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Depressive symptoms in chronic hepatitis C are associated with plasma apolipoprotein E deficiency

Lookup NU author(s): Dr David Sheridan, Dr Simon Bridge, Dr Daniel Felmlee, Dr R Neely, Emeritus Professor Margaret Bassendine


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Neuro-psychiatric and cognitive disorders are frequent in patients with chronic hepatitis C (CHC) virus (HCV) infection which adversely impact quality of life, antiviral treatment adherence and outcome. HCV has neurotrophic properties and affects lipid metabolism, essential for cognitive function. We evaluated the relationship of lipid profiles with depression and anxiety symptoms and the effects of 12-weeks of therapy with fluvastatin and omega-3 ethyl esters (n-3 PUFA) in a randomised pilot study of CHC prior non-responders. Participants (n = 60) had fasting lipid profiles and assessment of depression and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS) questionnaire at each study visit. At screening 26/60 (43 %) had HADS-A score a parts per thousand yen8 and 13/60 (22 %) had HADS-D scores a parts per thousand yen8. Depressed patients had significantly lower apolipoprotein-E concentrations (30 mg/l vs 39 mg/l, P = 0.029) than those without depression and a tendency toward lower total cholesterol (3.8 vs 4.4 mmol/l, P = 0.053). 3 patients discontinued lipid-modifying treatment because of worsening depression. However, there was a small but significant improvement in anxiety symptoms after 12-weeks of high-dose (2-4 g daily) n-3 PUFA. In conclusion, depression in CHC is associated with plasma apoE deficiency. We postulate that apoE deficiency disrupts blood brain barrier integrity to promote HCV infection of the CNS. High-dose n-PUFAs may alleviate anxiety in some CHC patients but the use of lipid lowering therapy must be balanced against risks of worsening depression.

Publication metadata

Author(s): Sheridan DA, Bridge SH, Crossey MME, Felmlee DJ, Thomas HC, Neely RDG, Taylor-Robinson SD, Bassendine MF

Publication type: Article

Publication status: Published

Journal: Metabolic Brain Disease

Year: 2014

Volume: 29

Issue: 3

Pages: 625-634

Print publication date: 01/09/2014

Online publication date: 12/03/2014

Acceptance date: 26/02/2014

ISSN (print): 0885-7490

ISSN (electronic): 1573-7365

Publisher: Springer US


DOI: 10.1007/s11011-014-9520-9


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Funder referenceFunder name
G0502028Medical Research Council (UK)