TINJAUAN PUSTAKA The Neuropharmacogenomical Perspectives of Bipolar Disorders Dito Anurogo 1S2 Biomedical Sciences, Faculty of Medicine, Universitas Gadjah Mada (FK UGM), Yogyakarta, Indonesia 2Indonesian Literacy Fellowship (ILF), UKM Jurnal Paradigma, FAM, IYHPS, HIMMPAS, ILC, HMP 3Health consultant in detik.com ABSTRACT Bipolar disorder (BD), also known as manic-depressive illness, is a brain disorder causing unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks, caused by multifactorial and enigmatic etiologies. The main objective of this overview is to review recent findings and critically evaluate BD based on neurogenomics and pharmacogenomics perspectives, through searching appropriate online database sources and relevant bibliographies. Recent studies and references explain genome-wide significant loci for bipolar disorder (polygenetics), potential biomarkers (apoptosis and neurotrophic factors, immuno-inflammatory factors, neurotrophins, BDNF, IGF-1, VEGF, etc.), dysregulation of immuno-inflammatory mechanisms, the role of neuroplasticity in the pathophysiology and treatment of BD, genetic effect of lithium response in BD. Stem cells, omics technologies, and optogenetics is considered to be effective strategies to overcome BD. Keywords: Biomarkers, bipolar disorder (BD), neurogenomics, neuropharmacogenomics, neuroplasticity, optogenetics, pharmacogenomics. ABSTRAK Bipolar disorder (BD), dikenal pula sebagai manic-depressive illness, adalah gangguan otak dengan etiologi enigmatik dan multifaktorial yang menyebabkan perubahan mood, energi, tingkat aktivitas, serta kemampuan untuk melakukan tugas sehari-hari. Review ini menelusuri penemuan- penelitian terkini dan mengevaluasi BD secara kritis berdasarkan perspektif neurogenomics dan pharmacogenomics, melalui pencarian database online dan bibliografi yang relevan. Pelbagai riset-referensi termutakhir menjelaskan genome-wide significant loci (poligenetik), biomarker potensial (faktor apoptosis dan neurotrofik, faktor imun-inflamasi, neurotrofin, BDNF, IGF-1, VEGF, dll), disregulasi mekanisme imunoinflamatori, peran neuroplastisitas, efek genetik respon lithium pada BD. Teknologi sel punca, teknologi berbasis –omics, dan optogenetics yang mengungkap aspek-aspek neurofarmakogenomik berdasarkan riset berkesinambungan dipertimbangkan menjadi strategi efektif untuk mengatasi BD. Dito Anurogo. Perspektif Neurofarmakogenomik Kelainan Bipolar. Kata kunci: Biomarkers, bipolar disorder (BD), neurogenomics, neuropharmacogenomics, neuroplasticity, optogenetics, pharmacogenomics. Introduction was to find out various researches and new pathways and the GSK-3β protein.5,6 Bipolar Disorder (BD) is a complex approaches in the management of BD, based neuropsychiatric disorder affecting 1-4% of on neurogenomics and pharmacogenomics Li response in BD can be determined using the population worldwide, with a lifetime perspectives. Literature for this overview GRANITE (Genetic Regulatory Analysis of prevalence of 2.8 to 6.5% and a genetic diversity was identified by searching database Networks Investigational Tool Environment), (heritability) of 59-93%. It is characterized sources (PubMed, Medline, PsycINFO, Web a genomic tool that provides visualization of by a cycle of recurrent depressive episodes, of Knowledge Content, Medscape, etc.), complex data sets and produces interactive manic-hypomanic episodes, and interspersed Cochrane Libraries, and recent bibliographies. networks. By measuring a large data set with intervals of remission.1,2,3 Lithium (Li) of mRNAs and miRNAs, the tools finds is the mainstay in BD management. Even Pharmacogenomics Perspective that the Let-7 miRNA family is consistently so, only about 30% BD patients indicate a Pharmacogenomic approach focuses on and preferentially downregulated by Li good response in long-term cohort studies.4 identifying genetic predictors of treatment in the BD responder group. The dynamic Multifactorial causes and uncertainty in response to Li and mood stabilizers. Candidate- networks created by GRANITE will lead to a research findings have made BD unable to be gene approaches have so far focused on genes more effective and reliable tool for clinical resolved until now. codifying for elements of biological pathways use in predicting BD patients’ response to shown to be target of lithium, such as proteins medications.7 Objective AND Methods of the intracellular second messenger cascade The main objective of this scientific review mediated by inositol, Wnt and neurotrophins Alamat Korespondensi email: [email protected] CDK-243/ vol. 43 no. 8 th. 2016 587 TINJAUAN PUSTAKA Neurogenomics Perspective inflammation, and cognition can lead to an Locus Implicated Gene(s) and Symbol(s) Neurogenomics is the study of the genes understanding that a change in inflammatory of the nervous system. In a broad scope, Genome-wide significant in bipolar disorder pathways may cause cognitive deficits neurogenomics is defined as the study of 10q21.2 Ankyrin 3 (ANK3) associated with BD.23 how the genome serves as a whole, which 12p13.3 Calcium channel, voltage-dependent, L-type, alpha 1C subunit (CACNA1C) contributes to the evolution, development, 11q14.1 Teneurin transmembrane protein 4 Biomarker Panel structure, and function of the nervous system. (TENM4, formerly known as ODZ4) In BD patients, biomarker panel is found to be Neurogenomics has applications in basic 19p12 Neurocan (NCAN) unique and distinctive such as the presence research, in pharmaceutical industry and in 6q25.2 Spectrin repeat containing, nuclear of endothelial inflammation. In the first year envelope 1 (SYNE1) the management of neurological disorders.8 of BD, the oxidant status rises. In patients 3p22.2 Tetratricopeptide repeat and ankyrin repeat containing 1 (TRANK1) with chronic BD, the potentiated antioxidant Brain abnormalities found in BD patients 5p15.31 Adenylate cyclase 2 (ADCY2) system also increases.24 include enlargement of the lateral ventricles 6q16.1 MicroRNA 2113 (MIR2113); POU class 3 and abnormal white substance, particularly homeobox 2 (POU3F2; formerly known Abnormalities in neurotrophins and other as OTF 7) in prefrontal cortex. Structural imaging 10q24.33 Arsenite methyltransferase (AS3MT) trophic factors have important implications in studies have also found volume deficits in Genome-wide significant in bipolar disorder + the etiology of BD. The role of neurotrophins the hippocampus in child and adolescent schizophrenia (combined) is important to be understood as the basis for BD patients and larger volumes of amygdala 2q32.1 Zinc finger protein 804A (ZNF804A) the development of new therapies.25,26 Recent in adults. N-acetylaspartate level as a 3p21.1 Inter-alpha-trypsin inhibitor heavy studies also reveal that the involvement of chain 3 (ITIH3); marker of neuronal integrity decreased in Inter-alpha-trypsin inhibitor heavy brain-derived neurotrophic factor (BDNF), the dorsolateral prefrontal cortex, anterior chain 4 (ITIH4); insulin-like growth factor (IGF-1), vascular cingulate, and hippocampus in BD patients.9,10 16p11.2 Mitogen-activated protein kinase 3 endothelial growth factor (VEGF), etc. shows (MAPK3) typical patterns in various different stages of Genome-wide significant in bipolar disorder + unipolar Preliminary studies of PET (positron emission depression (combined) BD. In the manic episode of BD, the serum tomography) reported a reduction in 3p21 Polybromo 1 (PBRM1) levels of fibroblast growth factor-2 (FGF-2), 5-hydroxytryptamine (5-HT1A) receptor NGF and IGF-1 are found to be increased, while binding potential in raphe and hippocampus- Calcium Signaling Abnormalities in the mixed episode of BD, the plasma levels amygdala in the depressives, especially in Ca+ channel signaling genes have a role in of BDNF are found to be decreased. BDNF bipolar depressives and unipolar depressives BD. Ca+ channel controls the movement of serum potentially serves as a BD biomarker. with bipolar relatives. One of the factors calcium between cells. There are certain BDNF-encoding genes are located on the that contribute to the reduction of 5-HT1A genetic changes that increase the flow of short arm of chromosome 11 in the region receptor binding in depression is the increased Ca leading to the brain, thus producing where some BD linkage studies have found cortisol secretion, since the expression of excitement.18 Calcium ions serve an important evidence of gene susceptibility. This clearly postsynaptic 5-HT1A receptor mRNA is under role in regulating the synthesis and the release indicates the potential of various biomarkers tonic inhibition by corticosteroid receptor of neurotransmitters, neuronal excitability, for identifying BD subgroups and developing stimulation in several brain regions.11 and long-term neuroplasticity. Numerous effective management.27-30 studies have successfully demonstrated the Recent GWAS (genome-wide association presence of intracellular Ca2+ in peripheral Inositol hexaphosphate (IP6, inositol studies) on BD populations have identified cells of BD patients.19 hexakisphosphate, phytic acid) is a naturally- a number of genes with strong statistical occuring derivative of phosphorylated myo- association to susceptibility to BD. One of Inflammatory Hypothesis inositol. Myo-inositol has been proven to be them is ankyrin 3 (ANK3), a gene that encodes Numerous studies have confirmed able to control mood symptoms and have multiple isoforms of ankyrin G protein, and dysregulation of immuno-inflammatory a good tolerability