Abstract

Transcriptional differences in interleukin-11 (IL11) after antidepressant treatment have been found to correspond to clinical response in major depressive disorder (MDD) patients. Expression differences were partly mediated by a single-nucleotide polymorphism (rs1126757), identified as a predictor of antidepressant response as part of a genome-wide association study. Here we attempt to identify whether DNA methylation, another baseline factor known to affect transcription factor binding, might also predict antidepressant response, using samples collected from the Genome-based Therapeutic Drugs for Depression project (GENDEP). DNA samples from 113 MDD individuals from the GENDEP project, who were treated with either escitalopram (n=80) or nortriptyline (n=33) for 12 weeks, were randomly selected. Percentage change in Montgomery–Åsberg Depression Rating Scale scores between baseline and week 12 were utilized as our measure of antidepressant response. The Sequenom EpiTYPER platform was used to assess DNA methylation across the only CpG island located in the IL11 gene. Regression analyses were then used to explore the relationship between CpG unit methylation and antidepressant response. We identified a CpG unit predictor of general antidepressant response, a drug by CpG unit interaction predictor of response, and a CpG unit by rs1126757 interaction predictor of antidepressant response. The current study is the first to investigate the potential utility of pharmaco-epigenetic biomarkers for the prediction of antidepressant response. Our results suggest that DNA methylation in IL11 might be useful in identifying those patients likely to respond to antidepressants, and if so, the best drug suited to each individual.

Highlights

  • Major depressive disorder (MDD) is predicted to be the second leading cause of disability by 2020.1 Antidepressants are currently the first line of treatment for MDD, but around two-thirds of patients fail to respond to the first antidepressant prescribed, and a third fail to respond to multiple antidepressant treatments.2 Studies have attempted to establish biomarkers to predict response to antidepressant medication and to personalize treatment

  • Genetic biomarkers have been investigated as predictors of clinical outcome; results from large-scale pharmacogenetic studies have mostly been unsuccessful in identifying genes that are robustly associated with clinical antidepressant response

  • Differential DNA methylation by drug predictors of antidepressant response Univariate linear regressions were performed to assess whether DNA methylation at any of the CpG units in IL11 acted as a predictor of differential response

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Summary

Introduction

Major depressive disorder (MDD) is predicted to be the second leading cause of disability by 2020.1 Antidepressants are currently the first line of treatment for MDD, but around two-thirds of patients fail to respond to the first antidepressant prescribed, and a third fail to respond to multiple antidepressant treatments. Studies have attempted to establish biomarkers to predict response to antidepressant medication and to personalize treatment. Major depressive disorder (MDD) is predicted to be the second leading cause of disability by 2020.1 Antidepressants are currently the first line of treatment for MDD, but around two-thirds of patients fail to respond to the first antidepressant prescribed, and a third fail to respond to multiple antidepressant treatments.. Studies have attempted to establish biomarkers to predict response to antidepressant medication and to personalize treatment. Genetic biomarkers have been investigated as predictors of clinical outcome; results from large-scale pharmacogenetic studies have mostly been unsuccessful in identifying genes that are robustly associated with clinical antidepressant response.. Recent evidence draws further support to results from one genome-wide association study performed in the Genomebased Therapeutic Drugs for Depression project (GENDEP), which identified a single-nucleotide polymorphism (SNP) (rs1126757) in interleukin-11 (IL11) that predicted response to the selective serotonin reuptake inhibitor escitalopram.. Recent evidence draws further support to results from one genome-wide association study performed in the Genomebased Therapeutic Drugs for Depression project (GENDEP), which identified a single-nucleotide polymorphism (SNP) (rs1126757) in interleukin-11 (IL11) that predicted response to the selective serotonin reuptake inhibitor escitalopram. Further investigation of IL11 at the transcriptional level found it to be expressed at a lower level in responders compared with that in nonresponders after treatment with escitalopram, but not before the initiation of escitalopram treatment. Gene expression differences after treatment were partially mediated by rs1126757, implicating rs1126757 as a treatment-emergent expression quantitative trait locus.

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