Pathway-based polygenic risk implicates GO: 17144 drug metabolism in recurrent depressive disorder

Abstract

The Psychiatric Genomics Consortium (PGC) has made major advances in the molecular etiology of MDD, confirming that MDD is highly polygenic, with any top risk loci conferring a very small proportion of variance in case-control status (1). Pathway enrichment results from PGC meta-analyses can also be used to help inform molecular drug targets. Prior to any knowledge of molecular biomarkers for MDD, drugs targeting molecular pathways have proved successful in treating MDD. However, it is possible that with information from PGC analyses, examining specific molecular pathway(s) implicated in MDD can further inform our study of molecular drug targets. Using a large case-control GWAS based on low-coverage whole genome sequencing (N = 10,640), we derived polygenic risk scores for MDD and for MDD specific to each of over 300 molecular pathways. We then used these data to identify sets of scores significantly predictive of case status, accounting for critical covariates. Over and above global polygenic risk for MDD, polygenic risk within the GO: 17144 drug metabolism pathway significantly predicted recurrent depression. In transcriptomic analyses, two pathway genes yielded suggestive signals at FDR q-values = .054: CYP2C19 (family of Cytochrome P450) and CBR1 (Carbonyl Reductase 1). Because the neuroleptic carbamazepine is a known inducer of CYP2C19, future research might examine whether drug metabolism PRS has any influence on clinical presentation and treatment response. Overall, results indicate that pathway-based risk might inform treatment of severe depression. We discuss limitations to the generalizability of these preliminary findings, and urge replication in future research.