Skip to main content Accessibility help

Serum levels of carcinoembryonic antigen (CEA) in patients with bipolar disorder

  • Ibrahim Kaplan (a1), Mahmut Bulut (a2), Abdullah Atli (a2), Mehmet Güneş (a2), Mehmet Cemal Kaya (a2) and Leyla Çolpan (a1)...



Carcinoembryonic antigen (CEA) is an oncofetal glycoprotein that is widely used as a tumour marker in adenocarcinomas. However, several non-neoplastic conditions, including acute and chronic inflammation and other inflammation-related conditions, are characterised by increased CEA concentrations.

Bipolar disorder (BD) ranks seventh among the worldwide burden of non-fatal diseases. Inflammatory biomarkers have been considered as one of the main key pillars of a multifactorial approach for prediction of BD in an at-risk population.

BP is accompanied by activation of inflammatory, cell-mediated and negative immunoregulatory cytokines.


We measured the levels of CEA in serum samples from 44 individuals with euthymic BP out-patients and 45 healthy controls. Patients were diagnosed according to the DSM-IV criteria. CEA was measured by an electrochemiluminescence immunoassay.


The mean serum CEA concentration was 2.36±1.52 and 1.77±0.98 µg/l in patients and controls, respectively. CEA levels were significantly increased in euthymic BP patients when compared with controls (p=0.031).


This study suggests that CEA is increased in BD and supports a role for immune activation in the core pathological mechanisms of BP. CEA levels may be a secondary marker for diagnosing BP.


Corresponding author

Ibrahim Kaplan, Department of Medical Biochemistry, Medical Faculty, Dicle University, Diyarbakır, Turkey. Tel: +90 505 451 2025; Fax: +90 412 248 8520; E-mail:


Hide All
1.Hammarstrom, S. The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues. Semin Cancer Biol 1999;9:6781. [Epub 15 April 1999].
2.Yalta, K, Yilmaz, A, Turgut, OOet al. Evaluation of tumor markers CA-125 and CEA in acute myocardial infarction. Adv Ther 2006;23:10521059. [Epub 6 February 2007].
3.Ruibal Morell, A. CEA serum levels in non-neoplastic disease. Int J Biol Markers 1992;7:160166. [Epub 1 July 1992].
4.Fukuda, I, Yamakado, M, Kiyose, H. Influence of smoking on serum carcinoembryonic antigen levels in subjects who underwent multiphasic health testing and services. J Med Syst 1998;22:8993. [Epub 8 May 1998].
5.Witherspoon, LR, Shuler, SE, Alyea, K, Husserl, FE. Carcinoembryonic antigen: assay following heat compared with perchloric acid extraction in patients with colon cancer, non-neoplastic gastrointestinal diseases, or chronic renal failure. J Nucl Med 1983;24:916921. [Epub 1 October 1983].
6.Amino, N, Kuro, R, Yabu, Yet al. Elevated levels of circulating carcinoembryonic antigen in hypothyroidism. J Clin Endocrinol Metab 1981;52:457462. [Epub 1 March 1981].
7.Bulut, I, Arbak, P, Coskun, Aet al. Comparison of serum CA 19.9, CA 125 and CEA levels with severity of chronic obstructive pulmonary disease. Med Princ Pract 2009;18:289293. [Epub 6 June 2009].
8.Park, JS, Choi, GS, Jang, YS, Jun, SH, Kang, H. Influence of obesity on the serum carcinoembryonic antigen value in patients with colorectal cancer. Cancer Epidemiol, Biomarkers Prev 2010;19:24612468. [Epub 24 August 2010].
9.Ganguly, A, Yeltsin, E, Robbins, J. Identification of a carcinoembryonic antigen binding protein on monocytes. Biochem Biophys Res Commun 2003;311:319323. [Epub 1 November 2003].
10.Aarons, CB, Bajenova, O, Andrews, Cet al. Carcinoembryonic antigen-stimulated THP-1 macrophages activate endothelial cells and increase cell-cell adhesion of colorectal cancer cells. Clin Exp Metastasis 2007;24:201209. [Epub 10 May 2007].
11.Steinan, MK, Krane-Gartiser, K, Langsrud, K, Sand, T, Kallestad, H, Morken, G. Cognitive behavioral therapy for insomnia in euthymic bipolar disorder: study protocol for a randomized controlled trial. Trials 2014;15:24 [Epub 18 January 2014].
12.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Press, 1994.
13.Ghouse, AA, Sanches, M, Zunta-Soares, G, Swann, AC, Soares, JC. Overdiagnosis of bipolar disorder: a critical analysis of the literature. Sci World J 2013;2013:297087. [Epub 19 December 2013].
14.Goldstein, BI, Kemp, DE, Soczynska, JK, McIntyre, RS. Inflammation and the phenomenology, pathophysiology, comorbidity, and treatment of bipolar disorder: a systematic review of the literature. J Clin Psychiatry 2009;70:10781090. [Epub 6 June 2009].
15.Lotrich, FE, Butters, MA, Aizenstein, H, Marron, MM, Reynolds, CF, Gildengers, AG. The relationship between interleukin-1 receptor antagonist and cognitive function in older adults with bipolar disorder. Int J Geriatr Psych 2014;29:635644.
16.Berk, M, Kapczinski, F, Andreazza, ACet al. Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci Biobehav Rev 2011;35:804817.
17.Maes, M, Lin, AH, Verkerk, Ret al. Serotonergic and noradrenergic markers of post-traumatic stress disorder with and without major depression. Neuropsychopharmacol 1999;20:188197. [Epub 14 January 1999].
18.Brietzke, E, Mansur, RB, Soczynska, JK, Kapczinski, F, Bressan, RA, McIntyre, RS. Towards a multifactorial approach for prediction of bipolar disorder in at risk populations. J Affect Dis 2012;140:8291.
19.Kang, K, Kim, YJ, Kim, YHet al. Lithium pretreatment reduces brain injury after intracerebral hemorrhage in rats. Neurol Res 2012;34:447454. [Epub 28 March 2012].
20.Nahman, S, Belmaker, RH, Azab, AN. Effects of lithium on lipopolysaccharide-induced inflammation in rat primary glia cells. Innate Immun 2012;18:447458. [Epub 14 October 2011].
21.Xuan, AG, Long, DH, Li, JHet al. Neuroprotective effects of valproic acid following transient global ischemia in rats. Life Sci 2012;90:463468.
22.Akdemir, A, Turkcapar, MG, Orsel, SD, Demirergi, N, Dag, I, Ozbay, MH. Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Compr Psychiatry 2001;42:161165.
23.Karadag, F, Oral, E, Yalçın, F. Young Mani Derecelendirme Ölçeginin Türkiye’de geçerlik ve güvenirligi. Türk Psikiyatri Dergisi 2002;13:107114.
24.Fletcher, RH. Carcinoembryonic antigen. Ann Intern Med 1986;104:6673.
25.Bast, RC, Bates, S, Bredt, ABet al. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. J Clin Oncol 1996;14:28432877.
26.Aarons, CB, Bajenova, O, Andrews, Cet al. Carcinoembryonic antigen-stimulated THP-1 macrophages activate endothelial cells and increase cell-cell adhesion of colorectal cancer cells. Clin Exp Metastas 2007;24:201209.
27.Minami, S, Furui, J, Kanematsu, T. Role of carcinoembryonic antigen in the progression of colon cancer cells that express carbohydrate antigen. Cancer Res 2001;61:27322735.
28.No, JI, Yang, JY, Hyun, HJ, Yeon, CS, Choi, HJ. Factors associated with serum levels of carcinoembryonic antigen in healthy non-smokers. Korean J Fam Med 2013;34:413419.
29.Bae, U, Shim, JY, Lee, HR, Shin, JY. Serum carcinoembryonic antigen level is associated with arterial stiffness in healthy Korean adult. Clinica Chimica Acta 2013;415:286289.
30.Kim, KC, Kim, HB, Suh, JK, Lee, SS, Lew, YS, Lee, SJ. The relationship between blood glucose and tumor marker (CEA, CA19-9) in patients with NIDDM. J Korean Diabetes Assoc 1991;15:8589.
31.Hamdani, N, Tamouza, R, Leboyer, M. Immuno-inflammatory markers of bipolar disorder: a review of evidence. Front Biosci (Elite Ed) 2012;4:21702182. [Epub 29 December 2011].
32.Kunz, M, Cereser, KM, Goi, PDet al. Serum levels of IL-6, IL-10 and TNF-alpha in patients with bipolar disorder and schizophrenia: differences in pro- and anti-inflammatory balance. Rev Bras Psiquiatr 2011;33:268274. [Epub 18 March 2011].
33.Brietzke, E, Kapczinski, F. TNF-alpha as a molecular target in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:13551361.
34.O’Brien, SM, Scully, P, Scott, LV, Dinan, TG. Cytokine profiles in bipolar affective disorder: focus on acutely ill patients. J Affect Dis 2006;90:263267.
35.Ortiz, MB, Goin, M, Gomez de Alzaga, MB, Hammarstrom, S, Jimenez de Asua, L. Mevalonate dependency of the early cell cycle mitogenic response to epidermal growth factor and prostaglandin F2 alpha in Swiss mouse 3T3 cells. J Cell Physiol 1995;162:139146. [Epub 1 January 1995].
36.Kim, YK, Jung, HG, Myint, AM, Kim, H, Park, SH. Imbalance between pro-inflammatory and anti-inflammatory cytokines in bipolar disorder. J Affect Dis 2007;104:9195.
37.Andreazza, AC, Kauer-Sant’anna, M, Frey, BNet al. Oxidative stress markers in bipolar disorder: a meta-analysis. J Affect Dis 2008;111:135144. [Epub 10 June 2008].
38.Dickerson, F, Stallings, C, Origoni, A, Vaughan, C, Khushalani, S, Yolken, R. Elevated C-reactive protein and cognitive deficits in individuals with bipolar disorder. J Affect Dis 2013;150:456459. [Epub 21 May 2013].
39.Kauer-Sant’Anna, M, Kapczinski, F, Andreazza, ACet al. Brain-derived neurotrophic factor and inflammatory markers in patients with early- vs. late-stage bipolar disorder. Int J Neuropsychopharmacol 2009;12:447458. [Epub 6 September 2008].
40.Martínez-Arán, A, Vieta, E, Reinares, Met al. Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004;161:262270.
41.Stevens, DP, Mackay, IR. Increased carcinoembryonic antigen in heavy cigarette smokers. Lancet 1973;2:12381239. [Epub 1 December 1973].


Serum levels of carcinoembryonic antigen (CEA) in patients with bipolar disorder

  • Ibrahim Kaplan (a1), Mahmut Bulut (a2), Abdullah Atli (a2), Mehmet Güneş (a2), Mehmet Cemal Kaya (a2) and Leyla Çolpan (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed