Bidirectional Mendelian Randomization and Multiphenotype GWAS Show Causality and Shared Pathophysiology Between Depression and Type 2 Diabetes

Natural products targeting ferroptosis in depression: Research progress and therapeutic prospects

BACKGROUND

Depression is recognized as a chronic mental illness, also influenced by neurotransmitter homeostasis, with its incidence increasing annually worldwide. This condition inflicts significant physical and psychological harm, severely compromising human health. It exhibits a broad morbidity spectrum, and some current treatments and medications are hindered by short-term efficacy, strong side effects, and other limitations.

PURPOSE

Due to the limitations, it is imperative to explore new treatment approaches and develop targeted drugs. Ferroptosis, a cell death mode dependent on iron, is believed to be intricately linked to the onset of depression. Thus, modulating cellular ferroptosis presents a promising avenue for the targeted therapy of depression.

METHODS

We conducted a comprehensive search of databases such as PubMed, Elsevier ScienceDirect, Google Scholar, and CNKI, using keywords such as "ferroptosis", "depression", "iron death", "safety", "efficacy", and "effectiveness". Our review included original scientific articles, clinical trials, meta-analyses, and review papers published up to February 2025, focusing on studies excluding non-natural products.

RESULTS

Several natural products derived from plant, animal, or microbial sources effectively target ferroptosis, alleviating depressive symptoms and demonstrating unique and favorable outcomes. This review provides an exhaustive overview of the sources, pharmacological actions, mechanisms, efficacy, and safety of these natural products, highlighting their potential clinical benefits and offering a comprehensive perspective on their properties.

CONCLUSION

This study offers concrete ideas and valuable insights for the development and application of these natural products in the targeted treatment of depression.

The bidirectional influence between type 2 diabetes mellitus and the state of depression and anxiety

Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease with several complications that has a negative impact on patients' physical and mental health. People's life pressures are increasing as society develop, resulting in a series of adverse emotions. If it is not paid attention to for a long time, it will lead to depression, anxiety, and other mental disorders. Depression and anxiety can occur separately or simultaneously, both of which are highly correlated. In recent years, the incidence of T2DM with the state of depression and anxiety has increased significantly. According to recent research, the state of depression and anxiety might increase the prevalence of T2DM and accelerate its progression by influencing patient's behavioral style and biological mechanisms. T2DM can also aggravate patients' state of depression and anxiety, worsening their life quality. However, few reviews have discussed the association between T2DM and the state of depression and anxiety. In order to reduce the prevalence of the two diseases, we ought to investigate them more thoroughly so that readers can recognize the close connection between the two and take appropriate interventions. Therefore, this article mainly discusses the interaction between T2DM and the state of depression and anxiety from behavioral and biological mechanisms, the effects of common hypoglycemic drugs on the state of depression and anxiety, and the effects of antidepressant anxiety treatments on T2DM. These three aspects are intended to shed light on the interaction between the two so as to find the appropriate interventions to reduce morbidity.

Causal association between depression and myalgia-related disorders: A bidirectional mendelian randomization study

OBJECTIVE

The connection between depression and myalgia-related disorders remains unclear. We investigated the bidirectional causal relationship between depression and five such disorders using Mendelian randomization (MR).

METHOD

Genetic instrumental variables for depression were obtained from a GWAS of 170,756 individuals with depression and 329,443 controls. The primary two-sample MR analysis used the inverse variance-weighted (IVW) method. Robustness was tested with MR Egger, weighted median, and weighted mode approaches. We also conducted heterogeneity, pleiotropy, and sensitivity analyses to ensure result reliability.

RESULTS

Depression showed significant positive associations with myalgia [IVW, OR = 1.468, 95 % CI: 1.246-1.729, P = 4.19 × 10-6], fibromyalgia [OR = 2.328, 95 % CI: 1.771-3.061, P = 1.39 × 10-9], and osteoarthritis [OR = 1.242, 95 % CI: 1.147-1.345, P = 9.58 × 10-8]. No causal association was found with myositis or rheumatoid arthritis (P > 0.05). In reverse MR, osteoarthritis showed a significant association with depression [OR = 1.113, 95 % CI: 1.025-1.210, P = 0.011], while other disorders did not (P > 0.05).

CONCLUSION

Our findings suggest a genetic causal relationship between depression and increased risk of myalgia, fibromyalgia, and osteoarthritis. Moreover, osteoarthritis may increase depression risk, supporting a potential bidirectional link. These results underscore the importance of timely depression management to mitigate risks of myalgia-related conditions.

Association analysis of factors influencing psychosomatic diseases among middle-aged and elderly people in China

OBJECTIVE

This study aimed to explore the association between psychological factors and noncommunicable chronic diseases (NCDs).

METHODS

This study used CLHLS database and included a sample of 10,702 cases. Single-factor and multi-factor logistic regression analyses were used to determine the possible risk factors for developing psychosomatic diseases.

RESULTS

Univariate logistic regression found statistically significant associations between the development of psychosomatic disorders and depression, anxiety, sleep duration, and dyslipidemia (P < 0.05). Multivariate logistic regression concluded that depression, anxiety, sleep duration <7 h, and dyslipidemia were risk factors for developing psychosomatic disorders. Depression was a significant risk factor for the development of diabetes (OR = 1.419; 95 %CI: 1.034, 1.946), bronchitis (OR = 1.416; 95 %CI: 1.025, 1.956), gastrointestinal ulcers (OR = 1.541; 95 %CI: 1.223, 1.942), and arthritis (OR = 1.225; 95 %CI: 1.047, 1.433). Anxiety was a significant risk factor for developing bronchitis (OR = 1.240; 95 %CI: 1.061, 1.449), gastrointestinal ulcers (OR = 1.257; 95 %CI: 1.017, 1.554), and arthritis (OR = 1.303; 95 %CI: 1.123, 1.512). Sleep duration <7 h was associated with the development of diabetes (OR = 1.473; 95 %CI: 1.200, 1.808), bronchitis (OR = 1.213; 95 %CI: 1.011, 1.455), gastrointestinal ulcers (OR = 1.795; 95 %CI: 1.356, 2.377), and arthritis (OR = 1.532; 95 %CI: 1.272, 1.845). Dyslipidemia was a significant risk factor for developing diabetes (OR = 3.945; 95%CI: 3.254, 4.783), bronchitis (OR = 1.769; 95 %CI: 1.398, 2.239), gastrointestinal ulcers (OR = 3.244; 95 %CI: 2.491, 4.226), and arthritis (OR = 3.733; 95 %CI: 3.114, 4.571).

CONCLUSIONS

The monitoring of psychological factors as a prospective observation sentinel for NCDs prevention and control should be improved, the traditional intervention model of NCDs prevention and control should be changed.

Exploring potential diagnostic markers and therapeutic targets for type 2 diabetes mellitus with major depressive disorder through bioinformatics and in vivo experiments

Type 2 diabetes mellitus (T2DM) and Major depressive disorder (MDD) act as risk factors for each other, and the comorbidity of both significantly increases the all-cause mortality rate. Therefore, studying the diagnosis and treatment of diabetes with depression (DD) is of great significance. In this study, we progressively identified hub genes associated with T2DM and depression through WGCNA analysis, PPI networks, and machine learning, and constructed ROC and nomogram to assess their diagnostic efficacy. Additionally, we validated these genes using qRT-PCR in the hippocampus of DD model mice. The results indicate that UBTD1, ANKRD9, CNN2, AKT1, and CAPZA2 are shared hub genes associated with diabetes and depression, with ANKRD9, CNN2 and UBTD1 demonstrating favorable diagnostic predictive efficacy. In the DD model, UBTD1 (p > 0.05) and ANKRD9 (p < 0.01) were downregulated, while CNN2 (p < 0.001), AKT1 (p < 0.05), and CAPZA2 (p < 0.01) were upregulated. We have discussed their mechanisms of action in the pathogenesis and therapy of DD, suggesting their therapeutic potential, and propose that these genes may serve as prospective diagnostic candidates for DD. In conclusion, this work offers new insights for future research on DD.

Multitrait Genetic Analysis Identifies Novel Pleiotropic Loci for Depression and Schizophrenia in East Asians

BACKGROUND AND HYPOTHESIS

While genetic correlations, pleiotropic loci, and shared genetic mechanisms of psychiatric disorders have been extensively studied in European populations, the investigation of these factors in East Asian populations has been relatively limited.

STUDY DESIGN

To identify novel pleiotropic risk loci for depression and schizophrenia (SCZ) in East Asians. We utilized the most comprehensive dataset available for East Asians and quantified the genetic overlap between depression, SCZ, and their related traits via a multitrait genome-wide association study. Global and local genetic correlations were estimated by LDSC and ρ-HESS. Pleiotropic loci were identified by the multitrait analysis of GWAS (MTAG).

STUDY RESULTS

Besides the significant correlation between depression and SCZ, our analysis revealed genetic correlations between depression and obesity-related traits, such as weight, BMI, T2D, and HDL. In SCZ, significant correlations were detected with HDL, heart diseases and use of various medications. Conventional meta-analysis of depression and SCZ identified a novel locus at 1q25.2 in East Asians. Further multitrait analysis of depression, SCZ and related traits identified ten novel pleiotropic loci for depression, and four for SCZ.

CONCLUSIONS

Our findings demonstrate shared genetic underpinnings between depression and SCZ in East Asians, as well as their associated traits, providing novel candidate genes for the identification and prioritization of therapeutic targets specific to this population.

Albuminuria and Mental Illness Risk: Results From National Health and Nutrition Examination Survey 2005-2018 and Mendelian Randomization Analyses

BACKGROUND

Recent evidence suggests a link between albuminuria and mental illness. However, whether this association is stable, and its specific mechanisms remain unclear.

METHODS

The cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Weighted multivariable-adjusted logistic regression, subgroup analysis, interaction tests, and restricted cubic spline (RCS) were conducted to assess the correlation between albuminuria and the risk of mental illness (depression). Subsequently, two-sample Mendelian randomization analyses were performed to investigate the relationship between albuminuria and various mental illnesses (anxiety disorder, persistent delusional disorder, schizophrenia, schizotypal personality disorder, panic disorder, post-traumatic stress disorder [PTSD], obsessive-compulsive disorder, bipolar I disorder, bipolar II disorder, depression, autism, social anxiety disorder).

RESULTS

Albuminuria was consistently found to have a significant association with the risk of depression, regardless of its classification as a continuous or outcome variable. A positive correlation was found between albuminuria and depression in different age groups, gender, race, education attainment, and those with hypertension, coronary heart disease, and diabetes. Further, there is a positive correlation between albuminuria and the occurrence of schizophrenia and persistent delusional disorder.

CONCLUSION

There is a close association between albuminuria and mental illness, with albuminuria being a risk factor for schizophrenia and persistent delusional disorder. Further research is needed to establish the specific connections.

Analysis of gut microbiota and depression and anxiety: Mendelian randomization from three datasets

BACKGROUND

Emerging evidence supports gut microbiota's association with mental distress, particularly depression and anxiety, the microbiota-gut-brain axis was the believed to be the underlying mechanism. This study investigated the causal relationships between specific gut microbiota and depression and anxiety disorders using large-scale genome-wide association study (GWAS) data.

METHODS

A two-sample bidirectional Mendelian randomization (MR) analysis was conducted to explore the causal effects of 211 microbial taxa on depression and anxiety across three large GWAS databases: FinnGen, Pan-UKBB, and PGC. Sensitive analyses were followed to validate the robustness of results. Random-effect meta-analysis was further performed to enhance the statistical power.

RESULTS

The MR analysis revealed that the Bifidobacteriales (IVW: OR 0.90, 95 %CI 0.83 to 0.98) and Bifidobacteriaceae (IVW: OR 0.90, 95 %CI 0.83 to 0.98) had a protective effect against depression. Clostridiales (cML-MA: OR 0.88, 95 %CI 0.81 to 0.95) and Parasutterella (cML-MA: OR 0.75, 95 %CI 0.64 to 0.88) showed negative associations with depression. Increased abundance of Oxalobacteraceae (cML-MA: OR 1.78, 95 %CI 1.24 to 2.56), Deltaproteobacteria (cML-MA: OR 2.17, 95 %CI 1.38 to 3.40), and Desulfovibrionales (cML-MA: OR 2.22, 95 %CI 1.41 to 3.49) was associated with a higher risk of depression. For anxiety, protective effects were found for Actinobacteria (phylum: IVW: OR 0.83, 95 %CI 0.76 to 0.87; class: IVW: OR 0.84, 95 %CI 0.75 to 0.93), Bifidobacteriales (IVW: OR 0.80, 95 %CI 0.75 to 0.85), Bifidobacteriaceae (IVW: OR 0.80, 95 %CI 0.75 to 0.85) and Bifidobacterium [g] (IVW: OR 0.79, 95 %CI 0.74 to 0.84). Lactobacillaceae [f] (cML-MA: OR 1.18, 95 %CI 1.08 to 1.28), Clostridia [c] (cML-MA: OR 1.15, 95 %CI 0.1.06 to 1.26) and Clostridiales [o] (IVW: OR 1.15, 95 %CI 1.05 to 1.27) were associated with increased anxiety risk. Meta-analysis results indicated significant associations, particularly the protective effects of Actinobacteria (OR 0.90, 95 % CI, 0.83 to 0.98) and Clostridiaceae1 (OR 0.91, 95 % CI, 0.83 to 0.99) on depression and several taxa on anxiety. No significant instrumental variables for depression or anxiety on gut microbiota were identified.

CONCLUSIONS

Our findings highlight specific gut microbiota that are associated with depression and anxiety, underscoring the causal relationships between these intestinal microbes and psychiatric disorders. These results suggest potential strategies for mitigating disease symptoms and improving quality of life through microbiome-targeted therapies. Further studies, including randomized controlled trials and investigations into sex-specific effects, are essential to validate and expand upon these findings.

AdipoRon attenuates depression-like behavior in T2DM mice via inhibiting inflammation and regulating autophagy

Adiponectin, an adipocyte-derived adipokine, exerts anti-inflammatory effects in the brain, but its specific function in type 2 diabetes mellitus(T2DM) has not been elucidated. Based on the common physiological and pathological mechanisms of T2DM and depression, this study revealed the protective effect of AdipoRon on T2DM-related depressive behavior and its molecular biological mechanism in vivo. Our results showed that AdipoRon treatment enhanced the sucrose consumption of T2DM mice in sucrose preference experiment, reduced the immobility time in the forced swimming experiment, and increased the total movement distance and cross times in the open field experiment. AdipoRon treatment inhibited the apoptosis of hippocampal cells, increased the number of synapses in the prefrontal cortex and hippocampus, and enhanced the density of dendritic spines in CA1 region of T2DM mice. AdipoRon could reduce NLRP3, ASC and IL-1β levels in the hippocampus and prefrontal cortex, increase the ratio of p-AMPK/AMPK and decrease p-mTOR/mTOR expression in T2DM mice. Furthermore, AdipoRon treatment increased the ratio of LC3II/LC3I and the expression of AdipoR1 in the prefrontal cortex and hippocampus of T2DM mice. All of these findings support the idea that AdipoRon reduces neuroinflammation and stimulates autophagy in T2DM mice via activating the AdipoR1/AMPK/mTOR pathway. AdipoRon may be a novel therapeutic agent for T2DM complicated depression.

Association of serum 25-hydroxyvitamin D with the risk of depression in individuals with prediabetes and diabetes: A prospective cohort study

OBJECTIVE

Serum 25-hydroxyvitamin D [25(OH)D] is known to be associated with depression. However, the evidence concerning the association between vitamin D status and depressive episodes in population with prediabetes and diabetes remains limited. This study seeks to investigate the potential relationship between vitamin D levels and depression in this population.

METHODS

This cohort study comprised 55,252 individuals with prediabetes and 17,369 patients with diabetes, who exhibited no signs of depression at baseline. Baseline 25(OH)D concentrations were assessed. Cox proportional hazard models were employed to estimate hazard ratios (HRs) and 95% CIs for depression, with adjustments made for potential confounding variables.

RESULTS

Over a mean follow-up period of 11.7 years, a total of 2,409 depression events were documented in participants with diabetes; and 6,078 depression events were recorded in the prediabetic participants, during a mean follow-up of 12.3 years. Vitamin D sufficiency (≥75 nmol/L) was observed in only 12.5% of individuals with prediabetes and 11.3% of those with diabetes. After multivariate adjustment, an inverse and dose-dependent relationship was identified between serum 25(OH)D concentrations and the risk of depression in prediabetic and diabetic participants (P trend <0.05). Compared with the lowest 25(OH)D level (<25 nmol/L), the highest level (≥75 nmol/L) exhibited a 17% reduction in the risk of depressive events (HR 0.83; 95% CI 0.75-0.93) among individuals with prediabetes and a 25% reduction (HR 0.75; 95% CI 0.61-0.90) among those with diabetes。 CONCLUSION: The findings of this study highlight the critical importance of prioritizing serum 25(OH)D levels in the management of depression in patients with diabetes and prediabetes.

Immune cell traits and causal relationships with cholecystitis: a mendelian randomization analysis

Cholecystitis, characterized by inflammation of the gallbladder, is intricately linked to immune cells and the cytokines they produce. Despite this association, the specific contributions of immune cells to the onset and progression of cholecystitis remain to be fully understood. To delineate this relationship, we utilized the Mendelian randomization (MR) method to scrutinize the causal connections between 731 immune cell phenotypes and cholecystitis. By conducting MR analysis on 731 immune cell markers from public datasets, this study seeks to understand their potential impact on the risk of cholecystitis. It aims to elucidate the interactions between immune phenotypes and the disease, aiming to lay the groundwork for advancing precision medicine and developing effective treatment strategies for cholecystitis. Taking immune cell phenotypes as the exposure factor and cholecystitis as the outcome event, this study used single nucleotide polymorphisms (SNPs) closely associated with both immune cell phenotypes and cholecystitis as genetic instrumental variables. We conducted a two-sample MR analysis on genome-wide association studies (GWAS) data. Our research thoroughly examined 731 immune cell markers, to determine potential causal relationships with susceptibility to cholecystitis. Sensitivity analyses were performed to ensure the robustness of our findings, excluding the potential impacts of heterogeneity and pleiotropy. To avoid reverse causality, we conducted reverse MR analyses with cholecystitis as the exposure factor and immune cell phenotypes as the outcome event. Among the 731 immune phenotypes, our study identified 21 phenotypes with a causal relationship to cholecystitis (P < 0.05). Of these, eight immune phenotypes exhibited a protective effect against cholecystitis (odds ratio (OR) < 1), while the other 13 immune phenotypes were associated with an increased risk of developing cholecystitis (OR > 1). Additionally, employing the false discovery rate (FDR) method at a significance level of 0.2, no significant causal relationship was found between cholecystitis and immune phenotypes. Our research has uncovered a significant causal relationship between immune cell phenotypes and cholecystitis. This discovery not only enhances our understanding of the role of immune cells in the onset and progression of cholecystitis but also establishes a foundation for developing more precise biomarkers and targeted therapeutic strategies. It provides a scientific basis for more effective and personalized treatments in the future. These findings are expected to substantially improve the quality of life for patients with cholecystitis and mitigate the impact of the disease on patients and their families.

Unraveling the genetic links between depression and type 2 diabetes

BACKGROUND

Type 2 diabetes (T2D) is a chronic metabolic disorder that has high comorbidity with mental disorders. The genetic relationships between T2D and depression are far from being well understood.

METHODS

We performed genetic correlation, polygenic overlap, Mendelian randomization (MR) analyses, cross-trait meta-analysis, and Bayesian colocalization analysis to assess genetic relationships between T2D and depression, in the forms of major depressive disorder (MDD) and depressed affect (DAF). Then, the summary data-based MR (SMR) analysis was performed to prioritize genes contributing to MDD and to T2D from functional perspective. MDD-driven signaling pathways were constructed to understand the influence of MDD on T2D at the molecular level.

RESULTS

T2D has positive genetic correlations both with MDD (rg = 0.14) and with DAF (rg = 0.19). The polygenic overlap analysis showed that about 60 % of causal variants for T2D are shared with MDD and DAF. The MR analysis indicated that genetic liabilities to both MDD (OR: 1.24, 95 % CI: 1.11-1.38) and DAF (OR: 1.48, 95 % CI: 1.23-1.78) are associated with an increased risk for T2D, while genetic liability to T2D is not associated with the risk for MDD (OR: 1.00, 95 % CI: 0.99-1.01) or DAF (OR: 1.01, 95 % CI: 1.00-1.02). The cross-trait meta-analysis identified 271 genomic loci, of which 29 were novel. Genetic predisposition to MDD and T2D shares six overlapping loci, involving some well-characterized genes, such as TCF4 and NEGR1. Colocalization analysis revealed three shared chromosome regions between MDD and T2D, which covers mediator genes including SCYL1, DENND1A, and MAD1L1. Molecular pathway analysis suggests mechanisms that promote the development of T2D through inflammatory pathways overactive in patients with MDD. The SMR analysis and the meta-analysis highlighted seven genes with functional implications for both MDD and T2D, including TNKS2, CCDC92, FADS1, ERI1, THUMPD3, NUCKS1, and PM20D1.

CONCLUSIONS

Our study points out that depression, in the forms of MDD and DAF, may increase the risk of T2D. Analysis of underlying genetic variation and the molecular pathways, connecting depression and T2D, indicate that the pathophysiological foundations of these two conditions have a notable overlap.

The impact of depression and cardiovascular disease on fall risk in type 2 diabetes mellitus: a gender and sleep status analysis

Background

This study aims to examine the combined effects of depressive symptoms (DS) and cardiovascular disease (CVD) on fall risk in patients with type 2 diabetes mellitus (T2DM), as well as evaluating the potential moderating effects of sleep status and gender.

Methods

This study analyzed 941 participants from the China Health and Retirement Longitudinal Study (CHARLS). Participants were divided into four groups: those with both depressive symptoms and CVD (DS+/CVD+), those with only depressive symptoms (DS+/CVD-), those with only CVD (DS-/CVD+), and those with neither depressive symptoms nor CVD (DS-/CVD-). Additionally, stratified analyses were conducted to differentiate participants based on sleep statuses and gender.

Results

In the absence of potential confounding variables, the phenotypes DS+/CVD+, DS+/CVD-, and DS-/CVD+ were each independently linked to a higher fall risk relative to the reference category DS-/CVD- (RR = 1.96, 95% CI: 1.25-3.07; RR = 1.92, 95% CI: 1.29-2.87; RR = 1.58, 95% CI: 1.03-2.42, respectively). Specifically, within the sleep sufficiency group, the DS+/CVD+, DS+/CVD-, and DS-/CVD+ phenotypes exhibited a significantly elevated risk of falls relative to the DS-/CVD- phenotype (RR = 2.23, 95% CI: 1.22-4.05; RR = 2.02, 95% CI: 1.19-3.43; RR = 1.73, 95% CI: 1.02-2.93, respectively). After adjusting for confounding variables, Males with DS-/CVD+ phenotypes are significantly more likely to fall (RR = 2.04, 95% CI: 1.04-3.98). In contrast, the DS+/CVD+ and DS+/CVD- phenotypes are linked to a heightened risk of falls in females, with relative risk of 1.79 (95% CI: 1.04-3.09) and 1.82 (95% CI: 1.11-2.98), respectively. Furthermore, there was no evidence of an additive interaction between depression and CVD in relation to fall risk among patients with T2DM (p > 0.05).

Conclusion

The co-occurrence of depression and CVD significantly elevates the risk of falls in diabetic patients. It is recommended that female patients prioritize the prevention and management of depression, whereas male patients should focus on the prevention and management of cardiovascular diseases. Additionally, ensuring adequate sleep is essential for all patients.

Association between triglyceride-glucose index and its combination with obesity indicators and depression: findings from NHANES 2005-2020

Background

The relationship between the triglyceride-glucose (TyG) index, its combination with obesity indicators, and depression remains understudied in the American population.

Methods

This cross-sectional study analyzed data from 10,423 adults in the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2020. We employed multivariable logistic regression analysis, smoothing techniques, generalized additive models, stratified analyses, and sensitivity analyses to examine the relationship between TyG, its combination (TyG-WC, TyG-WHtR, TyG-BMI) with obesity indicators, and depression.

Results

The results indicate that the TyG index, TyG-WC, TyG-WHtR, TyG-BMI, and depression exhibited a significant statistical association with depressive symptoms (all P for trend < 0.001). Specifically, a one-unit increase in the TyG index correlated with a 37% increase in the risk of depressive symptoms (95% CI: 1.21-1.55), a one-unit increase in TyG-WC correlated with a 3.26 times increase in the risk of depressive symptoms (95% CI: 2.22-4.80), a one-unit increase in TyG-WHtR correlated with a 27% increase in the risk of depressive symptoms (95% CI: 1.18-1.36), and a one-unit increase in TyG-BMI correlated with a 2.30 times increase in the risk of depressive symptoms (95% CI: 1.72-3.08). There was a significant nonlinear correlation between TyG-WC, TyG-WHtR, and TyG-BMI with depressive symptoms (all P for nonlinearity < 0.001), except for a linear correlation between the TyG index and depressive symptoms (P for linearity < 0.001).

Conclusion

Monitoring the TyG index, TyG-WC, TyG-WHtR, TyG-BMI may facilitate depression risk assessment and prevention.

Revealing the Causal Relationship Between Differential White Blood Cell Counts and Depression: A Bidirectional Two-Sample Mendelian Randomization Study

Background: The link between white blood cells (WBC) and depression has been studied, but the causal relationship remains unclear. This study aimed to elucidate the potential bidirectional causal links between six specific WBC count features and depression using a two-sample Mendelian randomization (MR) analysis, leveraging summary statistics from genome-wide association studies (GWAS). Method: The dataset on depression (N = 406,986) was sourced from the FinnGen database, while the dataset on WBC (N = 563,085) was obtained from a combined dataset of Blood Cell Consortium (BCX) and UK Biobank. The MR analyses employed include inverse variance weighted (IVW), MR-Egger, weighted median, contamination mixture method (conmix), and constrained maximum likelihood-based Mendelian randomization (cML-MA). A threshold p < 0.05 after false discovery rate (FDR) correction was set as the criterion for causality based on IVW. Results: Reverse MR analysis indicated a causal relationship where depression leads to an increase in overall WBC count (IVW beta = 0.031, p = 0.015, p FDR = 0.044) and specifically in basophil count (IVW beta = 0.038, p = 0.006, p FDR = 0.038), with a marginally significant impact on lymphocyte count (beta = 0.029, p = 0.036, p FDR = 0.071). Furthermore, forward MR analysis suggested a potential role of monocyte count in decreasing depression risk (p = 0.028), though this association did not retain statistical significance after FDR correction. Conclusion: These findings suggest that depression may causally influence the immune system by elevating overall WBC and basophil counts, with a marginally significant increase in lymphocyte levels. Conversely, higher monocyte count might confer some protection against depression, albeit with less statistial certainty. This study provides novel insights into the complex interplay between depression and immune function.

PEX11B palmitoylation couples peroxisomal dysfunction with Schwann cells fail in diabetic neuropathy

BACKGROUND

Diabetic neuropathy (DN) is a prevalent and painful complication of diabetes; however, the mechanisms underlying its pathogenesis remain unclear, and effective clinical treatments are lacking. This study aims to explore the role of peroxisomes in Schwann cells in DN.

METHODS

The abundance of peroxisomes in the sciatic nerves of mice or Schwann cells was analyzed using laser confocal super-resolution imaging and western blotting. The RFP-GFP-SKL (Ser-Lys-Leu) probe was utilized to assess pexophagy (peroxisomes autophagy) levels. To evaluate the palmitoylation of PEX11B, the acyl-resin assisted capture (acyl-RAC) assay and the Acyl-Biotin Exchange (ABE) assay were employed. Additionally, MR (Mendelian randomization) analysis was conducted to investigate the potential causal relationship between DN and MS (Multiple sclerosis).

RESULTS

There was a decrease in peroxisomal abundance in the sciatic nerves of diabetic mice, and palmitic acid (PA) induced a reduction in peroxisomal abundance by inhibiting peroxisomal biogenesis in Schwann cells. Mechanistically, PA induced the palmitoylation of PEX11B at C25 site, disrupting its self-interaction and impeding peroxisome elongation. Fenofibrate, a PPARα agonist, effectively rescued peroxisomal dysfunction caused by PA and restored the peroxisomal abundance in diabetic mice. Lastly, MR analysis indicates a notable causal influence of DN on MS, with its onset and progression intricately linked to peroxisomal dysfunction.

CONCLUSIONS

Targeting the peroxisomal biogenesis pathway may be an effective strategy for preventing and treating DN, underscoring the importance of addressing MS risk at the onset of DN.

Body Fat and Visceral Fat Values in Spanish Healthcare Workers: Associated Variables

BACKGROUND/OBJECTIVES

Excessive body adiposity is a significant public health challenge on a global scale. This study aimed to investigate the association between various sociodemographic factors and healthy lifestyle habits and the presence or absence of elevated body adiposity levels.

METHODOLOGY

Two studies were conducted, a retrospective longitudinal study and a cross-sectional descriptive study. The analysis included 44,939 healthcare workers, categorised into four professional groups, to explore the relationship between age, sex, smoking, physical activity, and adherence to the Mediterranean diet and body adiposity, assessed as elevated body fat (BF) and visceral fat (VF) levels. Descriptive statistics encompassed categorical and quantitative variables, analysed using frequencies, Student's t-tests, chi-square tests, and multinomial logistic regression models. Associations, concordances, and correlations were further examined using logistic regression and Cohen's and Pearson's kappa coefficients.

RESULTS

Age, sex, and physical activity were the factors most strongly associated with elevated BF and VF levels. Odds ratios (ORs) indicated the following significant associations: individuals aged 60 years and older exhibited ORs of 6.71 (95% CI: 5.68-7.74) for BF and 12.18 (95% CI: 10.01-14.26) for VF; male sex was associated with ORs of 2.21 (95% CI: 2.06-2.36) for BF and 12.51 (95% CI: 11.29-13.74) for VF. Sedentary behaviour was linked to ORs of 3.69 (95% CI: 3.41-3.97) for BF and 4.20 (95% CI: 3.78-4.63) for VF. Among healthcare professionals, nursing assistants and orderlies demonstrated the highest levels of adipose tissue accumulation.

CONCLUSIONS

Elevated BF and VF levels among healthcare personnel are significantly associated by lifestyle factors, sex, and age, with the most pronounced risk observed in nursing assistants and orderlies. Further research focusing on the causal relationships between lifestyle behaviours and adiposity in this population will provide valuable insights and support the design of targeted preventive strategies to mitigate its prevalence.

Association of intrinsic capacity with incident type 2 diabetes mellitus in older Chinese: Guangzhou Biobank Cohort Study

BACKGROUND

The World Health Organization introduced intrinsic capacity (IC) as a metric for healthy aging. However, we found no report on the association between IC and type 2 diabetes mellitus (T2DM). We investigated the association between IC and incident T2DM in older Chinese from the Guangzhou Biobank Cohort Study.

METHODS

IC was assessed across five domains equally: locomotion, vitality, cognition, psychological and sensory. Composite IC scores (0-10) were classified into three groups: poor (0-5.9), fair (6.0-8.9), and high (9.0-10), with higher scores representing greater IC. Multivariable linear regression and cox regression was used to analyze the association between IC with glycemia and T2DM, respectively.

RESULTS

Of 3582 participants with a mean age of 59.1 years (standard deviation (SD)=7.13) without baseline diabetes, during an average follow-up of 3.3 years (SD=0.86), 497 (13.87%) developed T2DM. After adjustments for potential confounders, those with baseline poor IC, versus high, had higher fasting glucose, 2-hour post-load glucose and glycosylated hemoglobin A1c at follow-up, and a higher risk of incident T2DM (HR (95%CI): 1.80 (1.20, 2.72)). Among IC domains, only vitality impairment was associated with an increased risk of T2DM (P for trend < 0.001).

CONCLUSION

We first reported the prospective associations of poor IC and vitality with higher glycemia and incident T2DM risk. Enhancing muscle strength to improve functional ability may be a possible intervention for reducing future risk of T2DM in older populations.

Joint effects of depressive symptoms and triglyceride-glucose index on cardiovascular events in acute coronary syndrome patients: The mediating role of TyGi

OBJECTIVE

Our aim was to explore the joint impacts of depressive symptoms along with triglyceride-glucose index (TyGi) on major adverse cardiovascular events (MACE) in patients who have acute coronary syndrome (ACS) and investigate whether the impact of depressive symptoms on MACE is mediated through the TyGi.

METHODS

This extensive cohort study included 3681 ACS patients. Depressive symptoms and TyGi were assessed at baseline, and the patients were subsequently followed for two years to monitor the occurrence of MACE.

RESULTS

Throughout the two-year monitoring period, 387 (10.5 %) patients with ACS experienced MACE. The TyGi was positively correlated with MACE risk (hazard ratio [HR]: 1.301, 95 % confidence interval [CI]: 1.112-1.522, p = .001). A nonlinear relation was observed between the TyGi and MACE (p for nonlinearity = 0.04). Joint analyses revealed that, unlike the non-depression & TyG low group, the depression & TyG low group had a two-fold elevation in MACE risk (HR: 2.108, 95 % CI: 1.499-2.966), while the depression & TyG high group represented an even higher risk (HR: 2.442, 95 % CI: 1.786-3.339). The mediation analysis results showcased that the TyGi was a significant mediator of the interplay between depressive symptoms and MACE.

CONCLUSION

Depressive symptoms and the TyGi jointly influence MACE risk in ACS patients, with the TyGi mediating this relation. Close monitoring and management of depressive symptoms and the TyGi are crucial during ACS rehabilitation.

Potential of Vitamin D and l-Cysteine Co-supplementation to Downregulate Mammalian Target of Rapamycin: A Novel Therapeutic Approach to Diabetes

Diabetes, a metabolic disease associated with an increased health care burden and mortality, is currently on the rise. Both upregulation of the mammalian target of rapamycin (mTOR) and decreased levels of vitamin D (VD) and l-cysteine (LC) have been associated with diabetes. The overactivation of mTOR leads to insulin desensitization and metabolic dysfunction including uncontrolled hyperglycemia. This review summarizes various studies that have shown an inhibitory effect of VD or LC on mTOR activity. Findings from preclinical studies suggest that optimizing the VD and LC status in patients with diabetes can result in mTOR suppression, which has the potential to protect these individuals from microvascular and macrovascular complications while enhancing the regulation of their blood glucose. Given this information, finding ways to suppress mTOR signaling and also increasing VD and LC status is a possible therapeutic approach that might aid patients with diabetes. Future clinical trials are needed to investigate whether VD and LC co-supplementation can successfully downregulate mTOR and can be used as adjuvant therapy in patients with diabetes.

The interface of depression and diabetes: treatment considerations

This state-of-the-art review explores the relationship between depression and diabetes, highlighting the two-way influences that make treatment challenging and worsen the outcomes of both conditions. Depression and diabetes often co-occur and share genetic, lifestyle, and psychosocial risk factors. Lifestyle elements such as diet, physical activity, and sleep patterns play a role on the development and management of both conditions, highlighting the need for integrated treatment strategies. The evidence suggests that traditional management strategies focusing on either condition in isolation fall short of addressing the intertwined nature of diabetes and depression. Instead, integrated care models encompassing psychological support and medical management are recommended to improve treatment efficacy and patient adherence. Such models require collaboration across multiple healthcare disciplines, including endocrinology, psychiatry, and primary care, to offer a holistic approach to patient care. This review also identifies significant patient-related barriers to effective management, such as stigma, psychological resistance, and health literacy, which need to be addressed through patient-centered education and support systems. Future directions for research include longitudinal studies in diverse populations to further elucidate causal relationships and the exploration of novel therapeutic targets, as well as the effectiveness of healthcare models aimed at preventing the onset of one condition in individuals diagnosed with the other.

Specific depressive symptoms, body mass index and diabetes in middle-aged and older Chinese adults: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

This study examined the association between specific depressive symptoms and incident diabetes, and whether overweight or obesity mediates this relationship among middle-aged and older adults in China.

METHODS

In a nationally representative prospective cohort study of 11,893 middle-aged and older Chinese adults without baseline diabetes, we used Cox models to assess the association between depressive symptoms and diabetes. The quantile g-computation (qgcomp) model evaluated the contribution of 10 specific depressive symptoms to diabetes risk, and a two-stage regression method explored the mediation effect of overweight or obesity.

RESULTS

Over a median follow-up of 7.1 years, 1,314 cases of diabetes were identified. Elevated depressive symptoms were associated with increased diabetes risk (HR 1.23; 95 % CI 1.09-1.38). Eight out of 10 depressive symptoms were significantly associated to diabetes, with loneliness (weight = 18 %; HR 1.23; 95 % CI 1.10-1.39), restless sleep (weight = 17 %; HR 1.16; 95 % CI 1.04-1.29), and bother (weight = 15 %; HR 1.19; 95 % CI 1.07-1.33) being the primary contributors. Mediation analysis showed that overweight and obesity reduced the depression-diabetes risk association by 8.21 % and 12.61 %, respectively.

LIMITATIONS

Diagnosis of diabetes was self-reported.

CONCLUSIONS

Eight out of ten specific depressive symptoms were associated to diabetes, overweight and obesity may partially mitigate the effect of depressive symptoms on diabetes among middle-aged and older adults in China.

CLINICAL IMPLICATIONS

Our results highlight the importance of tailoring diabetes prevention and management strategies according to specific depressive symptoms among middle-aged and older adults in China.

Antidepressants account for the causal effect of major depressive disorder on type 2 diabetes

BACKGROUND

Patients with major depressive disorder (MDD) face an elevated risk of type 2 diabetes (T2D). However, the contribution of the disease itself versus the side effects of antidepressants to this increased risk remains unclear.

OBJECTIVE

This study aimed to investigate the overall and independent effects of MDD and exposure to antidepressants on T2D risk.

METHODS

Summary genome-wide association study datasets were utilized for the Mendelian randomization (MR) and multivariable MR (MVMR) analyses, including ones for MDD (N = 500,199), antidepressants (N = 175,161), and T2D (N = 933,970). Bayesian colocalization analysis was used to reveal shared genetic variation between MDD, antidepressants, and T2D.

RESULTS

We found that both MDD (OR: 1.15, CI: 1.03-1.30, P = 0.016) and antidepressants (OR: 1.37, CI: 1.22-1.53, P = 2.75E-08) have overall causal effects on T2D. While T2D was associated with the risk of antidepressant use (OR: 1.08, CI: 1.06-1.11, P = 8.80E-10), but not with the risk of MDD (OR: 1.00, CI: 0.98-1.01, P = 0.661). Our MVMR analysis showed that the use of antidepressants is associated with higher risks of T2D (OR: 1.21, CI: 1.07-1.37, P = 7.19E-04), while MDD is not linked to the risk of T2D (OR: 1.01, CI: 0.86-1.18, P = 0.799). Colocalization analysis identified two shared genetic loci between antidepressants and T2D.

CONCLUSIONS

The elevated T2D risk in MDD patients is chiefly caused by antidepressant use. These findings emphasize the importance of considering the impact of antidepressants on metabolic health in individuals with MDD.

Casual correlation between overweight, obesity, and severe COVID-19 infection with respiratory failure: A two-sample Mendelian randomization

This study aimed to detect the causal association of overweight and obesity on severe COVID-19 infection with respiratory failure through a two-sample Mendelian randomization (MR) method based on the genome-wide association studies datasets. All genome-wide association studies summary data of exposures and outcome used in this study were obtained from the IEU database derived from Europeans. The study mainly used the inverse variance weighted method to test causal relationship. Simultaneously, MR-PRESSO and MR-EGGER were used to detect the pleiotropy, and sensitivity analysis was performed using leave-one-out analysis. In the inverse variance weighted analyses, we found no causal association between obesity (e.g., OR = 1.15, 95% CIs = 0.96-1.37, P = .13 for obesity-ebi-a-GCST90000255), obesity subtypes (e.g., OR = 1.93, 95% CIs = 0.90-4.14, P = .10 for obesity and other hyperalimentation) as well as overweight (OR = 0.90, 95% CIs = 0.64-1.27, P = .54) and severe COVID-19 infection with respiratory failure. The findings showed no causal association between obesity or overweight and severe COVID-19 infection with respiratory failure. Further validation is needed regarding whether obesity or overweight is a risk factor for it.

Balanced diets are associated with a lower risk of type 2 diabetes than plant-based diets

BACKGROUND & AIMS

Plant-based diets benefit human health, while the deficient in some nutrients limits its application. We aimed to examine whether balanced diets could be better in reducing diabetes risk than plant-based diets.

METHODS

In cross-sectional analysis of Environment-Inflammation-Metabolic-Diseases Study (EIMDS), we used a questionnaire to investigate the habit of balanced and plant-based diets. In the prospective analysis of UK Biobank, we used the plant-based diet index of health (hPDI) and unhealth (uPDI) to evaluate the plant-based diets, and defined the balanced diet as a daily intake of 5 categories and at least 12 types of food. After analyzing proteomic data in UK Biobank, we explored the causal relationship between signature proteins of balanced diets and incident diabetes based on summary-data-based Mendelian randomization (SMR).

RESULTS

Compared to participants who had plant-based diets, those who had balanced diets showed a lower risk of diabetes in EIMDS (Odd Ratio 0.65, 95%CI 0.44-0.95). In UK Biobank, after excluding participants with unhealthy plant-based diets, participants with balanced diets still showed a lower diabetes risk than participants with plant-based diets (Hazard Ratio 0.86, 95%CI 0.77-0.95). Proteomic analysis identified 107 downregulated and 2 upregulated proteins that were associated with higher and lower risk of diabetes, respectively. In SMR analyses, the downregulated signature proteins of balanced diets (AGR2, DBI, IL17RA and SERPINH1) were causally associated with diabetes incidence.

CONCLUSION

Adhered to a balanced diet is associated with a lower risk of diabetes compared to plant-based diet, which might be attributed to signature proteins such as AGR2, DBI, IL17RA and SERPINH1.

Deciphering the genetic interplay between depression and dysmenorrhea: a Mendelian randomization study

BACKGROUND

This study aims to explore the link between depression and dysmenorrhea by using an integrated and innovative approach that combines genomic, transcriptomic, and protein interaction data/information from various resources.

METHODS

A two-sample, bidirectional, and multivariate Mendelian randomization (MR) approach was applied to determine causality between dysmenorrhea and depression. Genome-wide association study (GWAS) data were used to identify genetic variants associated with both dysmenorrhea and depression, followed by colocalization analysis of shared genetic influences. Expression quantitative trait locus (eQTL) data were analyzed from public databases to pinpoint target genes in relevant tissues. Additionally, a protein-protein interaction (PPI) network was constructed using the STRING database to analyze interactions among identified proteins.

RESULTS

MR analysis confirmed a significant causal effect of depression on dysmenorrhea ['odds ratio' (95% confidence interval) = 1.51 (1.19, 1.91), P = 7.26 × 10-4]. Conversely, no evidence was found to support a causal effect of dysmenorrhea on depression (P = .74). Genetic analysis, using GWAS and eQTL data, identified single-nucleotide polymorphisms in several genes, including GRK4, TRAIP, and RNF123, indicating that depression may impact reproductive function through these genetic pathways, with a detailed picture presented by way of analysis in the PPI network. Colocalization analysis highlighted rs34341246(RBMS3) as a potential shared causal variant.

CONCLUSIONS

This study suggests that depression significantly affects dysmenorrhea and identifies key genes and proteins involved in this interaction. The findings underline the need for integrated clinical and public health approaches that screen for depression among women presenting with dysmenorrhea and suggest new targeted preventive strategies.

Depression in Cardiac Patients Is a Major Cardiovascular Event Risk Factor: A 12-Month Observational Study

Background: Depression is a known factor in poor cardiovascular outcomes but is often underassessed in cardiac units. This study evaluates the impact of depression on cardiovascular outcomes in patients undergoing cardiac interventions. Methods: The study included 133 patients who underwent uncomplicated procedures for degenerative aortic valve stenosis (n = 40), acute coronary syndrome (n = 29), or chronic coronary artery disease (n = 64). Depression was assessed using the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D). The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE). Patients were followed up for 12 months. Cox proportional hazards analysis was used to identify MACCE risk factors. Results: Depression was more frequently screened by HAM-D than BDI (42.9% vs. 30.8%, p < 0.001). During follow-up, 26 (19.5%) MACCEs occurred. In univariate analysis, risk factors included BDI score ≥ 11, HAM-D score ≥ 8, diabetes on insulin, anticoagulant use, atrial fibrillation, and serum creatinine level ≥ 130 µmol/L. Depression in the BDI increased the risk of the MACCE 3.6-fold (95%CI: 1.64-8.0, p = 0.001), whereas in the HAM-D, it increased the risk 4.9-fold (95%CI: 1.97-12.24, p < 0.001). Multivariate analysis showed HAM-D score ≥ 8 as the strongest predictor of MACCE (HR: 3.08, 95%CI: 1.18-8.08). Conclusions: Depression is a common finding in cardiovascular patients, and it is a strong risk factor for one-year cardiovascular mortality and adverse event risk. Therefore, we believe that common guidelines should be elaborated between relevant psychiatry and cardiology scientific societies.

Adverse childhood experiences and falls in older adults: The mediating role of depression

OBJECTIVES

To explore the relationship between adverse childhood experiences and falls in older adults, and the mediating effects of depression on such associations.

METHODS

This is a prospective study used survey data from the China Health and Retirement Longitudinal Study. Twelve expanded ACEs obtained from the 2014 Life History Survey. Depression levels were assessed using the Centre for Epidemiologic Studies Depression Scale-10. Self-reported outcomes of falling evaluated based on "Have you fallen down since the last survey?" and "How many times have you fallen down seriously enough to need medical treatment?" Logistic regression models were used to explore the relationship between ACEs with falls and recurrent falls. Poisson regression models were used to explore the relationship between ACEs and number of severe falls. Besides, mediation analysis was used to explore whether depression mediates the relationship between ACEs and falls in older adults.

RESULTS

The more adverse childhood experiences experienced, the higher the risk of fall and recurrent falls, and the more severe the falls. Additionally, depression partially mediated the relationship between adverse childhood experiences and falls. Besides, middle-aged individuals were more susceptible to the impact of adverse childhood experiences on falls than older individuals, especially males.

CONCLUSIONS

Exposure to adverse childhood experiences is associated with falls in older adults, and depression partially mediates this association. Middle-aged adults were more susceptible to the impact of adverse childhood experiences on falls. These offer important information for clinical practice and public health interventions to prevent falls and reduce fall-related injuries among older adults.

Relationship between thyroid-stimulating hormone and blood lipids in patients with first-episode depression

BACKGROUND

Previous studies demonstrated thyroid stimulating hormone (TSH) plays an important role in regulating lipid metabolism, but the relationship between the two is controversial. Meanwhile, it has not been reported in a population with major depressive disorder (MDD).

METHODS

We divided 1718 first-episode and drug naïve patients with MDD into a TSH abnormal group (TSH-AB) and a TSH normal group (TSH-NOR). The participants in the two groups were assessed by the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the positive subscale of Positive and Negative Syndrome Scale. The patients' blood was tested for TSH, free T3, free T4, fasting blood glucose, lipid indexes and body mass index was recorded.

RESULTS

The participants in the TSH-AB group had significantly higher HAMD scores, HAMA scores and total scores of positive symptoms, as well as higher incidence of suicide attempts than those in the TSH-NOR group, accompanied by significantly higher thyroglobulin antibodies, thyroid peroxidase antibodies, fasting blood glucose values, total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) levels compared with those of TSH-NOR patients. However, the high-density lipoprotein cholesterol (HDL-C) of TSH-AB patients was lower than those of TSH-NOR patients. TSH values were positively correlated with TC, TG, and LDL-C values, and negatively correlated with HDL-C value.

CONCLUSION

TSH was highly correlated with abnormal lipid metabolism in patients with MDD. The specific molecular mechanism of the relationship between TSH, lipid metabolism and the development of depression needs to be further in-depth investigation.

Plasma metabolites as mediators in the relationship between inflammation-related proteins and benign prostatic hyperplasia: insights from mendelian randomization

Benign prostatic hyperplasia (BPH) is a condition commonly observed in aging males. Inflammatory and metabolic factors are pivotal in the development and progression of BPH. The degree to which the effects of 91 inflammation-related proteins on BPH are mediated by 1400 plasma metabolites remains ambiguous. Our research analyzed the impact of these traits utilizing genetic evidence.Two-sample Mendelian randomization (MR) and multivariable MR (MVMR) were utilized in our study to infer the genetic causal effect of inflammation-related proteins on BPH, with metabolites serving as mediators. Increased levels of IL-2 were linked to a heightened incidence of BPH (β = 0.071, OR:1.074, 95% CI [1.002-1.152], p = 0.045), whereas lower concentrations of N6,N6-dimethyllysine were associated with decreased risk (β1=-0.127, p = 0.02; β2=-0.039, p = 0.008). The mediation effect was 0.005 (95% CI [0.0004, 0.012], OR: 1.005, 95% CI [1.000, 1.012]), accounting for 7.04% of the total effect. subsequently, we examined the phenotypic co-localization of the two pairings independently, revealing that the posterior probability of rs145516501 associated with IL-2 and BPH was 80.7%, whereas the posterior likelihood of rs4917820 linked to N6,N6-dimethyllysine levels and BPH was 95.9%. The research indicated that N6,N6-dimethyllysine levels seem to influence the causative relationship between IL-2 and BPH. These results elucidate the complex interplay between inflammation-related proteins and metabolism in the context of BPH, offering novel diagnostic and therapeutic avenues and enhancing our comprehension of the disease's etiology for prospective research.

Exploring Pathogenic Genes in Frozen Shoulder through weighted gene co-expression network analysis and Mendelian Randomization

Background: Frozen shoulder (FS) is characterized by the thickening and fibrosis of the joint capsule, leading to joint contracture and a reduction in joint volume. The precise etiology responsible for these pathological changes remains elusive. Therefore, the primary aim of this study was to explore the potential involvement of pathogenic genes in FS and analyze their underlying roles in the disease progression. Methods: Differential expression analysis and weighted gene co-expression network analysis (WGCNA) were employed to investigate co-expressed genes potentially associated with FS. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were conducted to elucidate the potential roles of these co-expressed genes. Subsequently, Mendelian randomization (MR) analysis was performed using expression quantitative trait loci datasets for the co-expressed genes, combined with summary statistics from the genome-wide association study of FS, aiming to identify key genes causally associated with FS. The identified key genes were further validated through reverse transcription-quantitative PCR (RT-qPCR). Additionally, a nomogram model and receiver operating characteristic (ROC) curves were established to assess the diagnostic value of the hub genes. Furthermore, the infiltration of immune cells was evaluated using the CIBERSORT algorithm and the relationship between key genes and immune-infiltrating cells was analyzed. Results: 295 overlapping co-expressed genes were identified by intersecting the differentially expressed genes with the hub genes obtained from associated modules identified through WGCNA. Utilizing MR analysis, four key genes, namely ADAMTS1, NR4A2, PARD6G and SMKR1, were found to exhibit positive causal relationships with FS, which were subsequently validated through RT-qPCR analysis. Moreover, the diagnostic value of these four key genes was demonstrated through the development of a nomogram model and the construction of ROC curves. Notably, a causal relationship between ADAMTS1 and immune cell infiltration in FS was observed. Conclusion: Our study suggested genetic predisposition to higher expression levels of ADAMTS1, NR4A2, PARD6G and SMKR1, was associated with an increased risk of FS. Further investigations elucidating the functional roles of these genes will enhance our understanding of the pathogenesis of FS and may facilitate the development of targeted treatment strategies.

Mitochondrial dysfunction and onset of type 2 diabetes along with its complications: a multi-omics Mendelian randomization and colocalization study

Background

Mitochondrial dysfunction plays a crucial role in Type 2 Diabetes Mellitus (T2DM) and its complications. However, the genetic pathophysiology remains under investigation. Through multi-omics Mendelian Randomization (MR) and colocalization analyses, we identified mitochondrial-related genes causally linked with T2DM and its complications.

Methods

Summary-level quantitative trait loci data at methylation, RNA, and protein levels were retrieved from European cohort studies. GWAS summary statistics for T2DM and its complications were collected from the DIAGRAM and FinnGen consortiums, respectively. Summary-data-based MR was utilized to estimate the causal effects. The heterogeneity in dependent instrument test assessed horizontal pleiotropy, while colocalization analysis determined whether genes and diseases share the same causal variant. Enrichment analysis, drug target analysis, and phenome-wide MR were conducted to further explore the biological functions, potential drugs, and causal associations with other diseases.

Results

Integrating evidence from multi-omics, we identified 18 causal mitochondrial-related genes. Enrichment analysis revealed they were not only related to nutrient metabolisms but also to the processes like mitophagy, autophagy, and apoptosis. Among these genes, Tu translation elongation factor mitochondrial (TUFM), 3-hydroxyisobutyryl-CoA hydrolase (HIBCH), and iron-sulfur cluster assembly 2 (ISCA2) were identified as Tier 1 genes, showing causal links with T2DM and strong colocalization evidence. TUFM and ISCA2 were causally associated with an increased risk of T2DM, while HIBCH showed an inverse causal relationship. The causal associations and colocalization effects for TUFM and HIBCH were validated in specific tissues. TUFM was also found to be a risk factor for microvascular complications in T2DM patients including retinopathy, nephropathy, and neuropathy. Furthermore, drug target analysis and phenome-wide MR underscored their significance as potential therapeutic targets.

Conclusions

This study identified 18 mitochondrial-related genes causally associated with T2DM at multi-omics levels, enhancing the understanding of mitochondrial dysfunction in T2DM and its complications. TUFM, HIBCH, and ISCA2 emerge as potential therapeutic targets for T2DM and its complications.

Short-physical performance battery: complete mediator of cognitive depressive symptoms and diabetes mellitus in hemodialysis patients

OBJECTIVE

This study aimed to examine the relationship between different dimensions of depressive symptoms and the presence of diabetes mellitus in hemodialysis patients. Additionally, the study sought to elucidate the mediating effect of physical performance on this association.

METHODS

This was a cross-sectional multicenter study conducted between July 2020 and March 2023, involving 1024 patients from eight hemodialysis centers in Shanghai. Diabetes mellitus was based on a documented physician diagnosis and blood glucose tests. Physical performance and depressive symptoms were assessed using short-physical performance battery (SPPB) and the patient health questionnaire-9, respectively. Regression and mediation analysis were applied to statistical analysis.

RESULTS

Among the 1024 participants, 39.26% (n = 402) were found to have coexisting diabetes mellitus. Diminished SPPB scores (OR = 0.843, 95% CI = 0.792-0.897) and cognitive depressive symptoms (OR = 1.068, 95% CI = 1.011-1.129) exhibited significant associations with diabetes mellitus, while somatic depressive symptoms did not show a significant correlation. Notably, SPPB emerged as a complete mediator in the relationship between cognitive depressive symptoms and diabetes mellitus. The observed indirect effect of SPPB on this relationship was estimated at 0.038 (95% CI: 0.021-0.057).

CONCLUSION

This study showed an association between diabetes mellitus and cognitive depressive symptoms in patients undergoing hemodialysis, with physical performance appearing to mediate the relationship between diabetes mellitus and depressive symptoms.

Causal relationship analysis between 35 blood/urine metabolites and gastroesophageal reflux disease: A Mendelian randomization combined meta-analysis study

Gastroesophageal reflux disease (GERD) is a common condition worldwide. Despite numerous studies on GERD, the causal relationships between blood/urine metabolites and GERD remain unclear. This study aims to explore the causal relationships between GERD and 35 blood/urine metabolites. In this study, we conducted Mendelian randomization (MR) analyses for 35 blood/urine metabolites with GERD phenotypes from the FinnGen R10 and UKB databases separately. We then performed a meta-analysis of the inverse variance weighted results from the 2 MR analyses and applied multiple corrections to the significant P values from the meta-analysis. Finally, we conducted reverse causality validation for the corrected positive blood/urine metabolite phenotypes with GERD. After conducting MR analysis combined with meta-analysis and performing multiple corrections, we found significant positive causal associations between only 3 blood/urine metabolites and GERD, with no significant reverse associations. Among them, 2 are risk factors for the occurrence of GERD: alanine aminotransferase levels (odds ratio (OR) = 1.120, 95% confidence interval (CI) = 1.064-1.180, P = .0005) and urate levels (OR = 1.095, 95% CI = 1.044-1.147, P = .005). Additionally, sex hormone-binding globulin levels are protective against GERD (OR = 0.928, 95% CI = 0.896-0.961, P = .0009). Elevated levels of the metabolites alanine aminotransferase and urate are associated with an increased risk of GERD, identifying them as risk factors for the condition. In contrast, higher levels of SHBG are linked to a decreased risk of GERD, indicating that SHBG is a protective factor against the disease.

Cardiovascular Disease, Genetic Susceptibility, and Risk of Psychiatric Disorders and Suicide Attempt: A Community-Based Matched Cohort Study Based on the UK Biobank

BACKGROUND

The associations between cardiovascular disease (CVD) and multiple psychiatric disorders and suicide attempt, and whether different genetic susceptibilities affect such links, have not been investigated clearly.

METHODS AND RESULTS

Based on the UK Biobank, we conducted a matched cohort study involving 63 923 patients who were first hospitalized with a CVD diagnosis between 1997 and 2020, and their 127 845 matched unexposed individuals. Cox models were used to examine the subsequent risk of psychiatric disorders and suicide attempt (ie, anxiety, depression, stress-related disorder, substance misuse, psychotic disorder, and suicide behaviors) following CVD. We further performed stratified analyses by polygenic risk score for each studied psychiatric condition to detect the possible effects of genetic susceptibility on the observed associations. We found an increased risk of any psychiatric disorders and suicide attempt among CVD patients, compared with matched unexposed individuals, particularly within 1 year following the CVD (fully adjusted hazard ratio [HR] within 1 year, 1.83 [95% CI, 1.58-2.12]; HR after 1 year, 1.24 [95% CI, 1.16-1.32]). By subtype, the risk elevations existed for any psychiatric disorders and suicide attempt following most categories of CVDs. Analyses stratified by polygenic risk score revealed little impact of genetic predisposition to studied psychiatric conditions on these observed links.

CONCLUSIONS

Patients hospitalized for CVD were at increased subsequent risk of multiple types of psychiatric disorders and suicide attempt, especially in the first year after hospitalization, irrespective of their genetic susceptibilities to studied psychiatric conditions, and these findings underscore the necessity of developing timely psychological interventions for this vulnerable population.

Temporal Relationship between HbA1c and Depressive Symptom Trajectories in a Longitudinal Cohort Study: The Mediating Role of Healthy Lifestyles

This study analyzed China Health and Retirement Longitudinal Study data to explore the HbA1c-depression link, including depressive trajectories, while considering the mitigating impact of healthy lifestyles. Cross-lagged panel models and group-based trajectory modeling were performed to investigate the temporal relationship between HbA1c levels and depressive symptoms, as well as the depressive trajectories. Structural equation models were used to assess the mediating effects of healthy lifestyles. The mean age of the participants was 57.66 ± 9.04 years, with 53.68% being female. Analyzing 8826 participants across three waves, we observed a significant prediction of subsequent depressive symptoms by the preceding HbA1c levels (β = 0.296; p < 0.001). Four distinct trajectories of depressive symptoms were distinguished: stable low, stable moderate, increasing, and stable high. Elevated HbA1c levels were associated with a higher risk of developing stable high (OR 1.12 and 95% CI 1.02-1.23), increasing (OR 1.21 and 95% CI 1.11-1.32), and stable moderate depressive symptoms (OR 1.07 and 95% CI 1.01-1.13). Engaging in two healthy life behaviors reduced stable high and increasing depressive pattern risks by 32% and 30%, respectively. Adherence to a healthy lifestyle lessened 7.2% of the impact of high HbA1c levels on the subsequent depressive symptoms. These findings highlight the potential benefits of incorporating adequate sleep and light physical activities, which might reduce the adverse impact of elevated HbA1c levels on depressive symptoms.

Pramipexole improves depression-like behavior in diabetes mellitus with depression rats by inhibiting NLRP3 inflammasome-mediated neuroinflammation and preventing impaired neuroplasticity

BACKGROUND

Diabetes mellitus (DM) is frequently associated with the occurrence and development of depression, and the co-occurrence of diabetes mellitus with depression (DD) may further reduce patients' quality of life. Recent research indicates that dopamine receptors (DRs) play a crucial role in immune and metabolic regulation. Pramipexole (PPX), a D2/3R agonist, has demonstrated promising neuroprotective and immunomodulatory effects. Nevertheless, the therapeutic effects and mechanisms of action of PPX on DM-induced depression are not clear at present.

METHODS

Depression, DM, and DD were induced in a rat model through a combination of a high-fat diet (HFD) supplemented with streptozotocin (STZ) and chronic unpredictable mild stress (CUMS) combined with solitary cage rearing. The pathogenesis of DD and the neuroprotective effects of DRs agonists were investigated using behavioral assays, enzyme-linked immunosorbent assay (ELISA), hematoxylin-eosin (HE) staining, Nissl staining, Western blotting (WB) and immunofluorescence (IF).

RESULTS

DD rats exhibited more severe dopaminergic, neuroinflammatory, and neuroplastic impairments and more pronounced depressive behaviors than rats with depression alone or DM. Our findings suggest that DRs agonists have significant therapeutic effects on DD rats and that PPX improved neuroplasticity and decreased neuroinflammation in the hippocampus of DD rats while also promoting DG cell growth and differentiation, ultimately mitigating depression-like behaviors.

LIMITATION

Our study is based on a rat model. Further evidence is needed to determine whether the therapeutic effects of PPX apply to patients suffering from DD.

CONCLUSIONS

Neuroinflammation mediated by damage to the dopaminergic system is one of the key pathogenic mechanisms of DD. We provide evidence that PPX has a neuroprotective effect on the hippocampus in DD rats and the mechanism may involve the inhibition of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome activation by DRs to attenuate the neuroinflammatory response and neuroplasticity damage.

Exploring the mediating role of calcium homeostasis in the association between diabetes mellitus, glycemic traits, and vascular and valvular calcifications: a comprehensive Mendelian randomization analysis

BACKGROUND

The interplay between diabetes mellitus (DM), glycemic traits, and vascular and valvular calcifications is intricate and multifactorial. Exploring potential mediators may illuminate underlying pathways and identify novel therapeutic targets.

METHODS

We utilized univariable and multivariable Mendelian randomization (MR) analyses to investigate associations and mediation effects. Additionally, the multivariable MR analyses incorporated cardiometabolic risk factors, allowing us to account for potential confounders.

RESULTS

Type 2 diabetes mellitus (T2DM) and glycated hemoglobin (HbA1c) were positively associated with both coronary artery calcification (CAC) and calcific aortic valvular stenosis (CAVS). However, fasting glucose (FG) was only linked to CAVS and showed no association with CAC. Additionally, CAVS demonstrated a causal effect on FG. Calcium levels partially mediated the impact of T2DM on both types of calcifications. Specifically, serum calcium was positively associated with both CAC and CAVS. The mediation effects of calcium levels on the impact of T2DM on CAC and CAVS were 6.063% and 3.939%, respectively. The associations between T2DM and HbA1c with calcifications were influenced by body mass index (BMI) and smoking status. However, these associations were generally reduced after adjusting for hypertension.

CONCLUSION

Our findings suggest a genetically supported causal relationship between DM, glycemic traits, and vascular and valvular calcifications, with serum calcium playing a critical mediating role.

Mendelian randomization and single-cell expression analyses identify the causal relationship between depression and chronic rhinosinusitis

Background

The causative relationship between chronic rhinosinusitis (CRS) and depression remains unclear. Herein we employed Mendelian randomization (MR) coupled with single-cell analysis to investigate the causality between CRS and depression.

Methods

Data pertaining to CRS and depression were mined from the genome-wide association study database, and a single-cell dataset was sourced from the literature. To explore causality, we conducted bidirectional MR analysis using MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode, with IVW representing the most important method. Further, sensitivity analysis was performed to evaluate the robustness of MR analysis results. Candidate genes were analyzed via single-cell combined MR analysis.

Results

Forward MR analysis indicated depression as a risk factor for CRS when depression was the exposure factor and CRS was the outcome (OR = 1.425, P < 0.001). Reverse MR analysis revealed the same positive relationship between CRS and depression when CRS was the exposure factor and depression was the outcome (OR = 1.012, P = 0.038). Sensitivity analysis validated the robustness of bidirectional MR analysis results. Ten cell types (endothelial, ciliated, basal, myeloid, mast, apical, plasma, glandular, fibroblast, and T cells) were identified in the single-cell dataset. The network of receptor-ligand pairs showed that in normal samples, cell-cell interactions were present among various cell types, such as epithelial, mast, myeloid, and endothelial cells. In contrast, CRS samples featured only one specific receptor-ligand pair, confined to myeloid cells. TCF4 and MEF2C emerged as potentially crucial for CRS-associated depression development.

Conclusions

Our findings suggest a bidirectional causal relationship between CRS and depression, offering a new perspective on the association between CRS and depression.

Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study

BACKGROUND

Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults.

METHODS

An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption.

RESULTS

The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms.

CONCLUSIONS

The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

Eight-year nationwide study of the bidirectional association between type 2 diabetes and depression in nearly 8 million German outpatients

INTRODUCTION

Research linking type 2 diabetes and depression mostly relied on hospital-based diagnoses or prescription data, overlooking many outpatient diagnoses. We aimed to quantify the risks of depression in individuals newly diagnosed with type 2 diabetes, and type 2 diabetes in those newly diagnosed with depression, while exploring potential risk differences depending on age, sex, and follow-up time.

RESEARCH DESIGN AND METHODS

We conducted a matched cohort study using German nationwide outpatient claims data from 2012 to 2022. Participants were individuals newly diagnosed with type 2 diabetes (N=294 642) or depression (N=1 271 537) in 2015, matched in a 1:4 ratio to controls without these conditions by age, sex, and region. The bidirectional risk was evaluated over an 8-year period using mixed-effects Cox proportional hazards models, adjusting for the Charlson Comorbidity Index, urbanicity, and area-level deprivation.

RESULTS

New type 2 diabetes diagnosis was associated with higher depression risk over 8 years (N=54 561 with depression, HR=1.23, 99% CI=1.21 to 1.24). Similarly, depression diagnosis was linked to an increased type 2 diabetes risk (N=71 848 with type 2 diabetes, HR=1.15, 99% CI=1.14 to 1.17). The association between depression and type 2 diabetes was stronger in younger age groups, especially under 34 years. Findings held across sex-stratified analyses. Time stratification showed a more pronounced association between type 2 diabetes and depression risk during the earlier follow-up quarters, whereas the risk of developing type 2 diabetes after depression diagnosis remained constant throughout the follow-up period.

CONCLUSIONS

Our findings confirm a bidirectional link between type 2 diabetes and depression, particularly in younger individuals. As type 2 diabetes and depression are frequent, future research needs to study whether preventive approaches can reduce the risk of developing this comorbidity.

Repurposing Ketamine in the Therapy of Depression and Depression-Related Disorders: Recent Advances and Future Potential

Depression represents a prevalent and enduring mental disorder of significant concern within the clinical domain. Extensive research indicates that depression is very complex, with many interconnected pathways involved. Most research related to depression focuses on monoamines, neurotrophic factors, the hypothalamic-pituitary-adrenal axis, tryptophan metabolism, energy metabolism, mitochondrial function, the gut-brain axis, glial cell-mediated inflammation, myelination, homeostasis, and brain neural networks. However, recently, Ketamine, an ionotropic N-methyl-D-aspartate (NMDA) receptor antagonist, has been discovered to have rapid antidepressant effects in patients, leading to novel and successful treatment approaches for mood disorders. This review aims to summarize the latest findings and insights into various signaling pathways and systems observed in depression patients and animal models, providing a more comprehensive view of the neurobiology of anxious-depressive-like behavior. Specifically, it highlights the key mechanisms of ketamine as a rapid-acting antidepressant, aiming to enhance the treatment of neuropsychiatric disorders. Moreover, we discuss the potential of ketamine as a prophylactic or therapeutic intervention for stress-related psychiatric disorders.

Jiao-tai-wan and its effective component-berberine improve diabetes and depressive disorder through the cAMP/PKA/CREB signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Jiao-tai-wan (JTW), a classic herbal formula of traditional Chinese medicine recorded in Han Shi Yi Tong, has been used to alleviate sleep disorders since ancient times. In modern pharmacological research, JTW has been adopted for treating diabetes mellitus and even exerts antidepressant effects. However, the potential mechanisms deserve further elucidation.

AIM OF THE STUDY

The prevalence of diabetes mellitus combined with depressive disorder (DD) is continuing to increase, yet it is currently under-recognized and its treatment remains inadequate. The present study aims to explore the underlying therapeutics and mechanisms of JTW on DD.

MATERIALS AND METHODS

Chronic restraint stress was used on db/db mice to construct a mouse model of DD. The therapeutic effects of JTW were assessed by glucolipid metabolic indexes, behavioral tests, and depression-related neurotransmitter levels. The inflammatory status and cell apoptosis of different mice were investigated and the changes in the cAMP/PKA/CREB pathway were detected. Combining the results of fingerprinting with molecular docking, the active components of JTW were screened. A cellular model was constructed by intervention of glucose combined with corticosterone (CORT). The levels of apoptosis and depression-related neurotransmitters in HT-22 cells were examined, and the changes in the cAMP/PKA/CREB pathway were tested. Finally, the activator and inhibitor of the PKA protein were used for reverse validation experiments.

RESULTS

JTW could improve the impaired glucose tolerance, lipid metabolism disorders, and depression-like symptoms in DD mice. Meanwhile, JTW could alleviate the inflammatory status, suppress the microglia activation, and improve hippocampal neuron apoptosis in DD mice. The dual effects of JTW might be associated with the activation of the cAMP/PKA/CREB pathway. Berberine (Ber) was identified for the in vitro experiment, it could reverse the apoptosis of HT-22 cells and up-regulate the depression-related neurotransmitter levels, and the effects of Ber were related to the activation of the cAMP/PKA/CREB pathway as well.

CONCLUSION

JTW could exert both hypoglycemic and antidepressant effects through activating the cAMP/PKA/CREB signaling pathway, its active component, Ber, could improve the damage to HT-22 cells induced by glucose combined with CORT via the activation of the cAMP/PKA/CREB pathway. Ber may be one of the effective components of the dual effects of JTW.

Clinical data mining: challenges, opportunities, and recommendations for translational applications

Clinical data mining of predictive models offers significant advantages for re-evaluating and leveraging large amounts of complex clinical real-world data and experimental comparison data for tasks such as risk stratification, diagnosis, classification, and survival prediction. However, its translational application is still limited. One challenge is that the proposed clinical requirements and data mining are not synchronized. Additionally, the exotic predictions of data mining are difficult to apply directly in local medical institutions. Hence, it is necessary to incisively review the translational application of clinical data mining, providing an analytical workflow for developing and validating prediction models to ensure the scientific validity of analytic workflows in response to clinical questions. This review systematically revisits the purpose, process, and principles of clinical data mining and discusses the key causes contributing to the detachment from practice and the misuse of model verification in developing predictive models for research. Based on this, we propose a niche-targeting framework of four principles: Clinical Contextual, Subgroup-Oriented, Confounder- and False Positive-Controlled (CSCF), to provide guidance for clinical data mining prior to the model's development in clinical settings. Eventually, it is hoped that this review can help guide future research and develop personalized predictive models to achieve the goal of discovering subgroups with varied remedial benefits or risks and ensuring that precision medicine can deliver its full potential.

Efficacy and Safety of Antidiabetic Agents for Major Depressive Disorder and Bipolar Depression: A Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled Trials

BACKGROUND

This meta-analysis aimed to determine the efficacy and safety of antidiabetic agents in the treatment of major depressive disorder and bipolar depression.

METHODS

Randomized controlled trials (RCTs) of antidiabetic agents in major depressive disorder or bipolar depression were searched in three electronic databases and three clinical trial registry websites from their inception up to October 2023. The differences in changes in the depression rating scale scores from baseline to endpoint or pre-defined sessions, response rate, remission rate, rate of side effects and dropout rate between antidiabetic agents and placebo were meta-analyzed.

RESULTS

Six RCTs involving 399 participants were included in the final meta-analysis, which did not find that antidiabetics outperformed the placebo in reducing depressive symptoms. The standardized mean difference (SMD) in the depression scores from baseline to endpoint was 0.25 (95% CI -0.1, 0.61). However, a subgroup analysis found a significant difference between antidiabetics and placebos in reducing depressive symptoms in Middle Eastern populations, with an SMD of 0.89 (95% CI 0.44, 1.34).

CONCLUSIONS

The current meta-analysis does not support the efficacy of antidiabetics being superior to the placebo in the treatment of unipolar and bipolar depression. However, a subgroup analysis indicates that patients from the Middle East may benefit from adding an antidiabetic medication to their ongoing medication(s) for their depression. Larger studies with good-quality study designs are warranted.

Heartache and Heartbreak: An Observational and Mendelian Randomization Study

BACKGROUND

Depression has a significant effect on cardiovascular disease (CVD), but uncertainties persist regarding which modifiable risk factors mediate the causal effects. We aim to determine whether depression is causally linked to CVD and which modifiable risk factors play potential mediating roles.

METHODS

We used a two-sample Mendelian randomization (MR) approach and NHANES 2007-2018 data to estimate the effects of depression on various CVD cases and investigated 28 potential mediators of the association between depression and CVD.

RESULTS

The results of our MR analysis indicated that genetically determined depression was associated with increased risk of several CVD, including coronary heart disease (odds ratio (OR) = 1.14; 95% confidence interval (CI): 1.05,1.22), myocardial infarction (OR = 1.19; 95% CI, 1.09,1.31), atrial fibrillation (OR = 1.14; 95% CI, 1.06,1.22), and stroke (OR = 1.13; 95% CI, 1.05,1.22). However, there was no causal association between depression and heart failure. Four out of 28 cardiometabolic risk factors, including hyperlipidemia, hypertension, diabetes, and prescription opioid use, were identified as mediators of the association between depression and various CVDs. Observational association analyses from NHANES data yielded consistent results.

CONCLUSION

Our findings demonstrated that depression has a causal detrimental effect on various CVDs. Four causal mediators (hyperlipidemia, hypertension, diabetes, and prescription opioid use) were screened to explain the causal effect. Implementing targeted management strategies for these risk factors may be warranted to mitigate the public health burden of CVD among individuals with depression.