Abstract
Mitochondrial defects in gene expression have been implicated in the pathophysiology of bipolar disorder and schizophrenia. We have now contrasted control brains with low pH versus high pH and showed that 28% of genes in mitochondrial-related pathways meet criteria for differential expression. A majority of genes in the mitochondrial, chaperone and proteasome pathways of nuclear DNA-encoded gene expression were decreased with decreased brain pH, whereas a majority of genes in the apoptotic and reactive oxygen stress pathways showed an increased gene expression with a decreased brain pH. There was a significant increase in mitochondrial DNA copy number and mitochondrial DNA gene expression with increased agonal duration. To minimize effects of agonal-pH state on mood disorder comparisons, two classic approaches were used, removing all subjects with low pH and agonal factors from analysis, or grouping low and high pH as a separate variable. Three groups of potential candidate genes emerged that may be mood disorder related: (a) genes that showed no sensitivity to pH but were differentially expressed in bipolar disorder or major depressive disorder; (b) genes that were altered by agonal-pH in one direction but altered in mood disorder in the opposite direction to agonal-pH and (c) genes with agonal-pH sensitivity that displayed the same direction of changes in mood disorder. Genes from these categories such as NR4A1 and HSPA2 were confirmed with Q-PCR. The interpretation of postmortem brain studies involving broad mitochondrial gene expression and related pathway alterations must be monitored against the strong effect of agonal-pH state. Genes with the least sensitivity to agonal-pH could present a starting point for candidate gene search in neuropsychiatric disorders.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
We are sorry, but there is no personal subscription option available for your country.
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Dyrskjot L . Classification of bladder cancer by microarray expression profiling: towards a general clinical use of microarrays in cancer diagnostics. Expert Rev Mol Diagn 2003; 3 (5): 635–647.
Ueda M, Ota J, Yamashita Y, Choi YL, Ohki R, Wada T et al. DNA microarray analysis of stage progression mechanism in myelodysplastic syndrome. Br J Haematol 2003; 123 (2): 288–296.
Chen CD, Welsbie DS, Tran C, Baek SH, Chen R, Vessella R et al. Molecular determinants of resistance to antiandrogen therapy. Nat Med 2004; 10 (1): 33–39.
Aston C, Jiang L, Sokolov BP . Transcriptional profiling reveals evidence for signaling and oligodendroglial abnormalities in the temporal cortex from patients with major depressive disorder. Mol Psychiatry 2005; 10 (3): 309–322.
Huffaker SJ, Ryan M, Sudhakaran P, Webster M, Goedert M, Bahn S . Large scale genechip analysis of post - mortem brains from schizophrenia and bipolar affective disorder patients. Program Number 312.16, in Abstract Viewer/ Itinerary Planner. Society for Neuroscience: Washington, DC, 2003.
Petryshen TL, O'Leary SB, Lehar J, Mootha VK, Raad R, Subramanian A et al. Identification of altered gene pathways in prefrontal cortex and cerebellum of schizophrenia, bipolar disorder, and depression patients. Program Number 312.12, in Abstract Viewer/Itinerary Planner. Society for Neuroscience: Washington, DC, 2003.
Sequeira A, Gwadry F, Ffrench-Mullen JM, Turecki G . Gene expression changes in suicides with and without major depression. Program Number 640.2, in Abstract Viewer/ Itinerary Planner. Society for Neuroscience: Washington DC, 2003.
Bezchlibnyk YB, Wang JF, McQueen GM, Young LT . Gene expression differences in bipolar disorder revealed by cDNA array analysis of post-mortem frontal cortex. J Neurochem 2001; 79 (4): 826–834.
Sibille E, Arango V, Galfalvy HC, Pavlidis P, Erraji-Benchekroun L, Ellis SP et al. Gene expression profiling of depression and suicide in human prefrontal cortex. Neuropsychopharmacology 2004; 29 (2): 351–361.
Iwamoto K, Bundo M, Kato T . Altered expression of mitochondria-related genes in postmortem brains of patients with bipolar disorder or schizophrenia, as revealed by large-scale DNA microarray analysis. Hum Mol Genet 2005; 14 (2): 241–253.
Konradi C, Eaton M, MacDonald ML, Walsh J, Benes FM, Heckers S . Molecular evidence for mitochondrial dysfunction in bipolar disorder. Arch Gen Psychiatry 2004; 61 (3): 300–308.
Jurata LW, Bukhman YV, Charles V, Capriglione F, Bullard J, Lemire AL et al. Comparison of microarray-based mRNA profiling technologies for identification of psychiatric disease and drug signatures. J Neurosci Methods 2004; 138 (1–2): 173–188.
Evans SJ, Choudary PV, Neal CR, Li JZ, Vawter MP, Tomita H et al. Dysregulation of the fibroblast growth factor system in major depression. Proc Natl Acad Sci USA 2004; 101 (43): 15506–15511.
Altar CA, Jurata LW, Charles V, Lemire A, Liu P, Bukhman Y et al. Deficient hippocampal neuron expression of proteasome, ubiquitin, and mitochondrial genes in multiple schizophrenia cohorts. Biol Psychiatry 2005; 58 (2): 85–96.
Harrison PJ . The neuropathology of primary mood disorder. Brain 2002; 125 (Part 7): 1428–1449.
Prabakaran S, Swatton JE, Ryan MM, Huffaker SJ, Huang JJ, Griffin JL et al. Mitochondrial dysfunction in Schizophrenia: evidence for compromised brain metabolism and oxidative stress. Mol Psychiatry 2004; 9 (7): 684–697, 643.
Middleton FA, Mirnics K, Pierri JN, Lewis DA, Levitt P . Gene expression profiling reveals alterations of specific metabolic pathways in schizophrenia. J Neurosci 2002; 22 (7): 2718–2729.
Sokolov BP, Jiang L, Trivedi NS, Aston C . Transcription profiling reveals mitochondrial, ubiquitin and signaling systems abnormalities in postmortem brains from subjects with a history of alcohol abuse or dependence. J Neurosci Res 2003; 72 (6): 756–767.
Hakak Y, Walker JR, Li C, Wong WH, Davis KL, Buxbaum JD et al. Genome-wide expression analysis reveals dysregulation of myelination-related genes in chronic schizophrenia. Proc Natl Acad Sci USA 2001; 98 (8): 4746–4751.
Vawter MP, Crook JM, Hyde TM, Kleinman JE, Weinberger DR, Becker KG et al. Microarray analysis of gene expression in the prefrontal cortex in schizophrenia: a preliminary study. Schizophr Res 2002; 58 (1): 11–20.
Vawter MP, Barrett T, Cheadle C, Sokolov BP, Wood III WH, Donovan, DM et al. Application of cDNA microarrays to examine gene expression differences in schizophrenia. Brain Res Bull 2001; 55 (5): 641–650.
Iwamoto K, Kakiuchi C, Bundo M, Ikeda K, Kato T . Molecular characterization of bipolar disorder by comparing gene expression profiles of postmortem brains of major mental disorders. Mol Psychiatry 2004; 9 (4): 406–416.
Kato T, Kato N . Mitochondrial dysfunction in bipolar disorder. Bipolar Disord 2000; 2 (3 Part 1): 180–190.
Mootha VK, Lepage P, Miller K, Bunkenborg J, Reich M, Hjerrild M et al. Identification of a gene causing human cytochrome c oxidase deficiency by integrative genomics. Proc Natl Acad Sci USA 2003; 100 (2): 605–610.
Robinson BH, De Meirleir L, Glerum M, Sherwood G, Becker L . Clinical presentation of mitochondrial respiratory chain defects in NADH-coenzyme Q reductase and cytochrome oxidase: clues to pathogenesis of Leigh disease. J Pediatr 1987; 110 (2): 216–222.
Li JZ, Vawter MP, Walsh DM, Tomita H, Evans SJ, Choudary PV et al. Systematic changes in gene expression in postmortem human brains associated with tissue pH and terminal medical conditions. Hum Mol Genet 2004; 13 (6): 609–616.
Hardy JA, Wester P, Winblad B, Gezelius C, Bring G, Eriksson A . The patients dying after long terminal phase have acidotic brains; implications for biochemical measurements on autopsy tissue. J Neural Transm 1985; 61 (3–4): 253–264.
Johnston NL, Cervenak J, Shore AD, Torrey EF, Yolken RH, Cerevnak J . Multivariate analysis of RNA levels from postmortem human brains as measured by three different methods of RT-PCR. Stanley Neuropathology Consortium. J Neurosci Methods 1997; 77 (1): 83–92.
Wester P, Bateman DE, Dodd PR, Edwardson JA, Hardy JA, Kidd AM et al. Agonal status affects the metabolic activity of nerve endings isolated from postmortem human brain. Neurochem Pathol 1985; 3 (3): 169–180.
Tomita H, Vawter MP, Walsh DM, Evans SJ, Choudary PV, Li J et al. Effect of agonal and postmortem factors on gene expression profile: quality control in microarray analyses of postmortem human brain. Biol Psychiatry 2004; 55 (4): 346–352.
Brodmann K . Vergleichende Lokalisationslehre der Grosshirnrinde in ihren Prinzipien dargestellt auf Grund des Zellenbaues. Barth: Leipzig, 1909.
Vogt BA, Nimchinsky EA, Vogt LJ, Hof PR . Human cingulate cortex: surface features, flat maps, and cytoarchitecture. J Comp Neurol 1995; 359 (3): 490–506.
Vawter MP, Evans S, Choudary P, Tomita H, Meador-Woodruff J, Molnar M et al. Gender-specific gene expression in post-mortem human brain: localization to sex chromosomes. Neuropsychopharmacology 2004; 29 (2): 373–384.
Ryan MM, Huffaker SJ, Webster MJ, Wayland M, Freeman T, Bahn S . Application and optimization of microarray technologies for human postmortem brain studies. Biol Psychiatry 2004; 55 (4): 329–336.
Harrison PJ, Heath PR, Eastwood SL, Burnet PW, McDonald B, Pearson RC . The relative importance of premortem acidosis and postmortem interval for human brain gene expression studies: selective mRNA vulnerability and comparison with their encoded proteins. Neurosci Lett 1995; 200 (3): 151–154.
Miller CL, Diglisic S, Leister F, Webster M, Yolken RH . Evaluating RNA status for RT-PCR in extracts of postmortem human brain tissue. Biotechniques 2004; 36 (4): 628–633.
Dai M, Wang P, Boyd AD, Kostov G, Athey B, Jones EG et al. Evolving gene/transcript definitions significantly alter the interpretation of GeneChip data. Nucleic Acids Res 2005; 33 (20): e175.
Manji HK, Duman RS . Impairments of neuroplasticity and cellular resilience in severe mood disorders: implications for the development of novel therapeutics. Psychopharmacol Bull 2001; 35 (2): 5–49.
Gray NA, Zhou R, Du J, Moore GJ, Manji HK . The use of mood stabilizers as plasticity enhancers in the treatment of neuropsychiatric disorders. J Clin Psychiatry 2003; 64 (Suppl 5): 3–17.
Hosack DA, Dennis Jr G, Sherman BT, Lane HC, Lempicki RA . Identifying biological themes within lists of genes with EASE. Genome Biol 2003; 4 (10): R70.
Dennis Jr G, Sherman BT, Hosack DA, Yang J, Gao W, Lane HC et al. DAVID: Database for Annotation, Visualization, and Integrated Discovery. Genome Biol 2003; 4 (5): P3.
Vawter MP, Shannon Weickert C, Ferran E, Matsumoto M, Overman K, Hyde TM et al. Gene expression of metabolic enzymes and a protease inhibitor in the prefrontal cortex are decreased in schizophrenia. Neurochem Res 2004; 29 (6): 1245–1255.
Neal Jr CR, Akil H, Watson Jr SJ . Expression of orphanin FQ and the opioid receptor-like (ORL1) receptor in the developing human and rat brain. J Chem Neuroanat 2001; 22 (4): 219–249.
Benes FM, Matzilevich D, Burke RE, Walsh J . The expression of proapoptosis genes is increased in bipolar disorder, but not in schizophrenia. Mol Psychiatry 2006; 11 (3): 241–251.
Xu F, Morin C, Mitchell G, Ackerley C, Robinson BH . The role of the LRPPRC (leucine-rich pentatricopeptide repeat cassette) gene in cytochrome oxidase assembly: mutation causes lowered levels of COX (cytochrome c oxidase) I and COX III mRNA. Biochem J 2004; 382 (Part 1): 331–336.
Vawter MP, Freed WJ, Kleinman JE . Neuropathology of bipolar disorder. Biol Psychiatry 2000; 48 (6): 486–504.
Traven A, Wong JM, Xu D, Sopta M, ngles CJ . Interorganellar communication. Altered nuclear gene expression profiles in a yeast mitochondrial dna mutant. J Biol Chem 2001; 276 (6): 4020–4027.
Poyton RO, McEwen JE . Crosstalk between nuclear and mitochondrial genomes. Annu Rev Biochem 1996; 65: 563–607.
Rotig A, Munnich A . Genetic features of mitochondrial respiratory chain disorders. J Am Soc Nephrol 2003; 14 (12): 2995–3007.
Morin C, Mitchell G, Larochelle J, Lambert M, Ogier H, Robinson BH et al. Clinical, metabolic, and genetic aspects of cytochrome C oxidase deficiency in Saguenay-Lac-Saint-Jean. Am J Hum Genet 1993; 53 (2): 488–496.
Hamakawa H, Murashita J, Yamada N, Inubushi T, Kato N, Kato T . Reduced intracellular pH in the basal ganglia and whole brain measured by 31P-MRS in bipolar disorder. Psychiatry Clin Neurosci 2004; 58 (1): 82–88.
Kato T, Shioiri T, Murashita J, Hamakawa H, Inubushi T, Takahashi S . Phosphorus-31 magnetic resonance spectroscopy and ventricular enlargement in bipolar disorder. Psychiatry Res 1994; 55 (1): 41–50.
Kato T, Takahashi S, Shioiri T, Inubushi T . Alterations in brain phosphorous metabolism in bipolar disorder detected by in vivo 31P and 7Li magnetic resonance spectroscopy. J Affect Disord 1993; 27 (1): 53–59.
Dager SR, Friedman SD, Parow A, Demopulos C, Stoll AL, Lyoo IK et al. Brain metabolic alterations in medication-free patients with bipolar disorder. Arch Gen Psychiatry 2004; 61 (5): 450–458.
Wasserman MJ, Corson TW, Sibony D, Cooke RG, Parikh SV, Pennefather PS et al. Chronic lithium treatment attenuates intracellular calcium mobilization. Neuropsychopharmacology 2004; 29 (4): 759–769.
Emamghoreishi M, Schlichter L, Li PP, Parikh S, Sen J, Kamble A et al. High intracellular calcium concentrations in transformed lymphoblasts from subjects with bipolar I disorder. Am J Psychiatry 1997; 154 (7): 976–982.
Munakata K, Iwamoto K, Bundo M, Kato T . Mitochondrial DNA 3243A>G mutation and increased expression of LARS2 gene in the brains of patients with bipolar disorder and schizophrenia. Biol Psychiatry 2005; 57 (5): 525–532.
Kato T, Takahashi Y . Deletion of leukocyte mitochondrial DNA in bipolar disorder. J Affect Disord 1996; 37 (2–3): 67–73.
Kato T, Stine OC, McMahon FJ, Crowe RR . Increased levels of a mitochondrial DNA deletion in the brain of patients with bipolar disorder. Biol Psychiatry 1997; 42 (10): 871–875.
Kato T, Kunugi H, Nanko S, Kato N . Association of bipolar disorder with the 5178 polymorphism in mitochondrial DNA. Am J Med Genet 2000; 96 (2): 182–186.
Coskun PE, Ruiz-Pesini E, Wallace DC . Control region mtDNA variants: longevity, climatic adaptation, and a forensic conundrum. Proc Natl Acad Sci USA 2003; 100 (5): 2174–2176.
Coskun PE, Beal MF, Wallace DC . Alzheimer's brains harbor somatic mtDNA control-region mutations that suppress mitochondrial transcription and replication. Proc Natl Acad Sci USA 2004; 101 (29): 10726–10731.
Melov S, Schneider JA, Coskun PE, Bennett DA, Wallace DC . Mitochondrial DNA rearrangements in aging human brain and in situ PCR of mtDNA. Neurobiol Aging 1999; 20 (5): 565–571.
Kato T, Kunugi H, Nanko S, Kato N . Mitochondrial DNA polymorphisms in bipolar disorder. J Affect Disord 2001; 62 (3): 151–164.
Kato T, Iwamoto K, Washizuka S, Mori K, Tajima O, Akiyama T et al. No association of mutations and mRNA expression of WFS1/wolframin with bipolar disorder in humans. Neurosci Lett 2003; 338 (1): 21–24.
Kakiuchi C, Iwamoto K, Ishiwata M, Kakiuchi C, Iwamoto K, Ishiwata M, Bundo M, Kasahara T, Kusumi I et al. Impaired feedback regulation of XBP1 as a genetic risk factor for bipolar disorder. Nat Genet 2003; 35 (2): 171–175.
Washizuka S, Kakiuchi C, Mori K, Kunugi H, Tajima O, Akiyama T et al. Association of mitochondrial complex I subunit gene NDUFV2 at 18p11 with bipolar disorder. Am J Med Genet 2003; 120B (1): 72–78.
Washizuka S, Kakiuchi C, Mori K, Tajima O, Akiyama T, Kato T . Expression of mitochondria-related genes in lymphoblastoid cells from patients with bipolar disorder. Bipolar Disord 2005; 7 (2): 146–152.
McCarroll SA, Murphy CT, Zou S, Pletcher SD, Chin CS, Jan YN et al. Comparing genomic expression patterns across species identifies shared transcriptional profile in aging. Nat Genet 2004; 36 (2): 197–204.
Trinklein ND, Aldred SF, Hartman SJ, Schroeder DI, Otillar RP, Myers RM . An abundance of bidirectional promoters in the human genome. Genome Res 2004; 14 (1): 62–66.
Jarskog LF, Gilmore JH, Selinger ES, Lieberman JA . Cortical bcl-2 protein expression and apoptotic regulation in schizophrenia. Biol Psychiatry 2000; 48 (7): 641–650.
Li X, Bijur GN, Jope RS . Glycogen synthase kinase-3beta, mood stabilizers, and neuroprotection. Bipolar Disord 2002; 4 (2): 137–144.
Cotter D, Mackay D, Chana G, Beasley C, Landau S, Everall IP . Reduced neuronal size and glial cell density in area 9 of the dorsolateral prefrontal cortex in subjects with major depressive disorder. Cereb Cortex 2002; 12 (4): 386–394.
Cotter D, Mackay D, Landau S, Kerwin R, Everall I . Reduced glial cell density and neuronal size in the anterior cingulate cortex in major depressive disorder. Arch Gen Psychiatry 2001; 58 (6): 545–553.
Bouras C, Kovari E, Hof PR, Riederer BM, Giannakopoulos P . Anterior cingulate cortex pathology in schizophrenia and bipolar disorder. Acta Neuropathol (Berlin) 2001; 102 (4): 373–379.
Ongur D, Drevets WC, Price JL . Glial reduction in the subgenual prefrontal cortex in mood disorders. Proc Natl Acad Sci USA 1998; 95 (22): 13290–13295.
Rajkowska G, Miguel-Hidalgo JJ, Wei J, Dilley G, Pittman SD, Meltzer HY et al. Morphometric evidence for neuronal and glial prefrontal cell pathology in major depression. Biol Psychiatry 1999; 45 (9): 1085–1098.
Chana G, Landau S, Beasley C, Everall IP, Cotter D . Two-dimensional assessment of cytoarchitecture in the anterior cingulate cortex in major depressive disorder, bipolar disorder, and schizophrenia: evidence for decreased neuronal somal size and increased neuronal density. Biol Psychiatry 2003; 53 (12): 1086–1098.
Weinbach EC, Costa JL, Nelson BD, Claggett CE, Hundal T, Bradley D et al. Effects of tricyclic antidepressant drugs on energy-linked reactions in mitochondria. Biochem Pharmacol 1986; 35 (9): 1445–1451.
Curti C, Mingatto FE, Polizello AC, Galastri LO, Uyemura SA, Santos AC . Fluoxetine interacts with the lipid bilayer of the inner membrane in isolated rat brain mitochondria, inhibiting electron transport and F1F0- ATPase activity. Mol Cell Biochem 1999; 199 (1–2): 103–109.
Eto K, Fukuda T, Araki Y, Inoue B, Ogata M . Effect of tricyclic drugs on mitochondrial membrane. Acta Med Okayama 1985; 39 (4): 289–295.
Roberton AM, Ferguson LR, Cooper GJ . Biochemical evidence that high concentrations of the antidepressant amoxapine may cause inhibition of mitochondrial electron transport. Toxicol Appl Pharmacol 1988; 93 (1): 118–126.
Holtz KM, Rice AM, Sartorelli AC . Lithium chloride inactivates the 20S proteasome from WEHI-3B D+ leukemia cells. Biochem Biophys Res Commun 2003; 303 (4): 1058–1064.
Rice AM, Sartorelli AC . Inhibition of 20 S and 26 S proteasome activity by lithium chloride: impact on the differentiation of leukemia cells by all-trans retinoic acid. J Biol Chem 2001; 276 (46): 42722–42727.
Kane JK, Konu O, Ma JZ, Li MD . Nicotine coregulates multiple pathways involved in protein modification/degradation in rat brain. Brain Res Mol Brain Res 2004; 132 (2): 181–191.
Bosetti F, Seemann R, Bell JM, Zahorchak R, Friedman E, Rapoport SI et al. Analysis of gene expression with cDNA microarrays in rat brain after 7 and 42 days of oral lithium administration. Brain Res Bull 2002; 57 (2): 205–209.
Liu J, Lewohl JM, Dodd PR, Randall PK, Harris RA, Mayfield RD . Gene expression profiling of individual cases reveals consistent transcriptional changes in alcoholic human brain. J Neurochem 2004; 90 (5): 1050–1058.
Ben-Shachar D . Mitochondrial dysfunction in schizophrenia: a possible linkage to dopamine. J Neurochem 2002; 83 (6): 1241–1251.
Acknowledgements
We appreciate the assistance of Preston Cartagena, PsyD and Richard Stein, PhD for their contributions to postmortem clinical characterization of subjects. We acknowledge Kathleen Burke as well as Jacque Berndt and the investigators and medical examiners at the Orange County Coroners Office for procurement of brain tissue. We also appreciate the technical contributions of Kevin Overman, Sharon Burke, Xiaohong Fan and Phong Nguyen. F Warren Lovell, MD, performed a neuropathological evaluation of the postmortem brains. Tissue specimens were processed and stored at the Human Brain and Spinal Fluid Resource Center, Veteran's Medical Center, Los Angeles under the direction of Wallace W Tourtellotte, MD, PhD This project is supported by the NIMH Conte Center Grant P50 MH60398, Pritzker Family Philanthropic Fund, William Lion Penzner Foundation (UCI), Della Martin Foundation (UCI), NIMH Grant #MH54844 (EGJ), WM Keck Foundation (EGJ) and the NIMH Program Project MH42251 (SJW and HA). The authors are members of a Conte Center supported by the NIMH and members of the Pritzker Neuropsychiatric Disorders Research Consortium, which is supported by the Pritzker Family Philanthropic Fund. A shared intellectual property agreement exists between the Pritzker Family Philanthropic Fund and all the universities involved, in order to encourage the development of appropriate findings for research and clinical applications. The academic and philanthropic entities involved in this Consortium are jointly filing patent applications related to the present findings.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supplementary Information accompanies the paper on the Molecular Psychiatry website (http://www.nature.com/mp)
Supplementary information
Rights and permissions
About this article
Cite this article
Vawter, M., Tomita, H., Meng, F. et al. Mitochondrial-related gene expression changes are sensitive to agonal-pH state: implications for brain disorders. Mol Psychiatry 11, 663–679 (2006). https://doi.org/10.1038/sj.mp.4001830
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.mp.4001830
Keywords
This article is cited by
-
Mitochondrial DNA content and oxidation in bipolar disorder and its role across brain regions
npj Schizophrenia (2019)
-
Accelerated epigenetic aging and mitochondrial DNA copy number in bipolar disorder
Translational Psychiatry (2017)
-
Aberrant telomere length and mitochondrial DNA copy number in suicide completers
Scientific Reports (2017)
-
Mood, stress and longevity: convergence on ANK3
Molecular Psychiatry (2016)
-
Proteomic analysis of the postsynaptic density implicates synaptic function and energy pathways in bipolar disorder
Translational Psychiatry (2016)