title: IL-23 and TGF-β1 levels as potential predictive biomarkers in treatment of bipolar I disorder with acute manic episode.
abstract: BACKGROUND
  Growing evidence suggests that immune dysfunction may be involved in the physiopathology of bipolar disorders, with typical first-line treatment using lithium and quetiapine serving to restore pro-inflammation status. This study aimed to explore the relationship between inflammatory cytokines-especially regulatory factors and the effect of combination treatment-with quetiapine and lithium in manic patients.
  
  
  METHODS
  41 patients of bipolar I disorder with manic episode were enrolled and received combination treatment with quetiapine and lithium. Blood sampling and assessments were performed at baseline and after 8-week treatment. YMRS was used to evaluate the severity of manic symptoms at the same time of detecting plasma levels. A control group comprised of 36 age and gender matched healthy volunteers were enrolled, and their blood samples were assessed at the time of enrollment.
  
  
  RESULTS
  TGF-β1 and IL-23 plasma levels in patients were significantly higher than healthy controls at baseline (P<0.05). When comparing remitted patients with non-remitted patients, initial plasma level TGF-β1 was higher (P=0.029) while IL-23 was lower (P=0.035). The plasma levels of TNF-α, TGF-β1, IL-23 and IL-17 significantly decreased after treatment among the patients who achieved response (P<0.05).
  
  
  CONCLUSIONS
  The relatively small sample size in patients and control groups should be considered as a limitation of the study.
  
  
  CONCLUSIONS
  The high initial plasma level of TGF-β1 and low initial plasma level of IL-23 indicated better prognosis during combination treatment with quetiapine and lithium in manic patients. The trend of decreasing plasma levels of TNF-α, TGF-β1, IL-23 and IL-17 indicated therapeutic effect.
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Haozhe
authors.initials: H
authors.lastname: Li
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: drhongwu@126.com.
authors.forename: Wu
authors.initials: W
authors.lastname: Hong
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China.
authors.forename: Zuowei
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Chenmei
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurology, Shanghai Changhai Hospital, Secondary Military Medical University, Shanghai, China.
authors.forename: Zezhi
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Biochemistry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: yirufang@aliyun.com.
authors.forename: Yiru
authors.initials: Y
authors.lastname: Fang
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001714:Bipolar Disorder / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D016022:Case-Control Studies; D003987:Dibenzothiazepines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D020381:Interleukin-17 / Q000097:blood*; D053759:Interleukin-23 / Q000097:blood*; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D000069348:Quetiapine Fumarate; D012720:Severity of Illness Index; D053773:Transforming Growth Factor beta1 / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D014150:Antipsychotic Agents; D015415:Biomarkers; D003987:Dibenzothiazepines; D020381:Interleukin-17; D053759:Interleukin-23; D018020:Lithium Compounds; D053773:Transforming Growth Factor beta1; D014409:Tumor Necrosis Factor-alpha; D000069348:Quetiapine Fumarate
keywords: Bipolar disorder; Interleukin; Mania; Transforming growth factor beta; Tumor necrosis factor alpha