithium responders and non-responders and tested in vivo for response to lithium by gene expression studies. SNPs in genes identified in these cellular studies will also be tested for association to response.DiscussionLithium is an extraordinarily important therapeutic drug in the clinical management of patients suffering from bipolar disorder. However, a significant proportion of patients, 30–40 %, fail to respond, and there is currently no method to identify the good lithium responders before initiation of treatment. Converging evidence suggests that genetic factors play a strong role in the variation of response to lithium, but only a few genes have been tested and the samples have largely been retrospective or quite small. The current study will collect an entirely unique sample of 700 patients with bipolar disorder to be stabilized on lithium monotherapy and followed for up to 2 years. This study will produce useful information to improve the understanding of the mechanism of action of lithium and will add to the development of a method to predict individual response to lithium, thereby accelerating recovery and reducing suffering and cost.Trial registrationClinicalTrials.govIdentifier: NCT01272531Registered: January 6, 2011

【 授权许可】

CC BY   
© Oedegaard et al. 2016