Identifying the Biological Pathways Involved in Bipolar Disorder Progression, Part 2

Stuart McKinlay, BHSc, McMaster University, Sonya Grewal, BSc, St. Michael's Hospital, Unity Health Toronto, and Bianca Wollenhaupt de Aguiar, BSc, MSc, PhD, McMaster University, examine the clinical implications and applications of their recent study for the treatment of bipolar disorder. 

In part 2 of this Q&A, McKinlay, Grewal, and Wollenhaupt de Aguiar discuss what clinicians can take away from their results and where future research needs to go. 

"Biomarkers of neuroprogression and late staging in bipolar disorder: A systematic review" was recently published in the Australian & New Zealand Journal of Psychiatry.

Catch up on part 1 here: Bipolar Disorder Progression Associated With Increase in Ventricular Size, Authors Say

Editor's Note: Answers have been lightly edited for clarity. 

Evi Arthur, Associate Digital Editor, Psych Congress Network: What practical applications of your findings exist for clinicians treating patients with bipolar disorder?

McKinlay, Grewal, and Wollenhaupt de Aguiar: Progressive inflammatory processes and brain alterations appear to be associated with illness progression in bipolar disorder. Through the principles of neuroprogression, inflammation, and neuroanatomical changes are proposed to be positively associated with cognitive and functional impairment. Therefore, it is important to identify bipolar disorder early in its course. According to the literature, bipolar disorder may also be a risk factor for major comorbidities including dementia, anxiety, and cardiovascular disease. The development of dementia, furthermore, is proposed to increase inflammation in patients through a recurrent feedback-loop of neuroprogressive deterioration. Consequently, identifying biological pathways that may be involved in illness progression is imperative to improve our understanding of the complex pathophysiology of bipolar disorder. In that sense, our findings offer clinicians a timely literature review that summarizes the current body of research in the field.

Arthur, PCN: Are you conducting any more research in this area, and what other studies do you feel are needed?

McKinlay, Grewal, and Wollenhaupt de Aguiar: Our research group continues to study the pathophysiology of bipolar disorder across various research projects. Based on the findings of this systematic review, most notably, we observed significant heterogeneity in the way that staging models were applied, which ultimately made it difficult to compare results across studies. Therefore, our suggestions for future research include the standardization of nomenclature in the use of clinical staging models across the field. We also believe that there is a strong need for more longitudinal cohort studies to better understand the progressive changes in biomarkers associated with illness progression in bipolar disorder.

Arthur, PCN: Any final thoughts or takeaways for clinicians pertaining to this research?

McKinlay, Grewal, and Wollenhaupt de Aguiar: Given that bipolar disorder has been associated with a progressive course of illness in a subset of patients, the development and implementation of a standardized nomenclature for clinical staging models is crucial to provide further understanding about the biological basis underlying illness progression in bipolar disorder. Through further research in the field, clinical staging models may help to improve early recognition and diagnosis and become an important part of future clinical practice.  

Stuart McKinlay, BHSc, completed his bachelor of health sciences (Honours) at McMaster University in 2021. He is a current student of the MD program at the University of Toronto (Class of 2026). His research interests include exploring the etiology and pathophysiological mechanisms associated with bipolar disorder. He is also interested in health services research, with a focus on integrated care delivery and long-term patient health outcomes. 

Sonya Grewal, BSc, is a research coordinator in the genomics health services and policy research program at St. Michael's Hospital, Unity Health Toronto. She completed her BSc at McMaster University in the Integrated Science program, where her undergraduate honours thesis focused on understanding biological pathways involved in bipolar disorder. Sonya is an incoming MSc student in Health Services Research at the University of Toronto, and her current research interests lie in clinical genomics and identifying best practices to enhance EDI in health services.

Bianca Wollenhaupt de Aguiar, BSc, MSc, Ph.D., is the research laboratory manager at the centre for clinical neurosciences in the department of psychiatry and behavioural neurosciences at McMaster University (Canada), where she focuses on translational projects aiming to understand the pathophysiology of bipolar disorder. Dr Wollenhaupt de Aguiar graduated in biomedical sciences with a Master's in medical sciences and a Ph.D. in biochemistry at the Federal University of Rio Grande do Sul (UFRGS), Brazil. She completed a Postdoctoral fellowship at the Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA) in 2016, and a Postdoctoral fellowship at the Department of Psychiatry and Behavioral Neurosciences at McMaster University, Canada, in 2021. Dr. Wollenhaupt de Aguiar’s research has been focused on the study of the molecular and neurobiological basis of psychiatric disorders, with an emphasis on bipolar disorder, since 2007.