Clinical Validation Study for EDIT-B Test: an Aid for Differential Diagnosis of Bipolar Disorder, Based on RNA Editing Blood Biomarkers

Study Overview
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Brief Summary
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Differentiation between major depressive disorder (MDD) and bipolar disorder (BD) as soon as possible in the patient journey represents a major clinical issue. When the patient is in a depressive phase, the symptoms are similar between the two pathologies and the current clinical scales fail in distinguishing them. Physicians often report this difficulty and as a consequence, the mean time from onset to bipolar disorder diagnosis is currently 7.5 years. These diagnostic delays and misdiagnosis lead to damaging consequences for patients and their loved ones: worsening of symptoms, comorbidities, suicide risk and inadequate care resulting in severe impairment in social and occupational functioning. Faced with these high expectations for accurate diagnostic methods for an earlier management of psychiatric patients, the combination of relevant clinical features and biomarkers could stand for a solution, leading to a personalised approach in patients with mood disorders. In a first clinical discovery study, a panel of RNA biomarkers in the blood of patients with a major depressive episode (MDE) has been identified, allowing to differentiate bipolar disorder from MDD (unipolar depression). These biomarkers are based on RNA modifications, namely RNA editing, that could be identified using molecular biology, NGS and artificial intelligence. This panel constitutes EDIT-B test, which is based on Alcediag's proprietary and patented biomarkers and algorithms. The present study aims to validate the biomarker signatures proposed by Alcediag by measuring the association between the modifications of the RNA editing and major depressive disorder/ bipolar disorder diagnosis, in patients with a MDE in real-life setting pilot centres.

Official Title
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Clinical Validation Study for EDIT-B Test: an Aid for Differential Diagnosis of Bipolar Disorder, Based on RNA Editing Blood Biomarkers

Conditions
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Bipolar Disorder, Major Depressive Disorder

Intervention / Treatment
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* Device: EDIT-B


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed informed consent. Male or female ≥ 18 and ≤ 80 years of age at inclusion. MADRS ≥ 20 In- and out-patients can be recruited. Diagnosed with MDE with the MINI for DSM-5 Currently treated for the MDE Diagnosed with MDD or BD with the MINI for DSM-5. For patients with BD: at least one manic or hypomanic episode For patients with MDD: at least one MDE Exclusion Criteria: MDD patients with first degree family history of bipolar disorder YMRS > 12 Pregnant women Unipolar or bipolar depression secondary to major central nervous system affections, including infections in the brain, tumours of the brain, stroke, Alzheimer's disease, Parkinson's disease, Multiple sclerosis, other major brain affections Schizo-affective patients Abbrevations: BD Bipolar Disorder DSM-5 Diagnostic and Statistical Manual of Mental disorders 5 MADRS Montgomery-Asberg Depression Rating Scale MDD Major Depressive Disorder MDE Major Depressive Episode MINI Mini-International Neuropsychiatric Interview YMRS Young Mania Rating Scale

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Bipolar disorder<br>Patients with depression suffering from bipolar disorder. | Device: EDIT-B<br>* To perform EDIT-B test, questionnaires and 2x0.5 mL whole blood are collected from each patient.<br>|
| Major depressive disorder<br>Patients with depression suffering from major depressive disorder. | Device: EDIT-B<br>* To perform EDIT-B test, questionnaires and 2x0.5 mL whole blood are collected from each patient.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnostic performances of EDIT-B signatures on MDD vs. BD differentiation in patients with depression. | The objective of this study is to estimate three EDIT-B signatures in term of their external validity. For this purpose, performances of the tests will be estimated by calculating for each signature its Sensitivity (i.e. the probability that a test will indicate 'bipolar disorders' among those with this disease), Specificity (i.e. the fraction of those without bipolar disorders who will have a negative test result) and its Accuracy to predict the diagnosis of bipolar disorders. In addition, Area under the ROC curves of each EDIT-B signature will be calculated. The categorisation of the type of disorder (MDD vs. BD) by experts will be based on the MINI considered as the gold standard for diagnosis. The performances of the tested signatures will be compared on a two-by-two basis by comparing sensitivities and specificity , using the methods based on Mac Nemar test proposed by Hawass. AUC-ROC of the 3 signatures will also be compared by DeLong method. | Specimen collection needed for evaluation of diagnostic performances: 1 day (= 1 visit). |