Use of a gene expression signature to identify trimetazidine for repurposing to treat bipolar depression

• Published in: Bipolar disorders Vol. 25; no. 8; pp. 661 - 670
• Main Authors: Bortolasci, Chiara C., Kidnapillai, Srisaiyini, Spolding, Briana, Truong, Trang T. T., Connor, Timothy, Swinton, Courtney, Panizzutti, Bruna, Liu, Zoe S. J., Sanigorski, Andrew, Dean, Olivia M., Crowley, Tamsyn, Richardson, Mark, Bozaoglu, Kiymet, Vlahos, Katerina, Cowdery, Stephanie, Watmuff, Brad, Steyn, Stephan F., Wolmarans, De Wet, Engelbrecht, Barend J., Perry, Christina, Drummond, Katherine, Pang, Terence, Jamain, Stéphane, Gray, Laura, McGee, Sean L., Harvey, Brian H., Kim, Jee Hyun, Leboyer, Marion, Berk, Michael, Walder, Ken
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.12.2023; Wiley; John Wiley and Sons Inc
• Subjects: Animal models; Animals; Astrocytes; bipolar depression; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - genetics; Cell differentiation; Disease Models, Animal; Drug Repositioning; drug repurposing; Electron transport; Gene expression; gene expression signature; Hedonic response; Humans; Leukocytes, Mononuclear; Life Sciences; MAP kinase; Mental depression; Neurotrophin 2; Original; Peripheral blood mononuclear cells; Pluripotency; Rats; Signal transduction; Social interactions; Stem cells; Transcriptome; Transcriptomics; Trimetazidine; Trimetazidine - pharmacology; Trimetazidine - therapeutic use; bipolar depression; drug repurposing; gene expression signature; trimetazidine
• ISSN: 1398-5647; 1399-5618; 1399-5618
• DOI: 10.1111/bdi.13319

Objectives The aim of this study was to repurpose a drug for the treatment of bipolar depression. Methods A gene expression signature representing the overall transcriptomic effects of a cocktail of drugs widely prescribed to treat bipolar disorder was generated using human neuronal‐like (NT2‐N) cells. A compound library of 960 approved, off‐patent drugs were then screened to identify those drugs that affect transcription most similar to the effects of the bipolar depression drug cocktail. For mechanistic studies, peripheral blood mononuclear cells were obtained from a healthy subject and reprogrammed into induced pluripotent stem cells, which were then differentiated into co‐cultured neurons and astrocytes. Efficacy studies were conducted in two animal models of depressive‐like behaviours (Flinders Sensitive Line rats and social isolation with chronic restraint stress rats). Results The screen identified trimetazidine as a potential drug for repurposing. Trimetazidine alters metabolic processes to increase ATP production, which is thought to be deficient in bipolar depression. We showed that trimetazidine increased mitochondrial respiration in cultured human neuronal‐like cells. Transcriptomic analysis in induced pluripotent stem cell‐derived neuron/astrocyte co‐cultures suggested additional mechanisms of action via the focal adhesion and MAPK signalling pathways. In two different rodent models of depressive‐like behaviours, trimetazidine exhibited antidepressant‐like activity with reduced anhedonia and reduced immobility in the forced swim test. Conclusion Collectively our data support the repurposing of trimetazidine for the treatment of bipolar depression.