Antipsychotic-induced epigenomic reorganization in frontal cortex of individuals with schizophrenia

Reviewer #1 (Public Review):

Zhu, et al present a genome-wide histone modification analysis comparing patients with schizophrenia (on or off antipsychotics) to non-psychiatric controls. The authors performed analyses across the dorsolateral prefrontal cortex and tested for enrichment of nearby genes and pathways. The authors performed an analysis measuring the effect of age on the epigenomic landscape as well. While this paper provides a unique resource around SCZ and its epigenetic correlates, and some potentially intriguing findings in the antipsychotic response dataset there were some potential missed opportunities - related to the integration of outside datasets and genotypes that could have strengthened the results and novelty of the paper.

Major Comments

1. Is there genotype data available for this cohort of donors or can it be generated? This would open several novel avenues of investigation for the authors. First the authors can test for enrichment of heritability for SCZ or even highly comorbid disorders such as bipolar. Second, it would allow the authors to directly measure the genetic regulation of histone markers by calculating QTLs (in this case histone hQTLs). The authors assert that although interesting, ATAC-seq approach does not provide the same chromatin state information as histone mods mapped by ChiP. Why do the authors not test this? There are several ATAC-seq datasets available for SCZ [https://pubmed.ncbi.nlm.nih.gov/30087329/]and an additional genomic overlap could help tease apart genetic regulation of the changes observed.

2. Can the authors theorize why their analysis found significant effects for H3K27Ac for antipsychotic use when a recent epigenomic study of SCZ using a larger cohort of samples and including the same histone modifications did not [https://pubmed.ncbi.nlm.nih.gov/30038276/]? Given the lower n and lower number of cells in this group, it would be helpful if the authors could speculate on why they see this. Do the authors know if there is any overlap with the Girdhar study donors or if there are other phenotypic differences that could account for this?

3. The reviewer is concerned about the low concordance between bulk nuclei RNA-seq and single-cell RNA-seq for SCZ (236 of 802 DEGs in NeuN+ and 63 of 1043 NEuN-). While it is not surprising for different cohorts to have different sets of DEGs these seem to be vastly different. Was there a particular cell type(s) that enriched for the authors' DEGs in the single-cell dataset? Do the authors know if any donors overlapped between these cohorts?

4. Functional enrichment analyses: details are not provided by the authors and should be added. The authors need to consider a) providing a gene universe, ie only considering the sets of genes with nearby H3K4me3/ H3K27ac levels, to such pathway tools, and b) should take into account the fact that some genes have many more peaks with data. There are known biases in seemingly just using the best p-value per gene in other epigenetic analysis (ie. DNA methylation data) and software is available to run correct analyses: https://pubmed.ncbi.nlm.nih.gov/23732277.

Reviewer #2 (Public Review):

The manuscript by Zhu has generated ChIP-seq and RNA-seq data from sizeable cohorts of SCZ patient samples and controls. The samples include 15 AF-SCZ samples and 15 controls, as well as 14 AT-SCZ samples and 14 controls. The genomics data was generated using techniques optimized for low-input samples: MOWChIP-seq and SMART-seq2 for histone profiles and transcriptome, respectively. The study has generated a significant data resource for the investigation of epigenomic alterations in SCZ. I am not convinced that the hierarchical pairwise design - first comparing AF-SCZ and AT-SCZ with their corresponding controls and secondarily contrasting the two comparisons is fully justified. The authors should repeat the statistical analysis by modeling all three groups simultaneously with an interaction effect for treatment or directly compare AF-SCZ to AT-SCZ groups and evaluate if the main conclusions remain supported.

Major comments

1. The manuscript did not discuss (mention) the quality control of RNA-seq data shown in Fig. 1B. The color scheme choice for the heatmap visualization did not provide a quantitative presentation of the specificity of the RNA-seq data. I would recommend using bar plots to present the results more quantitatively.

2. How does the specificity of this RNA-seq dataset compare to previous studies using a similar NeuN sorting strategy?

3. I appreciate the effort to assess the ChIP-seq data quality using phantompeakqualtools. However, prior knowledge/experience with this tool is required to fully understand the QC results. The authors should additionally provide browser shots at different scales for key neuronal/glial genes, so readers can have a more direct assessment of data quality, such as the enrichment of H3K4me3 at promoters (but not elsewhere), and H3K27ac at promoters and enhancers. Existing browser views, such as Fig. 2B are too zoomed out for assessing the data quality.

4. The pairwise regression model should be explicitly reported in methods.

5. The statistical strategy to compare AF-SCZ and AT-SCZ to their corresponding control groups was unjustified. Why not model all three groups simultaneously with an interaction effect for treatment or directly compare AF-SCZ to AT-SCZ groups? If the manuscript argues that the antipsychotic effect is the main novelty, why not directly compare AF-SCZ and AT-SCZ?

6. The method of pairwise comparison to corresponding control groups, then further comparing the pairwise results opens the study to a number of statistical vulnerabilities. For example, on page 12, the studies identified 166 DEGs between AF and control, and 1273 DEGs between AT and control. Instead of implicating a greater amount of difference between AT and control, such a result can often be driven by differences in between-group variance, rather than between-group means, that is, are the SCZ-AF and SCZ-treated effect size magnitudes and directionalities similar (but the treated group has lower variance) or are the two groups truly different in terms of means? The result in Fig. 5A suggests effect sizes for the two comparisons (AF-Ctrl and AT-Ctrl) are similar but have lower variability in the treated group.

7. The pairwise comparison further raised the possibility the results were driven by the difference in the two control cohorts rather than the two SCZ cohorts.