Abstract

The pathophysiology of bipolar disorder, especially the underlying mechanisms of the bipolarity between manic and depressive states, has yet to be clarified. Microglia, immune cells in the brain, play important roles in the process of brain inflammation, and recent positron emission tomography studies have indicated microglial overactivation in the brain of patients with bipolar disorder. We have recently developed a technique to induced microglia-like (iMG) cells from peripheral blood (monocytes). We introduce a novel translational approach focusing on bipolar disorder using this iMG technique. We hypothesize that immunological conditional changes in microglia may contribute to the shift between manic and depressive states, and thus we herein analyzed gene profiling patterns of iMG cells from three patients with rapid cycling bipolar disorder during both manic and depressive states, respectively. We revealed that the gene profiling patterns are different between manic and depressive states. The profiling pattern of case 1 showed that M1 microglia is dominant in the manic state compared to the depressive state. However, the patterns of cases 2 and 3 were not consistent with the pattern of case 1. CD206, a mannose receptor known as a typical M2 marker, was significantly downregulated in the manic state among all three patients. This is the first report to indicate the importance of shifting microglial M1/M2 characteristics, especially the CD206 gene expression pattern between depressive and manic states. Further translational studies are needed to dig up the microglial roles in the underlying biological mechanisms of bipolar disorder.

Highlights

  • We have recently developed a technique to induced microglia-like cells from peripheral blood

  • We have recently developed a technique to induced microglia-like cells from peripheral blood [13] and are confirming the utilities of this technique for psychiatric research [14, 15]

  • We have shown that downregulation of the CD206 gene of induced microglia-like (iMG) cells in the manic state was consistent across all three patients with bipolar disorder

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Summary

LIMITATION AND FUTURE PERSPECTIVES

One major limitation of the present study is that all three patients were on medication. Recent PET studies have suggested microglial overactivation in patients with bipolar disorder [7, 8]. Human PET studies should be conducted in patients with bipolar disorder during both manic–depressive states. One of the limitations in the present study is that iMG cells are not actual microglial cells in the brain. Recent immunological studies have suggested that immune cell activities, including microglia, are modulated by the circadian clock system [33], methylation [34], and/or external stress [35], which may contribute to the activation patterns of microglia during clinical courses of bipolar disorder. A previous study has shown that peripheral blood mononuclear cells from patients with rapid cycling bipolar disorder presented a different pattern of gene expression between manic and depressive states [36]. Further studies are required to determine the clinical importance of these pilot findings

CONCLUSION
Findings
ETHICS STATEMENT
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