Genome-wide association study identifies SESTD1 as a novel risk gene for lithium-responsive bipolar disorder.

This corrects the article DOI: 10.1038/mp.2015.165.

Genome-wide association study identifies SESTD1 as a novel risk gene for lithium-responsive bipolar disorder.

Lithium is the mainstay prophylactic treatment for bipolar disorder (BD), but treatment response varies considerably across individuals. Patients who respond well to lithium treatment might represent a relatively homogeneous subtype of this genetically and phenotypically diverse disorder. Here, we performed genome-wide association studies (GWAS) to identify (i) specific genetic variations influencing lithium response and (ii) genetic variants associated with risk for lithium-responsive BD. Patients with BD and controls were recruited from Sweden and the United Kingdom. GWAS were performed on 2698 patients with subjectively defined (self-reported) lithium response and 1176 patients with objectively defined (clinically documented) lithium response. We next conducted GWAS comparing lithium responders with healthy controls (1639 subjective responders and 8899 controls; 323 objective responders and 6684 controls). Meta-analyses of Swedish and UK results revealed no significant associations with lithium response within the bipolar subjects. However, when comparing lithium-responsive patients with controls, two imputed markers attained genome-wide significant associations, among which one was validated in confirmatory genotyping (rs116323614, P=2.74 × 10(-8)). It is an intronic single-nucleotide polymorphism (SNP) on chromosome 2q31.2 in the gene SEC14 and spectrin domains 1 (SESTD1), which encodes a protein involved in regulation of phospholipids. Phospholipids have been strongly implicated as lithium treatment targets. Furthermore, we estimated the proportion of variance for lithium-responsive BD explained by common variants ('SNP heritability') as 0.25 and 0.29 using two definitions of lithium response. Our results revealed a genetic variant in SESTD1 associated with risk for lithium-responsive BD, suggesting that the understanding of BD etiology could be furthered by focusing on this subtype of BD.

Prevention and reversal of cholera enterotoxin-induced intestinal secretion by methylprednisolone induction of Na+-K+-ATPase.

The relationship of the mucosal enzyme systems Na+-K+-activated adenosine triphophatase (Na-K-ATPase) and adenylate cyclase and their associated intestinal transport processes was studied in the rat ileum. Two ileal loops were constructed in each anesthetized rat; one loop was inoculated with saline, the other loop with choleragen. Net transport of water and electrolytes was measured in vivo after which enzyme activity was measured in the mucosa of the perfused loops. All doses of choleragen between 5 and 150 mug decreased water movement as early as 3 1/2 h after inoculation. A linear relationship between the dose of choleragen and the level of net water and electrolyte secretion was observed when choleragen doses between 5 and 150 mug were incubated in ileal loops for 4 h. Adenylate cyclase activity was always increased in secreting intestinal loops, whereas Na-K-ATPase was unaffected by choleragen. In animals pretreated with methylprednisolone acetate, 3 mg/100 g per day for 3 days before loop inoculation, saline loops had enhanced mucosal Na-K-ATPase activity had increased net water and electrolyte absorption; choleragen-exposed loops had increased adenylate cyclase and Na-K-ATPase activities, and net absorption of water and electrolytes 4 h after inoculation. These effects of methylprednisolone acetate were still present 19 1/2 h after inoculation. When a single injection of methylprednisolone acetate was given 3 1/2 h after choleragen inoculation, both adenylate cyclase and Na-K-ATPase were activated, and net intestinal absorption of water and electrolytes was observed 19 1/2 h after inoculation. These results suggest that methylprednisolone can prevent and reverse the secretory effects of choleragen by selectively stimulating a coexisting absorptive process.

Effects of acid-base variables on ion transport in rat colon.

Alterations in arterial acid-base variables have important effects on colonic electrolyte transport in vivo. To confirm the relative effects of these variables and to characterize the transport processes involved, we measured unidirectional 22Na and 36Cl fluxes across short-circuited, distal colonic mucosa of Sprague-Dawley rats. Stripped tissues were studied in Hepes buffer and in Ringer's solutions at HCO3 concentrations of 11, 21, and 39 mM, and CO2 tensions between 0 and 69.6 mmHg. Increases in PCO2, but not in either pH or HCO3 concentration, caused similar increases in JNanet and JClnet (net flux of sodium and chloride, respectively) from -0.2 +/- 0.3 and -1.5 +/- 0.4 mu eq/cm2 per h at PCO2 = 0 to 6.8 +/- 0.6 and 7.6 +/- 0.7 mu eq/cm2 per h, respectively, at PCO2 = 69.6 mmHg. These increases were accounted for by changes in Jms and were accompanied by small decreases in Isc. 1 mM acetazolamide decreased both JNanet and JClnet and their responses to increases in CO2. 0.75 mM luminal amiloride prevented the increase in sodium absorption, but did not affect the CO2-induced increase in chloride absorption. In the presence of amiloride, CO2 increased JR (residual flux). 0.1 mM luminal furosemide did not affect the CO2-induced increases in JNanet in the absence or presence of amiloride. Changes in HCO3 concentration did not alter JR. We conclude that ambient CO2 effects active, electroneutral sodium absorption in the rat distal colon. The process stimulated by CO2 is dependent on mucosal carbonic anhydrase activity and most likely represents Na/H and Cl/HCO3 ion exchange.

Potassium transport by the isolated perfused kidney.

Rat kidneys perfused outside of the body with an artificial medium are able to increase their fractional excretion of potassium in response to a rising concentration of potassium in the medium but never show net secretion of potassium. By contrast, isolated perfused kidneys from chronically potassium-loaded rats regularly secrete potassium in excess of the amount filtered. Ouabain completely blocks the secretion of potassium by these isolated kidneys, suggesting that Na-K-ATPase mediates potassium secretion by potassium-adapted rats. Neither sodium deprivation, pretreatment with deoxycorticosterone, nor pretreatment with methylprednisolone prepared the kidney to secrete potassium, despite stimulation of Na-K-ATPase activity in cortex or outer medulla. Potassium loading was the only maneuver tested that increased the activity of Na-Katpase in the inner medulla (white papilla) and also produced potassium secretion by the isolated kidney. Surgical ablation of the papilla abolished the net secretion of potassium normally seen in perfused kidneys of potassium-adapted rats, thus underlining the importance of the papilla in the process of potassium adaptation.

Na+-K+-activated adenosine triphosphatase and intestinal electrolyte transport. Effect of adrenal steroids.

Sodium-potassium-activated adenosine triphosphatase (Na-K-ATPase) is associated with electrolyte transport in many tissues. To help delineate its role in intestinal transport, changes in rat intestinal electrolyte and water transport induced by injecting methylprednisolone acetate 3 mg/100 g or deoxycorticosterone acetate (DOCA) 0.5 mg/100 g per day for 3 days were correlated with changes in Na-K-ATPase activity. Methylprednisolone increased sodium and water absorption, potassium secretion, transmural potential difference, and Na-K-ATPase activity in the jejunum, ileum, and colon. Examination of isolated epithelial cells demonstrated that the jejunal and ileal increase in Na-K-ATPase occurred in both the villus tip and crypermeability, Mg-ATPase, and adenylate cyclase activities were unchanged by methylprednisolone. DOCA increased sodium and water absorption, potassium secretion, transmural potential difference, and Na-K-ATPase activity in the colon alone. Colonic Mg-ATPase and adenylate cyclase activities were unaffected. Jejunal and ileal enzyme activity, electrolyte transport, and permeability were unchanged by DOCA. Methylprednisolone and DOCA were not additive in their effect on colonic Na-K-ATPase activity. Methylprednisolone and DOCA increased electrolyte and water transport and Na-K-ATPase activity concomitantly in specific segments of small intestine and colon. These data are consistent with an important role for Na-K-ATPase in intestinal electrolyte and water transport.

Evidence for genetic heterogeneity between clinical subtypes of bipolar disorder.

We performed a genome-wide association study of 6447 bipolar disorder (BD) cases and 12 639 controls from the International Cohort Collection for Bipolar Disorder (ICCBD). Meta-analysis was performed with prior results from the Psychiatric Genomics Consortium Bipolar Disorder Working Group for a combined sample of 13 902 cases and 19 279 controls. We identified eight genome-wide significant, associated regions, including a novel associated region on chromosome 10 (rs10884920; P=3.28 × 10-8) that includes the brain-enriched cytoskeleton protein adducin 3 (ADD3), a non-coding RNA, and a neuropeptide-specific aminopeptidase P (XPNPEP1). Our large sample size allowed us to test the heritability and genetic correlation of BD subtypes and investigate their genetic overlap with schizophrenia and major depressive disorder. We found a significant difference in heritability of the two most common forms of BD (BD I SNP-h2=0.35; BD II SNP-h2=0.25; P=0.02). The genetic correlation between BD I and BD II was 0.78, whereas the genetic correlation was 0.97 when BD cohorts containing both types were compared. In addition, we demonstrated a significantly greater load of polygenic risk alleles for schizophrenia and BD in patients with BD I compared with patients with BD II, and a greater load of schizophrenia risk alleles in patients with the bipolar type of schizoaffective disorder compared with patients with either BD I or BD II. These results point to a partial difference in the genetic architecture of BD subtypes as currently defined.

Metabolic adjustments of the kidney involved in the adaptation to potassium loading.

Potassium adaptation involves the development of the ability of the kidneys to secrete large amounts of potassium into the urine. This is accompanied by an adaptive increase in the specific activity of sodium-potassium-ATPase in the kidney, predominantly in the medulla and the papilla, but also involving the cortex. It is likely that these changes are localized to the distal tubule and are especially marked in the collecting ducts although there is no direct evidence bearing on this. Net secretion of potassium in isolated kidneys taken from chronically potassium loaded animals is completely eliminated when ouabain, a specific inhibitor of sodium-potassium-ATPase, is added to the perfusion medium. The secretion of potassium appears also to depend critically on the availability of glucose as substrate.

Potassium and renal failure.

Hyperkalemia caused by decreased renal K+ secretion may be seen in patients with mild, moderate, or severe ARF or CRF. Decreased K+ secretion by the distal tubule may be due primarily to a decrease in tubular fluid flow rate, as in ARF, or it may be due to diminished circulating aldosterone concentrations, as in patients with hyporeninemic hypoaldosteronism. Patients with CRF adapt to K+ loads by increasing K+ excretion per nephron as well as by transferring K+ more rapidly into cells. However, an increased K+ load may still produce hyperkalemia in the CRF patient because of limitations in the adaptive responses. Hyperkalemia may present a true medical emergency in the patient with renal failure. Although the serum K+concentration can usually be controlled by the administration of calcium, glucose and insulin, sodium bicarbonate, diuretics, and/or the use of K+ exchange resins, dialysis may be necessary. Hyperkalemia complicating acute or chronic renal failure is an important, common problem requiring the use of peritoneal dialysis or hemodialysis.

Aliskiren for geriatric lowering of systolic hypertension: a randomized controlled trial.

Efficacy and safety of the direct renin inhibitor aliskiren was compared with ramipril for treatment of essential systolic hypertension in elderly patients. A 36-week, randomized, double-blind, parallel-group, active-controlled, optional-titration study was performed in 901 patients (aliskiren, n=457; ramipril, n=444) > or =65 years of age with systolic blood pressure (SBP) > or =140 mm Hg. Aliskiren 150-300 mg per day or ramipril 5-10 mg per day for was administered for 12 weeks with optional add-on therapy of hydrochlorothiazide (12.5-25 mg per day) at week 12 and amlodipine (5-10 mg per day) at week 22. The primary end point was non-inferiority of aliskiren vs ramipril monotherapy for change from baseline in mean sitting SBP (msSBP) at week 12. Decreases from baseline msSBP and mean sitting diastolic BP with aliskiren monotherapy (-14.0 and -5.1 mm Hg, respectively) were non-inferior (P<0.001 for both values) and superior to ramipril monotherapy (-11.6, -3.6 mm Hg; P=0.02, P<0.01, respectively). More patients achieved BP control with aliskiren (42%) than ramipril (33%; P<0.01). At week 36, fewer patients receiving aliskiren-based therapy required add-on treatment with hydrochlorothiazide or amlodipine (P=0.01 and 0.048, respectively). Tolerability was similar, but more patients receiving ramipril reported cough (P<0.001). In elderly patients with systolic hypertension, aliskiren proved to be more effective and better overall anti-hypertensive therapy compared to ramipril.

Migration and the public sector: a survey.

"A review of the existing literature on human migration reveals relatively few studies that explicitly examine the relationships between public policy decisions and human migration flows. The surveyed literature includes studies of national policies, such as defence spending, migration subsidies and intergovernmental transfers, as well as sub-national policies, such as welfare and unemployment benefits, state and local taxes, education and other public services. Suggestions for incorporating public sector information into existing migration analysis frameworks and further areas of research are provided." The geographical focus is on developed countries. (SUMMARY IN FRE AND GER)

Intestinal "bioavailability" of solutes and water: we know how but not why.

Only minimal quantities of ingested and normally secreted solutes and water are excreted in the stool. This near 100% bioavailability means that the diet and kidneys are relatively more important determinants of solute, water and acid-base balance than the intestine. Intestinal bioavailability is based on excess transport capacity under normal conditions and the ability to adapt to altered or abnormal conditions. Indeed, the regulatory system of the intestine is as complex, segmented and multi factorial as in the kidney. Alterations in the rate and intestinal site of absorption reflect this regulation, and the diagnosis and treatment of various clinical abnormalities depend on the integrity of intestinal absorptive processes. However, the basis for this regulation an bioavailability are uncertain. Perhaps they had survival value for mammals, a phylogenic class that faced the twin threats of intestinal pathogens and shortages of solutes and water.

NaCl absorption in the rabbit ileum. Effect of acid-base variables.

In vivo and in vitro studies suggest that acid-base variables regulate ion transport in the rabbit ileum. The relative importance of these variables on active Na+ and Cl- absorption has not been defined. Isolated, stripped ileal segments were studied under short-circuited conditions in the Ussing flux chamber. Unidirectional 22Na and 36Cl fluxes were measured after changes in bathing solution pH, PCO2, and/or [HCO3-]. When pH was decreased from 7.6 to 7.1, net flux of Na+ increased from 0.1 +/- 0.7 to 2.6 +/- 0.7 mu Eq/cm2 per hour and net flux of Cl- increased from -2.0 +/- 0.9 to 1.3 +/- 0.6 mu Eq/cm2 per hour. These changes were rapid in onset, completely reversible, and accounted for by changes in mucosal-to-serosal fluxes of these ions. They were accompanied by small decreases in short-circuit current, but there were no changes in residual flux. These pH effects were not inhibited by the presence of luminal bumetanide (1 mmol/L), furosemide (1 mmol/L), hydroflumethiazide (1 mmol/L), or 4,4'-diisothiocyanostilbene-2,2'-disulfonate (1 mmol/L), or by the carbonic anhydrase inhibitor methazolamide (1 mmol/L). When data from all combinations of acid-base conditions were combined and analyzed by linear regression, pH was the only variable that correlated with mucosal-to-serosal fluxes (r = -0.84) and net flux (r = -0.85) for Na+, mucosal-to-serosal fluxes (r = -0.96) and net flux (r = -0.99) for Cl-, and short-circuit current (r = 0.97). These findings suggest that extracellular pH modulates active Na+ and Cl- absorption in the rabbit ileum.

Membrane site of action of CO2 on colonic sodium absorption.

Increases in ambient CO2 tension increase colonic sodium absorption by increasing mucosal to serosal sodium flux. We examined the membrane site of CO2 action by utilizing the polyene antibiotic nystatin to create aqueous pores in the apical membrane. Under these conditions, the basolateral rather than the apical membrane is rate limiting for sodium absorption. Pairs of stripped rat distal colonic segments were mounted in modified Ussing chambers in a Ringer-HCO3 solution gassed with either 3% CO2-97% O2 or 11% CO2-89% O2. Mucosal-to-serosal 22Na and 36Cl fluxes were measured under short-circuited conditions, and ouabain-sensitive absorption was calculated before and after the addition of mucosal nystatin 300 U/ml. Ouabain-sensitive sodium absorption was fivefold greater at 11% CO2 than at 3% CO2 before nystatin addition. Nystatin increased short-circuit current (Isc), transcolonic conductance (Gt) and ouabain-sensitive sodium absorption at 3% CO2 but only increased Isc and Gt at 11% CO2. The levels of sodium absorption at 3% and 11% CO2 after nystatin were equal and identical to the level measured at 11% CO2 in the absence of nystatin. Ouabain-sensitive chloride absorption was similar at 3% and 11% CO2 in the absence of nystatin and was not affected by nystatin addition. These findings suggest that ambient CO2 tension affects colonic sodium absorption by a selective action at the apical membrane.

Effect of CO2 on rat colonic Na absorption: studies with nystatin.

An increase in ambient CO2 tension from 3% to 11% augments colonic Na absorption in the rat. The membrane site of action of CO2 was examined by measuring colonic Na absorption in the Ussing chamber when nystatin was used to permeabilize the luminal (apical) membrane. The equal rates of ouabain-sensitive Na absorption at 3% and 11% CO2 in the presence of nystatin and at 11% CO2 in its absence suggested that CO2 acted at the luminal membrane. This finding was also observed at a submaximal rate of Na absorption (produced by lowering bathing solution Na from 140 to 27 mmol/L) and in a Cl-free solution (to prevent cell swelling). The basolateral membrane was indeed rate limiting for Na absorption in the presence of nystatin, because methylprednisolone (3 mg/kg SC for 3 days to increase sodium-potassium--stimulated adenosine triphosphatase activity) increased Na absorption measured in the presence of nystatin and because CO2 increased absorption in steroid-treated rats in the absence of nystatin. These results validate the protocol and confirm the luminal site of action of CO2 and nystatin on colonic Na absorption.

Acid-base effects on ileal sodium chloride absorption in vitro.

Previous work from this laboratory has shown that in the intact animal, ileal sodium chloride absorption is responsive to alterations in systemic acid-base balance. In vitro studies were undertaken to determine the nature of the active transport process affected. Paired, unstripped ileal tissues from Sprague-Dawley rats were mounted in modified Ussing chambers, and unidirectional 22Na and 36Cl fluxes were measured under short-circuited conditions (Isc). Acid-base effects were examined by changing either bathing solution partial pressure of CO2 (PCO2) or HCO3 concentration or by the addition of HCl or NaOH to a non-HCO3 N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (HEPES) buffer. When pH was decreased from 7.6 to 7.1, net sodium absorption increased twofold regardless of the means by which pH was changed. This increase was primarily accounted for by an increase in mucosal-to-serosal flux. Net chloride absorption was affected in a similar way, but the increase in absorption was primarily accounted for by an increase in mucosal-to-serosal flux only in the HEPES buffer. These changes were accompanied by reductions in Isc and residual flux. When all groups were considered, mucosal-to-serosal Na (JNam----s) and net Na (JNanet) fluxes correlated strongly with bathing solution pH (r = 0.84 and 0.94, respectively, P less than 0.01). These data indicate that an active ileal sodium chloride absorptive process is specifically responsive to changes in bathing solution pH. In addition, pH may affect ileal electrogenic chloride, HCO3, and/or H secretion.

Relative effects of systemic pH, PCO2, and bicarbonate concentration on ileal ion transport.

To determine the relative effects of systemic pH, CO2 tension (PCO2), and bicarbonate concentration on ileal electrolyte transport, states of acute metabolic acidosis and alkalosis were created in Sprague-Dawley rats by gavage feeding (NH4)2SO4 and NaHCO3, respectively. During in situ perfusion of the ileum in anesthetized animals, electrolyte transport was measured before and after respiratory compensation of the systemic pH. Acute respiratory acidosis and alkalosis also were studied by ventilating animals with 0, 3, or 8% CO2. When animals in all groups were considered, net sodium absorption correlated very well with blood pH (r = -0.97). Net bicarbonate secretion correlated with the plasma bicarbonate concentration (r = 0.91) independently of blood pH and PCO2. Net chloride absorption correlated with blood PCO2 (r = 0.92) and was altered when systemic pH and bicarbonate concentration changed in opposite directions. Alterations in luminal pH and PCO2 did not affect electrolyte transport. These results suggest that systemic pH affects a sodium chloride absorptive process and that the plasma bicarbonate concentration affects a chloride absorptive-bicarbonate secretory exchange process in the rat ileum.

Effect of arterial carbon dioxide tension on amiloride-sensitive sodium absorption in the colon.

To examine the nature of the electroneutral sodium chloride absorptive process affected by arterial carbon dioxide tension (PCO2), we measured the effects of amiloride on colonic sodium absorption at concentrations (0.75 mM) known to inhibit cell membrane sodium-hydrogen ion exchange. During sequential in situ perfusions of distal colon with amiloride-free and amiloride-containing solutions, water and electrolyte transport was measured in anesthetized, mechanically ventilated rats during normocapnia, respiratory alkalosis, or respiratory acidosis. During amiloride-free perfusions, alkalosis decreased and acidosis increased net water, sodium, and chloride absorption without changing the transmural potential difference. Perfusion of amiloride (0.75 mM) caused a similar fractional decrease in net sodium absorption in alkalotic (-53.3 +/- 10.2%), normocapnic (-46.3 +/- 6.5%), and acidotic rats (-57.2 +/- 5.2%). Net water (-43%) and chloride absorption also exhibited equivalent fractional reductions in the three acid-base states during amiloride perfusion, although net chloride absorption was reduced only about 20%. These results suggest that the specific colonic sodium absorptive process affected by arterial PCO2 is an amiloride-sensitive, sodium-hydrogen ion exchange process. Arterial PCO2 probably also affects a mucosal chloride-bicarbonate exchange process that results in its overall effect on electroneutral sodium chloride absorption by the distal colon.

Effect of acute metabolic alkalosis and acidosis on intestinal electrolyte transport in vivo.

The effects of acute metabolic alkalosis and acidosis on intestinal electrolyte transport were studied in adult Sprague-Dawley rats. Animals were made alkalotic or acidotic by gavage feeding of 1 M solutions of NaCl (pH = 7.42), NaHCO3 (pH = 7.52), NH4Cl (pH = 7.18), or 0.75 M (NH4)2SO4 (pH = 7.21). After 1-3 h, animals were anesthetized and prepared for in vivo perfusion of the jejunum, ileum, and colon. The jejunum exhibited increased net potassium absorption in alkalosis and decreased potassium absorption in acidosis. In the ileum, net sodium absorption and potassium secretion were decreased, and bicarbonate secretion was increased in alkalosis, and opposite effects were observed in acidosis. The ileal lumen minus blood gradient for PCO2 (an index of hydrogen ion secretion) was greater in acidotic than in alkalotic animals. The levels of ileal sodium, bicarbonate, and potassium transport and the PCO2 gradient correlated well with the plasma pH and bicarbonate concentration in individual animals. In the colon, net bicarbonate secretion and chloride absorption increased and potassium secretion decreased in alkalosis, and opposite effects were observed in acidosis. The colonic lumen minus blood PCO2 gradient was not affected by acid-base balance. Colonic bicarbonate transport correlated with the plasma chloride concentration as well as with the plasma pH. The acid-base disorders had no effect on transmural potential difference. These results suggest that acute metabolic alkalosis and acidosis alter sodium and hydrogen ion transport in the ileum and chloride and bicarbonate transport in the colon.