Postmortem evidence of brain inflammatory markers in bipolar disorder: a systematic review

Bipolar disorder (BD) is a chronic affective disorder with extreme mood swings that include mania or hypomania and depression. Though the exact mechanism of BD is unknown, neuroinflammation is one of the numerous investigated etiopathophysiological causes of BD. This article presents a systematic re...

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Bibliographic Details
Published in:Molecular psychiatry 2020-01, Vol.25 (1), p.94-113
Main Authors: Giridharan, Vijayasree V., Sayana, Pavani, Pinjari, Omar F., Ahmad, Naveed, da Rosa, Maria Ines, Quevedo, João, Barichello, Tatiana
Format: Article
Language:English
Subjects:
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Affective disorders
Astrocytes
Behavioral Sciences
Biological Psychology
Bipolar disorder
Brain
Brain research
Central nervous system
Chemokines
Cytokines
Forensic science
Heterogeneity
Inflammation
Medicine
Medicine & Public Health
Microglia
Mood
Neurosciences
Online databases
Parenchyma
Pharmacotherapy
Psychiatry
Review Article
Reviews
Systematic review
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Summary:Bipolar disorder (BD) is a chronic affective disorder with extreme mood swings that include mania or hypomania and depression. Though the exact mechanism of BD is unknown, neuroinflammation is one of the numerous investigated etiopathophysiological causes of BD. This article presents a systematic review of the data regarding brain inflammation evaluating microglia, astrocytes, cytokines, chemokines, adhesion molecules, and other inflammatory markers in postmortem BD brain samples. This systematic review was performed according to PRISMA recommendations, and relevant studies were identified by searching the PubMed/MEDLINE, PsycINFO, EMBASE, LILACS, IBECS, and Web of Science databases for peer-reviewed journal articles published by March 2019. Quality of included studies appraised using the QUADAS-2 tool. Among the 1814 articles included in the primary screening, 51 articles measured inflammatory markers in postmortem BD brain samples. A number of studies have shown evidence of inflammation in BD postmortem brain samples. However, an absolute statement cannot be concluded whether neuroinflammation is present in BD due to the large number of studies did not evaluate the presence of infiltrating peripheral immune cells in the central nervous system (CNS) parenchyma, cytokines levels, and microglia activation in the same postmortem brain sample. For example, out of 15 studies that evaluated microglia cells markers, 8 studies found no effect of BD on these cells. Similarly, 17 out of 51 studies evaluating astrocytes markers, 9 studies did not find any effect of BD on astrocyte cells, whereas 8 studies found a decrease and 2 studies presented both increase and decrease in different brain regions. In addition, multiple factors account for the variability across the studies, including postmortem interval, brain area studied, age at diagnosis, undergoing treatment, and others. Future analyses should rectify these potential sources of heterogeneity and reach a consensus regarding the inflammatory markers in postmortem BD brain samples.
ISSN:1359-4184
1476-5578
DOI:10.1038/s41380-019-0448-7