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Report for Clinical Trial NCT03795688
Developed by Shray Alag, 2020.
SNP Clinical Trial Gene
The Role of Sex Steroids and Serotonin Brain Dynamics in Perinatal Mental Health
Hormonal transitions such as across pregnancy and postpartum may trigger depressive episodes in some women. It is not known why, but estrogen sensitivity may play a critical role. A preclinical human risk model showed that depressive symptoms induced by pharmacological sex-hormone manipulation is linked to increases in serotonin transporter (SERT) brain binding, which lowers serotonergic brain tone. It is currently unknown if these findings translates to women across pre- to postpartum transitions. This longitudinal project studies a group of women who will deliver by planned caesarian, thus permitting the collection of cerebrospinal fluid (csf) containing central markers of serotonergic signaling, at the latest point in pregnancy. The women are followed across late pregnancy, delivery and 6 months postpartum to illuminate relations between sex-hormones, stress-regulation, estradiol sensitivity, csf markers of neurotransmission, serotonin transporter genotype variance, and potential development of subclinical or manifest depressive symptoms. Further, markers of relevance for the infant brain development and stress-regulation will be obtained from placenta tissue and umbilical cord blood. A subgroup of 70 women will participate in a brain imaging program early postpartum (week 3-5), which includes an evaluation of brain activity and structure and in vivo molecular brain imaging serotonergic markers. Thus, serotonergic markers in csf can be combined with postpartum molecular brain imaging of key features of serotonin signaling. Women in the imaging program are selected based on variation in their level of mental distress immediately postpartum (day 2-5). The study's main hypothesis is that women with high-expressing SERT genotypes are more sensitive to peripartum hormonal transition in terms of changes in serotonergic tone and emergence of depressive symptoms and that such an association will be stronger in the presence of candidate gene transcript biomarkers of oestrogen sensitivity. A further hypothesis is that in vivo molecular brain imaging and csf based serotonergic markers will be associated with depressive symptoms both early and later postpartum. Ideally, this project will provide a rationale for future targeted prevention and/or treatment of perinatal depression in women at high risk, which holds grand potential to protect not only mother but also infant brain health long-term.
NCT03795688 Major Depressive Disorder Perinatal Depression MeSH:Depressive Disorder Depressive Disorder, Major
HPO:Depressivity
1 Interventions
Name: Pregnancy
Primary Outcomes
Description: Edinburgh Postnatal Depression Scale. Score range: 0-30. Higher scores indicate more symptoms of postpartum depression. Total group
Measure: Depressive symptoms Time: Week 3-6 postpartumDescription: Score on the Hamilton 17-item depression scale. Score range: 0-52. Higher scores indicate more depressive symptoms. Assessed in imaging group
Measure: Depressive symptoms Time: Week 3-6 postpartumDescription: 116 a priori defined gene transcripts, which where differentially expressed in third trimester of women who later developed perinatal depression with postpartum onset relative to pregnant women who did not and to other depressed (reference Mehta et al, 2014, Psychological Medicine) and confirmed to be coupled to estrogen fluctuations (Mehtaet al. 2018 British Journal of Psychiatry) will be evaluated in the total group. Also DNA methylation of the genes of these transcripts will be determined and analysed in terms of their predictive value (above chance) for perinatal depression.
Measure: Gene transcript and DNA methylation markers of estrogen sensitivity Time: Prior to caesarean sectionDescription: Latent variable construct of brain 5-HT4R level based on quantification of 5-HT4R binding from 11C-SB207145 positron emission tomography in primary volumes of interest; neocortex, nucleus caudatus, putamen and hippocampus. Assessed in imaging group.
Measure: Cerebral serotonin 4 receptor binding postpartum Time: Week 3-6 postpartumDescription: Assessed in total group
Measure: CSF levels of GABA Time: On day of caesarean sectionDescription: Assessed in total group
Measure: CSF levels of serotonin metabolite (5-HIAA) Time: On day of caesarean sectionDescription: Cortisol awakening response, area under the curve with respect to baseline from 0 to 60 minutes from awakening.
Measure: Cortisol awakening response Time: Week 3-6 postpartumDescription: Provides an estimate of cortisol exposure up to 6 months prior to delivery, total group
Measure: Hair cortisol level mothers Time: On day of caesarean section.Description: Provides an estimate of fetal cortisol exposure, infants from total group
Measure: Hair cortisol level newborns Time: Day 0-5 postpartum.Description: Hippocampal brain volume (including hippocampus) from structural MRI, imaging group.
Measure: Hippocampal volumes Time: Week 3-6 postpartum.Description: fMRI (BOLD response) based assessment of brain activity in response to reward, relative to non-reward, stimuli. Assessed in imaging cohort
Measure: functional MRI response to reward Time: Week 3-6 postpartum.Description: rsfMRI based spontaneous co-fluctuations in low frequency BOLD signal, (functional connectivity). Assessed with rsfMRI scan in the resting state, i.e. non-goal oriented spontaneous thought and awake. Assessed in imaging group.
Measure: Resting state functional connectivity MRI Time: Week 3-6 postpartumDescription: Change in epigenetic SERT status from late pregnancy to postpartum week 3-6.
Measure: Change in epigenetic SERT status Time: From just before delivery to 3-6 weeks postpartumDescription: Composite measure of hsCRP, TNF-α, IL-6, IL-18 and IL-10 levels, total group
Measure: Concentration of inflammatory markers, i.e hsCRP and immunoactive cytokines, in peripheral blood Time: At week 3-6Description: fMRI (BOLD response) based assessment of brain activity to emotionally salient, relative to neutral, stimuli. Assessed in imaging cohort.
Measure: functional MRI response to emotional faces Time: Week 3-6 postpartum.Secondary Outcomes
Description: Score on the Hamilton 17-item depression scale. Score range: 0-52. Higher scores indicate more depressive symptoms. Assessed in imaging group
Measure: Depressive symptoms Time: Day 3-5 postpartumDescription: Score on the Hamilton 17-item depression scale. Score range: 0-52. Higher scores indicate more depressive symptoms. Assessed in imaging group
Measure: Depressive symptoms Time: Week 12 postpartumDescription: Edinburgh Postnatal Depression Scale. Score range: 0-30. Higher scores indicate more symptoms of postpartum depression. Assessed in total group
Measure: Depressive symptoms Time: Day 3-5 postpartumDescription: Edinburgh Postnatal Depression Scale. Score range: 0-30. Higher scores indicate more symptoms of postpartum depression. Assessed in all
Measure: Depressive symptoms Time: 6 months postpartumDescription: Assessed in total group
Measure: CSF levels of serotonin Time: On day of caesarean sectionDescription: Assessed in total group
Measure: CSF levels of dopamine metabolites Time: On day of caesarean sectionDescription: Assessed in total group
Measure: CSF levels of noradrenaline metabolites Time: On day of caesarean sectionDescription: Composite measure of IFN-c, IFN-alfa TNF-alfa og IL-6, in total group
Measure: CSF levels of inflammatory markers Time: On day of caesarean sectionDescription: Estradiol level in peripheral blood, total group
Measure: Estradiol level Time: Prior to caesarean section.Description: Estradiol level peripheral blood, total group
Measure: Estradiol level Time: At week 3-6 postpartum.Description: Estradiol change pre- to postpartum, peripheral blood total group
Measure: Change in estradiol level Time: From baseline (caesarean section to week 3-6 postpartum)Description: Progesterone level in peripheral blood
Measure: Progesterone level Time: Prior to caesarean section.Description: Progesterone level in peripheral blood
Measure: Progesterone level Time: At week 3-6 postpartum.Description: Progesterone change pre- to postpartum, peripheral blood total group
Measure: Change in progesterone level Time: From baseline (caesarean section to week 3-6 postpartum)Description: Allopregnanolone level in peripheral blood
Measure: Allopregnanolone level Time: Prior to caesarean section.Description: Allopregnanolone level in peripheral blood
Measure: Allopregnanolone level Time: At week 3-6 postpartum.Description: Change in allopregnanolone level in peripheral blood
Measure: Change in allopregnanolone level Time: From baseline (caesarean section to week 3-6 postpartum)Description: Cortisol change pre- to postpartum, peripheral blood total group
Measure: Change in cortisol level Time: From baseline (caesarean section to week 3-6 postpartum)Description: Cortisol awakening response, area under the curve with respect to baseline from 0 to 60 minutes from awakening.
Measure: Cortisol awakening response Time: Week 12 postpartumDescription: Cortisol awakening response, area under the curve with respect to baseline from 0 to 60 minutes from awakening.
Measure: Cortisol awakening response Time: Prior to caesarean sectionDescription: Change in cortisol awakening response, from caesarean section to 3-6 weeks postpartum.
Measure: Change in cortisol awakening response Time: ´From baseline (caesarean section to week 3-6 postpartum)Description: Methylation status for the SERT gene, total group
Measure: DNA methylation of the SERT gene Time: Prior to caesarean sectionDescription: DNA Methylation status for the SERT gene, total group
Measure: DNA methylation of the SERT gene Time: Week 3-6 postpartumDescription: Methylation status for the FK506-binding protein 51 (FKBP5) gene, total group
Measure: DNA methylation of the FK506-binding protein 51 (FKBP5) gene Time: Prior to caesarean section.Description: Methylation status for the FK506-binding protein 51 (FKBP5) gene, total group
Measure: DNA methylation of the FK506-binding protein 51 (FKBP5) gene Time: Week 3-6 postpartumDescription: Change in methylation status for the FK506-binding protein 51 (FKBP5) gene from late pregnancy to postpartum week 3-6.
Measure: Change in DNA methylation of the FK506-binding protein 51 (FKBP5) gene Time: From baseline (caesarean section to week 3-6 postpartum)Description: Methylation status for the glucocorticoid receptor gene, total group
Measure: DNA methylation of the glucocorticoid receptor gene Time: Prior to caesarean section.Description: Methylation status for the glucocorticoid receptor gene, total group
Measure: DNA methylation of the glucocorticoid receptor gene Time: Week 3-6 postpartumDescription: Change in methylation status for the glucocorticoid receptor gene from late pregnancy to postpartum week 3-6.
Measure: Change in DNA methylation of the glucocorticoid receptor gene Time: From baseline (caesarean section to week 3-6 postpartum)Description: Methylation status for the COMT gene, total group
Measure: DNA methylation of the COMT gene Time: Prior to caesarean section.Description: Methylation status for the COMT gene, total group
Measure: DNA methylation of the COMT gene Time: Week 3-6 postpartumDescription: Change in methylation status for the COMT gene from just before delivery to 3-6 weeks postpartum
Measure: Change in DNA methylation of the COMT gene Time: From baseline (caesarean section to week 3-6 postpartum)Description: Methylation status for the MAO-A gene, total group
Measure: DNA methylation of the MAO-A gene Time: Prior to caesarean section.Description: Change in methylation status for the MAO-A gene, total group
Measure: Change in DNA methylation of the MAO-A gene Time: From baseline (caesarean section to week 3-6 postpartum)Description: Methylation status for the MAO-A gene, total group
Measure: DNA methylation of the MAO-A gene Time: Week 3-6 postpartumDescription: Methylation status for the oxytocin receptor gene, total group
Measure: DNA methylation of the oxytocin receptor gene Time: Prior to caesarean section.Description: Methylation status for the oxytocin receptor gene, total group
Measure: DNA methylation of the oxytocin receptor gene Time: Week 3-6 postpartumDescription: Change in methylation status for the oxytocin receptor gene, total group
Measure: Change in DNA methylation of the oxytocin receptor gene Time: From baseline (caesarean section to week 3-6 postpartum)Description: Methylation status for the oxytocin gene, total group
Measure: DNA methylation of the oxytocin gene Time: Prior to caesarean section.Description: Methylation status for the oxytocin gene, total group
Measure: DNA methylation of the oxytocin gene Time: Week 3-6 postpartumDescription: Change methylation status for the oxytocin gene, total group
Measure: Change in DNA methylation of the oxytocin gene Time: From baseline (caesarean section to week 3-6 postpartum)Description: Composite measure of hsCRP, TNF-α, IL-6, IL-18 and IL-10 levels, total group
Measure: Systemic inflammation peripheral blood hsCRP and immunoactive cytokines Time: Prior to caesarean section.Description: Change in composite measure of hsCRP, TNF-α, IL-6, IL-18 and IL-10 levels, total group
Measure: Change in systemic inflammation peripheral blood hsCRP and immunoactive cytokines Time: From baseline (caesarean section to week 3-6 postpartumDescription: Family History Assessment Module (OS-FHAM). Number of first degree relatives with a history of depressive episodes or bipolar disorder. Total group.
Measure: Self reported family history of mood disorders Time: Day 3-5 postpartum or beforeDescription: Barratt Impulsiveness Scale (BIS-11), self-reported. Range: 30-120. Total group.
Measure: Self reported impulsiveness score Time: Day 3-5 postpartum or beforeDescription: NEO-PI-R - Revised NEO Personality Inventory, self-reported. Participants may score 20-80 for each of the personality traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism. The higher the score, the more prominent is the personality trait. Total group.
Measure: Self reported Neuroticism score from NEO personality questionnaire Time: Day 3-5 postpartum or beforeDescription: Parental bonding instrument (PBI), both parents, self-reported. Total group.
Measure: Self reported parental bonding quality Time: Day 3-5 postpartum or beforeDescription: Perceived Stress Scale (PSS), range 0-40, a score of 0 indicates no perceived stress. Total group.
Measure: Self-reported perceived stress Time: Day 3-5 postpartumDescription: Perceived Stress Scale (PSS), range 0-40, a score of 0 indicates no perceived stress. Total group.
Measure: Self-reported perceived stress Time: Week 3-6 postpartumDescription: Change in Perceived Stress Scale (PSS), range 0-40, a score of 0 indicates no perceived stress. Total group.
Measure: Change in self-reported perceived stress Time: Change from day 3-5 to week 3-6 postpartumDescription: Snaith-Hamilton Pleasure Scale (SHAPS), range 0-14, a score of 0 indicates no self-reported anhedonia. Total group.
Measure: Self-reported anhedonia Time: Day 3-5 postpartumDescription: Snaith-Hamilton Pleasure Scale (SHAPS), range 0-14, a score of 0 indicates no self-reported anhedonia. Total group.
Measure: Self-reported anhedonia Time: Week 3-6 postpartumDescription: Change in Snaith-Hamilton Pleasure Scale (SHAPS) score, range 0-14, a score of 0 indicates no self-reported anhedonia. Total group.
Measure: Change in self-reported anhedonia Time: Change from day 3-5 to week 3-6 postpartumDescription: Rumination Response Scale (RRS), range 22-88, a score of 22 indicates no ruminative symptoms. Total group.
Measure: Self-reported rumination Time: Day 3-5 postpartumDescription: Rumination Response Scale (RRS), range 22-88, a score of 22 indicates no ruminative symptoms. Total group.
Measure: Self-reported rumination Time: Week 3-6 postpartumDescription: Change in Rumination Response Scale (RRS) score, range 22-88, a score of 22 indicates no ruminative symptoms. Total group.
Measure: Change in elf-reported rumination Time: Change from day 3-5 to week 3-6 postpartumDescription: Profile of Mood States (POMS), range 0-260, a score of 0 indicates no mood disturbance. Total group.
Measure: Self-reported mood Time: Day 3-5 postpartumDescription: Profile of Mood States (POMS), range 0-260, a score of 0 indicates no mood disturbance. Total group.
Measure: Self-reported mood Time: Week 3-6 postpartumDescription: Change in Profile of Mood States (POMS) score, range 0-260, a score of 0 indicates no mood disturbance. Total group.
Measure: Change in self-reported mood Time: Change from day 3-5 to week 3-6 postpartumDescription: Pittsburgh Sleep Quality Index (PSQI), range 0-21, a score of 0 indicates a healthy sleep quality. Total group.
Measure: Self-reported sleep quality Time: Day 3-5 postpartumDescription: Pittsburgh Sleep Quality Index (PSQI), range 0-21, a score of 0 indicates a healthy sleep quality. Total group.
Measure: Self-reported sleep quality Time: Week 3-6 postpartumDescription: Change in Pittsburgh Sleep Quality Index (PSQI), range 0-21, a score of 0 indicates a healthy sleep quality. Total group.
Measure: Change in self-reported sleep quality Time: Change from day 3-5 to week 3-6 postpartumDescription: Brief symptom Inventory-53 item (BSI-53), range 0-212, increasing score means worsening of symptoms.Total group.
Measure: Self-reported psychiatric symptoms Time: Day 3-5 postpartumDescription: Brief symptom Inventory-53 item (BSI-53), range 0-212, increasing score means worsening of symptoms.Total group.
Measure: Self-reported psychiatric symptoms Time: Week 3-6 postpartumDescription: Change in Brief symptom Inventory-53 item (BSI-53) score, range 0-212, increasing score means worsening of symptoms.Total group.
Measure: Change in self-reported psychiatric symptoms Time: Change from day 3-5 to week 3-6 postpartumDescription: WHO-5 well-being index, range 0-100, low score means less well-being. Total group.
Measure: Self-reported well-being Time: Day 3-5 postpartumDescription: WHO-5 well-being index, range 0-100, low score means less well-being. Total group.
Measure: Self-reported well-being Time: Week 3-6 postpartumDescription: Change in WHO-5 well-being index, range 0-100, low score means less well-being. Total group.
Measure: Change in self-reported well-being Time: Change from day 3-5 to week 3-6 postpartumDescription: State Trait Anxiety Inventory (STAI-AD-D), state and trait subscales each have a range of 20-80, 20 means no anxiety. Total group.
Measure: Self-reported anxiety Time: Day 3-5 postpartumDescription: State Trait Anxiety Inventory (STAI-AD-D), state subscale range 20-80, 20 means no anxiety. Total group.
Measure: Self-reported anxiety Time: Week 3-6 postpartumDescription: Change in State Trait Anxiety Inventory (STAI-AD-D) score, state subscale range 20-80, 20 means no anxiety. Total group.
Measure: Change in self-reported anxiety Time: Change from day 3-5 to week 3-6 postpartumDescription: Obsessive-Compulsive Inventory (OCI) score, self-reported, range 0-72, higher scores indicate more symptoms. Total group.
Measure: Self-reported obsessive and compulsive symptoms Time: Day 3-5Description: Obsessive-Compulsive Inventory (OCI) score, self-reported, range 0-72, higher scores indicate more symptoms. Total group.
Measure: Self-reported obsessive and compulsive symptoms Time: Week 3-6 postpartumDescription: Change in Obsessive-Compulsive Inventory (OCI) score, self-reported, range 0-72, higher scores indicate more symptoms. Total group.
Measure: Change in self-reported obsessive and compulsive symptoms Time: Change from day 3-5 to week 3-6 postpartumDescription: Performance on Simple Reaction Time, in imaging cohort.
Measure: Performance on Simple Reaction Time Time: Week 3-6 postpartumDescription: Gray matter brain volume prefrontal cortex and anterior cingulate cortex
Measure: Gray matter brain volume prefrontal cortex and anterior cingulate cortex Time: At week 3-6 postpartumDescription: Composite measure of serotonin, tryptophan og tryptofan hydroxylase levels relative to 5-HIAA, in placenta sample. Infants from total group
Measure: Serotonergic turnover in placenta Time: At delivery.Description: 11-beta-hydroxysteroid dehydrogenase type 2 activity in placenta. Infants from total group
Measure: 11-beta-hydroxysteroid dehydrogenase type 2 activity in placenta Time: At deliveryDescription: Composite measure of methylation status for the FKBP5, glucocorticoid receptor, 11-beta hydroxysteroid dehydrogenase type 2 genes. Infants from total group
Measure: Methylation status of genes relevant for stress-hormone regulation in placenta Time: At deliveryDescription: Composite measure of the methylation status for monoamine oxidase, serotonin receptor and serotonin transporter genes. Infants from total group
Measure: Methylation status of genes related to serotonergic signaling in placenta Time: At deliveryDescription: Composite measure of methylation status and gene transcript profiles of Glucocorticoid receptor, FKBP5, oxytocin and oxytocin receptors, Brain-derived neurotrophic factor (BDNF) genes. Assessed in blood from umbilical cord blood sample from infants, total group.
Measure: Methylation status and gene transcript profiles of relevance for early brain development and stress regulation in newborn infants Time: At delivery.Other Outcomes
Description: val158met (rs4680) status, binary variable, i.e. "val/val, val/met" vs "met/met" variants
Measure: COMT-genotype (rs4680) variant, i.e met/met vs other polymorphisms Time: Prior to caesarean section.Description: BDNF val66met (rs6265) status, binary variable, i.e. "val/val" versus "met-carrier" status
Measure: BDNF genotype (rs6265) status, i.e. val/val versus met-carrier variants Time: Prior to caesarean section.Description: 5-HTTLPR genotype status (binary), i.e. high-expressing LALA vs low-expressing (S or LG) variants, based on SLC6A4, i.e. L or S variants, and further subtyping on rs25531 haplotype L(A)L(A) vs LGLA, LGLG or variants containing as S as specified above.
Measure: 5-HTT genotype status, i.e LALA vs low-expressing (S or LG) variants Time: Prior to caesarean section.Description: In house interview based on Kennerley Maternity Blues Questionnaire, range: 0-28, higher score indicates more severe postpartum blues symptoms. High blues score is associated with greater risk for perinatal depression at week 3-6.
Measure: Postpartum blues symptoms Time: Day 3-5 postpartum.Description: In house interview based on Stein's Maternity Blues Scale, range 0-26. High blues score is associated with greater risk for perinatal depression at week 3-6.
Measure: Postpartum blues symptoms Time: Day 3-5 postpartum.Time Perspective: Prospective
Cohort
There are 3 SNPs
SNPs
1 rs25531
L or S variants, and further subtyping on rs25531 haplotype L(A)L(A) vs LGLA, LGLG or variants containing as S as specified above..
2 rs4680
Assessed in blood from umbilical cord blood sample from infants, total group.. COMT-genotype (rs4680) variant, i.e met/met vs other polymorphisms.
val158met (rs4680) status, binary variable, i.e. "val/val, val/met" vs "met/met" variants.
3 rs6265
BDNF genotype (rs6265) status, i.e. val/val versus met-carrier variants.
BDNF val66met (rs6265) status, binary variable, i.e. "val/val" versus "met-carrier" status.