Glucose dysregulation in antipsychotic-naive first-episode psychosis: in silico exploration of gene expression signatures

Abstract

Antipsychotic (AP)-naive first-episode psychosis (FEP) patients display early dysglycemia, including insulin resistance and prediabetes. Metabolic dysregulation may therefore be intrinsic to psychosis spectrum disorders (PSDs), independent of the metabolic effects of APs. However, the potential biological pathways that overlap between PSDs and dysglycemic states remain to be identified. Using meta-analytic approaches of transcriptomic datasets, we investigated whether AP-naive FEP patients share overlapping gene expression signatures with non-psychiatrically ill early dysglycemia individuals. We meta-analyzed peripheral transcriptomic datasets of AP-naive FEP patients and non-psychiatrically ill early dysglycemia subjects to identify common gene expression signatures. Common signatures underwent pathway enrichment analysis and were then used to identify potential new pharmacological compounds via Integrative Library of Integrated Network-Based Cellular Signatures (iLINCS). Our search results yielded 5 AP-naive FEP studies and 4 early dysglycemia studies which met inclusion criteria. We discovered that AP-naive FEP and non-psychiatrically ill subjects exhibiting early dysglycemia shared 221 common signatures, which were enriched for pathways related to endoplasmic reticulum stress and abnormal brain energetics. Nine FDA-approved drugs were identified as potential drug treatments, of which the antidiabetic metformin, the first-line treatment for type 2 diabetes, has evidence to attenuate metabolic dysfunction in PSDs. Taken together, our findings support shared gene expression changes and biological pathways associating PSDs with dysglycemic disorders. These data suggest that the pathobiology of PSDs overlaps and potentially contributes to dysglycemia. Finally, we find that metformin may be a potential treatment for early metabolic dysfunction intrinsic to PSDs.

Fig. 1. Study workflow.

AP-naive FEP antipsychotic-naive first-episode psychosis, GEO Gene Expression Omnibus, DEG differentially expressed gene, iLINCS Library of Integrated Network-Based Cellular Signatures.

Fig. 2. PRISMA flowchart.

PRISMA flowchart of antipsychotic-naive first-episode psychosis (AP-naive FEP) and non-psychiatrically ill early dysglycemia studies.

Fig. 3. Pathways that are potentially impacted by drugs.

The pathways associated with dysglycemia in psychosis spectrum disorders (PSDs) and the possible mechanisms by which flunisolide, metformin, clobetasol and tamoxifen may reverse dysglycemia.