Another issue we are concerned with is the analyses of SNPs in or around NOTCH4 and their associations with gene expression. Dieset et al. observed significant effects of the SNPs on NOTCH4 expression only in healthy individuals but not in bipolar patients, although the effect went in the same direction. Are these significantly associated SNPs authentic genetic risk factors for bipolar disorder? We examined their associations with bipolar disorder in the case-control samples of European ancestries published by the Psychiatric GWAS Consortium (2), which are the largest samples so far. However, none of these SNPs were significant (Table 1), suggesting that they are not risk variants for bipolar disorder even if they show strong associations with NOTCH4 expression in healthy individuals. On the other hand, if the increased NOTCH4 expression in patients was related to genetic mechanisms in bipolar disorder, the gene may harbor unidentified SNPs that are significantly associated with up-regulated NOTCH4 expression in patients. We think these SNPs may be the authentic risk genetic variants for bipolar disorder, and we call for future studies.