IL-23 and TGF-β1 levels as potential predictive biomarkers in treatment of bipolar I disorder with acute manic episode.

Background Growing evidence suggests that immune dysfunction may be involved in the physiopathology of bipolar disorders, with typical first-line treatment using lithium and quetiapine serving to restore pro-inflammation status. This study aimed to explore the relationship between inflammatory cytokines—especially regulatory factors and the effect of combination treatment—with quetiapine and lithium in manic patients. Methods 41 patients of bipolar I disorder with manic episode were enrolled and received combination treatment with quetiapine and lithium. Blood sampling and assessments were performed at baseline and after 8-week treatment. YMRS was used to evaluate the severity of manic symptoms at the same time of detecting plasma levels. A control group comprised of 36 age and gender matched healthy volunteers were enrolled, and their blood samples were assessed at the time of enrollment. Results TGF-β1 and IL-23 plasma levels in patients were significantly higher than healthy controls at baseline ( P <0.05). When comparing remitted patients with non-remitted patients, initial plasma level TGF-β1 was higher ( P =0.029) while IL-23 was lower ( P =0.035). The plasma levels of TNF-α, TGF-β1, IL-23 and IL-17 significantly decreased after treatment among the patients who achieved response ( P <0.05). Limitations The relatively small sample size in patients and control groups should be considered as a limitation of the study. Conclusions The high initial plasma level of TGF-β1 and low initial plasma level of IL-23 indicated better prognosis during combination treatment with quetiapine and lithium in manic patients. The trend of decreasing plasma levels of TNF-α, TGF-β1, IL-23 and IL-17 indicated therapeutic effect. [ABSTRACT FROM AUTHOR]