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de Bartolomeis A, De Simone G, De Prisco M, Barone A, Napoli R, Beguinot F, Billeci M, Fornaro M. Insulin effects on core neurotransmitter pathways involved in schizophrenia neurobiology: a meta-analysis of preclinical studies. Implications for the treatment. Mol Psychiatry 2023; 28:2811-2825. [PMID: 37085712 PMCID: PMC10615753 DOI: 10.1038/s41380-023-02065-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
Impairment of insulin action and metabolic dysregulation have traditionally been associated with schizophrenia, although the molecular basis of such association remains still elusive. The present meta-analysis aims to assess the impact of insulin action manipulations (i.e., hyperinsulinemia, hypoinsulinemia, systemic or brain insulin resistance) on glutamatergic, dopaminergic, γ-aminobutyric acid (GABA)ergic, and serotonergic pathways in the central nervous system. More than one hundred outcomes, including transcript or protein levels, kinetic parameters, and other components of the neurotransmitter pathways, were collected from cultured cells, animals, or humans, and meta-analyzed by applying a random-effects model and adopting Hedges'g to compare means. Two hundred fifteen studies met the inclusion criteria, of which 180 entered the quantitative synthesis. Significant impairments in key regulators of synaptic plasticity processes were detected as the result of insulin handlings. Specifically, protein levels of N-methyl-D-aspartate receptor (NMDAR) subunits including type 2A (NR2A) (Hedges' g = -0.95, 95%C.I. = -1.50, -0.39; p = 0.001; I2 = 47.46%) and 2B (NR2B) (Hedges'g = -0.69, 95%C.I. = -1.35, -0.02; p = 0.043; I2 = 62.09%), and Postsynaptic density protein 95 (PSD-95) (Hedges'g = -0.91, 95%C.I. = -1.51, -0.32; p = 0.003; I2 = 77.81%) were found reduced in insulin-resistant animal models. Moreover, insulin-resistant animals showed significantly impaired dopamine transporter activity, whereas the dopamine D2 receptor mRNA expression (Hedges'g = 3.259; 95%C.I. = 0.497, 6.020; p = 0.021; I2 = 90.61%) increased under insulin deficiency conditions. Insulin action modulated glutamate and GABA release, as well as several enzymes involved in GABA and serotonin synthesis. These results suggest that brain neurotransmitter systems are susceptible to insulin signaling abnormalities, resembling the discrete psychotic disorders' neurobiology and possibly contributing to the development of neurobiological hallmarks of treatment-resistant schizophrenia.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy.
| | - Giuseppe De Simone
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Michele De Prisco
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
- URT Genomic of Diabetes, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy
| | - Francesco Beguinot
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
- URT Genomic of Diabetes, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Michele Fornaro
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
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Zhang JP, Lencz T, Zhang RX, Nitta M, Maayan L, John M, Robinson DG, Fleischhacker WW, Kahn RS, Ophoff RA, Kane JM, Malhotra AK, Correll CU. Pharmacogenetic Associations of Antipsychotic Drug-Related Weight Gain: A Systematic Review and Meta-analysis. Schizophr Bull 2016; 42:1418-1437. [PMID: 27217270 PMCID: PMC5049532 DOI: 10.1093/schbul/sbw058] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although weight gain is a serious but variable adverse effect of antipsychotics that has genetic underpinnings, a comprehensive meta-analysis of pharmacogenetics of antipsychotic-related weight gain is missing. In this review, random effects meta-analyses were conducted for dominant and recessive models on associations of specific single nucleotide polymorphisms (SNP) with prospectively assessed antipsychotic-related weight or body mass index (BMI) changes (primary outcome), or categorical increases in weight or BMI (≥7%; secondary outcome). Published studies, identified via systematic database search (last search: December 31, 2014), plus 3 additional cohorts, including 222 antipsychotic-naïve youth, and 81 and 141 first-episode schizophrenia adults, each with patient-level data at 3 or 4 months treatment, were meta-analyzed. Altogether, 72 articles reporting on 46 non-duplicated samples (n = 6700, mean follow-up = 25.1wk) with 38 SNPs from 20 genes/genomic regions were meta-analyzed (for each meta-analysis, studies = 2-20, n = 81-2082). Eleven SNPs from 8 genes were significantly associated with weight or BMI change, and 4 SNPs from 2 genes were significantly associated with categorical weight or BMI increase. Combined, 13 SNPs from 9 genes (Adrenoceptor Alpha-2A [ADRA2A], Adrenoceptor Beta 3 [ADRB3], Brain-Derived Neurotrophic Factor [BDNF], Dopamine Receptor D2 [DRD2], Guanine Nucleotide Binding Protein [GNB3], 5-Hydroxytryptamine (Serotonin) Receptor 2C [HTR2C], Insulin-induced gene 2 [INSIG2], Melanocortin-4 Receptor [MC4R], and Synaptosomal-associated protein, 25kDa [SNAP25]) were significantly associated with antipsychotic-related weight gain (P-values < .05-.001). SNPs in ADRA2A, DRD2, HTR2C, and MC4R had the largest effect sizes (Hedges' g's = 0.30-0.80, ORs = 1.47-1.96). Less prior antipsychotic exposure (pediatric or first episode patients) and short follow-up (1-2 mo) were associated with larger effect sizes. Individual antipsychotics did not significantly moderate effect sizes. In conclusion, antipsychotic-related weight gain is polygenic and associated with specific genetic variants, especially in genes coding for antipsychotic pharmacodynamic targets.
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Affiliation(s)
- Jian-Ping Zhang
- *To whom correspondence should be addressed; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, 75-59 263rd Street, Glen Oaks, NY 11020, US; tel: 718-470-8471, fax: 718-470-1905, e-mail:
| | | | - Ryan X. Zhang
- Department of Psychology and Neuroscience, Duke University, Durham, NY
| | - Masahiro Nitta
- Drug Development Division, Sumitomo Dainippon Pharma Co. Ltd, Tokyo, Japan
| | - Lawrence Maayan
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Majnu John
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY;,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY;,Department of Mathematics, Hofstra University, Hempstead, NY
| | | | | | - Rene S. Kahn
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roel A. Ophoff
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - John M. Kane
- Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY
| | | | - Christoph U. Correll
- Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY,Both authors contributed equally to the article
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Association between GNB3 c.825C > T polymorphism and the risk of overweight and obesity: A meta-analysis. Meta Gene 2016; 9:18-25. [PMID: 27114919 PMCID: PMC4833052 DOI: 10.1016/j.mgene.2016.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/31/2016] [Accepted: 03/15/2016] [Indexed: 01/06/2023] Open
Abstract
Background The association between G protein β-polypeptide 3 gene (GNB3) c.825C > T polymorphism (rs5443) and the risk of overweight/obesity has been investigated in many published studies, but the results were conflicting and inconclusive. A meta-analysis was performed to make a more accurate assessment of the relationship. Methods The PubMed, ProQuest Health & Medical Complete, Web of Science, Chinese Biomedical Medical databases (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wan Fang databases were searched to identify eligible literatures. Pooled odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were used to assess the strength of association between GNB3 c.825C > T polymorphism and overweight/obesity. Results Eleven articles including 15 case–control studies with a total of 10,396 subjects (3171 cases of overweight/obesity and 7225 controls) were enrolled in the meta-analysis. The GNB3 c.825C > T was significantly associated with overweight/obesity under a recessive model (OR = 1.22, 95% CI: 1.04–1.44, P = 0.015). Moreover, the GNB3 825T allele was obviously associated with overweight alone in all inheritable models (P < 0.05) except in a recessive model (P = 0.084). In the stratification analysis by potential confounding variables, a significant association was observed between GNB3 c.825C > T polymorphism and overweight/obesity risk in males under an allelic model (P = 0.008), a homozygous model (P = 0.014), a recessive model (P = 0.005), and a dominant model (P = 0.049). And the results also showed that GNB3 c.825C > T polymorphism was significantly associated with overweight/obesity in subgroups of mean age less than 30 years, consistent with HWE, and high-quality studies (P = 0.027, P = 0.043, P = 0.040, respectively) under a recessive model, but not in other subgroups. Meta-regression also revealed that P value of HWE, publication year, and the quality scores of studies were the sources of heterogeneity in a recessive model and an allelic model. “Leave one out” sensitivity analyses indicated that the association was more significant after excluding some studies. The funnel plot and Egger's linear regression test and Begg's test revealed no apparent publication bias. Conclusion This meta-analysis suggests that the presence of TT homozygote might be one of the genetic factors susceptible to overweight/obesity and that males or aged under 30 years increase the genetic susceptibility.
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Key Words
- BMI, body mass index
- CBM, Chinese Biomedical Medical databases
- CIs, confidence intervals
- CNKI, Chinese National Knowledge Infrastructure
- G protein β-polypeptide 3
- GNB3, G protein β-polypeptide 3 gene
- HB, hospital based
- HWE, Hardy–Weinberg equilibrium
- MOOSE, guidelines from meta-analysis of observational studies in epidemiology
- Meta-analysis
- NOS, the Newcastle–Ottawa Quality Assessment Scale
- ORs, pooled odds ratios
- Obesity
- Overweight
- PB, population based
- PCR–RFLP, polymerase chain reaction–restriction fragment length polymorphism
- Polymorphism
- WHO, World Health Organization
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Chen PS, Chang HH, Huang CC, Lee CC, Lee SY, Chen SL, Huang SY, Yang YK, Lu RB. A longitudinal study of the association between the GNB3 C825T polymorphism and metabolic disturbance in bipolar II patients treated with valproate. THE PHARMACOGENOMICS JOURNAL 2016; 17:155-161. [PMID: 26856249 DOI: 10.1038/tpj.2015.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
This longitudinal study aimed to investigate the associations between the polymorphisms of guanine nucleotide-binding protein subunit β-3 (GNB3) C825T and metabolic disturbance in bipolar II disorder (BP-II) patients being treated with valproate (VPA). A 100 BP-II patients received a 12-week course of VPA treatment, and their body weight and metabolic indices were measured. At baseline, the GNB3 C825T polymorphisms were associated with the triglyceride level (P=0.032) in BP-II patients. During the VPA treatment course, the polymorphisms were not only associated with body mass index (BMI) and waist circumference (P-values=0.009 and 0.001, respectively), but also with total cholesterol, triglyceride, low-density lipoprotein and leptin levels (P-values=0.004, 0.002, 0.031 and 0.015, respectively). Patients with the TT genotype had a lower BMI, smaller waist circumference, and lower levels of lipids and leptin than those with the CT or CC genotypes undergoing the VPA treatment course.
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Affiliation(s)
- P S Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - H H Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C-C Huang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C C Lee
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - S-L Chen
- Department of Neurology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - S-Y Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Y K Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - R-B Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
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Tang H, McGowan OO, Reynolds GP. Polymorphisms of serotonin neurotransmission and their effects on antipsychotic drug action. Pharmacogenomics 2015; 15:1599-609. [PMID: 25340734 DOI: 10.2217/pgs.14.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The receptor pharmacology of many antipsychotic drugs includes actions at various serotonin (5-hydroxytryptamine [5-HT]) receptors. The 5-HT neurotransmitter system is thought to be involved in many of the consequences of treatment with antipsychotic drugs, including both symptom response, primarily of negative and depressive symptoms, and adverse effects, notably extrapyramidal side effects and weight gain. There is substantial interindividual variability in these drug effects, to which genetic variability contributes. We review here the influence of functional polymorphisms in genes associated with 5-HT function, including the various processes of neurotransmitter synthesis, receptors, transporters and metabolism, on the clinical response to, and adverse effects of, antipsychotic drugs. The relatively young field of epigenetics also contributes to the variability of 5-HT-related genes in influencing drug response. Several of these findings inform our understanding of the mechanisms of antipsychotic drug action, and also provide the opportunity for the development of genetic testing for personalized medicine.
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Affiliation(s)
- Hao Tang
- Department of Neurology, First People's Hospital of Yunnan Province, Kunming, 650021 China
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Brandl EJ, Kennedy JL, Müller DJ. Pharmacogenetics of antipsychotics. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:76-88. [PMID: 24881126 PMCID: PMC4079237 DOI: 10.1177/070674371405900203] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE During the past decades, increasing efforts have been invested in studies to unravel the influence of genetic factors on antipsychotic (AP) dosage, treatment response, and occurrence of adverse effects. These studies aimed to improve clinical care by predicting outcome of treatment with APs and thus allowing for individualized treatment strategies. We highlight most important findings obtained through both candidate gene and genome-wide association studies, including pharmacokinetic and pharmacodynamic factors. METHODS We reviewed studies on pharmacogenetics of AP response and adverse effects published on PubMed until early 2012. Owing to the high number of published studies, we focused our review on findings that have been replicated in independent studies or are supported by meta-analyses. RESULTS Most robust findings were reported for associations between polymorphisms of the cytochrome P450 system, the dopamine and the serotonin transmitter systems, and dosage, treatment response, and adverse effects, such as AP-induced weight gain or tardive dyskinesia. These associations were either detected for specific medications or for classes of APs. CONCLUSION First promising and robust results show that pharmacogenetics bear promise for a widespread use in future clinical practice. This will likely be achieved by developing algorithms that will include many genetic variants. However, further investigation is warranted to replicate and validate previous findings, as well as to identify new genetic variants involved in AP response and for replication of existing findings.
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Affiliation(s)
- Eva J Brandl
- Postdoctoral Research Fellow, Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario
| | - James L Kennedy
- Head, Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario; Director, Neuroscience Research Department, Neuroscience Department, CAMH, Toronto, Ontario; l'Anson Professor of Psychiatry and Medical Science, University of Toronto, Toronto, Ontario
| | - Daniel J Müller
- Head, Pharmacogenetics Research Clinic, Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario; Associate Professor, University of Toronto, Toronto, Ontario
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Cognitive Functions across the GNB3 C825T Polymorphism in an Elderly Italian Population. Neurol Res Int 2013; 2013:597034. [PMID: 24251036 PMCID: PMC3819753 DOI: 10.1155/2013/597034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/27/2013] [Indexed: 11/20/2022] Open
Abstract
To verify whether the C825T polymorphism of the GNB3 influences the response to neuropsychological tests, mini-mental state examination, digit span (DS), immediate and delayed prose memory, memory with interference at 10 and 30 seconds (MI 10 and 30), trail making tests (TMTs) A and B, abstraction task, verbal fluency (VF) test, figure drawing and copying, overlapping figures test and clock test were performed in 220 elderly men and women free from clinical dementia and from neurological and psychiatric diseases randomly taken from the Italian general population and analysed across the C825T polymorphism. The performance of DS, immediate and delayed prose memory, VF, and TMTs was worse in subjects who were TT for the polymorphism in comparison to the C-carriers. The performance of all tests declined with age. In the case of DS, immediate and delayed prose memory, MI 10 and VF, this trend was maintained in the C-carriers but not in TT. In the case of prose memory, of memory with interference, and of VF, schooling reduced the detrimental interaction between age and genotype. The C825T polymorphism of GNB3 gene therefore influences memory and verbal fluency, being additive to the effects of age and partially mitigated by schooling.
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Kumar R, Kohli S, Alam P, Barkotoky R, Gupta M, Tyagi S, Jain SK, Pasha MAQ. Interactions between the FTO and GNB3 genes contribute to varied clinical phenotypes in hypertension. PLoS One 2013; 8:e63934. [PMID: 23691120 PMCID: PMC3653800 DOI: 10.1371/journal.pone.0063934] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/10/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The genes FTO and GNB3 are implicated in essential hypertension but their interaction remains to be explored. This study investigates the role of interaction between the two genes in the pathophysiology of essential hypertension. METHODS/PRINCIPAL FINDINGS In a case-control study comprising 750 controls and 550 patients, interaction between the polymorphisms of FTO and GNB3 was examined using multifactor dimensionality reduction (MDR). The influence of interaction on clinical phenotypes like systolic and diastolic blood pressure, mean arterial pressure and body mass index was also investigated. The 3-locus MDR model comprising FTO rs8050136C/A and GNB3 rs1129649T/C and rs5443C/T emerged as the best disease conferring model. Moreover, the interacted-genotypes having either 1, 2, 3, 4 or 5 risk alleles correlated with linearly increasing odds ratios of 1.91 (P = 0.027); 3.93 (P = 2.08E-06); 4.51 (P = 7.63E-07); 7.44 (P = 3.66E-08) and 11.57 (P = 1.18E-05), respectively, when compared with interacted-genotypes devoid of risk alleles. Furthermore, interactions among haplotypes of FTO (H1-9) and GNB3 (Ha-d) differed by >1.5-fold for protective-haplotypes, CTGGC+TC [H2+Ha] and CTGAC+TC [H4+Ha] (OR = 0.39, P = 0.003; OR = 0.22, P = 6.86E-05, respectively) and risk-haplotypes, AAAGC+CT [H3+Hc] and AAAGC+TT [H3+Hd] (OR = 2.91, P = 9.98E-06; OR = 2.50, P = 0.004, respectively) compared to individual haplotypes. Moreover, the effectiveness of gene-gene interaction was further corroborated with a 1.29-, 1.25- and 1.38-fold higher SBP, MAP and BMI, respectively, in patients having risk interacted-haplotype H3+Hc and 2.48-fold higher SBP having risk interacted-haplotype H3+Hd compared to individual haplotypes. CONCLUSION Interactions between genetic variants of FTO and GNB3 influence clinical parameters to augment hypertension.
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Affiliation(s)
- Rahul Kumar
- Functional Genomics Unit, Council of Scientific and Industrial Research -Institute of Genomics and Integrative Biology, Delhi, India
- Department of Biotechnology, Hamdard University, New Delhi, India
| | - Samantha Kohli
- Functional Genomics Unit, Council of Scientific and Industrial Research -Institute of Genomics and Integrative Biology, Delhi, India
| | - Perwez Alam
- Functional Genomics Unit, Council of Scientific and Industrial Research -Institute of Genomics and Integrative Biology, Delhi, India
| | | | - Mohit Gupta
- Department of Cardiology, G. B. Pant hospital, New Delhi, India
| | - Sanjay Tyagi
- Department of Cardiology, G. B. Pant hospital, New Delhi, India
| | - S. K. Jain
- Department of Biotechnology, Hamdard University, New Delhi, India
| | - M. A. Qadar Pasha
- Functional Genomics Unit, Council of Scientific and Industrial Research -Institute of Genomics and Integrative Biology, Delhi, India
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Abstract
Metabolic disturbances are more prevalent in patients with schizophrenia (SCZ) than in the general population. The endocannabinoid system plays an important role in the regulation of dopamine transmission and several metabolic pathways, and the endocannabinoid receptor type 1 gene (CNR1) is considered a candidate gene for both SCZ and metabolic disorders. We examined whether genetic variation in CNR1 was associated with metabolic syndrome (MetS) in a naturalistic cohort of 407 patients with SCZ. The minor alleles of rs6928499, rs1535255, and rs2023239 were nominally associated with a lower risk of MetS [odds ratio (OR), 0.56; 95% confidence interval (CI), 0.37-0.84; P = 0.006; OR, 0.56; 95% CI, 0.37-0.84; P = 0.006; and OR, 0.44; 95% CI, 0.27-0.72; P = 0.001, respectively, adjusted for age, sex, duration of illness, clozapine or olanzapine treatment). These differences were mainly due to differences in high-density lipoprotein cholesterol and fasting glucose but not in body mass index or waist circumference. No significant association of the other polymorphisms (rs806377, rs1049353, rs6454674, and rs806379) with MetS was found. These results provide evidence that the prevalence of MetS is associated with the CNR1 gene in patients with SCZ during long-term treatment with antipsychotic treatment. Further studies are needed to uncover the exact molecular basis for this association, which could provide novel treatment targets for the MetS.
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Vitamin D insufficiency in obese patients with severe mental illness taking olanzapine. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2012. [DOI: 10.1007/s12349-012-0102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zhang JP, Malhotra AK. Pharmacogenetics of antipsychotics: recent progress and methodological issues. Expert Opin Drug Metab Toxicol 2012. [PMID: 23199282 DOI: 10.1517/17425255.2013.736964] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Antipsychotic drug is the mainstay of treatment for schizophrenia, and there are large inter-individual differences in clinical response and side effects. Pharmacogenetics provides a valuable tool to fulfill the promise of personalized medicine by tailoring treatment based on one's genetic markers. AREAS COVERED This article reviews the recent progress in pharmacogenetic research of antipsychotic drugs since 2010, focusing on two areas: antipsychotic-induced weight gain and clozapine-induced agranulocytosis. The article also provides discussion on the important methodological issues in this area of research. The specific aim of this article is to provide the reader with up-to-date evidence in pharmacogenetic research, and for them to gain familiarity to the issues and challenges facing the field. EXPERT OPINION Pharmacogenetic studies of antipsychotic drugs are promising despite many challenges. Recent advances as reviewed in this article push the field closer to routine clinical utilization of pharmacogenetic testing. Progress in genomic technology and bioinformatics, larger sample sizes, better phenotype characterization, and careful consideration of study design issues will help to elevate antipsychotic pharmacogenetics to its next level.
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Affiliation(s)
- Jian-Ping Zhang
- Feinstein Institute of Medical Research, Zucker Hillside Hospital, Division of Psychiatry Research, Department of Psychiatry, North Shore-Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
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Liou TH, Chen HH, Wang W, Wu SF, Lee YC, Yang WS, Lee WJ. ESR1, FTO, and UCP2 genes interact with bariatric surgery affecting weight loss and glycemic control in severely obese patients. Obes Surg 2012; 21:1758-65. [PMID: 21720911 DOI: 10.1007/s11695-011-0457-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Significant variability in weight loss and glycemic control has been observed in obese patients receiving bariatric surgery. Genetic factors may play a role in the different outcomes. METHODS Five hundred and twenty severely obese patients with body mass index (BMI) ≥35 were recruited. Among them, 149 and 371 subjects received laparoscopic adjustable gastric banding (LAGB) and laparoscopic mini-gastric bypass (LMGB), respectively. All individuals were genotyped for five obesity-related single nucleotide polymorphisms on ESR1, FTO, PPARγ, and UCP2 genes to explore how these genes affect weight loss and glycemic control after bariatric surgery at the 6th month. RESULTS Obese patients with risk genotypes on rs660339-UCP2 had greater decrease in BMI after LAGB compared to patients with non-risk genotypes (-7.5 vs. -6 U, p = 0.02). In contrast, after LMGB, obese patients with risk genotypes on either rs712221-ESR1 or rs9939609-FTO had significant decreases in BMI (risk vs. non-risk genotype, -12.5 vs. -10.0 U on rs712221, p = 0.02 and -12.1 vs. -10.6 U on rs9939609, p = 0.04) and a significant amelioration in HbA1c levels (p = 0.038 for rs712221 and p < 0.0001 for rs9939609). The synergic effect of ESR1 and FTO genes on HbA1c amelioration was greater (-1.54%, p for trend <0.001) than any of these genes alone in obese patients receiving LMGB. CONCLUSIONS The genetic variants in the ESR, FTO, and UCP2 genes may be considered as a screening tool prior to bariatric surgery to help clinicians predict weight loss or glycemic control outcomes for severely obese patients.
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Affiliation(s)
- Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Reduced prevalence of the C825T polymorphism of the G-protein beta subunit gene in women with breast cancer. Int J Biol Markers 2011; 26:234-40. [PMID: 22034052 DOI: 10.5301/jbm.2011.8751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the prevalence of the C825T polymorphism in the GNB3 gene in women with and without breast cancer and its possible association with clinical or pathological features of breast disease. SUBJECTS AND METHODS We included 134 women with breast cancer and a control group of 129 healthy women. The case group responded to a questionnaire on lifestyle, reproductive factors and family history. Clinical data were also evaluated. The risk for cancer was calculated and PCR was carried out for the detection of the polymorphism. Statistical analysis was performed using the package R Environment, with confidence intervals of 95% and a significance level of 5% (p and lt;0.05). RESULTS The frequency of the TT genotype was significantly greater in women of the control group (30.2%) than women with breast cancer (14.9%) (p=0.02). The polymorphism was not associated with clinical features, age at diagnosis (p=0.07), age at menarche (p=0.17), and age at menopause (p=0.60). The TT genotype did not have a higher frequency in patients with high BMI (p=0.98). The risk for cancer showed no correlation with the presence of the polymorphism. CONCLUSIONS Our data indicate that the C825T polymorphism in the GNB3 gene has no relationship to the risk for breast cancer or the characteristics of the disease.
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Risselada AJ, Mulder H, Heerdink ER, Egberts TCG. Pharmacogenetic testing to predict antipsychotic-induced weight gain: a systematic review. Pharmacogenomics 2011; 12:1213-27. [DOI: 10.2217/pgs.11.67] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Weight gain is an important side effect of antipsychotic drugs. Since the high interindividual difference in weight gain suggests that genetic factors play a role in this weight gain, studies have tried to identify these factors. Most of these studies were carried out in the past few years and focussed largely on receptor polymorphisms, although some tried to explain the variation in weight gain by differences in pharmacokinetics. Unfortunately, the results of these association studies are often conflicting, which makes it hard to apply this genetic knowledge in daily clinical practice. This article summarizes the findings of these association studies and focuses on differences in study methodology in an attempt to explain why study results could have been conflicting. Furthermore, the feasibility of genetic testing in today’s clinical practice is discussed, using a model that consists of four components; analytical validity, clinical validity, clinical utility and ethical, legal and social issues.
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Affiliation(s)
- Arne J Risselada
- Department of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, PO Box 30001, 9400 RA Assen, The Netherlands
| | - Hans Mulder
- Department of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, PO Box 30001, 9400 RA Assen, The Netherlands
| | - Eibert R Heerdink
- Department of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Chen PS, Yeh TL, Lee IH, Lin CB, Tsai HC, Chen KC, Chiu NT, Yao WJ, Yang YK, Chou YH. Effects of C825T polymorphism of the GNB3 gene on availability of dopamine transporter in healthy volunteers — A SPECT study. Neuroimage 2011; 56:1526-30. [DOI: 10.1016/j.neuroimage.2010.10.082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 09/30/2010] [Accepted: 10/30/2010] [Indexed: 10/18/2022] Open
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Zhang JP, Malhotra AK. Pharmacogenetics and antipsychotics: therapeutic efficacy and side effects prediction. Expert Opin Drug Metab Toxicol 2011; 7:9-37. [PMID: 21162693 DOI: 10.1517/17425255.2011.532787] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
IMPORTANCE OF THE FIELD Antipsychotic drug is the mainstay of treatment for schizophrenia, and there are large inter-individual differences in clinical response and side effects. Pharmacogenetics provides a valuable tool to fulfill the promise of personalized medicine by tailoring treatment based on one's genetic markers. AREAS COVERED IN THIS REVIEW This article reviews the pharmacogenetic literature from early 1990s to 2010, focusing on two aspects of drug action: pharmacokinetics and pharmacodynamics. Genetic variants in the neurotransmitter receptors including dopamine and 5-HT and metabolic pathways of drugs including CYP2D6 and COMT were discussed in association with clinical drug response and side effects. WHAT THE READER WILL GAIN Readers are expected to learn the up-to-date evidence in pharmacogenetic research and to gain familiarity to the issues and challenges facing the field. TAKE HOME MESSAGE Pharmacogenetic research of antipsychotic drugs is both promising and challenging. There is consistent evidence that some genetic variants can affect clinical response and side effects. However, more studies that are designed specifically to test pharmacogenetic hypotheses are clearly needed to advance the field.
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Affiliation(s)
- Jian-Ping Zhang
- The Zucker Hillside Hospital, Feinstein Institute of Medical Research, North Shore-Long Island Jewish Health System, Division of Psychiatry Research, Department of Psychiatry, Glen Oaks, NY 11004, USA.
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Correll CU, Lencz T, Malhotra AK. Antipsychotic drugs and obesity. Trends Mol Med 2010; 17:97-107. [PMID: 21185230 DOI: 10.1016/j.molmed.2010.10.010] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 12/15/2022]
Abstract
Mechanisms underlying antipsychotic cardiometabolic adverse effects are incompletely understood. This hampers the identification of high-risk patients, low-risk antipsychotics and preventive/ameliorative treatments. Recent clinical, molecular and genetic data suggest that: (i) antipsychotic-naïve samples provide the greatest power for mechanistic studies; (ii) weight and metabolic effects can be discordant, pointing to overlapping and distinct mechanisms; (iii) antipsychotics affect satiety and energy homeostasis signaling; (iv) the specific peptides mediating these effects are unknown but probably overlap with those involved in idiopathic obesity; and (v) single nucleotide polymorphisms in genes encoding known neurotransmitter receptors and metabolic proteins are promising pharmacogenomic targets for countering adverse affects. However, sophisticated molecular studies and genome-wide association studies, ideally in antipsychotic-naïve/first episode samples, are needed to further advance the field.
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C825T polymorphism of the GNB3 gene on valproate-related metabolic abnormalities in bipolar disorder patients. J Clin Psychopharmacol 2010; 30:512-7. [PMID: 20814328 DOI: 10.1097/jcp.0b013e3181f03f50] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Valproate (VPA) is a mood stabilizer for treating patients with bipolar disorder (BD). It may cause metabolic abnormalities in certain bipolar patients. However, the genetic factors that influence the susceptibility remain unclear. Genetic polymorphism of the G-protein β3 subunit (GNB3) is reported to be associated with metabolic phenotypes. In the current study, we investigated the possible associations between the GNB3 variation and VPA-induced metabolic abnormalities. METHODS Subjects (n = 96) who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for BD were recruited from the National Cheng Kung University Hospital. Their metabolic indices were measured. RESULTS The variation of GNB3 C825T showed an association with higher plasma total cholesterol (P = 0.037), triglyceride (P = 0.014), and leptin (P < 0.001) levels in BD patients treated with VPA. After adjusting for age, sex, types of BDs, and serum concentration of VPA, the variation of GNB3 C825T remained significantly associated with the levels of serum leptin and body mass index (BMI; P < 0.001 and P = 0.030, respectively). In addition, the GNB3 C825T showed significant drug-single-nucleotide polymorphism interactions with insulin levels (P = 0.033), triglyceride levels (P = 0.013), leptin levels (P = 0.013), and BMI (P = 0.018). These results indicated that the T allele may be associated with lower serum leptin levels and BMI in BD patients treated with VPA. CONCLUSIONS The current study provides evidence that BD patients who are T allele carriers of the GNB3 C825T polymorphism have a lower risk for VPA-induced metabolic abnormalities. Further studies about the underlying mechanisms of G protein in VPA-induced metabolic abnormalities are warranted.
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Maayan L, Correll CU. Management of antipsychotic-related weight gain. Expert Rev Neurother 2010; 10:1175-200. [PMID: 20586697 DOI: 10.1586/ern.10.85] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite variations across individuals and agents, antipsychotics are associated with clearly documented weight gain and adverse metabolic effects. Although increased appetite/caloric intake and various receptors, hormones and peptides have been implicated, biological mechanisms contributing to the increase in weight and glucose and lipid abnormalities with antipsychotics are largely unknown. This has hampered the creation of antipsychotics that are free of cardiometabolic effects, even in antipsychotic-naive/early-phase patients, as well as the development of strategies that can prevent or drastically diminish the adverse cardiometabolic effects. In general, three strategies can reduce the cardiometabolic risk of antipsychotics: switching to a less orexigenic/metabolically adverse antipsychotic; adjunctive behavioral treatments; and adjunctive pharmacologic interventions. However, each of these strategies has only been shown to be modestly effective. Among different behavioral interventions (N = 14, n = 746), group and individual treatment, dietary counseling and cognitive-behavioral therapy seem to be similarly effective. Among 15 different pharmacologic strategies (N = 35, n = 1629), only metformin, fenfluramine, sibutramine, topiramate and reboxetine were more effective than placebo, with the most evidence being available for metformin, and no head-to-head trials comparing individual pharmacologic interventions. However, even in the most successful trials the risk reduction was modest. Weight was not decreased to a pretreatment level, and despite superiority compared with placebo, weight gain still often occurred, particularly in antipsychotic-naive patients and when interventions were 'preventively' coinitiated with antipsychotics. Future research should focus on combining treatment modalities or agents and on exploring novel mechanism-based interventions.
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Affiliation(s)
- Lawrence Maayan
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Abstract
Currently available antipsychotic drugs (APDs) carry significant, though highly variable, liability to neurologic and metabolic side effects. Pharmacogenetics approaches offer the possibility of identifying patient-specific biomarkers for predicting risk of these side effects. To date, a few single nucleotide polymorphisms (SNPs) in a handful of genes have received convergent support across multiple studies. The primary focus has been on SNPs in dopamine and serotonin receptor genes: persuasive meta-analytic evidence exists for an effect of the dopamine D2 and D3 receptor genes (DRD2 and DRD3) in risk for tardr inesia (TD) and for an effect of variation at the receptor gene (HTR2C) for liability to APD-inducec gain. However, effect sizes appear to be modest, and pharmacoeconomic considerations have not been sufficiently studied, thereby limiting clinical applicability at this time. Effects of these genes and others on risk for TD, extrapyramidal side effects, hyperprolactinemia, and weight gain are revieved in this article.
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Affiliation(s)
- Todd Lencz
- Center for Translational Psychiatry, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
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Chabroux S, Haffen E, Penfornis A. [Diabetes and second-generation (atypical) antipsychotics]. ANNALES D'ENDOCRINOLOGIE 2009; 70:202-10. [PMID: 19700142 DOI: 10.1016/j.ando.2009.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 07/21/2009] [Indexed: 11/26/2022]
Abstract
Schizophrenia is a common psychiatric illness (1% of the general population), characterized by the association of positive and negative symptoms and cognitive disorders. Antipsychotics, typical or atypical, are known to induce in patients with schizophrenia weight gain and abnormalities in glucose and lipid metabolisms. These modifications, in addition to metabolic risk factors, intrinsic to the psychiatric illness (physical inactivity, smoking, diabetes), increase the risk of cardiovascular complications. Some antipsychotics are associated with a higher risk of metabolic disorders. Before starting such a medication, all risk factors must be taken into account. In case of even effectiveness, one should consider the risk of inducing metabolic disorders, as well as the intrinsic risk factors of the patient, in order to prescribe the medication associated with the lower metabolic risk. Regarding iatrogenic diabetes, the risk of occurrence seems different, depending on the molecules, being more marked for clozapine, olanzapine, risperidone, quietapine then amisulpride, aripiprazole and finally ziprasidone. The physiopathology seems to involve both an increase in insulin resistance and an alteration of insulin secretion. Nevertheless, the benefit/risk often remains largely in favour of treatment, the atypical antipsychotics are at least equally effective and better tolerated on the cognitive and neurological functions than conventional antipsychotics being. They have particularly far fewer extrapyramidal effects. The reversibility of pathologies induced by atypical antipsychotics led to the formulation of guidelines, leading to regular clinical and biological follow-up.
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Affiliation(s)
- S Chabroux
- Service d'endocrinologie-métabolisme et diabétologie-nutrition, pôle PACTE, hôpital Jean-Minjoz, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Park YM, Chung YC, Lee SH, Lee KJ, Kim H, Choi JE, Kang SG, Lee MS, Kim L, Lee HJ. G-protein beta3 Subunit Gene 825C/T Polymorphism Is Not Associated with Olanzapine-Induced Weight Gain in Korean Schizophrenic Patients. Psychiatry Investig 2009; 6:39-43. [PMID: 20046372 PMCID: PMC2796038 DOI: 10.4306/pi.2009.6.1.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 02/15/2009] [Accepted: 02/17/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Weight gain is a possible adverse effect of the use of antipsychotics, and is an important factor for long-term health and treatment compliance. Olanzapine is an atypical antipsychotic known to cause considerable weight gain. A relationship between weight gain and the G protein beta3 subunit gene (GNB3) 825C/T polymorphism has been reported. We therefore examined this possible association in a Korean schizophrenic patient group receiving olanzapine treatment. METHODS Weight and height measurements were obtained prior to starting olanzapine and measured again after long-term treatment. Genotyping for the 825C/T polymorphism was performed using a PCR-based method. RESULTS We found that long-term treatment with olanzapine resulted in mean gains in weight and body mass index (BMI) of 5.2 kg and 1.93 kg/m(2), respectively. There was a no significant difference in the mean body weight change from baseline to the endpoint after olanzapine treatment between the genotype groups (p=0.796). There were also no significant differences in genotype or allele frequencies between the severe weight-gain (more than 10%) and minimal weight-gain (less than 10%) groups (chi(2)=0.037, p=0.98; chi(2)=0.020, p=0.89). CONCLUSION The finding from this study thus does not support a relationship between the GNB3 825C/T polymorphism and weight gain in Korean schizophrenic patients receiving olanzapine treatment.
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Affiliation(s)
- Young-Min Park
- Department of Psychiatry, Inje University College of Medicine, Goyang, Korea
| | - Young-Cho Chung
- Department of Psychiatry, Inje University College of Medicine, Goyang, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University College of Medicine, Goyang, Korea
| | - Kang-Joon Lee
- Department of Psychiatry, Inje University College of Medicine, Goyang, Korea
| | - Hyun Kim
- Department of Psychiatry, Inje University College of Medicine, Goyang, Korea
| | - Jung-Eun Choi
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
- Division of Brain Korea 21 Biomedical Science, Korea University College of Medicine, Seoul, Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Leen Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
- Division of Brain Korea 21 Biomedical Science, Korea University College of Medicine, Seoul, Korea
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