Bipolar Disorder: Biological Pathways Becoming Clearer

John I. Nurnberger, Jr., M.D., Ph.D. Professor of Psychiatry Joyce and Iver Small Professor of Interview with:
John I. Nurnberger, Jr., M.D., Ph.D.
Professor of Psychiatry
Joyce and Iver Small Professor of Psychiatry
Indiana University School of Medicine What are the main findings of this study?

Dr. Nurnberger: The main findings of the study are the biological pathways identified to be associated with bipolar disorder, including those involved in hormonal regulation, calcium channels, second messenger systems, and glutamate signaling. Gene expression studies implicated neuronal development pathways as well.

These findings highlight the role of certain neurobiological processes that have been considered in prior hypotheses of bipolar disorder. They underline a role for calcium signaling, which has only been clearly implicated in the genetics of bipolar disorder in recent years. They also feature hormonal processes such as the hypothalamic-pituitary-adrenal axis, which has been known to be involved in stress responses, but has not been prominent in many recent theories of the pathogenesis of bipolar disorder. What should clinicians and patients take away from this report?

Dr. Nurnberger: Clinicians and patients should take away the message that the genetic results that have been accumulating over the last few years are interpretable and explainable in terms of biological pathways that we understand. There may also be implications for new strategies for treatment and prevention of episodes of illness. What further research do you recommend as a result of these findings?

Dr. Nurnberger: Research on calcium channel abnormalities and on the hypothalamic-pituitary-adrenal axis in bipolar disorder may identify persistent abnormalities as biomarkers. Targeting these systems (and other systems noted) for drug development may also be advantageous. Additional genetic studies should identify more precise targets as well as biological subgroups of patients.


Identification of Pathways for Bipolar Disorder: A Meta-analysis
Nurnberger JI, Jr, Koller DL, Jung J, et al. Identification of Pathways for Bipolar Disorder: A Meta-analysis. JAMA Psychiatry. 2014;():. doi:10.1001/jamapsychiatry.2014.176.


Last Updated on April 19, 2014 by Marie Benz MD FAAD