Factors neurobiològics associats a la resposta i resistència al tractament en la depressió major

• Autores: Metodi Veselinov Draganov
• Directores de la Tesis: María J. Portella (dir. tes.)
• Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2020
• Idioma: español
• Tribunal Calificador de la Tesis: N. Cardoner (presid.), Maria Serra Blasco (secret.), Clara López Solà (voc.)
• Programa de doctorado: Programa de Doctorado en Neurociencias por la Universidad Autónoma de Barcelona
• Enlaces
  • Tesis en acceso abierto en: TDX
• Resumen

  • Depression is a heterogeneous disease affecting a substantial part of the world population at a given point in their life. In the mild cases people might feel sad and loose passion for several days for the things they enjoy doing in everyday life, while in the severe cases the person might need a combination of antidepressants and psychotherapy for several years. In the latter cases, starting the treatment late due to various factors such as unclear diagnose can hinder the future chances of success. At the moment the diagnosis is based on a clinical examination of the exhibited symptoms. The major problem comes from the aforementioned fact that while depression has highly heterogeneous subtypes, clinicians still lack the precise knowledge of the neurobiological factors associated with them, especially evident in Treatment Resistant Depression. In these cases, the standard trial and error treatment with antidepressants can have detrimental results for the patient’ mental health, as well as for the society measured in economic losses due to absence at work and cost of longer treatment. Therefore, neurobiological factors associated with treatment response and resistance are highly desirable in order to provide clues for more precisely targeted treatment and increase the response rate. This thesis is focused on building on and expanding the existing knowledge by providing evidence for novel genetic, epigenetic and neuroimaging markers for treatment resistance, especially those related to inflammation.

    The first study explored 153 depressed patients that were scored on their level of resistance and based on this they were divided into resistant and non-resistant group. The two samples were compared in several genetic (allele, genotype, haplotype) and epigenetic (methylation status) analyses. The results suggested that variants in the IL-1β, IL-6 and IL-6R genes might be associated with resistance.

    The second study investigated potential neurochemical glutamatergic alterations associated with worse response measured by MRI Spectroscopy. 50 patients provided samples for genotyping and underwent a standardized protocol to acquire metabolic levels at the vmPFC area. Results showed that one of the examined genetic mutation located in the promoter area of the IL-1β gene might be associated with increased glutamatergic levels and increased resistance.

    In conclusion, the results from both studies suggest that Treatment Resistant Depression might represent a separate subtype characterized by specific neurobiological factors. The IL-1β gene, together with the IL-6/IL-6R genes complex seem to play a specific role in the response to antidepressants, hence providing an exciting opportunity for further investigation and tentative targets for developing novel personalized treatments in the near future.