Epigenetics and immunology: Under-recognized aspects of suicidality

Figure 3 The role of biomarkers in suicide risk assessment and future therapeutics. This conceptual illustration, based on the synthesis of recent literature, demonstrates the possible future directions for suicide risk assessment and personalized treatment strategies. On the left side, a potential future suicide risk assessment strategy is presented, in which various tools (peripheral blood biomarkers, neuroimaging, artificial intelligence technology) may aid the clinician in evaluating suicide risk. Increased or decreased levels of some of the potential immunological (interleukins, chemokines, etc.) and epigenetic biomarkers, are listed, based on reported associations in suicidality and depression. On the right side, possible future therapeutic options are presented for suicide risk alleviation and/or the treatment of underlying psychiatric disorders, that may be used in combination with established treatment options. Immune modulators and anti-inflammatory agents are listed, but not epigenetic modifiers, as there is stronger implication for the clinical implementation of the former. Blood-based biomarker measurement in peripheral blood, e.g., via enzyme-linked immunosorbent assay or multi-marker panels, could contribute to individualized risk profiling and thus enable personalized therapy. AI: Artificial intelligence; CRP: C-reactive protein; TNF-α: Tumor necrosis factor alpha; VEGF: Vascular endothelial growth factor; IL: Interleukin; CCL: Chemokine C-C motif ligand; CXCL: Chemokine (C-X-C motif) ligand; ELISA: Enzyme-linked immunosorbent assay; IFN-γ: Interferon gamma; SIRT: Sirtuin; P2X7: Purinoceptor 7; NLRP3: NLR family pyrin domain containing 3; ECT: Electroconvulsive therapy; TMS: Transcranial magnetic stimulation. Created in BioRender. Šmon J. (2025) https://BioRender.com/jm04fz5.