Melatonin and Response to Lithium

Study Overview
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Brief Summary
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Bipolar disorders are mental illnesses characterized by the recurrence of mood-episodes, that can have a severe impact on the life of individuals. The effect of lithium, one of the main medications used to treat acute episodes or prevent them from happening, is very different from one individual to an-other. So far, there is no way to predict in advance for whom patient this treatment will be effective or for whom it will not. Finding markers that can predict as early as possible the efficiency of this treatment is a major field of current research in psychiatry, in order to avoid maintaining an inefficient treatment for several years that can have negative side-effects. Over the past decades, it has been shown by multiple studies that lithium can act on the biological clock, that regulates circadian rhythmicity of the body (i.e. rhythms that presents a 24 hours periods, such as rhythms of sleep and activity, feeding, social activities...). But it is still very unclear whether the effect of lithium in regulating the mood in bipolar disorders is mediated by this action. Melatonin is one of the key-regulator of circadian rhythmicity of the human body. Our hypothesis, based on some previous studies, is that the action of lithium in type-1 bipolar disorder (BD-I) is related to an action on melatonin secretion. To test that, we want in this study to compare the noctunal secretion of melatonin between BD-I individuals with a good response to lithium versus with a poor response to lithium.

Detailed Description
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The study is a monocentric case-control study comparing the level of urinary nocturnal secretion of 6-sulfatoxy-melatonin between good-responders (GR) and non-responders (NR) to lithium in euthymic BD-1 individuals. The study will also compare the levels of 14-3-3 proteins and miR-451 between these two groups. They are regulators of melatonin-synthesis, that on one hand have been previously associated in autism spectrum disorders to melatonin level modifications and on the other hand have been shown in one preclinical study in rat to be regulated by a lithium treatment. Euthymic BD-1 patients treated by lithium will be pre-selected and lithium response will be assessed by clinicians using the validated ALDA-scale. V1 = inclusion (D0) : assessment of inclusion and exclusion criteria written consent collection of socio-demographic data, clinical data questionaries : MADRS (Montgomery-Absberg Depressive scale for depressive symptoms), YMRS (Young Mania Rating Scale for manic symptoms), Berlin score (risk of undiagnosed obstructive sleep apnea) ALDA scale for assessment of lithium response information and furniture for one-night urine collection and one-week sleep diary planning of V2, the day after diurnal urine collection V2 (D8 to D30): collection of the urine collection and the sleep diary blood sample for measure of plasmatic level of lithium, 14.3.3 proteins and miR-451 Self-questionaries : PSQI (Pittsburg Sleep Quality Index for sleep assesment), CSM (Composite Scale of Morningness for assessment of morning vs evening chronotype), CTI (Circadian Type Inventory for assessment of chronotype)

Official Title
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A Case-control Study Comparing Melatonin Nocturnal Secretion Between Lithium Responders Versus Non Responders in Type 1 Bipolar Disorder.

Conditions
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Bipolar Disorder I

Intervention / Treatment
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* Diagnostic Test: urine collection
* Diagnostic Test: Level of Protein 14.3.3
* Diagnostic Test: Level of miR-451


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BD-1 as defined by DSM-5 Age : 18 to 60 Current treatment by lithium for more than one year Euthymia defined by : MADRS <8 and YMRS <8 at inclusion ; no hospitalization or change in mood-stabilizing treatment in the previous 3 months Health condition compatible with blood and urinal sampling Being affiliated to french social security Written consent Exclusion Criteria: Treatment by : melatonin, agomelatin, benzodiazepines or hypnotic in the last 15 days Treatment by a strong CYP1A2 inducer in the last month : ciprofloxacine, dihydralazine, fluvoxamine, norfloxacine Current substance use disorder except for tobacco Chronic renal failure with glomerular filtration rate <60mL/min Jetlag in the last 15 days or life-event impacting circadian rhythmicity (birth, grief, night-work...) Sleep disorders such as Obstructive Sleep-Apnea, restless leg syndrome, narcolepsy Pregnancy, breastfeeding Guardianship Inability to understand french, illiteracy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| good-responders (GR) to lithium in euthymic BD-1 individuals<br> | Diagnostic Test: urine collection<br>* Urine collection will be made on a 12 hours period (20h00-8h00), the night before V2 at V2 : 2 mL urinal sample for measure of 6-SMT concentration (ng/mL) and creatinin (mg/mL) Measure of 6-SMT will be made by a validated radio-immunology assay<br>Diagnostic Test: Level of Protein 14.3.3<br>* blood sample at V2 (2x7mL ACD tubes) measured by ELISA<br>Diagnostic Test: Level of miR-451<br>* blood sample at V2 (2.5mL PAX-gene tube) measured by quantitative RT-PCR<br>|
| non-responders (NR) to lithium in euthymic BD-1 individuals<br> | Diagnostic Test: urine collection<br>* Urine collection will be made on a 12 hours period (20h00-8h00), the night before V2 at V2 : 2 mL urinal sample for measure of 6-SMT concentration (ng/mL) and creatinin (mg/mL) Measure of 6-SMT will be made by a validated radio-immunology assay<br>Diagnostic Test: Level of Protein 14.3.3<br>* blood sample at V2 (2x7mL ACD tubes) measured by ELISA<br>Diagnostic Test: Level of miR-451<br>* blood sample at V2 (2.5mL PAX-gene tube) measured by quantitative RT-PCR<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ratio between 6-sulfatoxy-melatonin (6-SMT) concentration and creatinin concentration on a 12-hours nocturnal urine collection | Ratio between 6-sulfatoxy-melatonin (6-SMT) concentration and creatinin concentration on a 12-hours nocturnal urine collection (8pm to 8am) : Urine collection will be made on a 12 hours period (20h00-8h00), the night before D30 at D30 : 2 mL urinal sample for measure of 6-SMT concentration (ng/mL) and creatinin (mg/mL) Measure of 6-SMT will be made by a validated radio-immunology assay | at day 30 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Level of Protein 14.3.3 | Level of Protein 14.3.3 in ng/mL : blood sample at D30 (2x7mL ACD tubes) measured by ELISA | at day 30 | 
| Level of miR-451 | Level of miR-451 blood sample at D30 (2.5mL PAX-gene tube) measured by quantitative RT-PCR | at day 30 | 
| Level of plasmatic lithium | Level of plasmatic lithium (mmol/L) blood sample at D30 (mmol/L) 5mL tube with sodium heparinate | at day 30 | 
| Level of intraerythrocytic lithium | Level of intraerythrocytic lithium (mmol/L) blood sample at D30 (mmol/L) 4mL EDTA tube | at day 30 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lithium