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Research ArticleOriginal Article
Open Access

Association of intron 4 VNTR polymorphism in the NOS3 gene with rapid cycling and treatment resistance in bipolar disorder: a case-control study

Hasan M. Aytac, Mustafa Pehlivan, Yasemin Oyaci and Sacide Pehlivan
Neurosciences Journal October 2022, 27 (4) 229-236; DOI: https://doi.org/10.17712/nsj.2022.4.20220040
Hasan M. Aytac
From the Department of Psychiatry (Aytac), Basaksehir Cam and Sakura City Hospital, from the Department of Hematology (Pehlivan), Gaziantep University, Gaziantep, from the Department of Medical Biology (Oyaci, Pehlivan), Istanbul Faculty of Medicine, Istanbul University, Turkey
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  • For correspondence: [email protected]
Mustafa Pehlivan
From the Department of Psychiatry (Aytac), Basaksehir Cam and Sakura City Hospital, from the Department of Hematology (Pehlivan), Gaziantep University, Gaziantep, from the Department of Medical Biology (Oyaci, Pehlivan), Istanbul Faculty of Medicine, Istanbul University, Turkey
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Yasemin Oyaci
From the Department of Psychiatry (Aytac), Basaksehir Cam and Sakura City Hospital, from the Department of Hematology (Pehlivan), Gaziantep University, Gaziantep, from the Department of Medical Biology (Oyaci, Pehlivan), Istanbul Faculty of Medicine, Istanbul University, Turkey
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Sacide Pehlivan
From the Department of Psychiatry (Aytac), Basaksehir Cam and Sakura City Hospital, from the Department of Hematology (Pehlivan), Gaziantep University, Gaziantep, from the Department of Medical Biology (Oyaci, Pehlivan), Istanbul Faculty of Medicine, Istanbul University, Turkey
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Article Figures & Data

Tables

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    Table 1

    - Sociodemographic characteristics and the Scale Scores of BD patients.

    Bipolar disorderMean±SD
    Age41.27±11.61
    Age of onset25.47±8.70
    Duration of disease15.93±10.71
    Number of hospital3,68±4.56
    Dep. Episode1.55±2.51
    Manic episode4.48±4.96
    Total episode6.03±5.54
    HAM-D11.36±7.47
    YMRS7.95±8.72
    CGI-S5.01±0.90
    CGI-I2.07±0.84

    SD - standard deviation, hospital - hospitalization, Dep - depressive, HAM-D - Hamilton depression rating scale, YMRS - Young mania rating scale, CGI-S - clinical global impression scale-severity, CGI-I - clinical global impression scale-improvement

      • View popup
      Table 2

      - Comparison of genotype distributions of NOS3 intron 4 VNTR variants in BD patients with the control group.

      GenotypesBipolar disorderHealthy controlOR95% CIP-value
      NOS3n=95 (%)n=95 (%)   
      b/b66 (69.5)77 (81.1)1.880*0.958-3.687*.064*
      b/a25 (26.3)17 (17.9)0.610*0.304-1.223*.162*
      a/a4 (4.2)1 (1.1)0.242*0.027-2.207*.174*
      Allele     
      b157 (82.6)171 (90)   
      a33 (17.4)19 (10)1.892*1.033-3.463*.037*

      OR - odds ratio, CI - confidence interval,

      • ↵* Pearson chi-square

      • View popup
      Table 3

      - Comparison of NOS3 genotype and allele frequency distributions of rapid cycling BD patients with non-rapid cycling BD patients and the control groups.

      GenotypesRapid cycling yesRapid cycling noOR95% CIP-value
      NOS3n=20 (%)n=75 (%)   
      b/b9 (45)57 (76)0.258*0.092-0.722*.007*
      b/a9 (45)16 (21.3)3.017*1.067-8.534*.033*
      a/a2 (10)2 (2.7)0.247&0.032-1.871&.194&
      Allele     
      b27 (67.5)130 (86.7)   
      a13 (32.5)20 (13.3)3.130*1.389-7.049*.004*
      NOS3 Healthy control   
      b/b9 (45)77 (81.1)0.191*0.069-0.530*.001*
      b/a9 (45)17 (17.9)3.754&1.347-10.466&.016&
      a/a2 (10)1 (1.1)10.444&0.899-121.379&.078&
      Allele     
      b27 (67.5)171(90)   
      a13 (32.5)19 (10)0.231*0.102-0.521*.000*

      OR - odds ratio, CI - confidence interval,

      • ↵* Pearson chi-square &Fisher’s Exact Test

      • View popup
      Table 4

      - Comparison of NOS3 genotype and allele frequency distributions of treatment resistant BD patients with treatment-responsive BD patients and the control groups.

      GenotypesTreat. Res.
      yes
      Treat. Res.
      No
      OR95% CIP-value
      NOS3n=25 (%)n=70 (%)   
      b/b12 (48)54 (77.1)3.6561.396-9.575*.007*
      b/a11 (44)14 (20)0.318*0.119-0.850*.019*
      a/a2 (8)2 (2.9)0.338&0.045-2.540&.282&
      Allele     
      b35 (55.1)122 (87.1)   
      a15 (44.9)18 (12.9)2.905*1.330-6.346*.006*
      NOS3 Healthy control   
      b/b12 (48)77 (81.1)0.216*0.085-0.551*.001*
      b/a11 (44)17 (17.9)3.605*1.397-9.304*.006*
      a/a2 (8)1 (1.1)8.174&0.710-94.097&.110&
      Allele     
      b35 (55.1)171 (63.9)   
      a15 (44.9)19 (36.1)0.259*0.120-0.559*.000*

      Treat - treatment; Res - resistance; OR - odds ratio; CI - confidence interval,

      • ↵* Pearson chi-square&Fisher’s Exact Test

      • View popup
      Table 5

      - Comparison of scale scores and clinical parameters regarding the NOS3 intron 4 genotype distributions of BD patients.

      Scale Scores and Clinical Parameters(b/b) (n= 66)(b/a, a/a) (n=29)*P-value
      Median (min-max)Mean±SDMedian (min-max)Mean±SD
      HAM-D score9(0-31)11.39 ±6.969(0-34)11.31±8.67.771
      YMRS score6(0-37)7.48±8.081(0-35)9.03±10.10.575
      CGI-S score5(2-7)4.96±0.915(3-6)5.10±0.90.297
      CGI-I score2(1-4)1.96±0.822(1-4)2.37±0.94.037
      Dep. episode0(0-12)1.63±2.650(0-9)1.37±2.19.604
      Manic episode2.5(0-21)3.69±3.542(1-25)6.27±6.98.388
      Total episode4(1-23)5.31±4.634(1-27)7.65±7.03.311
      Age of onset23.5(10-52)25.89±9.3424(13-44)24.51±7.06.647
      Duration of disease13.5(0.5-40)14.25±9.0118(1-40)19.75±13.22.081
      Number of hospt.2(0-18)2.75±3.102(0-21)5.79±6.39.040

      SD - standard deviation, min - minimum, max - maximum, CGI-S - clinical global impression scale-severity, CGI-I - clinical global impression scale-improvement, HAM-D - Hamilton depression rating scale, YMRS - Young mania rating scale, dep - depressive, hospt - hospitalization

      • ↵* Mann Whitney U test,

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    1 Oct 2022
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    Association of intron 4 VNTR polymorphism in the NOS3 gene with rapid cycling and treatment resistance in bipolar disorder: a case-control study
    Hasan M. Aytac, Mustafa Pehlivan, Yasemin Oyaci, Sacide Pehlivan
    Neurosciences Journal Oct 2022, 27 (4) 229-236; DOI: 10.17712/nsj.2022.4.20220040

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    Association of intron 4 VNTR polymorphism in the NOS3 gene with rapid cycling and treatment resistance in bipolar disorder: a case-control study
    Hasan M. Aytac, Mustafa Pehlivan, Yasemin Oyaci, Sacide Pehlivan
    Neurosciences Journal Oct 2022, 27 (4) 229-236; DOI: 10.17712/nsj.2022.4.20220040
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