Programa E-Health ICOnnecta't: un ecosistema para fomentar el bienestar en cáncer a través de la propuesta europea ONCOMMUN

Introducción: A pesar de que los tratamientos psico-oncológicos han demostrado su efectividad en disminuir el malestar emocional y mejorar la calidad de vida de las personas con cáncer, aún existen numerosas barreras que limitan su acceso. La transformación a online de esta atención se plantea como una solución para aumentar la cobertura del servicio y mejorar su coste-utilidad. Objetivo: Crear un ecosistema digital de salud para reducir el impacto del cáncer, aumentando el bienestar y la calidad de vida del ciudadano con cáncer. Método: Programa dirigido a pacientes diagnosticadas de cáncer de mama en fase de supervivencia aguda. Es un programa de atención escalonada dividido en 4 niveles de intervención jerarquizados por complejidad: Nivel 1, cribado y monitorización psicosocial; Nivel 2, Campus: psicoeducación y educación sanitaria; Nivel 3, soporte psicosocial comunitario; y Nivel 4, tratamiento psicoterapéutico grupal. Resultados: En 2019, 259 mujeres fueron incluidas en el programa (39,91% de los nuevos casos de cáncer de mama en los centros participantes). Solo el 3,47% (n = 9) requirió atención clínica especializada (Nivel 4). Conclusión: El programa Iconnecta't adopta un modelo integrado de atención psicosocial en cáncer que se adecúa a las necesidades específicas de los supervivientes. Da solución a algunas de las barreras de la atención sanitaria tradicional, democratizando el acceso a los servicios mediante el uso de tecnologías de uso común en la mayoría de ciudadanos. En un futuro próximo se prevé la implementación progresiva a otras neoplasias, junto con un ensayo clínico controlado y aleatorizado que evaluará su eficacia

Involvement of NRN1 gene in schizophrenia-spectrum and bipolar disorders and its impact on age at onset and cognitive functioning

Objectives Neuritin 1 gene (NRN1) is involved in neurodevelopment processes and synaptic plasticity and its expression is regulated by brain-derived neurotrophic factor (BDNF). We aimed to investigate the association of NRN1 with schizophrenia-spectrum disorders (SSD) and bipolar disorders (BPD), to explore its role in age at onset and cognitive functioning, and to test the epistasis between NRN1 and BDNF. Methods The study was developed in a sample of 954 SSD/BPD patients and 668 healthy subjects. Genotyping analyses included 11 SNPs in NRN1 and one functional SNP in BDNF. Results The frequency of the haplotype C-C (rs645649-rs582262) was significantly increased in patients compared to controls (P = 0.0043), while the haplotype T-C-C-T-C-A (rs3763180-rs10484320-rs4960155-rs9379002-rs9405890-rs1475157) was more frequent in controls (P = 3.1 × 10-5). The variability at NRN1 was nominally related to changes in age at onset and to differences in intelligence quotient, in SSD patients. Epistasis between NRN1 and BDNF was significantly associated with the risk for SSD/BPD (P = 0.005). Conclusions Results suggest that: (i) NRN1 variability is a shared risk factor for both SSD and BPD, (ii) NRN1 may have a selective impact on age at onset and intelligence in SSD, and (iii) the role of NRN1 seems to be not independent of BDNF

Genetic risk factors in Schizophrenia and Neurodevelopmental disorders: Association and epistatic analyses of Neuritin-1 gene and white matter related genes = Factores genéticos en esquizofrenia y enfermedades del neurodesarrollo: análisis de asociación y epistáticos en el gen Neuritina-1 y en genes relacionados con la materia blanca

[eng] Nowadays, it is estimated that about 450 million people suffer from a mental or behavioural disorder in the world. According to World health organization (WHO), 33% of the years lived with disability (YLD) are due to psychiatric disorders. In this regard, psychotic disorders including schizophrenia (SZ), remain one of the most mysterious and costliest mental disorders in terms of human suffering and social expenditure. In recent years, the field of molecular genetics has been uncovering evidence of the complex polygenetic architecture of SZ and related disorders. In addition, GWAS studies have identified several genes associated with SZ, which have been shown to converge in complex and identifiable molecular pathways related to synaptic plasticity, neurotransmission and connectivity processes. Also, these studies have reported an important genetic overlap across several psychiatric disorders such as Schizophrenia (SZ), Bipolar disorder (BPD), Major Depressive Disorder (MDD) or Autism Spectrum Disorders (ASD), which adds to the consideration of common pathophysiological mechanisms among these disorders. In this sense, a growing body of evidence has established that connectivity and synaptic plasticity, modulated by neuronal activity, is an inherent feature of brain function during both development and adulthood. The present dissertation hypothesizes that genetic variability of genes involved in either synaptic plasticity (NRN1, BDNF and DTNBP1) and/or white matter related pathways (and their interactions) will be associated with SSD. In addition, due to the clinical, cognitive, neuroimaging and genetic overlap observed across different psychiatric disorders, we also hypothesize that the studied genetic variability will be also associated with other neurodevelopmental psychiatric disorders, such as ASD and BPD. In this sense, four studies have been carried out. The first three studies, analyse genetic variability at Neuritin-1 gene (NRN1) and its relationship with the risk for developing SSD and BPD, and also with some clinical and cognitive phenotypes both in patients and in healthy subjects from the general population. Moreover, in these studies we also analyzed whether NRN1 action is modulated by other genes such as BDNF and DTNBP1. The fourth study analyses the integrative effects of a set of white matter related genes (Oligodendrocyte/myelination related genes - OMR) and its contribution to both SSD and ASD. Our results focused on the genetic variability at NRN1 gene, suggest that genetic variability of NRN1 gene has an impact on the risk for developing SSD/BPD and also on the presence of depressive symptoms in the general population. Its pleiotropic effect is also evidenced by its effect on different phenotypes: such as cognitive performance and age at onset. Moreover, our genexgene interaction results suggest that NRN1 action is modulated by the BDNF and DTNBP1 genes. On the other hand, the results of the fourth study suggest that some of the OMR genetic risk variants seem to be shared across SZ-ASD continuum. The fact that some OMR genes are marginally associated with both disorders and also, due to their involvement in the detected epistatic effects, seem to support the notion that dysregulation in myelination processes may underlie susceptibility to develop ASD or SSD. To conclude, further genetic studies are needed to elucidate the biological background underlying mental disorders, which can ultimately lead to better treatment in order to improve the quality life of the patients.[spa] Actualmente, se estima que alrededor de 450 millones de personas en el mundo sufren de un trastorno mental o de la conducta. Según la Organización Mundial de la Salud (OMS), el 33% de los años vividos con discapacidad (YLD) se asocian a trastornos psiquiátricos. En este sentido, los trastornos psicóticos, incluyendo la esquizofrenia (EQ), siguen siendo uno de los trastornos mentales más desconocidos y costosos en términos de sufrimiento humano y gasto social. En los últimos años, el campo de la genética molecular ha estado descubriendo evidencias acerca de la compleja arquitectura poligénica de la EQ y de otros trastornos relacionados. Además, los estudios GWAS han identificado varios genes asociados con EQ, los cuales se ha demostrado que convergen en vías moleculares complejas e identificables relacionados con la plasticidad sináptica, la neurotransmisión y los procesos de conectividad. Además, estos estudios han informado de un importante solapamiento genético a través de varios trastornos psiquiátricos como la esquizofrenia (EQ), el trastorno bipolar (TB), el trastorno depresivo mayor (TDM) o los trastornos del espectro autista (TEA), lo que se suma a la consideración de mecanismos fisiopatológicos comunes en estos trastornos. En este sentido, el creciente cuerpo de evidencias ha establecido que la conectividad y la plasticidad sináptica modulada por la actividad neuronal, es una característica inherente de la función cerebral durante el desarrollo y la edad adulta. La presente tesis plantea la hipótesis de que la variabilidad genética en genes implicados en la plasticidad sináptica (NRN1, BDNF y DTNBP1) y/o en las vías relacionadas con la materia blanca (y sus interacciones) se asociarán con Trastornos del Espectro de la Esquizofrenia (TEE). Además, debido al solapamiento clínico, cognitivo, de neuroimagen y genético observado a través de los diferentes trastornos psiquiátricos, también hipotetizamos que la variabilidad genética estudiada se asocia con otros trastornos psiquiátricos del neurodesarrollo, como el TEE y TEA. En este sentido, se han llevado a cabo cuatro estudios. Los tres primeros estudios analizan la variabilidad genética del gen Neuritin-1 (NRN1) y su relación con el riesgo de desarrollar TEE y TB, así como algunos fenotipos clínicos y cognitivos tanto en pacientes como en sujetos sanos de la población general. Además, en estos estudios también analizamos si la acción de NRN1 es modulada por otros genes como BDNF y DTNBP1. El cuarto estudio analiza los efectos integradores de un conjunto de genes relacionados con la materia blanca (genes relacionados con Oligodendrocitos/mielinización - OMR) y su contribución a TEE y TEA. Nuestros resultados centrados en la variabilidad genética del gen NRN1, sugieren que su variabilidad genética tendría un impacto en el riesgo de desarrollar TEE / TB y también en la presencia de síntomas depresivos en la población general. Este efecto pleiotrópico también se ve respaldado por sus efectos sobre otros fenotipos: como el rendimiento cognitivo y la edad de inicio. Además, nuestros resultados de interacción genéticas (gxg) sugieren que la acción de NRN1 es modulada por los genes BDNF y DTNBP1. Por otro lado, los resultados del cuarto estudio sugieren que algunas de las variantes de riesgo genético de los genes OMR parecen ser compartidas a través de del continuum TEE-TEA. El hecho de que algunos genes OMR estén ligeramente asociados con ambos trastornos, así como también, debido a su participación en los efectos epistáticos detectados, parece apoyar la noción de que la desregulación en los procesos de mielinización podría ser subyacente a la susceptibilidad para desarrollar TEE o TEA. Para concluir, se necesitan más estudios genéticos que ayuden a descifrar el trasfondo biológico subyacente a los trastornos mentales, lo que en última instancia puede conducir a un mejor tratamiento con el fin de mejorar la calidad de vida de los pacientes

Neurotrophins role in depressive symptoms and executive function performance: Association analysis of NRN1 gene and its interaction with BDNF gene in a non-clinical sample.

BACKGROUND: Neuritin-1 is a neurotrophic factor involved in synaptic plasticity that has been associated with depressive disorders, schizophrenia and cognitive performance. The study of genotype-phenotype relationships in healthy individuals is a useful framework to investigate the etiology of brain dysfunctions. We therefore aimed to investigate in a non-clinical sample whether NRN1 gene contributes to the psychopathological profile, with a particular focus on the clinical dimensions previously related to the NRN1 gene (i.e. depressive and psychotic). Furthermore, we aimed to analyze: i) the role of NRN1 on executive functions, ii) whether the association between either NRN1-psychopathological profile or NRN1-cognitive performance is moderated by the BDNF gene. METHODS: The sample comprised 410 non-clinical subjects who filled in the self-reported Brief Symptom Inventory (BSI) and were assessed for executive performance (Verbal Fluency, Wisconsin Card Sorting Test (WCST) and Letter-Number subscale (WAIS-III)). Genotyping included nine SNPs in NRN1 and one in BDNF. RESULTS: i) GG homozygotes (rs1475157-NRN1) showed higher scores on BSI depressive dimension and on total scores compared to A carriers (corrected p-values: 0.0004 and 0.0003, respectively). ii) a linear trend was detected between GG genotype of rs1475157 and a worse cognitive performance in WCST total correct responses (uncorrected p-value: 0.029). iii) Interaction between rs1475157-NRN1 and Val66Met-BDNF was found to modulate depressive symptoms (p=0.001, significant after correction). LIMITATIONS: Moderate sample size; replication in a larger sample is needed. CONCLUSIONS: NRN1 is associated with depressive symptoms and executive function in a non-clinical sample. Our results also suggest that the role of NRN1 seems to be modulated by BDNF

Association and epistatic analysis of white matter related genes across the continuum schizophrenia and autism spectrum disorders: The joint effect of NRG1-ErbB genes.

Background: Schizophrenia-spectrum disorders (SSD) and Autism spectrum disorders (ASD) are neurodevelopmental disorders that share clinical, cognitive, and genetic characteristics, as well as particular white matter (WM) abnormalities. In this study, we aimed to investigate the role of a set of oligodendrocyte/myelin-related (OMR) genes and their epistatic effect on the risk for SSD and ASD. Methods: We examined 108 SNPs in a set of 22 OMR genes in 1749 subjects divided into three independent samples (187 SSD trios, 915 SSD cases/control, and 91 ASD trios). Genetic association and gene-gene interaction analyses were conducted with PLINK and MB-MDR, and permutation procedures were implemented in both. Results: Some OMR genes showed an association trend with SSD, while after correction, the ones that remained significantly associated were MBP, ERBB3, and AKT1. Significant gene-gene interactions were found between (i) NRG1 MBP (perm p-value¼0.002) in the SSD trios sample, (ii) ERBB3 AKT1 (perm p-value¼0.001) in the SSD case-control sample, and (iii) ERBB3 QKI (perm p-value¼0.0006) in the ASD trios sample. Discussion: Our results suggest the implication of OMR genes in the risk for both SSD and ASD and highlight the role of NRG1 and ERBB genes. These findings are in line with the previous evidence and may suggest pathophysiological mechanisms related to NRG1/ERBBs signalling in these disorders