Use of a gene expression signature to identify trimetazidine for repurposing to treat bipolar depression

Chiara C. Bortolasci, Srisaiyini Kidnapillai, Briana Spolding, Trang T. T. Truong, Timothy Connor, Courtney Swinton, Bruna Panizzutti, Zoe S. J. Liu, Andrew Sanigorski, Olivia M. Dean, Tamsyn Crowley, Mark Richardson, Kiymet Bozaoglu, Katerina Vlahos, Stephanie Cowdery, Brad Watmuff, Stephan F. Steyn, De Wet Wolmarans, Barend J. Engelbrecht, Christina PerryKatherine Drummond, Terence Pang, Stéphane Jamain, Laura Gray, Sean L. McGee, Brian H. Harvey, Jee Hyun Kim, Marion Leboyer, Michael Berk, Ken Walder*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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Objectives: The aim of this study was to repurpose a drug for the treatment of bipolar depression. Methods: A gene expression signature representing the overall transcriptomic effects of a cocktail of drugs widely prescribed to treat bipolar disorder was generated using human neuronal-like (NT2-N) cells. A compound library of 960 approved, off-patent drugs were then screened to identify those drugs that affect transcription most similar to the effects of the bipolar depression drug cocktail. For mechanistic studies, peripheral blood mononuclear cells were obtained from a healthy subject and reprogrammed into induced pluripotent stem cells, which were then differentiated into co-cultured neurons and astrocytes. Efficacy studies were conducted in two animal models of depressive-like behaviours (Flinders Sensitive Line rats and social isolation with chronic restraint stress rats). Results: The screen identified trimetazidine as a potential drug for repurposing. Trimetazidine alters metabolic processes to increase ATP production, which is thought to be deficient in bipolar depression. We showed that trimetazidine increased mitochondrial respiration in cultured human neuronal-like cells. Transcriptomic analysis in induced pluripotent stem cell-derived neuron/astrocyte co-cultures suggested additional mechanisms of action via the focal adhesion and MAPK signalling pathways. In two different rodent models of depressive-like behaviours, trimetazidine exhibited antidepressant-like activity with reduced anhedonia and reduced immobility in the forced swim test. Conclusion: Collectively our data support the repurposing of trimetazidine for the treatment of bipolar depression.

Original languageEnglish
Pages (from-to)661–670
Number of pages10
JournalBipolar Disorders
Issue number8
Early online date8 Mar 2023
Publication statusPublished - Dec 2023
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • bipolar depression
  • drug repurposing
  • gene expression signature
  • trimetazidine


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