Exploring genetic associations between vitiligo and mental disorders using Mendelian randomization
Yingwei Wang
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorTao Yao
Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorYunlu Lin
Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorLili Ye
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorShuting Li
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorCorresponding Author
Yu Gao
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Correspondence
Yu Gao and Jianming Wu, Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, Xueyuan West Road, Lucheng District, Wenzhou, ZheJiang Province 325027, China.
Email: [email protected] and [email protected]
Search for more papers by this authorCorresponding Author
Jianming Wu
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Correspondence
Yu Gao and Jianming Wu, Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, Xueyuan West Road, Lucheng District, Wenzhou, ZheJiang Province 325027, China.
Email: [email protected] and [email protected]
Search for more papers by this authorYingwei Wang
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorTao Yao
Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorYunlu Lin
Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorLili Ye
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorShuting Li
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Search for more papers by this authorCorresponding Author
Yu Gao
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Correspondence
Yu Gao and Jianming Wu, Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, Xueyuan West Road, Lucheng District, Wenzhou, ZheJiang Province 325027, China.
Email: [email protected] and [email protected]
Search for more papers by this authorCorresponding Author
Jianming Wu
Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
Correspondence
Yu Gao and Jianming Wu, Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, Xueyuan West Road, Lucheng District, Wenzhou, ZheJiang Province 325027, China.
Email: [email protected] and [email protected]
Search for more papers by this authorAbstract
Although a large number of existing studies have confirmed that people with vitiligo are prone to mental disorders, these observational studies may be subject to confounding factors and reverse causality, so the true causal relationship is inconclusive. We conducted a bidirectional Mendelian randomization (MR) analysis to assess the causality between vitiligo and mental disorders, namely depression, anxiety, insomnia, schizophrenia, bipolar disorder, obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Summary statistics from large available genome-wide association study (GWAS) datasets for generalized vitiligo (n = 44 266), depression (n = 173 005), anxiety (n = 17 310), insomnia (n = 386 988), schizophrenia (n = 130 644), bipolar disorder (n = 413 466), OCD (n = 9725) and ADHD (n = 225 534) were utilized. Inverse-variance weighted (IVW), MR-Egger and weighted median were employed to estimate causal effects. Sensitivity analysis and MR Pleiotropy Residual Sum and Outliers (MR PRESSO) were conducted to assess heterogeneity and pleiotropy, ensuring the robustness of the results. Additionally, we corrected for estimating bias that might be brought on by sample overlap using MRlap. In our findings, none of the rigorous bidirectional MR analyses uncovered a significant causal association. Even after applying the MRlap correction, the effect sizes remained statistically nonsignificant, thereby reinforcing the conclusions drawn via IVW. In summary, our genetic-level investigation did not reveal a causal link between generalized vitiligo and mental disorders.
CONFLICT OF INTEREST STATEMENT
The authors have no conflicts of interest to declare.
Open Research
DATA AVAILABILITY STATEMENT
The GWAS data used in our analysis are from published GWAS original texts or public open databases, and we would like to thank the original data contributors who contributed to this analysis, without whose research we would not have been able to conduct this analysis. Links or websites where the data used in this paper are detailed in Table 1.
Supporting Information
Filename | Description |
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exd14979-sup-0001-FigureS1.pdfPDF document, 5.5 MB |
Figure S1 Scatter plots of estimates for the association of generalized vitiligo with (a) depression, (b) anxiety, (c) insomnia, (d) schizophrenia, (e) bipolar disorder, (f) obsessive-compulsive disorder (OCD) and (g) attention-deficit hyperactivity disorder (ADHD). The causal influence is represented by the slope value, which is equal to the b-value computed using the three methods. A positive slope denotes a risk factor for exposure, whereas a negative slope suggests the reverse. |
exd14979-sup-0002-FigureS2.pdfPDF document, 4.1 MB |
Figure S2 Funnel plots of estimates for the association of generalized vitiligo with (a) depression, (b) anxiety, (c) insomnia, (d) schizophrenia, (e) bipolar disorder, (f) obsessive-compulsive disorder (OCD) and (g) attention-deficit hyperactivity disorder (ADHD). |
exd14979-sup-0003-FigureS3.pdfPDF document, 7.4 MB |
Figure S3 Leave-one-out results for generalized vitiligo with (a) depression, (b) anxiety, (c) insomnia, (d) schizophrenia, (e) bipolar disorder, (f) obsessive-compulsive disorder (OCD) and (g) attention-deficit hyperactivity disorder (ADHD). |
exd14979-sup-0004-TableS1.xlsxExcel 2007 spreadsheet , 51.4 KB |
Table S1 Robust significant single nucleotide polymorphisms for vitiligo. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Sehgal VN, Srivastava G. Vitiligo: compendium of clinico-epidemiological features. Indian J Dermatol Venereol Leprol. 2007; 73(3): 149-156.
- 2Bergqvist C, Ezzedine K. Vitiligo: a review. Dermatol Basel Switz. 2020; 236(6): 571-592.
- 3Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet Lond Engl. 2015; 386(9988): 74-84.
- 4Yanik ME, Erfan G, Albayrak Y, Aydin M, Kulac M, Kuloglu M. Reduced serum brain-derived neurotrophic factor in patients with first onset vitiligo. Neuropsychiatr Dis Treat. 2014; 10: 2361-2367.
- 5Ezzedine K, Eleftheriadou V, Jones H, et al. Psychosocial effects of vitiligo: a systematic literature review. Am J Clin Dermatol. 2021; 22(6): 757-774.
- 6Do Bú EA, Santos VMD, Lima KS, Pereira CR, Alexandre MES, Bezerra VADS. Neuroticism, stress, and rumination in anxiety and depression of people with vitiligo: an explanatory model. Acta Psychol (Amst). 2022; 227:103613.
- 7Osinubi O, Grainge MJ, Hong L, et al. The prevalence of psychological comorbidity in people with vitiligo: a systematic review and meta-analysis. Br J Dermatol. 2018; 178(4): 863-878.
- 8Patel KR, Singam V, Rastogi S, Lee HH, Silverberg NB, Silverberg JI. Association of vitiligo with hospitalization for mental health disorders in US adults. J Eur Acad Dermatol Venereol. 2019; 33(1): 191-197.
- 9Benros ME, Pedersen MG, Rasmussen H, Eaton WW, Nordentoft M, Mortensen PB. A nationwide study on the risk of autoimmune diseases in individuals with a personal or a family history of schizophrenia and related psychosis. Am J Psychiatry. 2014; 171(2): 218-226.
- 10Papadopoulos L, Bor R, Legg C, Hawk JL. Impact of life events on the onset of vitiligo in adults: preliminary evidence for a psychological dimension in aetiology. Clin Exp Dermatol. 1998; 23(6): 243-248.
- 11Bowden J, Davey Smith G, Burgess S. Mendelian randomization with invalid instruments: effect estimation and bias detection through egger regression. Int J Epidemiol. 2015; 44(2): 512-525.
- 12Burgess S, Timpson NJ, Ebrahim S, Davey SG. Mendelian randomization: where are we now and where are we going? Int J Epidemiol. 2015; 44(2): 379-388.
- 13Burgess S, Butterworth A, Thompson SG. Mendelian randomization analysis with multiple genetic variants using summarized data. Genet Epidemiol. 2013; 37(7): 658-665.
- 14Burgess S, Thompson SG. CRP CHD genetics collaboration. Avoiding bias from weak instruments in Mendelian randomization studies. Int J Epidemiol. 2011; 40(3): 755-764.
- 15Jin Y, Andersen G, Yorgov D, et al. Genome-wide association studies of autoimmune vitiligo identify 23 new risk loci and highlight key pathways and regulatory variants. Nat Genet. 2016; 48(11): 1418-1424.
- 16 1000 Genomes Project Consortium, Abecasis GR, Auton A, et al. An integrated map of genetic variation from 1,092 human genomes. Nature. 2012; 491(7422): 56-65.
- 17Freuer D, Linseisen J, Meisinger C. Association between inflammatory bowel disease and both psoriasis and psoriatic arthritis: a bidirectional 2-sample Mendelian randomization study. JAMA Dermatol. 2022; 158(11): 1262-1268.
- 18Wray NR, Ripke S, Mattheisen M, et al. Genome-wide association analyses identify 44 risk variants and refine the genetic architecture of major depression. Nat Genet. 2018; 50(5): 668-681.
- 19Otowa T, Hek K, Lee M, et al. Meta-analysis of genome-wide association studies of anxiety disorders. Mol Psychiatry. 2016; 21(10): 1391-1399.
- 20Watanabe K, Jansen PR, Savage JE, et al. Genome-wide meta-analysis of insomnia prioritizes genes associated with metabolic and psychiatric pathways. Nat Genet. 2022; 54(8): 1125-1132.
- 21Trubetskoy V, Pardiñas AF, Qi T, et al. Mapping genomic loci implicates genes and synaptic biology in schizophrenia. Nature. 2022; 604(7906): 502-508.
- 22Mullins N, Forstner AJ, O'Connell KS, et al. Genome-wide association study of more than 40,000 bipolar disorder cases provides new insights into the underlying biology. Nat Genet. 2021; 53(6): 817-829.
- 23 International obsessive compulsive disorder foundation genetics collaborative (IOCDF-GC) and OCD collaborative genetics association studies (OCGAS). Revealing the complex genetic architecture of obsessive-compulsive disorder using meta-analysis. Mol Psychiatry. 2018; 23(5): 1181-1188.
- 24Demontis D, Walters GB, Athanasiadis G, et al. Genome-wide analyses of ADHD identify 27 risk loci, refine the genetic architecture and implicate several cognitive domains. Nat Genet. 2023; 55(2): 198-208.
- 25Verbanck M, Chen CY, Neale B, Do R. Detection of widespread horizontal pleiotropy in causal relationships inferred from Mendelian randomization between complex traits and diseases. Nat Genet. 2018; 50(5): 693-698.
- 26Bowden J, Davey Smith G, Haycock PC, Burgess S. Consistent estimation in Mendelian randomization with some invalid instruments using a weighted median estimator. Genet Epidemiol. 2016; 40(4): 304-314.
- 27Shen S, Chu M, Miao H, et al. Assessment of relationships between bullous pemphigoid and neurological diseases: a bidirectional two-sample Mendelian randomization study. Exp Dermatol. 2023; 29. doi:10.1111/exd.14869. Online ahead of print.
10.1111/exd.14869 Google Scholar
- 28Jin C, Li R, Deng T, et al. Association between dried fruit intake and pan-cancers incidence risk: a two-sample Mendelian randomization study. Front Nutr. 2022; 9:899137.
- 29Bowden J, Spiller W, Del Greco MF, et al. Improving the visualization, interpretation and analysis of two-sample summary data Mendelian randomization via the radial plot and radial regression. Int J Epidemiol. 2018; 47(6): 2100.
- 30Burgess S. Sample size and power calculations in Mendelian randomization with a single instrumental variable and a binary outcome. Int J Epidemiol. 2014; 43(3): 922-929.
- 31Di Bartolomeo L, Custurone P, Irrera N, et al. Vitiligo and mental health: natural Compounds' usefulness. Antioxid Basel Switz. 2023; 12(1): 176.
- 32Liu JW, Tan Y, Chen T, Liu W, Qian YT, Ma DL. Location, spreading and Oral corticosteroids are associated with insomnia in vitiligo patients: a case-control study. Clin Cosmet Investig Dermatol. 2021; 14: 971-980.
- 33Salman A, Kurt E, Topcuoglu V, Demircay Z. Social anxiety and quality of life in vitiligo and acne patients with facial involvement: a cross-sectional controlled study. Am J Clin Dermatol. 2016; 17(3): 305-311.
- 34Linthorst Homan MW, Spuls PI, de Korte J, Bos JD, Sprangers MA, van der Veen JPW. The burden of vitiligo: patient characteristics associated with quality of life. J Am Acad Dermatol. 2009; 61(3): 411-420.
- 35Dutton M, Can AT, Lagopoulos J, Hermens DF. Stress, mental disorder and ketamine as a novel, rapid acting treatment. Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol. 2022; 65: 15-29.
- 36Mosenson JA, Zloza A, Klarquist J, Barfuss AJ, Guevara-Patino JA, Poole ICL. HSP70i is a critical component of the immune response leading to vitiligo. Pigment Cell Melanoma Res. 2012; 25(1): 88-98.
- 37Xu Z, Chen D, Hu Y, et al. Anatomically distinct fibroblast subsets determine skin autoimmune patterns. Nature. 2022; 601(7891): 118-124.
- 38Tulic MK, Cavazza E, Cheli Y, et al. Innate lymphocyte-induced CXCR3B-mediated melanocyte apoptosis is a potential initiator of T-cell autoreactivity in vitiligo. Nat Commun. 2019; 10(1): 2178.
- 39Khandaker GM, Dantzer R, Jones PB. Immunopsychiatry: important facts. Psychol Med. 2017; 47(13): 2229-2237.
- 40Mehta D. The genetic double whammy - autoimmune and mental health disorders. Brain Behav Immun. 2020; 89: 7-8.
- 41Liu X, Nudel R, Thompson WK, et al. Genetic factors underlying the bidirectional relationship between autoimmune and mental disorders - findings from a Danish population-based study. Brain Behav Immun. 2021; 91: 10-23.
- 42Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009; 71(2): 171-186.
- 43Haapakoski R, Mathieu J, Ebmeier KP, Alenius H, Kivimäki M. Cumulative meta-analysis of interleukins 6 and 1β, tumour necrosis factor α and C-reactive protein in patients with major depressive disorder. Brain Behav Immun. 2015; 49: 206-215.
- 44Najjar S, Pearlman DM, Alper K, Najjar A, Devinsky O. Neuroinflammation and psychiatric illness. J Neuroinflammation. 2013; 10: 43.
- 45Goldsmith DR, Rapaport MH, Miller BJ. A meta-analysis of blood cytokine network alterations in psychiatric patients: comparisons between schizophrenia, bipolar disorder and depression. Mol Psychiatry. 2016; 21(12): 1696-1709.
- 46Miller BJ, Buckley P, Seabolt W, Mellor A, Kirkpatrick B. Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry. 2011; 70(7): 663-671.
- 47Haroon E, Raison CL, Miller AH. Psychoneuroimmunology meets neuropsychopharmacology: translational implications of the impact of inflammation on behavior. Neuropsychopharmacol off Publ Am Coll Neuropsychopharmacol. 2012; 37(1): 137-162.
- 48Zandi MS, Irani SR, Lang B, et al. Disease-relevant autoantibodies in first episode schizophrenia. J Neurol. 2011; 258(4): 686-688.
- 49Pearlman DM, Najjar S. Meta-analysis of the association between N-methyl-d-aspartate receptor antibodies and schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder. Schizophr Res. 2014; 157(1–3): 249-258.
- 50Tylee DS, Sun J, Hess JL, et al. Genetic correlations among psychiatric and immune-related phenotypes based on genome-wide association data. Am J Med Genet Part B Neuropsychiatr Genet off Publ Int Soc Psychiatr Genet. 2018; 177(7): 641-657.
- 51Euesden J, Danese A, Lewis CM, Maughan B. A bidirectional relationship between depression and the autoimmune disorders – new perspectives from the national child development study. PLoS One. 2017; 12(3):e0173015.
- 52Sheth VM, Guo Y, Qureshi AA. Comorbidities associated with vitiligo: a ten-year retrospective study. Dermatology. 2013; 227(4): 311-315.
- 53Gey A, Diallo A, Seneschal J, et al. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms: autoimmune thyroid disease in vitiligo. Br J Dermatol. 2013; 168(4): 756-761.
- 54Cadmus SD, Lundgren AD, Ahmed AM. Therapeutic interventions to lessen the psychosocial effect of vitiligo in children: a review. Pediatr Dermatol. 2018; 35(4): 441-447.
- 55Ramien ML, Ondrejchak S, Gendron R, et al. Quality of life in pediatric patients before and after cosmetic camouflage of visible skin conditions. J Am Acad Dermatol. 2014; 71(5): 935-940.
- 56Zabetian S, Jacobson G, Lim HW, Eide MJ, Huggins RH. Quality of life in a vitiligo support group. J Drugs Dermatol JDD. 2017; 16(4): 344-350.
- 57Jha A, Mehta M, Khaitan B, Sharma V, Ramam M. Cognitive behavior therapy for psychosocial stress in vitiligo. Indian J Dermatol Venereol Leprol. 2016; 82(3): 308-310.