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Li T, Hu K, Ye L, Ma J, Huang L, Guo C, Huang X, Jiang J, Xie X, Guo C, He Q. Association of Antipsychotic Drugs with Venous Thromboembolism: Data Mining of Food and Drug Administration Adverse Event Reporting System and Mendelian Randomization Analysis. J Atheroscler Thromb 2024; 31:396-418. [PMID: 38030236 PMCID: PMC10999720 DOI: 10.5551/jat.64461] [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] [Received: 07/04/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS Past observational studies have reported on the association between antipsychotic drugs and venous thromboembolism (VTE); however, the conclusions remain controversial, and its mechanisms are yet to be fully understood. Thus, in this study, we aim to determine the associations of antipsychotic drugs with VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), and their potential mechanisms. METHODS We first mined the adverse event signals of VTE, DVT, and PE caused by antipsychotic drugs in Food and Drug Administration Adverse Event Reporting System (FAERS). Next, we used two-sample Mendelian randomization (MR) method to investigate the association of antipsychotic drug target gene expression with VTE, DVT, and PE, using single-nucleotide polymorphisms as genetic instruments. We not only used the expression of all antipsychotic drug target genes as exposure to perform MR analyses but also analyzed the effect of single target gene expression on the outcomes. RESULTS In the FAERS, 1694 cases of VTE events were reported by 16 drugs. However, using the MR approach, no significant association was determined between the expression of all antipsychotic target genes and VTE, DVT, or PE, either in blood or brain tissue. Although the analysis of single gene expression data showed that the expression of nine genes was associated with VTE events, these targets lacked significant pharmacological action. CONCLUSIONS Adverse event mining results have supported the claim that antipsychotic drugs can increase the risk of VTE. However, we failed to find any genetic evidence for this causal association and potential mechanisms. Thus, vigilance is still needed for antipsychotic drug-related VTE despite the limited supporting evidence.
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Affiliation(s)
- Tong Li
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Kai Hu
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, P.R. China
- Clinical Research Center for Epileptic disease of Hunan Province, Central South University, Hunan, P.R. China
| | - Ling Ye
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Junlong Ma
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Longjian Huang
- Youjiang Medical University for Nationalities, Guangxi, P.R. China
| | - Chengjun Guo
- School of Applied Mathematics, Guangdong University of Technology, Guangdong, P.R. China
| | - Xin Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Jie Jiang
- Department of Pediatrics, The Affiliated Changsha Central Hospital, University of South China Hengyang Medical School,University of South China, Hunan, P.R. China
| | - Xiaoxue Xie
- Department of Radiotherapy, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Hunan, P.R. China
| | - Chengxian Guo
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Qingnan He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
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Moon JJ, Kim HS, Shim JC, Ahn JM, Jung DU, Kim DJ, Jeong HE, Kim EY, Jeon DW, Kim SJ, Shin JG. Possible genetic biomarker associated with antipsychotic-induced amenorrhea in female patients with schizophrenia. Int Clin Psychopharmacol 2024; 39:29-35. [PMID: 37551597 DOI: 10.1097/yic.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
This study explored the association of pharmacogenomics with antipsychotic-induced amenorrhea in female patients with schizophrenia. A total of 89 female schizophrenia patients aged 18-40 receiving consistent antipsychotics at a consistent dose for more than 3 months were enrolled in this study. Amenorrhea was defined as the absence of menstrual period for 3 months or three periods in a row. Serum levels of prolactin, estradiol, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone were measured and Cytochrome P450 2D6, dopamine receptor D2 ( DRD2 ) and estrogen receptor 1 were genotyped. Twenty-two patients with amenorrhea had higher prolactin levels and lower estradiol levels than those without amenorrhea (94.1 vs. 71.5 ng/ml for prolactin; P = 0.044 and 27.0 vs. 46.7 pg/ml for estradiol; P = 0.007, respectively). Multiple logistic regression analysis identified DRD2 -141C deletion [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.01-4.17; P = 0.049] and drugs increasing prolactin levels (OR = 6.17, 95% CI = 1.28-29.64; P = 0.023) as significant covariates for antipsychotic-induced amenorrhea. This study suggests that DRD2 -141C deletion is associated with antipsychotic-induced amenorrhea although further studies are needed.
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Affiliation(s)
- Jung-Joon Moon
- Department of Psychiatry, Inje University Busan Paik Hospital
| | - Ho-Sook Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine
| | | | - Jung-Mee Ahn
- Department of Psychiatry, Inje University Busan Paik Hospital
| | - Do-Un Jung
- Department of Psychiatry, Inje University Busan Paik Hospital
| | - Dong-Jin Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine
| | - Hye-Eun Jeong
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine
| | - Eun-Young Kim
- Department of Clinical Pharmacology, Inje University Busan Paik Hosptial
| | - Dong-Wook Jeon
- Department of Psychiatry, Inje University Busan Paik Hospital
| | - Sung-Jin Kim
- Department of Psychiatry, Inje University Busan Paik Hospital
| | - Jae-Gook Shin
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine
- Department of Clinical Pharmacology, Inje University Busan Paik Hosptial
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
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Thanos PK, Hanna C, Mihalkovic A, Hoffman A, Posner A, Butsch J, Blum K, Georger L, Mastrandrea LD, Quattrin T. Genetic Correlates as a Predictor of Bariatric Surgery Outcomes after 1 Year. Biomedicines 2023; 11:2644. [PMID: 37893019 PMCID: PMC10603884 DOI: 10.3390/biomedicines11102644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
This study analyzed genetic risk assessments in patients undergoing bariatric surgery to serve as a predictive factor for weight loss parameters 1 year after the operation. Thirty (30) patients were assessed for Genetic Addiction Risk Severity (GARS), which analyzes neurogenetic polymorphisms involved in addiction and reward deficiency. Genetic and psychosocial data collected before the operation were correlated with weight loss data, including changes in weight, body mass index (BMI), and percent of expected weight loss (%EWL). Results examined correlations between individual gene risk alleles, 1-year body weight data, and psychosocial trait scores. Spearman's correlations revealed that the OPRM1 (rs1799971) gene polymorphism had significant negative correlation with 1-year weight (rs = -0.4477, p < 0.01) and BMI (rs = -0.4477, p < 0.05). In addition, the DRD2 risk allele (rs1800497) was correlated negatively with BMI at 1 year (rs = -0.4927, p < 0.05), indicating that one risk allele copy was associated with lower BMI. However, this allele was positively correlated with both ∆Weight (rs = 0.4077, p < 0.05) and %EWL (rs = 0.5521, p < 0.05) at 1 year post-surgery. Moreover, the overall GARS score was correlated with %EWL (rs = 0.4236, p < 0.05), ∆Weight (rs = 0.3971, p < 0.05) and ∆BMI (rs = 0.3778, p < 0.05). Lastly, Food Cravings Questionnaire (FCQ) scores were negatively correlated with %EWL (rs = -0.4320, p < 0.05) and ∆Weight at 1 year post-surgery (rs = -0.4294, p < 0.05). This suggests that individuals with a higher genetic addiction risk are more responsive to weight loss treatment, especially in the case of the DRD2 polymorphism. These results should translate clinically to improve positivity and attitude related to weight management by those individuals born with the risk alleles (rs1800497; rs1799971).
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Affiliation(s)
- Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
| | - Colin Hanna
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
| | - Abrianna Mihalkovic
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
| | - Aaron Hoffman
- Department of Surgery, Methodist Hospital Medical Center, Dallas, TX 75208, USA
| | - Alan Posner
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - John Butsch
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Kenneth Blum
- Division of Nutrigenomics, SpliceGen, Therapeutics, Inc., Austin, TX 78701, USA;
- Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Center, Dayton, OH 45435, USA
- Division of Addiction Research & Education, Center for Exercise Sports & Global Mental Health, Western University Health Sciences, Pomona, CA 91766, USA
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA
- Institute of Psychology, ELTE Eötvös Loránd University, 1075 Budapest, Hungary
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, West Bengal, India
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Lesley Georger
- Department of Natural Sciences and Mathematics, D’Youville University, Buffalo, NY 14201, USA;
| | - Lucy D. Mastrandrea
- UBMD Pediatrics, JR Oishei Children’s Hospital, University at Buffalo, Buffalo, NY 14203, USA (T.Q.)
| | - Teresa Quattrin
- UBMD Pediatrics, JR Oishei Children’s Hospital, University at Buffalo, Buffalo, NY 14203, USA (T.Q.)
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Teng Y, Sandhu A, Liemburg EJ, Naderi E, Alizadeh BZ. The Progress and Pitfalls of Pharmacogenetics-Based Precision Medicine in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:jpm13030471. [PMID: 36983653 PMCID: PMC10052041 DOI: 10.3390/jpm13030471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
The inadequate efficacy and adverse effects of antipsychotics severely affect the recovery of patients with schizophrenia spectrum disorders (SSD). We report the evidence for associations between pharmacogenetic (PGx) variants and antipsychotics outcomes, including antipsychotic response, antipsychotic-induced weight/BMI gain, metabolic syndrome, antipsychotic-related prolactin levels, antipsychotic-induced tardive dyskinesia (TD), clozapine-induced agranulocytosis (CLA), and drug concentration level (pharmacokinetics) in SSD patients. Through an in-depth systematic search in 2010–2022, we identified 501 records. We included 29 meta-analyses constituting pooled data from 298 original studies over 69 PGx variants across 39 genes, 4 metabolizing phenotypes of CYP2D9, and 3 of CYP2C19. We observed weak unadjusted nominal significant (p < 0.05) additive effects of PGx variants of DRD1, DRD2, DRD3, HTR1A, HTR2A, HTR3A, and COMT (10 variants) on antipsychotic response; DRD2, HTR2C, BDNF, ADRA2A, ADRB3, GNB3, INSIG2, LEP, MC4R, and SNAP25 (14 variants) on weight gain; HTR2C (one variant) on metabolic syndrome; DRD2 (one variant) on prolactin levels; COMT and BDNF (two variants) on TD; HLA-DRB1 (one variant) on CLA; CYP2D6 (four phenotypes) and CYP2C19 (two phenotypes) on antipsychotics plasma levels. In the future, well-designed longitudinal naturalistic multi-center PGx studies are needed to validate the effectiveness of PGx variants in antipsychotic outcomes before establishing any reproducible PGx passport in clinical practice.
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Affiliation(s)
- Yuxin Teng
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Amrit Sandhu
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Edith J. Liemburg
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Elnaz Naderi
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA
| | - Behrooz Z. Alizadeh
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Correspondence: ; Tel.: +31-0361-1987
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Faron-Górecka A, Latocha K, Pabian P, Kolasa M, Sobczyk-Krupiarz I, Dziedzicka-Wasylewska M. The Involvement of Prolactin in Stress-Related Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3257. [PMID: 36833950 PMCID: PMC9959798 DOI: 10.3390/ijerph20043257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
The most important and widely studied role of prolactin (PRL) is its modulation of stress responses during pregnancy and lactation. PRL acts as a neuropeptide to support physiological reproductive responses. The effects of PRL on the nervous system contribute to a wide range of changes in the female brain during pregnancy and the inhibition of the hypothalamic-pituitary axis. All these changes contribute to the behavioral and physiological adaptations of a young mother to enable reproductive success. PRL-driven brain adaptations are also crucial for regulating maternal emotionality and well-being. Hyperprolactinemia (elevated PRL levels) is a natural and beneficial phenomenon during pregnancy and lactation. However, in other situations, it is often associated with serious endocrine disorders, such as ovulation suppression, which results in a lack of offspring. This introductory example shows how complex this hormone is. In this review, we focus on the different roles of PRL in the body and emphasize the results obtained from animal models of neuropsychiatric disorders.
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Affiliation(s)
- Agata Faron-Górecka
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Katarzyna Latocha
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Paulina Pabian
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Magdalena Kolasa
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Iwona Sobczyk-Krupiarz
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Marta Dziedzicka-Wasylewska
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
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6
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Nguyen HD, Jo WH, Hoang NHM, Kim MS. Risperidone ameliorated 1,2-Diacetylbenzene-induced cognitive impairments in mice via activating prolactin signaling pathways. Int Immunopharmacol 2023; 115:109726. [PMID: 36641890 DOI: 10.1016/j.intimp.2023.109726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/26/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Cognitive impairment and organic solvent exposure have been becoming public health concerns due to an increasingly aging population, increased life expectancy, urbanization, and industrialization. Converging evidence indicates the link between 1,2-diacetylbenzene (DAB), prolactin (PRL), risperidone, and cognitive impairment. However, these relationships remain unclear. We investigated the therapeutic properties of risperidone in DAB-induced cognitive impairment using both in vivo and in silico methods. Risperidone alleviated DAB-induced cognitive impairment in hippocampal mice, possibly by inhibiting GSK-3β, β-amyloid, CDK5, BACE, and tau hyperphosphorylation. Risperidone also attenuated the activation of TREM-1/DAP12/NLRP3/caspase-1/IL-1β, and TLR4/NF-κB pathways caused by DAB. Furthermore, risperidone inhibited DAB-induced oxidative stress, advanced glycation end products, and proinflammatory cytokines, as well as increased the expression of Nrf2, IL-10, Stat3, MDM2, and catalase activity. On the other hand, risperidone activated the expression of IRS1, PI3K, AKT, BDNF, Drd2, Scna5, and Trt as well as reduced the Bax/Bcl2 ratio and Caspase-3 levels. In silico analyses identified the prolactin signaling pathway, miR-155-5p, miR-34a-5p, and CEBPB as the main molecular mechanisms involved in the pathophysiology of DAB-induced cognitive impairment and targeted by risperidone. Our results suggest that risperidone could be used to treat cognitive impairment caused by organic solvents, especially DAB.
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Affiliation(s)
- Hai Duc Nguyen
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Won Hee Jo
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Ngoc Hong Minh Hoang
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Min-Sun Kim
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon 57922, Republic of Korea.
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Vasiliu O. The pharmacogenetics of the new-generation antipsychotics - A scoping review focused on patients with severe psychiatric disorders. Front Psychiatry 2023; 14:1124796. [PMID: 36873203 PMCID: PMC9978195 DOI: 10.3389/fpsyt.2023.1124796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Exploring the possible correlations between gene variations and the clinical effects of the new-generation antipsychotics is considered essential in the framework of personalized medicine. It is expected that pharmacogenetic data will be useful for increasing the treatment efficacy, tolerability, therapeutic adherence, functional recovery, and quality of life in patients with severe psychiatric disorders (SPD). This scoping review investigated the available evidence about the pharmacokinetics, pharmacodynamics, and pharmacogenetics of five new-generation antipsychotics, i.e., cariprazine, brexpiprazole, aripiprazole, lumateperone, and pimavanserin. Based on the analysis of 25 primary and secondary sources and the review of these agents' summaries of product characteristics, aripiprazole benefits from the most relevant data about the impact of gene variability on its pharmacokinetics and pharmacodynamics, with significant consequences on this antipsychotic's efficacy and tolerability. The determination of the CYP2D6 metabolizer status is important when administering aripiprazole, either as monotherapy or associated with other pharmacological agents. Allelic variability in genes encoding dopamine D2, D3, and serotonin, 5HT2A, 5HT2C receptors, COMT, BDNF, and dopamine transporter DAT1 was also associated with different adverse events or variations in the clinical efficacy of aripiprazole. Brexpiprazole also benefits from specific recommendations regarding the CYP2D6 metabolizer status and the risks of associating this antipsychotic with strong/moderate CYP2D6 or CYP3A4 inhibitors. US Food and Drug Administration (FDA) and European Medicines Agency (EMA) recommendations about cariprazine refer to possible pharmacokinetic interactions with strong CYP3A4 inhibitors or inducers. Pharmacogenetic data about cariprazine is sparse, and relevant information regarding gene-drug interactions for lumateperone and pimavanserin is yet lacking. In conclusion, more studies are needed to detect the influence of gene variations on the pharmacokinetics and pharmacodynamics of new-generation antipsychotics. This type of research could increase the ability of clinicians to predict favorable responses to specific antipsychotics and to improve the tolerability of the treatment regimen in patients with SPD.
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Affiliation(s)
- Octavian Vasiliu
- Department of Psychiatry, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
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Płaza O, Gałecki P, Orzechowska A, Gałecka M, Sobolewska-Nowak J, Szulc A. Pharmacogenetics and Schizophrenia-Can Genomics Improve the Treatment with Second-Generation Antipsychotics? Biomedicines 2022; 10:biomedicines10123165. [PMID: 36551925 PMCID: PMC9775397 DOI: 10.3390/biomedicines10123165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/19/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Schizophrenia (SCZ) is a complex psychiatric disorder of multifactorial origin, in which both genetic and environmental factors have an impact on its onset, course, and outcome. Large variability in response and tolerability of medication among individuals makes it difficult to predict the efficacy of a chosen therapeutic method and create universal and precise guidelines for treatment. Pharmacogenetic research allows for the identification of genetic polymorphisms associated with response to a chosen antipsychotic, thus allowing for a more effective and personal approach to treatment. This review focuses on three frequently prescribed second-generation antipsychotics (SGAs), risperidone, olanzapine, and aripiprazole, and aims to analyze the current state and future perspectives in research dedicated to identifying genetic factors associated with antipsychotic response. Multiple alleles of genes involved in pharmacokinetics (particularly isoenzymes of cytochrome P450), as well as variants of genes involved in dopamine, serotonin, and glutamate neurotransmission, have already been identified as ones of significant impact on antipsychotic response. It must, however, be noted that although currently obtained results are promising, trials with bigger study groups and unified protocols are crucial for standardizing methods and determining objective antipsychotic response status.
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Affiliation(s)
- Olga Płaza
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Partyzantów 2/4, 05-800 Pruszków, Poland
- Correspondence:
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Agata Orzechowska
- Department of Adult Psychiatry, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Małgorzata Gałecka
- Department of Psychotherapy, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Justyna Sobolewska-Nowak
- Department of Adult Psychiatry, Medical University of Łódź, Aleksandrowska 159, 91-229 Łódź, Poland
| | - Agata Szulc
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Partyzantów 2/4, 05-800 Pruszków, Poland
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The Gender-Specific Association of DRD2 Polymorphism with Metabolic Syndrome in Patients with Schizophrenia. Genes (Basel) 2022; 13:genes13081312. [PMID: 35893053 PMCID: PMC9331510 DOI: 10.3390/genes13081312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Metabolic syndrome is widespread in patients with schizophrenia receiving long-term antipsychotic therapy. Dopamine D2 receptors play an important role in mediating both the therapeutic actions of antipsychotics and their side effects. The present study examined the association of two polymorphisms of the DRD2 gene with metabolic syndrome in patients with schizophrenia. Methods: We examined 517 patients from several regions of Siberia (Russia) with a clinical diagnosis of schizophrenia. Genotyping of two single nucleotide polymorphisms rs1799732 and rs4436578 of the dopamine D2 receptor gene (DRD2) was performed in a population of 471 patients. The results were analyzed using chi-square tests. Results: Functional polymorphism rs1799732 of the DRD2 gene is associated with drug-induced metabolic syndrome in women with schizophrenia. Conclusions: Our results show that the DRD2 gene may be involved in the pathogenesis of metabolic disorders in patients with schizophrenia. Further analysis of possible genetic markers will allow for personalized treatment with minimal side effects and optimal efficacy. This which seems relevant in light of the recent focus on improving the quality of life and ensuring a high level of social adaptation of patients with schizophrenia.
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Koller D, Almenara S, Mejía G, Saiz-Rodríguez M, Zubiaur P, Román M, Ochoa D, Navares-Gómez M, Santos-Molina E, Pintos-Sánchez E, Abad-Santos F. Metabolic Effects of Aripiprazole and Olanzapine Multiple-Dose Treatment in a Randomised Crossover Clinical Trial in Healthy Volunteers: Association with Pharmacogenetics. Adv Ther 2021; 38:1035-1054. [PMID: 33278020 PMCID: PMC7889573 DOI: 10.1007/s12325-020-01566-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/07/2020] [Indexed: 12/11/2022]
Abstract
Introduction Aripiprazole and olanzapine are atypical antipsychotics. Both drugs can induce metabolic changes; however, the metabolic side effects produced by aripiprazole are more benign. The aim of the study was to evaluate if aripiprazole and olanzapine alter prolactin levels, lipid and glucose metabolism and hepatic, haematological, thyroid and renal function. Methods Twenty-four healthy volunteers received a daily oral dose of 10 mg aripiprazole and 5 mg olanzapine tablets for 5 days in a crossover randomised clinical trial and were genotyped for 51 polymorphisms in 18 genes by qPCR. Drug plasma concentrations were measured by LC–MS. The biochemical and haematological analyses were performed by enzymatic methods. Results Olanzapine induced hyperprolactinaemia but aripiprazole did not. Dopamine D3 receptor (DRD3) Ser/Gly and ATP binding cassette subfamily B member 1 (ABCB1) rs10280101, rs12720067 and rs11983225 polymorphisms and cytochrome P450 3A (CYP3A) phenotype had an impact on plasma prolactin levels. C-peptide concentrations were higher after aripiprazole administration and were influenced by catechol-O-methyltransferase (COMT) rs4680 and rs13306278 polymorphisms. Olanzapine and the UDP glucuronosyltransferase family 1 member A1 (UGT1A1) rs887829 polymorphism were associated with elevated glucose levels. CYP3A poor metabolizers had increased insulin levels. Volunteers’ weight decreased significantly during aripiprazole treatment and a tendency for weight gain was observed during olanzapine treatment. Triglyceride concentrations decreased as a result of olanzapine and aripiprazole treatment, and varied on the basis of CYP3A phenotypes and the apolipoprotein C-III (APOC3) rs4520 genotype. Cholesterol levels were also decreased and depended on 5-hydroxytryptamine receptor 2A (HTR2A) rs6314 polymorphism. All hepatic enzymes, platelet and albumin levels, and prothrombin time were altered during both treatments. Additionally, olanzapine reduced the leucocyte count, aripiprazole increased free T4 and both decreased uric acid concentrations. Conclusions Short-term treatment with aripiprazole and olanzapine had a significant influence on the metabolic parameters. However, it seems that aripiprazole provokes less severe metabolic changes. Trial Registration Clinical trial registration number (EUDRA-CT): 2018-000744-26 Graphical Abstract ![]()
Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01566-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dora Koller
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Susana Almenara
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Gina Mejía
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Miriam Saiz-Rodríguez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- Research Unit, Fundación Burgos Por La Investigación de La Salud, Hospital Universitario de Burgos, Burgos, Spain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Manuel Román
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Dolores Ochoa
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Marcos Navares-Gómez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Elena Santos-Molina
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Elena Pintos-Sánchez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
- UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.
- UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.
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11
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Zhang L, Qi H, Xie YY, Zheng W, Liu XH, Cai DB, Ng CH, Ungvari GS, Xiang YT. Efficacy and Safety of Adjunctive Aripiprazole, Metformin, and Paeoniae-Glycyrrhiza Decoction for Antipsychotic-Induced Hyperprolactinemia: A Network Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2021; 12:728204. [PMID: 34658963 PMCID: PMC8511431 DOI: 10.3389/fpsyt.2021.728204] [Citation(s) in RCA: 2] [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: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022] Open
Abstract
Aripiprazole, metformin, and paeoniae-glycyrrhiza decoction (PGD) have been widely used as adjunctive treatments to reduce antipsychotic (AP)-induced hyperprolactinemia in patients with schizophrenia. However, the comparative efficacy and safety of these medications have not been previously studied. A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety between aripiprazole, metformin, and PGD as adjunctive medications in reducing AP-induced hyperprolactinemia in schizophrenia. Both international (PubMed, PsycINFO, EMBASE, and Cochrane Library databases) and Chinese (WanFang, Chinese Biomedical, and Chinese National Knowledge infrastructure) databases were searched from their inception until January 3, 2019. Data were analyzed using the Bayesian Markov Chain Monte Carlo simulations with the WinBUGS software. A total of 62 RCTs with 5,550 participants were included in the meta-analysis. Of the nine groups of treatments included, adjunctive aripiprazole (<5 mg/day) was associated with the most significant reduction in prolactin levels compared to placebo (posterior MD = -65.52, 95% CI = -104.91, -24.08) and the other eight treatment groups. Moreover, adjunctive PGD (>1:1) was associated with the lowest rate of all-cause discontinuation compared to placebo (posterior odds ratio = 0.45, 95% CI = 0.10, 3.13) and adjunctive aripiprazole (>10 mg/day) was associated with fewer total adverse drug events than placebo (posterior OR = 0.93, 95% CI = 0.65, 1.77) and other eight treatment groups. In addition, when risperidone, amisulpride, and olanzapine were the primary AP medications, adjunctive paeoniae/glycyrrhiza = 1:1, aripiprazole <5 mg/day, and aripiprazole >10 mg/day were the most effective treatments in reducing the prolactin levels, respectively. Adjunctive aripiprazole, metformin, and PGD showed beneficial effects in reducing AP-induced hyperprolactinemia in schizophrenia, with aripiprazole (<5 mg/day) being the most effective one.
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Affiliation(s)
- Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Qi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yun-Yi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiao-Hui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia.,Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR China
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12
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Ivashchenko DV, Khoang SZ, Tazagulova MK, Makhmudova BV, Buromskaya NI, Shimanov PV, Deitch RV, Dorina IV, Nastovich MI, Akmalova KA, Kachanova AA, Grishina EA, Savchenko LM, Shevchenko YS, Sychev DA. The polymorphic variants DRD2 rs1800497 and ABCB1 3435C>T are associated with antipsychotic safety parameters in adolescents with an acute psychotic episode: the results of a pilot study. ACTA ACUST UNITED AC 2020. [DOI: 10.14412/2074-2711-2020-5-24-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Children and adolescents are more likely than adults to experience adverse side effects when taking antipsychotics. Pharmacogenetic testing allows one to more accurately choose the initial dose of a drug. The genes of pharmacokinetic factors have been shown to be of high prognostic value for the safety of antipsychotics in adults.Patients and methods. The study enrolled 36 adolescents (58.3% male) (mean age, 14.83±1.84 years). All the patients took an antipsychotic. The follow-up lasted 28 days. On 14 and 28 days of treatment, its efficiency and safety were evaluated using the Children's Global Assessment Scale (CGAS), the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersњgelser Side Effects Rating Scale (UKU-SERS), the Simpson-Angus Scale (SAS), and the Barnes Akathisia Rating Scale (BARS). The patients were genotyped for CYP3A4*22, CYP3A5*3, CYP2D6*4, *9, *10, ABCB1 1236C>T, 2677G>T/A, 3435C>T, DRD2 rs1800497, DRD4 rs1800955, and HTR2A rs6313.Results and discussion. The decrease in the mean score of the PANSS subscale “Productive symptoms” was more pronounced in carriers of the DRD2 rs1800497 polymorphic variant (-6.5 [-10.25; -3.75] vs -3 [-6.5; -2 ] on 14 day (p=0.028) and (-11 [-13; -9.5] vs -5 [-9; -3.5] on 28 day (p=0.001) compared to baseline. The carriage of ABCB1 3435CT+TT was associated with worse tolerance to pharmacotherapy on 14 day (the total score of the UKU-SERS M, 8 [3; 11.75] vs M, 2 [1; 6]; p=0.034). The carriers of DRD2 rs1800497 reported a greater severity of antipsychotic-induced neurological disorders (UKU-SERS subscale score M, 1 [0; 2.25] vs M 0 [0; 1]; p=0.029).Conclusion. The polymorphic variants DRD2 rs1800497 and ABCB1 3435C>T were established to be significantly associated with the efficacy and safety of antipsychotics in adolescents with an acute psychotic episode.
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Affiliation(s)
- D. V. Ivashchenko
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - S. Z. Khoang
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - M. Kh. Tazagulova
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | | | - N. I. Buromskaya
- G.E. Sukhareva Research and Practical Center for Mental Health of Children and Adolescents, Moscow Healthcare Department
| | - P. V. Shimanov
- G.E. Sukhareva Research and Practical Center for Mental Health of Children and Adolescents, Moscow Healthcare Department
| | - R. V. Deitch
- G.E. Sukhareva Research and Practical Center for Mental Health of Children and Adolescents, Moscow Healthcare Department
| | - I. V. Dorina
- G.E. Sukhareva Research and Practical Center for Mental Health of Children and Adolescents, Moscow Healthcare Department
| | - M. I. Nastovich
- G.E. Sukhareva Research and Practical Center for Mental Health of Children and Adolescents, Moscow Healthcare Department
| | - K. A. Akmalova
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - A. A. Kachanova
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - E. A. Grishina
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - L. M. Savchenko
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - Yu. S. Shevchenko
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - D. A. Sychev
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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13
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Chiang TI, Lane HY, Lin CH. D2 dopamine receptor gene (DRD2) Taq1A (rs1800497) affects bone density. Sci Rep 2020; 10:13236. [PMID: 32764574 PMCID: PMC7414035 DOI: 10.1038/s41598-020-70262-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia patients are susceptible to lower bone mineral density (BMD). However, studies exploring the genetic effects are lacking. Genes that affect the activity of antipsychotics may be associated with BMD, particularly in patients receiving long-term antipsychotic treatment. We aimed to explore the relationship between the dopamine receptor D2 (DRD2) gene Taq1A (rs1800497) polymorphism and BMD in chronic schizophrenia patients. We recruited schizophrenia patients (n = 47) and healthy controls (n = 39) from a medical center in Taiwan and collected data that may affect BMD. Patients’ BMD was measured by dual-energy X-ray absorptiometer (DEXA). DRD2 rs1800497 was genotyped through polymerase chain reaction–Restriction Fragment Length Polymorphism (PCR–RFLP). Among all participants, subjects with DRD2 rs1800497(T;T) allele had lower DEXA T score and DEXA Z score compared to those with rs1800497(C;T) and rs1800497(C;C) alleles (p = 0.008, 0.003, respectively). In schizophrenia patients, subjects with rs1800497(T;T) allele also had lower DEXA Z score compared to the other two alleles (p = 0.045). Our findings suggest that individuals with the DRD2 rs1800497(T;T) had lower BMD than those with the rs1800497(C;T) and rs1800497(C;C) genotypes. Therefore, genes should be considered as one of the risk factors of lower BMD.
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Affiliation(s)
- Ting-I Chiang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong District, Kaohsiung City, 833, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Hsueh-Shih Rd., North Dist., Taichung City, 404, Taiwan. .,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan. .,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
| | - Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong District, Kaohsiung City, 833, Taiwan. .,Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Hsueh-Shih Rd., North Dist., Taichung City, 404, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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14
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Koller D, Abad-Santos F. The pharmacogenetics of aripiprazole-induced hyperprolactinemia: what do we know? Pharmacogenomics 2020; 21:571-574. [PMID: 32397867 DOI: 10.2217/pgs-2020-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Dora Koller
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
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15
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Yoshida K, Müller DJ. Pharmacogenetics of Antipsychotic Drug Treatment: Update and Clinical Implications. MOLECULAR NEUROPSYCHIATRY 2020; 5:1-26. [PMID: 32399466 PMCID: PMC7206586 DOI: 10.1159/000492332] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/20/2018] [Indexed: 12/24/2022]
Abstract
Numerous genetic variants have been shown to be associated with antipsychotic response and adverse effects of schizophrenia treatment. However, the clinical application of these findings is limited. The aim of this narrative review is to summarize the most recent publications and recommendations related to the genetics of antipsychotic treatment and shed light on the clinical utility of pharmacogenetics/pharmacogenomics (PGx). We reviewed the literature on PGx studies with antipsychotic drugs (i.e., antipsychotic response and adverse effects) and commonly used commercial PGx tools for clinical practice. Publications and reviews were included with emphasis on articles published between January 2015 and April 2018. We found 44 studies focusing on antipsychotic response and 45 studies on adverse effects (e.g., antipsychotic-induced weight gain, movement disorders, hormonal abnormality, and clozapine-induced agranulocytosis/granulocytopenia), albeit with mixed results. Overall, several gene variants related to antipsychotic response and adverse effects in the treatment of patients with schizophrenia have been reported, and several commercial pharmacogenomic tests have become available. However, further well-designed investigations and replication studies in large and well-characterized samples are needed to facilitate the application of PGx findings to clinical practice.
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Affiliation(s)
- Kazunari Yoshida
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daniel J. Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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16
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The effect of CYP2D6 variation on antipsychotic-induced hyperprolactinaemia: a systematic review and meta-analysis. THE PHARMACOGENOMICS JOURNAL 2020; 20:629-637. [PMID: 32015455 DOI: 10.1038/s41397-019-0142-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
Hyperprolactinemia is a known adverse drug reaction to antipsychotic treatment. Antipsychotic blood levels are influenced by cytochrome P450 enzymes, primarily CYP2D6. Variation in CYP450 genes may affect the risk of antipsychotic-induced hyperprolactinemia. We undertook a systematic review and meta-analysis to assess whether CYP2D6 functional genetic variants are associated with antipsychotic-induced hyperprolactinemia. The systematic review identified 16 relevant papers, seven of which were suitable for the meta-analysis (n = 303 participants including 134 extreme metabolisers). Participants were classified into four phenotype groups as poor, intermediate, extensive, and ultra-rapid metabolisers. A random effects meta-analysis was used and Cohen's d calculated as the effect size for each primary study. We found no significant differences in prolactin levels between CYP2D6 metabolic groups. Current evidence does not support using CYP2D6 genotyping to reduce risk of antipsychotic-induced hyperprolactinemia. However, statistical power is limited. Future studies with larger samples and including a range of prolactin-elevating drugs are needed.
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17
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Miuli A, Pettorruso M, Romanelli E, Stigliano G, Di Giuda D, De-Giorgio F, Martinotti G, di Giannantonio M. Does DRD2 Taq1A Mediate Aripiprazole-Induced Gambling Disorder? A Pharmacogenetic Hypothesis. Front Psychiatry 2020; 11:275. [PMID: 32351415 PMCID: PMC7174678 DOI: 10.3389/fpsyt.2020.00275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022] Open
Abstract
Second-generation antipsychotics (SGA) are a pharmacological class widely used in psychiatry thanks to their efficacy and good tolerability profile. One of the most used SGA is aripiprazole (ARI) because of its several formulations and safe metabolic and cardiac profile. As reported in a recent review, there are growing numbers of reports about ARI-induced gambling disorder (ARI-induced GD) which should encourage clinicians to use ARI more cautiously. Given the common genetic susceptibility of both GD and ARI's clinical response to a genetic polymorphism on the D2 receptor (DRD2/ANKK1 Taq1A; rs1800497), the hypothesis regarding the origin of this phenomenon could be found in the altered sensitization of dopamine's receptors that certain individuals carry genetically. The identification of a possible genetic susceptibility (detectable by genetic tests) could provide clinicians with an explanation for the ARI-induced GD and the possibility of using genetic screening tools for those cases of suspected predisposition; this would allow the clinician to prescribe ARI with less apprehension. The confirmation of this hypothesis through future pharmacogenetic studies may be useful for clinicians to have a correct understanding of the phenomenon.
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Affiliation(s)
- Andrea Miuli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Ester Romanelli
- Medical Genetics Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Gianfranco Stigliano
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Daniela Di Giuda
- Institute of Nuclear Medicine, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio De-Giorgio
- Section of Legal Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.,Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire, Hatfield, United Kingdom
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
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18
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Zheng W, Cai DB, Yang XH, Ungvari GS, Ng CH, Shi ZM, Hu ML, Ning YP, Xiang YT. Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia: a meta-analysis. Gen Psychiatr 2019; 32:e100091. [PMID: 31673677 PMCID: PMC6802974 DOI: 10.1136/gpsych-2019-100091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/15/2019] [Accepted: 08/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Hyperprolactinaemia is a common antipsychotic (AP)-induced adverse effect, particularly in female patients. Aims This meta-analysis examined the efficacy and safety of adjunctive aripiprazole in preventing AP-related hyperprolactinaemia in patients with first-episode schizophrenia. Methods PubMed, PsycINFO, EMBASE, Cochrane Library, WanFang and China Journal Net databases were searched to identify eligible randomised controlled trials (RCTs). Primary outcomes were the reductions of serum prolactin level and prolactin-related symptoms. Data were independently extracted by two reviewers and analysed using RevMan (V.5.3). Weighted/standardised mean differences (WMDs/SMDs)±95% CIs were reported. Results In the five RCTs (n=400), the adjunctive aripiprazole (n=197) and the control groups (n=203) with a mean of 11.2 weeks of treatment duration were compared. The aripiprazole group had a significantly lower endpoint serum prolactin level in all patients (five RCTs, n=385; WMD: −50.43 ng/mL (95% CI: −75.05 to −25.81), p<0.00001; I2=99%), female patients (two RCTs, n=186; WMD: −22.58 ng/mL (95% CI: −25.67 to −19.49), p<0.00001; I2=0%) and male patients (two RCTs, n=127; WMD: −68.80 ng/mL (95% CI: −100.11 to −37.49), p<0.0001). In the sensitivity analysis for the endpoint serum prolactin level in all patients, the findings remained significant (p<0.00001; I2=96%). The aripiprazole group was superior to the control group in improving negative symptoms as assessed by the Positive and Negative Syndrome Scale (three RCTs, n=213; SMD: −0.51 (95% CI: −0.79 to −0.24), p=0.0002; I2=0%). Adverse effects and discontinuation rates were similar between the two groups. Conclusions Adjunctive aripiprazole appears to be associated with reduced AP-induced hyperprolactinaemia and improved prolactin-related symptoms in first-episode schizophrenia. Further studies with large sample sizes are needed to confirm these findings.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine, Shenzhen, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Zhan-Ming Shi
- Chongqing Jiangbei Mental Health Center, Chongqing, China
| | - Mei-Ling Hu
- Shangrao Fifth People's Hospital, Shangrao, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
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19
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Koller D, Belmonte C, Saiz-Rodríguez M, Zubiaur P, Román M, Ochoa D, Abad-Santos F. Effects of aripiprazole on circadian prolactin secretion related to pharmacogenetics in healthy volunteers. Basic Clin Pharmacol Toxicol 2019; 126:236-246. [PMID: 31520576 DOI: 10.1111/bcpt.13323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/10/2019] [Indexed: 01/09/2023]
Abstract
Aripiprazole treatment in schizophrenic patients was previously associated with lower or normalized prolactin levels. Genetic variants in cytochrome P450 (CYP) (CYP2D6), dopamine receptor (DRD2, DRD3) and serotonin receptor (HTR2A, HTR2C) genes were previously associated with antipsychotic-induced hyperprolactinaemia. Our aim was to evaluate whether aripiprazole affects prolactin secretion and its relationship with pharmacogenetics. Thirty-one healthy volunteers receiving a 10-mg single oral dose of aripiprazole were genotyped for 12 polymorphisms in CYP2D6, DRD2, DRD3, HTR2A and HTR2C genes by qPCR. Aripiprazole and dehydro-aripiprazole plasma concentrations were measured by HPLC-MS/MS. Prolactin concentrations of the 31 volunteers taking aripiprazole and 12 volunteers receiving ibuprofen were determined by ELISA. Prolactin concentrations after ibuprofen intake were considered as control, since it is known to cause no effect. Prolactin concentrations were slightly higher in the aripiprazole group compared to the ibuprofen group. All prolactin pharmacokinetic parameters were higher in females than in males. CYP2D6 poor and intermediate metabolizers had notably higher prolactin Cmax and AUC0-12 than normal and ultrarapid metabolizers. The DRD3 rs6280 polymorphism affected prolactin levels: volunteers carrying Ser/Ser genotype had significantly lower prolactin levels than volunteers carrying the Gly allele. Furthermore, HTR2C rs3813929 C/C homozygotes had significantly lower prolactin levels than T allele carriers. Nevertheless, aripiprazole did increase prolactin levels compared to ibuprofen.
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Affiliation(s)
- Dora Koller
- Clinical Pharmacology Department, University Hospital of the Princess, Teófilo Hernando Institute, School of Medicine, Health Research Institute of the Princess (IP), Autonomus University of Madrid, Madrid, Spain
| | - Carmen Belmonte
- Clinical Pharmacology Department, University Hospital of the Princess, Teófilo Hernando Institute, School of Medicine, Health Research Institute of the Princess (IP), Autonomus University of Madrid, Madrid, Spain.,UICEC University Hospital of the Princess, Platform SCREN (Spanish Clinical Research Network), Health Research Institute of the Princess (IP), Madrid, Spain
| | - Miriam Saiz-Rodríguez
- Clinical Pharmacology Department, University Hospital of the Princess, Teófilo Hernando Institute, School of Medicine, Health Research Institute of the Princess (IP), Autonomus University of Madrid, Madrid, Spain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, University Hospital of the Princess, Teófilo Hernando Institute, School of Medicine, Health Research Institute of the Princess (IP), Autonomus University of Madrid, Madrid, Spain
| | - Manuel Román
- Clinical Pharmacology Department, University Hospital of the Princess, Teófilo Hernando Institute, School of Medicine, Health Research Institute of the Princess (IP), Autonomus University of Madrid, Madrid, Spain.,UICEC University Hospital of the Princess, Platform SCREN (Spanish Clinical Research Network), Health Research Institute of the Princess (IP), Madrid, Spain
| | - Dolores Ochoa
- Clinical Pharmacology Department, University Hospital of the Princess, Teófilo Hernando Institute, School of Medicine, Health Research Institute of the Princess (IP), Autonomus University of Madrid, Madrid, Spain.,UICEC University Hospital of the Princess, Platform SCREN (Spanish Clinical Research Network), Health Research Institute of the Princess (IP), Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, University Hospital of the Princess, Teófilo Hernando Institute, School of Medicine, Health Research Institute of the Princess (IP), Autonomus University of Madrid, Madrid, Spain.,UICEC University Hospital of the Princess, Platform SCREN (Spanish Clinical Research Network), Health Research Institute of the Princess (IP), Madrid, Spain
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20
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Ma L, Xiang Q, Zhou S, Tan Y, Zhang X, Yang T, Xie Q, Mu G, Zhao X, Zhou Y, Li S, Cui Y. Association of dopamine D2 receptor gene polymorphisms with prolactin levels related to risperidone treatment: A systematic review and meta-analysis. J Clin Pharm Ther 2019; 44:543-552. [PMID: 31056781 DOI: 10.1111/jcpt.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Dopamine D2 receptor (DRD2) polymorphisms are inconsistently associated with elevated prolactin levels related to risperidone treatment. The aim of this systematic review and meta-analysis was to investigate whether DRD2 polymorphisms could modulate prolactin levels in patients treated with risperidone. METHODS Three electronic databases (PubMed, EMBASE and the Cochrane Library) were searched for studies investigating the effect of DRD2 polymorphisms on prolactin levels in patients treated with risperidone until May 2018. Summary standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated with Hedges' g tests for effect estimates using random effects models. The heterogeneity, sensitivity, univariable meta-regression, subgroup analyses and publication biases were calculated. RESULTS AND DISCUSSION After initially identifying 886 studies, 772 patients from eight studies were included. Summary SMDs indicated that compared with A1 non-carriers, Taq1A A1 carriers did not have different risperidone-related prolactin levels (SMD: 0.13; 95% CI: -0.18 to 0.43; P = 0.423) among patients with schizophrenia (SCZ; SMD: 0.07; 95% CI: -0.14 to 0.29; P = 0.505) or among those without SCZ (SMD: 0.16; 95% CI: -0.39 to 0.71; P = 0.562). There was no significant difference between Del carriers and Del non-carriers with regard to risperidone-related prolactin levels (SMD: -0.00; 95% CI: -0.59 to 0.58; P = 0.996). In an Asian subgroup analysis, we also noted that compared with Taq1A A1A2 carriers, Taq1A A1A1 carriers had lower prolactin levels (SMD: -0.34; 95% CI: -0.66 to -0.02; P = 0.040). However, there was no significant difference in prolactin levels between A1A1 carriers and A2A2 carriers (SMD: -0.27; 95% CI: -0.60 to 0.05; P = 0.098), or between A2 carriers and A2 non-carriers (SMD: 0.29; 95% CI: -0.01 to 0.59; P = 0.059). Based on univariable meta-regression analyses, the effects of publication year, study design, ethnicity, comparison groups and study quality could bias the identified association of DRD2 Taq1A with risperidone-related prolactin levels. WHAT IS NEW AND CONCLUSION The findings of this study suggest that there is no significant difference between Taq1A A1 carriers and non-A1 carriers with regard to risperidone-related prolactin levels. As there were few A1 homozygotes, large prospective studies with robust designs are still needed to investigate whether A1A1 could affect risperidone-related prolactin levels in the Asian population.
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Affiliation(s)
- Lingyue Ma
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Shuang Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Yunlong Tan
- Psychiatry Research Center, Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Xiaodan Zhang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Ting Yang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Qiufen Xie
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Guangyan Mu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Xia Zhao
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Suxia Li
- National Institute on Drug Dependence, Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
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21
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Oishi K, Kanahara N, Takase M, Oda Y, Nakata Y, Niitsu T, Ishikawa M, Sato Y, Iyo M. Vulnerable combinations of functional dopaminergic polymorphisms to late-onset treatment resistant schizophrenia. PLoS One 2018; 13:e0207133. [PMID: 30408108 PMCID: PMC6224074 DOI: 10.1371/journal.pone.0207133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022] Open
Abstract
Background A significant portion of patients with schizophrenia who respond to initial antipsychotic treatment acquire treatment resistance. One of the possible pathogeneses of treatment-resistant schizophrenia (TRS) is antipsychotic-induced dopamine supersensitivity psychosis (Ai-DSP). Patients with this disease progression might share some genetic vulnerabilities, and thus determining individuals with higher risks of developing Ai-DSP could contribute to preventing iatrogenic development of TRS. Therefore, we decided to examine whether combinations of functional single nucleotide polymorphisms (SNPs) known to affect dopaminergic functions are related to Ai-DSP development. Methods In this case-control study, 357 Japanese participants diagnosed with schizophrenia or schizoaffective disorder were recruited and divided into two groups, those with and without Ai-DSP. As functional SNPs, we examined rs10770141 of the tyrosine hydroxylase gene, rs4680 of the catechol-O-methyltransferase gene, and rs1799732 and rs1800497 of the DRD2 genes, which are known to possess strong directional ties to dopamine synthesis, dopamine degradation and post-synaptic DRD2 prevalence, respectively. Results Among the 357 Japanese patients with schizophrenia or schizoaffective disorder, 130 were classified as Ai-DSP(+) and the other 227 as Ai-DSP(-). Significantly higher proportions of Ai-DSP(+) patients were found to have the SNP combinations of rs10770141/rs4680 (57.9%, OR2.654, 95%CI1.036–6.787, P = 0.048) and rs10770141/rs4680/ rs1800497 (64.3%, OR4.230, 95%CI1.306–13.619, P = 0.029). However, no single SNP was associated with Ai-DSP. Conclusions We preliminarily found that carrying particular combinations of functional SNPs, which are related to relatively higher dopamine synthesis and dopamine degradation and lower naïve DRD2, might indicate vulnerability to development of Ai-DSP. However, further studies are needed to validate the present results.
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Affiliation(s)
- Kengo Oishi
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
- * E-mail:
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chuou-ku, Chiba, Chiba, Japan
| | - Masayuki Takase
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
- Zucker Hillside Hospital, Glen Oaks, NY, United States of America
| | - Yasunori Oda
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
| | - Yusuke Nakata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
| | - Masatomo Ishikawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
| | - Yasunori Sato
- Department of Global Clinical Research, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Chiba, Japan
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22
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Gassó P, Mas S, Bioque M, Cabrera B, Lobo A, González-Pinto A, Díaz-Caneja CM, Corripio I, Vieta E, Castro-Fornieles J, Sarró S, Mané A, Sanjuan J, Llerena A, Lafuente A, Saiz-Ruiz J, Bernardo M. Impact of NTRK2, DRD2 and ACE polymorphisms on prolactin levels in antipsychotic-treated patients with first-episode psychosis. J Psychopharmacol 2018; 32:702-710. [PMID: 29767567 DOI: 10.1177/0269881118773026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hyperprolactinemia is a common side-effect of antipsychotics (APs), which may trigger serious secondary problems and compromise the adherence to treatment which is crucial for prognosis, especially in patients presenting with a first-episode of psychosis (FEP). AIMS We evaluated, in some cases for the first time, the effect of polymorphisms in multiple candidate genes on serum prolactin (PRL) levels in an AP-treated FEP cohort recruited in the multicenter PEPs study (Phenotype - genotype and environmental interaction; Application of a predictive model in first psychotic episodes). METHODS PRL concentration was measured in serum from 222 patients. A total of 167 polymorphisms were selected in 23 genes. Genetic association analysis was performed in the whole sample and also in homogenous subgroups of patients treated with APs with a high (N = 101) or low risk (N = 95) of increasing PRL release, which showed significant differences in their PRL levels. RESULTS After Bonferroni correction, polymorphisms in NTRK2, DRD2 and ACE genes were associated with PRL concentration. CONCLUSION Our results give more support to the impact of DRD2, but also of other genes related to dopamine availability such as ACE. Moreover, this study provides the first evidence for the involvement of NTRK2, which suggests that pathways other than the ones related to dopamine or serotonin may participate in the AP-related PRL levels.
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Affiliation(s)
- Patricia Gassó
- 1 Department of Basic Clinical Practice, University of Barcelona, Spain.,2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sergi Mas
- 1 Department of Basic Clinical Practice, University of Barcelona, Spain.,2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Miquel Bioque
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,4 Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Spain
| | - Bibiana Cabrera
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,4 Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Spain
| | - Antonio Lobo
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,5 Department of Medicine and Psychiatry, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Spain
| | - Ana González-Pinto
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,6 Hospital Universitario Araba, Servicio de Psiquiatria, UPV/EHU, Bioaraba, Spain
| | - Covadonga M Díaz-Caneja
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,7 Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,8 Department of Psychiatry, Hospital de Sant Pau, Barcelona, Spain.,9 Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Eduard Vieta
- 2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,10 Bipolar Disorder Unit, Hospital Clinic of Barcelona, University of Spain
| | - Josefina Castro-Fornieles
- 2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,11 Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic of Barcelona, Spain.,12 Department of Medicine, University of Barcelona, Spain
| | - Salvador Sarró
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,13 FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Anna Mané
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,14 Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Julio Sanjuan
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,15 INCLIVA, Universidad de Valencia, Hospital Clínico Universitario de Valencia, Spain
| | - Adrián Llerena
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,16 CICAB Clinical Research Center, Extremadura University Hospital and Medical School, Badajoz, Spain
| | - Amalia Lafuente
- 1 Department of Basic Clinical Practice, University of Barcelona, Spain.,2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jerónimo Saiz-Ruiz
- 3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,17 Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Miguel Bernardo
- 2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,4 Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Spain.,12 Department of Medicine, University of Barcelona, Spain
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- 1 Department of Basic Clinical Practice, University of Barcelona, Spain.,2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,3 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,6 Hospital Universitario Araba, Servicio de Psiquiatria, UPV/EHU, Bioaraba, Spain.,7 Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain.,9 Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.,10 Bipolar Disorder Unit, Hospital Clinic of Barcelona, University of Spain.,11 Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic of Barcelona, Spain.,12 Department of Medicine, University of Barcelona, Spain.,13 FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,14 Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,17 Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,18 Biomedical Research Institute Sant Pau, IIB Sant Pau, Barcelona, Spain.,19 Department of Family Medicine, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,20 Department of Neuroradiology, Hospital Quirónsalud, Instituto de Investigación Sanitaria Aragón (IIS Aragon), Zaragoza, Spain.,21 INCLIVA, Universidad de Valencia, Spain.,22 INCLIVA, Hospital Clínico Universitario de Valencia, Spain.,23 Department of Psychiatry, Bellvitge University Hospital-IDIBELL; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain.,24 Department of Psychiatry, University of Oviedo, Spain.,25 Department of Neuroscience, University of the Basque Country (UPV-EHU), Bizkaia, Spain.,26 Santiago Apóstol University Hospital, Psychiatry/ Bioaraba Research Institute Vitoria - Álava, Spain.,27 BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain.,28 Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain.,29 Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Spain.,30 Neuroscience Research Australia, School of Medical Sciences, University of New South Wales, ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,31 Department of Psychiatry, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,32 Department of Medicine, Universitat de València, Spain
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Abstract
PURPOSE OF REVIEW This review highlights recent advances in the investigation of genetic factors for antipsychotic response and side effects. RECENT FINDINGS Antipsychotics prescribed to treat psychotic symptoms are variable in efficacy and propensity for causing side effects. The major side effects include tardive dyskinesia, antipsychotic-induced weight gain (AIWG), and clozapine-induced agranulocytosis (CIA). Several promising associations of polymorphisms in genes including HSPG2, CNR1, and DPP6 with tardive dyskinesia have been reported. In particular, a functional genetic polymorphism in SLC18A2, which is a target of recently approved tardive dyskinesia medication valbenazine, was associated with tardive dyskinesia. Similarly, several consistent findings primarily from genes modulating energy homeostasis have also been reported (e.g. MC4R, HTR2C). CIA has been consistently associated with polymorphisms in the HLA genes (HLA-DQB1 and HLA-B). The association findings between glutamate system genes and antipsychotic response require additional replications. SUMMARY The findings to date are promising and provide us a better understanding of the development of side effects and response to antipsychotics. However, more comprehensive investigations in large, well characterized samples will bring us closer to clinically actionable findings.
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Deng Y, Huang J, Zhang H, Zhu X, Gong Q. Association of expression of DRD2 rs1800497 polymorphism with migraine risk in Han Chinese individuals. J Pain Res 2018; 11:763-769. [PMID: 29695928 PMCID: PMC5905461 DOI: 10.2147/jpr.s151350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Previous studies suggested that single-nucleotide polymorphisms in dopamine receptor D2 (DRD2) are the susceptibility loci for migraine. This study was aimed at evaluating the contribution of DRD2 rs1800497 and its expression to migraine risk in Han Chinese subjects. Methods In total, 250 patients with migraine and 250 age- and sex-matched control subjects were included in this study. TaqMan allelic discrimination assay was used for DRD2 rs1800497 genotyping. Plasma DRD2 concentration was determined using enzyme-linked immunosorbent assay. Results Significant associations were observed for the rs1800497 genotype (c2=6.37, p=0.041) and allele (c2=4.69, p=0.03; odds ratio [OR]=1.33, 95% CI=1.03-1.72, power=58%) frequencies between the migraine and control groups. Sex analysis indicated a positive association for rs1800497 between female patients with migraine and control individuals (genotype: c2=7.84, p=0.019; allele: c2=6.60, p=0.010; OR=1.61, 95% CI=1.12-2.30, power=73.4%). Furthermore, a significant association was observed only in female patients with migraine without aura (MO) (genotype: c2=6.88, p=0.032; allele: c2=5.65, p=0.017; OR=1.59, 95% CI=1.08-2.36, power=65.1%). The mean plasma DRD2 levels in the control group (mean±SD: 24.20±2.78) were significantly lower than those in the migraine with aura (MA) (30.86±3.69, p<0.0001) and MO groups (31.88±4.99, p<0.0001). Additionally, there was a sex-based difference in DRD2 expression in the MA (male vs female: 29.46±3.59 vs 32.27±3.27, p<0.01) and MO groups (male vs female: 29.18±3.50 vs 34.58±4.84, p<0.0001). Moreover, plasma DRD2 levels in patients were significantly different among the three genotypes (CC vs CT vs TT: 24.76±3.76 vs 30.93±3.85 vs 37.06±3.95, p<0.0001). Similar results were observed both in the MA (CC vs CT vs TT: 25.09±3.84 vs 28.57±2.84 vs 33.37±1.58, p<0.0001) and MO groups (CC vs CT vs TT: 24.65±3.79 vs 31.65±3.86 vs 38.29±3.74, p<0.0001). Conclusion Our case-control study suggested that the DRD2 polymorphism rs1800497 was significantly associated with the risk of migraine in Han Chinese females. Additionally, the plasma DRD2 level was high in patients with migraine. Females with migraine had considerably higher DRD2 levels than males with migraine. DRD2 expression may be regulated by DRD2 rs1800497 genotype in patients with migraine.
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Affiliation(s)
- Yingfeng Deng
- Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Jianping Huang
- Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Huijun Zhang
- Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Xueqin Zhu
- Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Qin Gong
- Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
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Chen H, Fan Y, Zhao L, Hao Y, Zhou X, Guan Y, Li Z. Successful treatment with risperidone increases 5-HT 3A receptor gene expression in patients with paranoid schizophrenia - data from a prospective study. Brain Behav 2017; 7:e00798. [PMID: 28948091 PMCID: PMC5607560 DOI: 10.1002/brb3.798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The relationship between peripheral 5-HT3A receptor mRNA level and risperidone efficiency in paranoid schizophrenia patients is still unknown. METHODS A total 52 first-episode and drug-naive paranoid schizophrenia patients who were treated with risperidone and 53 matched healthy controls were enrolled. Patients were naturalistically followed up for 8 weeks. Positive and Negative Syndrome Scale (PANSS) was applied to assess symptom severity of the patients at baseline and at the end of 8th week. RESULTS There was no difference in 5-HT3A receptor mRNA level between paranoid schizophrenia patients and healthy controls at baseline (p = .24). Among 47 patients who completed 8-week naturalistic follow-up, 37 were responders to risperidone treatment. 5-HT3A receptor mRNA level of paranoid schizophrenia patients did not change in overall patients after 8-week treatment with risperidone (p = .29). However, 5-HT3A receptor mRNA level in responders increased significantly (p = .04), but not in nonresponders (p = .81). CONCLUSIONS Successful treatment with risperidone increases 5-HT3A receptor gene expression in patients with paranoid schizophrenia, indicating that 5-HT3A receptor may be involved in the mechanism of risperidone effect.
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Affiliation(s)
- Hongying Chen
- Department of Neurology Ren Ji Hospital School of Medicine Shanghai Jiao Tong University Shanghai China.,Department of Psychiatry Changning Mental Health Center Shanghai China
| | - Yong Fan
- Department of Psychiatry Qingdao Mental Health Center Qingdao Shandong China
| | - Lei Zhao
- Department of Psychiatry Qingdao Mental Health Center Qingdao Shandong China
| | - Yong Hao
- Department of Neurology Ren Ji Hospital School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Xiajun Zhou
- Department of Neurology Ren Ji Hospital School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Yangtai Guan
- Department of Neurology Ren Ji Hospital School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Zezhi Li
- Department of Neurology Ren Ji Hospital School of Medicine Shanghai Jiao Tong University Shanghai China
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Zheng W, Yang XH, Cai DB, Ungvari GS, Ng CH, Wang N, Ning YP, Xiang YT. Adjunctive metformin for antipsychotic-related hyperprolactinemia: A meta-analysis of randomized controlled trials. J Psychopharmacol 2017; 31:625-631. [PMID: 28372526 DOI: 10.1177/0269881117699630] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hyperprolactinemia is a common and severe antipsychotic-induced adverse drug reaction. This meta-analysis of randomized controlled trials systematically examined the efficacy and safety of adjunctive metformin for antipsychotic-related hyperprolactinemia in schizophrenia patients. Two independent investigators searched, extracted, and synthesized data. Weighted mean differences and risk ratios with their 95% confidence intervals were calculated using random effect model. Four randomized controlled trials ( n=509) comparing adjunctive metformin ( n=253) with the control groups ( n=256), lasting 22.7 weeks of treatment, were included in the meta-analysis. The metformin group had significantly lower serum prolactin level at endpoint (four randomized controlled trials, n=501; weighted mean difference: -6.87 ug/L (95% confidence interval: -13.24 to -0.51), p=0.03; I2=80%) with "moderate quality" based on the grading of recommendations assessment, development, and evaluation system. In patients with menstrual disturbances, the rate of menstruation resumption was 66.7% in the metformin group and 4.8% in the control group. Adverse drug reactions and all-cause discontinuation (three randomized controlled trials, n=339, risk ratio: 0.76 (95% confidence interval: 0.29, 1.97), p=0.57; I2= 0%) were similar between the two groups. Adjunctive metformin appears to be effective and safe for reducing antipsychotic-induced hyperprolactinemia and prolactin-related symptoms in schizophrenia patients. Higher quality randomized controlled trials with a large sample size are warranted to confirm these findings.
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Affiliation(s)
- Wei Zheng
- 1 Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Xin-Hu Yang
- 1 Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Dong-Bin Cai
- 2 Clinics of Chinese Medicine, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gabor S Ungvari
- 3 The University of Notre Dame Australia/Marian Centre, Perth, Australia.,4 School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- 5 Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Nan Wang
- 6 Department of General Psychiatry, Institute of Mental Health, Singapore
| | - Yu-Ping Ning
- 1 Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Yu-Tao Xiang
- 7 Unit of Psychiatry, University of Macau, Macau SAR, China
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Alladi CG, Mohan A, Shewade DG, Rajkumar RP, Adithan S, Subramanian K. Risperidone-Induced Adverse Drug Reactions and Role of DRD2 (-141 C Ins/Del) and 5HTR2C (-759 C>T) Genetic Polymorphisms in Patients with Schizophrenia. J Pharmacol Pharmacother 2017; 8:28-32. [PMID: 28405133 PMCID: PMC5370325 DOI: 10.4103/jpp.jpp_197_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the adverse drug reaction (ADR) profile of risperidone and their association with dopamine (DRD2 - 141 C Ins/Del/rs1799732) and serotonin receptor (5HTR2C -759 C>T/rs3813929) gene polymorphisms in patients with schizophrenia. MATERIALS AND METHODS The study was conducted among 289 patients who were diagnosed with schizophrenia and were on treatment with risperidone (4-8 mg/day)-based therapy for a minimum of 4 weeks. Genotyping was carried by real-time quantitative polymerase chain reaction. All the patients were observed for the occurrences of ADRs during the study. Changes in prolactin levels and body weight were analyzed for a subgroup of 102 and 97 patients, respectively. RESULTS Risperidone-induced extrapyramidal symptoms (EPSs) were seen in 36.7% of patients. Among them, tremors were the most common symptom 31.8%. Risperidone-induced hyperprolactinemia and weight gain were seen in 87.2% and 53.6% in subgroup patients. Adverse effects such as sedation, gastrointestinal effects, and amenorrhea were seen in 9.7% (28/289), 5.1% (15/289), and 6.1% (7/114), respectively. Occurrence of DRD2 - 141 Ins/Del and Del/Del polymorphisms were significantly associated with increased prolactin levels in response to risperidone (odds ratio [OR] = 10.45; 95% confidence interval = 1.29-84.89, P = 0.004). No such association was observed with 5HTR2C (-759 C>T) polymorphism. Weight gain and EPS were not associated with the above genetic polymorphisms. CONCLUSION Hyperprolactinemia, weight gain, and EPSs (>36.7%) were common adverse effects of risperidone. DRD2 - 141C Ins/Del and Del/Del polymorphisms were significantly associated with increased prolactin levels (OR = 10.45) in response to risperidone.
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Affiliation(s)
- Charanraj Goud Alladi
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Anbarasan Mohan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Deepak Gopal Shewade
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Surendiran Adithan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Karthick Subramanian
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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