Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics

A Plasma Proteomics-Based Model for Identifying the Risk of Postpartum Depression Using Machine Learning

Postpartum depression (PPD) poses significant risks to maternal and infant health, yet proteomic analyses of PPD-risk women remain limited. This study analyzed plasma samples from 30 healthy postpartum women and 30 PPD-risk women using mass spectrometry, identifying 98 differentially expressed proteins (29 upregulated and 69 downregulated). Principal component analysis revealed distinct protein expression profiles between the groups. Functional enrichment and PPI analyses further explored the biological functions of these proteins. Machine learning models (XGBoost and LASSO regression) identified 17 key proteins, with the optimal logistic regression model comprising P13797 (PLS3), P56750 (CLDN17), O43173 (ST8SIA3), P01593 (IGKV1D-33), and P43243 (MATR3). The model demonstrated excellent predictive performance through ROC curves, calibration, and decision curves. These findings suggest potential biomarkers for early PPD risk assessment, paving the way for personalized prediction. However, limitations include the lack of diagnostic interviews, such as the Structured Clinical Interview for DSM-V (SCID), to confirm PPD diagnosis, a small sample size, and limited ethnic diversity, affecting generalizability. Future studies should expand sample diversity, confirm diagnoses with SCID, and validate biomarkers in larger cohorts to ensure their clinical applicability.

Current Strategies and Future Directions of Wearable Biosensors for Measuring Stress Biochemical Markers for Neuropsychiatric Applications

Most wearable biosensors aimed at capturing psychological state target stress biomarkers in the form of physical symptoms that can correlate with dysfunction in the central nervous system (CNS). However, such markers lack the specificity needed for diagnostic or preventative applications. Wearable biochemical sensors (WBSs) have the potential to fill this gap, however, the technology is still in its infancy. Most WBSs proposed thus far target cortisol. Although cortisol detection is demonstrated as a viable method for approximating the extent and severity of psychological stress, the hormone also lacks specificity. Multiplex WBSs that simultaneously target cortisol alongside other viable stress-related biochemical markers (SBMs) can prove to be indispensable for understanding how psychological stress contributes to the pathophysiology of neuropsychiatric illnesses (NPIs) and, thus, lead to the discovery of new biomarkers and more objective clinical tools. However, none target more than one SBM implicated in NPIs. Till this review, cortisol's connection to dysfunctions in the CNS, to other SBMs, and their implication in various NPIs has not been discussed in the context of developing WBS technology. As such, this review is meant to inform the biosensing and neuropsychiatric communities of viable future directions and possible challenges for WBS technology for neuropsychiatric applications.

Conventional and new immunotherapies for immune system dysregulation in postpartum mood disorders: comparisons to immune system dysregulations in bipolar disorder, major depression, and postpartum autoimmune thyroid disease

INTRODUCTION

Postpartum mood disorders are heterogenous disorders and comprise postpartum psychosis and postpartum depression. Evidence is accumulating that systemic monocyte/macrophage activation, low-grade inflammation and (premature senescence related) T cell defects increase the risk for mood disorders outside pregnancy by affecting the function of microglia and T cells in the emotional brain (the cortico-limbic system) leading to inadequate mood regulation upon stress.

AREAS COVERED

The evidence in the literature that similar immune dysregulations are present in postpartum mood disorders.

RESULTS

The physiological postpartum period is characterized by a rapid T cell surge and a mild activation of the monocyte/macrophage system. Postpartum mood disorder patients show a diminished T cell surge (including that of T regulatory cells) and an increase in low grade inflammation, that is, an increased inflammatory state of monocytes/macrophages and higher levels of serum pro-inflammatory cytokines.

EXPERT OPINION

Anti-inflammatory agents (e.g. COX-2 inhibitors) and T cell boosting agents (e.g. low-dose IL-2 therapy) should be further investigated as treatment. The hypothesis should be investigated that postpartum mood disorders are active episodes (triggered by changes in the postpartum immuno-endocrine milieu) in ongoing, dynamically fluctuating aberrant neuro-immune-endocrine trajectories leading to mood disorders in women (inheritably) vulnerable to these disorders.

Variability in perinatal sleep quality is associated with an atypical cortisol awakening response and increased mood symptoms

OBJECTIVE

Pregnancy is often typified with a decrease in sleep quality, which for many women, progressively worsens across gestation and into the postpartum. A mechanism linking poor sleep with certain adverse pregnancy outcomes is dysregulation of the HPA axis resulting in atypically elevated cortisol production. While total cortisol output normally increases across pregnancy, the cortisol awakening response (CAR), a response to waking up, is influenced by factors such as stress and mood. It attenuates as pregnancy progresses, with normalization in the first weeks after delivery. The goals of the present study were to (1) assess the temporal relationship between sleep quality and cortisol indices across the perinatal period; (2) evaluate whether sleep quality was associated with postpartum mood; and (3) assess whether cortisol mediated these associations.

METHOD

Data were collected as part of the Healthy Babies Before Birth (HB3) study. Sleep quality, depressive and anxiety symptoms, and cortisol from four time-points (8-16 weeks gestation, 30-36 weeks gestation, 6 months postpartum, and 1-year postpartum) were assessed. Participants (N = 223) who had sleep quality (PSQI) and cortisol data from at least 1 of 4 time-points were included in analyses. Three salivary cortisol indices were calculated: cortisol awakening response (CAR), diurnal slope, and area under the curve (AUC). Multi-level models were run to predict cortisol parameters based on deviations and typical maternal sleep quality at each wave as well as mood outcomes.

RESULTS

Multilevel (time, wave, and person) modeling indicated that sleep quality was not associated with any of the cortisol indices, and none significantly varied across time. However, when PSQI scores were higher than the woman's own mean sleep quality, the CAR slope was steeper (+1 point in PSQI, γ=0.18), and when PSQI scores were lower than mean, the CAR slope was flatter (-1 point, γ=0.11). Poorer sleep quality was associated with greater depression severity (γ = 0.367) and anxiety symptoms (γ = 0.120). Cortisol did not mediate the relationship between sleep quality and depression symptoms.

DISCUSSION

Increases in PSQI scores, but not higher mean PSQI scores, were associated with a larger CAR. There was no association between sleep quality and the diurnal slope or AUC. These data suggest that variability in sleep quality is significantly associated with the amount of cortisol secreted upon awakening.

Advancements and Challenges in Aptamer-Based Therapeutics and Diagnostics Across Diverse Medical Domains: A Comprehensive Review

Aptamers, which are single-stranded DNA or RNA molecules, are increasingly recognized as important tools in diagnostics and therapeutics across various medical disciplines such as oncology, respiratory diseases, and neurological disorders. This review provides a comprehensive evaluation of the recent progress and obstacles encountered in the field of aptamer-based applications. Aptamers have shown promise in oncology for early cancer detection and targeted drug delivery, effectively reducing off-target effects. They also hold potential for significantly impacting the management of respiratory conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD) by selectively targeting cytokines and regulating the inflammatory response. In the realm of neurological disorders, aptamers offer novel methods by influencing the gut-brain axis and proposing potential approaches for early detection and specific therapy. Despite these notable benefits, persistent challenges remain in areas such as molecular stability, delivery mechanisms, and economic viability. This review offers a comprehensive overview of aptamer-based diagnostics and therapeutics while exploring potential avenues for future research.

Modifiable lifestyle factors influencing psychiatric disorders mediated by plasma proteins: A systemic Mendelian randomization study

BACKGROUND

Psychiatric disorders are emerging as a serious public health hazard, influencing an increasing number of individuals worldwide. However, the effect of modifiable lifestyle factors on psychiatric disorders remains unclear.

METHODS

Genome-wide association studies (GWAS) summary statistics were obtained mainly from Psychiatric Genomics Consortium and UK Biobank, with sample sizes varying between 10,000 and 1,200,000. The two-sample Mendelian randomization (MR) method was applied to investigate the causal associations between 45 lifestyle factors and 13 psychiatric disorders, and screen potential mediator proteins from 2992 candidate plasma proteins. We implemented a four-step framework with step-by-step screening incorporating two-step, univariable, and multivariable MR.

RESULTS

We found causal effects of strenuous sports or other exercise on Tourette's syndrome (OR [95%CI]: 0.0047 [5.24E-04-0.042]); lifelong smoking index on attention-deficit hyperactivity disorder (10.53 [6.96-15.93]), anxiety disorders (3.44 [1.95-6.05]), bipolar disorder (BD) (2.25 [1.64-3.09]), BD II (2.89 [1.81-4.62]), and major depressive disorder (MDD) (2.47 [1.90-3.20]); and educational years on anorexia nervosa (AN) (1.47 [1.22-1.76]), and MDD (0.74 [0.66-0.83]). Five proteins were found to have causal associations with psychiatric disorders, namely ADH1B, GHDC, STOM, CD226, and TP63. STOM, a membrane protein deficient in the erythrocytes of hereditary stomatocytosis patients, may mediate the effect of educational attainment on AN.

LIMITATIONS

The mechanisms underlying the effects of lifestyle factors on psychiatric disorders require further investigation.

CONCLUSIONS

These findings could help assess the risk of psychiatric disorders based on lifestyle factors and also support lifestyle interventions as a prevention strategy for mental illness.

Prenatal mood and anxiety disorders and associated cytokine changes

BACKGROUND

We examined whether women with prenatal mood and anxiety disorders would exhibit differential pro- and anti-inflammatory marker trajectories during the prenatal and postpartum periods compared to women without these disorders.

METHODS

Approximately 179 pregnant women participated in a longitudinal study conducted in two urban areas. Blood samples for inflammatory markers were collected at six study visits. The Structured Clinical Interview for the DSM-IV (SCID) was administered to participants scoring above cutoffs on anxiety and depression. Pregnant women with SCID Axis I diagnoses of mood and/or anxiety disorders were compared to other participants on inflammatory markers. Multilevel modeling tested associations between SCID diagnoses and within-person interleukin (IL)6 and IL10 trajectories.

RESULTS

Prenatal SCID diagnoses were associated with linear, quadratic and cubic change in IL6 from prenatal to postpartum timepoints. Women with a prenatal SCID diagnosis had steeper decreases and increases in IL6 during prenatal and postpartum periods. SCID diagnoses were associated with lower IL10 in mid-pregnancy to postpartum (b = -0.078, SE = 0.019; p = .015).

LIMITATIONS

Future studies would benefit from a larger sample size and a larger number of participants with SCID diagnoses. Future research should also examine whether different prenatal Axis 1 diagnoses are associated with different patterns of immune response in pregnancy.

CONCLUSIONS

Pregnant women with prenatal mood and anxiety disorders had greater fluctuations in IL6 across prenatal and postpartum periods and lower IL10 through pregnancy and postpartum. They may have different proinflammatory states that remain after birth without a reciprocal anti-inflammatory response.

Bruton's tyrosine kinase-bearing B cells and microglia in neuromyelitis optica spectrum disorder

BACKGROUND

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory autoimmune disease of the central nervous system that involves B-cell receptor signaling as well as astrocyte-microglia interaction, which both contribute to evolution of NMOSD lesions.

MAIN BODY

Through transcriptomic and flow cytometry analyses, we found that Bruton's tyrosine kinase (BTK), a crucial protein of B-cell receptor was upregulated both in the blood and cerebrospinal fluid of NMOSD patients. Blockade of BTK with zanubrutinib, a highly specific BTK inhibitor, mitigated the activation and maturation of B cells and reduced production of causal aquaporin-4 (AQP4) autoantibodies. In a mouse model of NMO, we found that both BTK and pBTK expression were significantly increased in microglia. Transmission electron microscope scan demonstrated that BTK inhibitor ameliorated demyelination, edema, and axonal injury in NMO mice. In the same mice colocalization of GFAP and Iba-1 immunofluorescence indicated a noticeable increase of astrocytes-microglia interaction, which was alleviated by zanubrutinib. The smart-seq analysis demonstrated that treatment with BTK inhibitor instigated microglial transcriptome changes including downregulation of chemokine-related genes and genes involved in the top 5 biological processes related to cell adhesion and migration, which are likely responsible for the reduced crosstalk of microglia and astrocytes.

CONCLUSIONS

Our results show that BTK activity is enhanced both in B cells and microglia and BTK inhibition contributes to the amelioration of NMOSD pathology. These data collectively reveal the mechanism of action of BTK inhibition and corroborate BTK as a viable therapeutic target.

Pathophysiological impact of CXC and CX3CL1 chemokines in preeclampsia and gestational diabetes mellitus

Diabetes-related pathophysiological alterations and various female reproductive difficulties were common in pregnant women with gestational diabetes mellitus (GDM), who had 21.1 million live births. Preeclampsia (PE), which increases maternal and fetal morbidity and mortality, affects approximately 3%-5% of pregnancies worldwide. Nevertheless, it is unclear what triggers PE and GDM to develop. Therefore, the development of novel moderator therapy approaches is a crucial advancement. Chemokines regulate physiological defenses and maternal-fetal interaction during healthy and disturbed pregnancies. Chemokines regulate immunity, stem cell trafficking, anti-angiogenesis, and cell attraction. CXC chemokines are usually inflammatory and contribute to numerous reproductive disorders. Fractalkine (CX3CL1) may be membrane-bound or soluble. CX3CL1 aids cell survival during homeostasis and inflammation. Evidence reveals that CXC and CX3CL1 chemokines and their receptors have been the focus of therapeutic discoveries for clinical intervention due to their considerable participation in numerous biological processes. This review aims to give an overview of the functions of CXC and CX3CL1 chemokines and their receptors in the pathophysiology of PE and GDM. Finally, we examined stimulus specificity for CXC and CX3CL1 chemokine expression and synthesis in PE and GDM and preclinical and clinical trials of CXC-based PE and GDM therapies.