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Elsheikh SSM, Müller DJ, Pouget JG. Pharmacogenetics of Antipsychotic Treatment in Schizophrenia. Methods Mol Biol 2022; 2547:389-425. [PMID: 36068471 DOI: 10.1007/978-1-0716-2573-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Antipsychotics are the mainstay treatment for schizophrenia. There is large variability between individuals in their response to antipsychotics, both in efficacy and adverse effects of treatment. While the source of interindividual variability in antipsychotic response is not completely understood, genetics is a major contributing factor. The identification of pharmacogenetic markers that predict antipsychotic efficacy and adverse reactions is a growing area of research and holds the potential to replace the current trial-and-error approach to treatment selection in schizophrenia with a personalized medicine approach.In this chapter, we provide an overview of the current state of pharmacogenetics in schizophrenia treatment. The most promising pharmacogenetic findings are presented for both antipsychotic response and commonly studied adverse reactions. The application of pharmacogenetics to schizophrenia treatment is discussed, with an emphasis on the clinical utility of pharmacogenetic testing and directions for future research.
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Affiliation(s)
| | - Daniel J Müller
- The Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Jennie G Pouget
- The Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Taylor DL, Tiwari AK, Lieberman JA, Potkin SG, Meltzer HY, Knight J, Remington G, Müller DJ, Kennedy JL. Pharmacogenetic Analysis of Functional Glutamate System Gene Variants and Clinical Response to Clozapine. MOLECULAR NEUROPSYCHIATRY 2016; 2:185-197. [PMID: 28277565 DOI: 10.1159/000449224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 08/17/2016] [Indexed: 01/16/2023]
Abstract
Altered glutamate neurotransmission is implicated in the etiology of schizophrenia (SCZ) and the pharmacogenetics of response to clozapine (CLZ), which is the drug of choice for treatment-resistant SCZ. Response to antipsychotic therapy is highly variable, although twin studies suggest a genetic component. We investigated the association of 10 glutamate system gene variants with CLZ response using standard genotyping procedures. GRM2 (rs4067 and rs2518461), SLC1A2 (rs4354668, rs4534557, and rs2901534), SLC6A9 (rs12037805, rs1978195, and rs16831558), GRIA1 (rs2195450), and GAD1 (rs3749034) were typed in 163 European SCZ/schizoaffective disorder patients deemed resistant or intolerant to previous pharmacotherapy. Response was assessed following 6 months of CLZ monotherapy using change in Brief Psychiatric Rating Scale (BPRS) scores. Categorical and continuous response variables were analyzed using χ2 tests and analysis of covariance, respectively. We report no significant associations following correction for multiple testing. Prior to correction, nominally significant associations were observed for SLC6A9, SLC1A2, GRM2, and GRIA1. Most notably, CC homozygotes of rs16831558 located in the glycine transporter 1 gene (SLC6A9) exhibited an allele dose-dependent improvement in positive symptoms compared to T allele carriers (puncorrected = 0.008, pcorrected = 0.08). To clarify the role of SLC6A9 in clinical response to antipsychotic medication, and CLZ in particular, this finding warrants further investigation in larger well-characterized samples.
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Affiliation(s)
- Danielle L Taylor
- Neuroscience Research Department, Campbell Family Research Institute, Toronto, Ont., Canada; Institute of Medical Science, Toronto, Ont., Canada
| | - Arun K Tiwari
- Neuroscience Research Department, Campbell Family Research Institute, Toronto, Ont., Canada
| | - Jeffrey A Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, N.Y, USA
| | - Steven G Potkin
- Department of Psychiatry, University of California, Irvine, Calif, USA
| | - Herbert Y Meltzer
- Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
| | - Joanne Knight
- Neuroscience Research Department, Campbell Family Research Institute, Toronto, Ont., Canada; Institute of Medical Science, Toronto, Ont., Canada; Department of Psychiatry, University of Toronto, Toronto, Ont., Canada; Lancaster Medical School and Data Science Institute, Lancaster University, Lancaster, UK
| | - Gary Remington
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ont., Canada; Department of Psychiatry, University of Toronto, Toronto, Ont., Canada
| | - Daniel J Müller
- Neuroscience Research Department, Campbell Family Research Institute, Toronto, Ont., Canada; Institute of Medical Science, Toronto, Ont., Canada; Department of Psychiatry, University of Toronto, Toronto, Ont., Canada
| | - James L Kennedy
- Neuroscience Research Department, Campbell Family Research Institute, Toronto, Ont., Canada; Institute of Medical Science, Toronto, Ont., Canada; Department of Psychiatry, University of Toronto, Toronto, Ont., Canada
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Abstract
Antipsychotics are the mainstay treatment for schizophrenia. There is large variability between individuals in their response to antipsychotics, both in efficacy and adverse effects of treatment. While the source of interindividual variability in antipsychotic response is not completely understood, genetics is a major contributing factor. The identification of pharmacogenetic markers that predict antipsychotic efficacy and adverse reactions is a growing area of research, and holds the potential to replace the current trial-and-error approach to treatment selection in schizophrenia with a personalized medicine approach.In this chapter, we provide an overview of the current state of pharmacogenetics in schizophrenia treatment. The most promising pharmacogenetic findings are presented for both antipsychotic response and commonly studied adverse reactions. The application of pharmacogenetics to schizophrenia treatment is discussed, with an emphasis on the clinical utility of pharmacogenetic testing and directions for future research.
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Gerretsen P, Müller DJ, Tiwari A, Mamo D, Pollock BG. The intersection of pharmacology, imaging, and genetics in the development of personalized medicine. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20135894 PMCID: PMC3181934 DOI: 10.31887/dcns.2009.11.4/pgerretsen] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We currently rely on large randomized trials and meta-analyses to make clinical decisions; this places us at a risk of discarding subgroup or individually specific treatment options owing to their failure to prove efficacious across entire populations. There is a new era emerging in personalized medicine that will focus on individual differences that are not evident phenomenologically. Much research is directed towards identifying genes, endophenotypes, and biomarkers of disease that will facilitate diagnosis and predict treatment outcome. We are at the threshold of being able to predict treatment response, primarily through genetics and neuroimaging. In this review we discuss the most promising markers of treatment response and adverse effects emerging from the areas of pharmacogenetics and neuroimaging in depression and schizophrenia.
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Affiliation(s)
- Philip Gerretsen
- Centre for Addiction and Mental Health, University of Toronto, Canada
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Gupta M, Chauhan C, Bhatnagar P, Gupta S, Grover S, Singh PK, Purushottam M, Mukherjee O, Jain S, Brahmachari SK, Kukreti R. Genetic susceptibility to schizophrenia: role of dopaminergic pathway gene polymorphisms. Pharmacogenomics 2009; 10:277-91. [DOI: 10.2217/14622416.10.2.277] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We investigated 16 polymorphisms from three genes, dopamine receptor D2 (DRD2), catechol-O-methyl transferase (COMT) and brain derived neurotrophic factor (BDNF), which are involved in the dopaminergic pathways, and have been reported to be associated with susceptibility to schizophrenia and response to antipsychotic therapy. Materials & methods: Single-locus association analyses of these polymorphisms were carried out in 254 patients with schizophrenia and 225 controls, all of southern Indian origin. Additionally, multifactor-dimensionality reduction analysis was performed in 422 samples (243 cases and 179 controls) to examine the gene–gene interactions and to identify combinations of multilocus genotypes associated with either high or low risk for the disease. Results: Our results demonstrated initial significant associations of two SNPs for DRD2 (rs11608185, genotype: χ2 = 6.29, p-value = 0.043; rs6275, genotype: χ2 = 8.91, p-value = 0.011), and one SNP in the COMT gene (rs4680, genotype: χ2 = 6.67, p-value = 0.035 and allele: χ2 = 4.75, p-value = 0.029; odds ratio: 1.33, 95% confidence interval: 1.02–1.73), but not after correction for multiple comparisons indicating a weak association of individual markers of DRD2 and COMT with schizophrenia. Multifactor-dimensionality reduction analysis suggested a two locus model (rs6275/DRD2 and rs4680/COMT) as the best model for gene–gene interaction with 90% cross-validation consistency and 42.42% prediction error in predicting disease risk among schizophrenia patients. Conclusion: The present study thus emphasizes the need for multigene interaction studies in complex disorders such as schizophrenia and to understand response to drug treatment, which could lead to a targeted and more effective treatment.
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Affiliation(s)
- Meenal Gupta
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
| | - Chitra Chauhan
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
| | - Pallav Bhatnagar
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
| | - Simone Gupta
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
| | - Sandeep Grover
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
| | - Prashant K Singh
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
| | | | - Odity Mukherjee
- National Institute of Mental Health and Neuro Sciences, India
| | - Sanjeev Jain
- National Institute of Mental Health and Neuro Sciences, India
| | - Samir K Brahmachari
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
| | - Ritushree Kukreti
- Functional Genomics Unit, Institute of Genomics and Integrative Biology (Council of Scientific and Industrial Research), Mall Road, Delhi 110 007, India
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Kukreti R, Tripathi S, Bhatnagar P, Gupta S, Chauhan C, Kubendran S, Janardhan Reddy YC, Jain S, Brahmachari SK. Association of DRD2 gene variant with schizophrenia. Neurosci Lett 2005; 392:68-71. [PMID: 16183199 DOI: 10.1016/j.neulet.2005.08.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 08/24/2005] [Accepted: 08/27/2005] [Indexed: 10/25/2022]
Abstract
Schizophrenia is a complex multifactorial disorder for which the pathobiology still remains elusive. Dysfunction of the dopamine D2 receptor signaling has been associated with the illness, but numerous studies provide confounding results. This study investigates the association of synonymous polymorphisms (His313 and Pro319) in the dopamine D2 receptor gene with schizophrenia using a case-control approach, with 101 cases and 145 controls. Our results demonstrated that genotype distribution for the His313 polymorphism was significantly different between schizophrenia patients and control subjects (p=0.0012), while the Pro319 polymorphism did not show any association with the disease. The results suggest that the synonymous SNP His313 in DRD2 may be associated with the illness. However, there is a need for further replication studies with larger sample sets.
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Affiliation(s)
- Ritushree Kukreti
- GenoMed Lab, Gene Quest Laboratory, Nicholas Piramal India Ltd at Institute of Genomics and Integrative Biology, CSIR, Mall Road, Delhi 110007, India.
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Müller DJ, Klempan TA, De Luca V, Sicard T, Volavka J, Czobor P, Sheitman BB, Lindenmayer JP, Citrome L, McEvoy JP, Lieberman JA, Honer WG, Kennedy JL. The SNAP-25 gene may be associated with clinical response and weight gain in antipsychotic treatment of schizophrenia. Neurosci Lett 2005; 379:81-9. [PMID: 15823421 DOI: 10.1016/j.neulet.2004.12.037] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Revised: 12/13/2004] [Accepted: 12/16/2004] [Indexed: 10/25/2022]
Abstract
The synaptosomal-associated protein of 25 kDa (SNAP-25) is an essential component of the core complex that mediates presynaptic vesicle trafficking. Thus, SNAP-25 is directly involved in the release of neurotransmitters. Quantitative alterations of SNAP-25 expression have been reported in brain regions and cerebrospinal fluid (CSF) of schizophrenics and in haloperidol treated rats. This observed altered expression may be influenced by genetic variants of SNAP-25. We hypothesized that polymorphisms of the SNAP-25 gene (sites DdeI, MnlI and TaiI in the 3'UTR) are associated with antipsychotic drug response and induced weight gain. A sample of 59 patients with prior suboptimal response to antipsychotic treatment and diagnosed with DSM-IV schizophrenia or schizoaffective disorder was examined. Patients were administered clozapine, haloperidol, olanzapine or risperidone for up to 14 weeks. Clinical response was defined as the difference between the baseline and the endpoint total scores on the Positive and Negative Syndrome Scale (PANSS). Weight was assessed at baseline and at study endpoint. ANOVA revealed that the MnlI and TaiI polymorphisms were associated with response (F[2,53] = 4.57, p = 0.01 and F[2,52] = 3.53, p = 0.03) and with weight gain (F[2,52] = 4.28, p = 0.01 and F[2,51] = 3.38, p = 0.04). When covariates were included, the MnlI polymorphism remained significantly associated with changes of PANSS scores, but not with weight gain. The DdeI polymorphism was not associated with response or weight gain. These findings suggest that SNAP-25 gene variants affect clinical response in patients with prior poor response to antipsychotics. Weight changes do not seem to be associated with polymorphism of the SNAP-25 gene, however, replication in independent samples is warranted.
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Affiliation(s)
- Daniel J Müller
- Neurogenetics Section, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College Street R30, Toronto, Ont. M5T 1R8, Canada.
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