LAUSR

Background A disrupted circadian clock has been linked to the risk of several neuropsychiatric disorders. Likewise, circadian rhythms have been suggested as mediators of the mechanism of action of lithium in bipolar disorder. Nonetheless the relationship between the ‘clock genes’ that regulate circadian rhythms and lithium treatment response is not completely understood. To our knowledge there has not been a systematic pathway / enrichment analysis of clock genes in the context of psychiatric traits, in general, and of clinical response to lithium, in particular. The objective of this study was to perform formal gene set enrichment analyses for circadian clock genes, using publicly available GWAS summary statistics from several psychiatric disorders, as well as the results from The International Consortium on Lithium Genetics (ConLiGen) GWAS (Hou et al., 2016). Methods Based on previous literature (Pizarro et al., 2013; Chen et al., 2016) and available resources (e.g. http://circadb.hogeneschlab.org/) curated gene sets related to circadian control were generated. These sets can be divided in three categories: clock modulator (upstream) genes, core clock genes and clock controlled (downstream) genes. GWAS summary statistics from schizophrenia, bipolar disorder, major depressive disorder, ADHD, autism, Alzheimer's disease and continuous/dichotomous lithium response were used as reference. Gene set enrichment analyses were carried out using both INRICH and MAGMA. Results Gene set enrichment analyses using INRICH and MAGMA reported a significant enrichment of a set of 19 genes that constitute the ‘core clock’ in the dichotomous lithium response phenotype (INRICH: empirical P=0.001; corrected P=0.008; MAGMA: competitive P=0.005; corrected P=0.0336). None of the circadian gene sets showed a significant enrichment in any of the other psychiatric traits included in this study (all corrected P>0.05). Discussion Our results suggest the involvement of those genes that constitute the core clock machinery in the determination of the clinical response to lithium in bipolar disorder patients. The specificity of these results suggests that the participation of circadian rhythms is especially relevant in the modulation of lithium response rather than in the overall risk of mental illness. A better understanding of potential links between circadian mechanisms, genetic risk factors, and the lithium treatment response may open new avenues into the clinical management of bipolar disorder.