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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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Marin MCD, Pedro MOP, Perrotte G, Martins-da-Silva AS, Lassi DLS, Blaas IK, Castaldelli FI, Brisola dos Santos MB, Kortas GT, Campos MW, Torales J, Ventriglio A, Périco CDAM, Negrão AB, Leopoldo K, de Andrade AG, Malbergier A, Castaldelli-Maia JM. Pharmacological Treatment of Alcohol Cravings. Brain Sci 2023; 13:1206. [PMID: 37626562 PMCID: PMC10452441 DOI: 10.3390/brainsci13081206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: The treatment of substance addiction is challenging and has persisted for decades, with only a few therapeutic options. Although there are some recommendations for specific treatments for Alcohol Use Disorder (AUD), there is no specific medication used to treat alcohol cravings, which could benefit millions of patients that are suffering from alcoholism. Cravings, or the urge to use drugs, refer to the desire to experience the effects of a previously experienced psychoactive substance. (2) Methods: We included original studies of alcohol abuse or dependence extracted from a controlled, blind, pharmacological treatment study which presented measures and outcomes related to alcohol cravings. (3) Results: Specific drugs used for the treatment of alcoholism, such as Naltrexone and Acamprosate, have had the best results in relieving craving symptoms, as well as promoting abstinence. Baclofen and anticonvulsants such as Gabapentin and Topiramate have shown good results in promoting abstinence and the cessation of cravings. (4) Conclusions: Specific drugs used for the treatment of alcoholism to obtain the best results can be considered the gold standard for promoting abstinence and relieving cravings. Anticonvulsants and Baclofen also had good results, with these medications being considered as second-line ones. Varenicline is an option for alcohol dependents who also concomitantly ingest tobacco.
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Affiliation(s)
- Matheus Cheibub David Marin
- Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo 05021-001, Brazil; (M.C.D.M.); (D.L.S.L.); (I.K.B.); (G.T.K.); (A.B.N.); (A.G.d.A.); (A.M.)
- Hospital Sírio-Libanês, São Paulo 01308-050, Brazil; (M.O.P.P.); (M.B.B.d.S.)
| | - Maria Olívia Pozzolo Pedro
- Hospital Sírio-Libanês, São Paulo 01308-050, Brazil; (M.O.P.P.); (M.B.B.d.S.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil; (A.S.M.-d.-S.); (K.L.)
| | - Giuliana Perrotte
- Department of Neuroscience, Medical School, FMABC University Center, Santo André 09060-870, Brazil; (G.P.); (C.d.A.-M.P.)
| | - Anderson S. Martins-da-Silva
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil; (A.S.M.-d.-S.); (K.L.)
| | - Dangela L. S. Lassi
- Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo 05021-001, Brazil; (M.C.D.M.); (D.L.S.L.); (I.K.B.); (G.T.K.); (A.B.N.); (A.G.d.A.); (A.M.)
| | - Israel Kanaan Blaas
- Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo 05021-001, Brazil; (M.C.D.M.); (D.L.S.L.); (I.K.B.); (G.T.K.); (A.B.N.); (A.G.d.A.); (A.M.)
- Department of Neuroscience, Medical School, FMABC University Center, Santo André 09060-870, Brazil; (G.P.); (C.d.A.-M.P.)
| | | | | | - Guilherme Trevizan Kortas
- Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo 05021-001, Brazil; (M.C.D.M.); (D.L.S.L.); (I.K.B.); (G.T.K.); (A.B.N.); (A.G.d.A.); (A.M.)
- Hospital Sírio-Libanês, São Paulo 01308-050, Brazil; (M.O.P.P.); (M.B.B.d.S.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil; (A.S.M.-d.-S.); (K.L.)
| | - Marcela Waisman Campos
- Department of Cognitive Neurology, Neuropsychiatry, and Neuropsychology, Fleni, Buenos Aires C1428AQK, Argentina;
| | - Julio Torales
- Department of Medical Psychology, School of Medical Sciences, Universidad Nacional de Asunción, San Lorenzo 111454, Paraguay;
- Regional Institute of Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo 050106, Paraguay
- School of Health Sciences, Universidad Sudamericana, Pedro Juan Caballero 130112, Paraguay
| | - Antonio Ventriglio
- Department of Experimental Medicine, Medical School, University of Foggia, 71100 Foggia, Italy;
| | | | - André B. Negrão
- Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo 05021-001, Brazil; (M.C.D.M.); (D.L.S.L.); (I.K.B.); (G.T.K.); (A.B.N.); (A.G.d.A.); (A.M.)
| | - Kae Leopoldo
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil; (A.S.M.-d.-S.); (K.L.)
| | - Arthur Guerra de Andrade
- Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo 05021-001, Brazil; (M.C.D.M.); (D.L.S.L.); (I.K.B.); (G.T.K.); (A.B.N.); (A.G.d.A.); (A.M.)
- Hospital Sírio-Libanês, São Paulo 01308-050, Brazil; (M.O.P.P.); (M.B.B.d.S.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil; (A.S.M.-d.-S.); (K.L.)
- Department of Neuroscience, Medical School, FMABC University Center, Santo André 09060-870, Brazil; (G.P.); (C.d.A.-M.P.)
| | - André Malbergier
- Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo 05021-001, Brazil; (M.C.D.M.); (D.L.S.L.); (I.K.B.); (G.T.K.); (A.B.N.); (A.G.d.A.); (A.M.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil; (A.S.M.-d.-S.); (K.L.)
| | - João Maurício Castaldelli-Maia
- Hospital Sírio-Libanês, São Paulo 01308-050, Brazil; (M.O.P.P.); (M.B.B.d.S.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil; (A.S.M.-d.-S.); (K.L.)
- Department of Neuroscience, Medical School, FMABC University Center, Santo André 09060-870, Brazil; (G.P.); (C.d.A.-M.P.)
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Graham DP, Harding MJ, Nielsen DA. Pharmacogenetics of Addiction Therapy. Methods Mol Biol 2022; 2547:437-490. [PMID: 36068473 DOI: 10.1007/978-1-0716-2573-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Drug addiction is a serious relapsing disease that has high costs to society and to the individual addicts. Treatment of these addictions is still in its nascency, with only a few examples of successful therapies. Therapeutic response depends upon genetic, biological, social, and environmental components. A role for genetic makeup in the response to treatment has been shown for several addiction pharmacotherapies with response to treatment based on individual genetic makeup. In this chapter, we will discuss the role of genetics in pharmacotherapies, specifically for cocaine, alcohol, and opioid dependences. The continued elucidation of the role of genetics should aid in the development of new treatments and increase the efficacy of existing treatments.
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Affiliation(s)
- David P Graham
- Michael E. DeBakey Veterans Affairs Medical Center, and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mark J Harding
- Michael E. DeBakey Veterans Affairs Medical Center, and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - David A Nielsen
- Michael E. DeBakey Veterans Affairs Medical Center, and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
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Blum K, Modestino EJ, Baron D, Brewer R, Thanos P, Elman I, Badgaiyan RD, Downs BW, Bagchi D, McLaughlin T, Bowirrat A, Roy AK, Gold MS. Endorphinergic Enhancement Attenuation of Post-traumatic Stress Disorder (PTSD) via Activation of Neuro-immunological Function in the Face of a Viral Pandemic. ACTA ACUST UNITED AC 2021; 10:86-97. [PMID: 34466374 DOI: 10.2174/2211556009999210104221215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Polymorphic gene variants, particularly the genetic determinants of low dopamine function (hypodopaminergia), are known to associate with Substance Use Disorder (SUD) and a predisposition to PTSD. Addiction research and molecular genetic applied technologies supported by the National Institutes of Health (NIH) have revealed the complex functions of brain reward circuitry and its crucial role in addiction and PTSD symptomatology. Discussion It is noteworthy that Israeli researchers compared mice with a normal immune system with mice lacking adaptive immunity and found that the incidence of PTSD increased several-fold. It is well established that raising endorphinergic function increases immune response significantly. Along these lines, Blum's work has shown that D-Phenylalanine (DPA), an enkephalinase inhibitor, increases brain endorphins in animal models and reduces stress in humans. Enkephalinase inhibition with DPA treats Post Traumatic Stress Disorder (PTSD) by restoring endorphin function. The Genetic Addiction Risk Severity (GARS) can characterize relevant phenotypes, genetic risk for stress vulnerability vs. resilience. GARS could be used to pre-test military enlistees for adaptive immunity or as part of PTSD management with customized neuronutrient supplementation upon return from deployment. Conclusion Based on GARS values, with particular emphasis on enhancing immunological function, pro-dopamine regulation may restore dopamine homeostasis. Recognition of the immune system as a "sixth sense" and assisting adaptive immunity with Precision Behavioral Management (PBM), accompanied by other supportive interventions and therapies, may shift the paradigm in treating stress disorders.
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Affiliation(s)
- Kenneth Blum
- Western University Health Sciences, Graduate School of Biomedical Sciences, Pomona, CA, USA.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Division of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA.,Division of Nutrigenomics, Victory Nutrition International, Lederoch, PA., USA
| | | | - David Baron
- Western University Health Sciences, Graduate School of Biomedical Sciences, Pomona, CA, USA
| | - Raymond Brewer
- Division of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA
| | - Panayotis Thanos
- Behavioral Neuropharmacology & Neuroimaging Laboratory on Addiction, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - Igor Elman
- Department of Psychiatry, Harvard School of Medicine, Cambridge MA, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy I Memorial VA Hospital, San Antonio, TX. and Long School of Medicine, University of Texas Medical Center, San Antonio TX, USA
| | - B William Downs
- Division of Nutrigenomics, Victory Nutrition International, Lederoch, PA., USA
| | - Debasis Bagchi
- Division of Nutrigenomics, Victory Nutrition International, Lederoch, PA., USA.,Department of Pharmaceutical Sciences, University of Houston, School of Pharmacy, Houston, TX., USA
| | | | - Abdalla Bowirrat
- Department of Neuroscience and Genetics, Interdisciplinary Center Herzliya, Herzliya, Israel
| | - A Kenison Roy
- Department of Psychiatry, University of Tulane School of Medicine, New Orleans, LA, USA
| | - Mark S Gold
- Department of Psychiatry, Washington University, School of Medicine, St. Louis, MO., USA
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Tan Y, Sun R, Liu L, Yang D, Xiang Q, Li L, Tang J, Qiu Z, Peng W, Wang Y, Ye L, Ren G, Xiang T. Tumor suppressor DRD2 facilitates M1 macrophages and restricts NF-κB signaling to trigger pyroptosis in breast cancer. Am J Cancer Res 2021; 11:5214-5231. [PMID: 33859743 PMCID: PMC8039962 DOI: 10.7150/thno.58322] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/12/2021] [Indexed: 12/12/2022] Open
Abstract
Rationale: Breast cancer (BrCa) is the most common cancer worldwide, and the 5-year relative survival rate has declined in patients diagnosed at stage IV. Advanced BrCa is considered as incurable, which still lack effective treatment strategies. Identifying and characterizing new tumor suppression genes is important to establish effective prognostic biomarkers or therapeutic targets for late-stage BrCa. Methods: RNA-seq was applied in BrCa tissues and normal breast tissues. Through analyzing differentially expressed genes, DRD2 was selected for further analysis. And expression and promoter methylation status of DRD2 were also determined. DRD2 functions were analyzed by various cell biology assays in vitro. Subcutaneous tumor model was used to explore DRD2 effects in vivo. A co-cultivated system was constructed to investigate interactions of DRD2 and macrophages in vitro. WB, IHC, IF, TUNEL, qRT-PCR, Co-IP, Antibody Array, and Mass Spectrum analysis were further applied to determine the detailed mechanism. Results: In BrCa, DRD2 was found to be downregulated due to promoter methylation. Higher expression of DRD2 positively correlated with longer survival times especially in HER2-positive patients. DRD2 also promoted BrCa cells sensitivity to Paclitaxel. Ectopic expression of DRD2 significantly inhibited BrCa tumorigenesis. DRD2 also induced apoptosis as well as necroptosis in vitro and in vivo. DRD2 restricted NF-κB signaling pathway activation through interacting with β-arrestin2, DDX5 and eEF1A2. Interestingly, DRD2 also regulated microenvironment as it facilitated M1 polarization of macrophages, and triggered GSDME-executed pyroptosis. Conclusion: Collectively, this study novelly manifests the role of DRD2 in suppressing BrCa tumorigenesis, predicting prognosis and treatment response. And this study further reveals the critical role of DRD2 in educating M1 macrophages, restricting NF-κB signaling pathway and triggering different processes of programmed cell death in BrCa. Taking together, those findings represent a predictive and therapeutic target for BrCa.
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Lawford BR, Young R, Noble EP, Kann B, Ritchie T. The D2 dopamine receptor (DRD2) gene is associated with co-morbid depression, anxiety and social dysfunction in untreated veterans with post-traumatic stress disorder. Eur Psychiatry 2020; 21:180-5. [PMID: 16632165 DOI: 10.1016/j.eurpsy.2005.01.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 01/14/2005] [Indexed: 11/19/2022] Open
Abstract
AbstractObjective.To identify clusters of patients with post-traumatic stress disorder (PTSD) according to symptom profile and to examine the association of the A1 allele of the D2 dopamine receptor (DRD2) gene with these clusters.Method.Fifty-seven untreated Caucasian Vietnam veterans with PTSD were administered the General Health Questionnaire-28 (GHQ) and the Mississippi Scale for combat-related PTSD. DRD2 allelic status was determined by PCR.Results.Subjects with the DRD2 Al allele compared to those without this allele had significantly higher scores on GHQ 2 (anxiety/insomnia), GHQ 3 (social dysfunction) and GHQ 4 (depression). Cluster analysis of the GHQ data identified two primary groups. A high psychopathology cluster (cluster 3), featured by high co-morbid levels of somatic concerns, anxiety/insomnia, social dysfunction and depression, and a low psychopathology cluster (cluster 1), manifested by the reverse pattern. Scores in each of the four GHQ groups were significantly higher in cluster 3 than cluster 1, as was Mississippi Scale PTSD score. DRD2 A1 allele veterans compared to those without this allele were significantly more likely to be found in the high than the low psychopathology cluster group.Conclusions.DRD2 variants are associated with severe co-morbid psychopathology in PTSD subjects.
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Nieto SJ, Grodin EN, Ray LA. On the path towards personalized medicine: Implications of pharmacogenetic studies of alcohol use disorder medications. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020; 5:43-54. [PMID: 34291172 DOI: 10.1080/23808993.2020.1724510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction The heritability of alcohol use disorder (AUD) is estimated to be ~50%; however, the genetic basis of the disease is still poorly understood. The genetic variants identified thus far only explain a small percentage of AUD phenotypic variability. While genome-wide association studies (GWAS) are impacted by technical and methodological limitations, genetic variants that have been identified independently of GWAS findings can moderate the efficacy of AUD medications. Areas Covered This review discusses findings from clinical pharmacogenetic studies of AUD medications. While the pharmacogenetic studies reviewed involve several genetic variants in the major neurotransmitter systems, genetic loci in the opioid system have garnered the most attention. Expert Opinion The clinical utility of pharmacogenetics in AUD populations is uncertain at this time. There are several ongoing prospective clinical trials that will enhance knowledge regarding the applicability of pharmacogenetics in clinical populations. We recommend that future work in this area consider reverse translating from genotype to phenotype, mapping genes to stages of the addiction cycle, mapping genes to neural circuits, and harnessing large population-based cohorts.
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Affiliation(s)
- Steven J Nieto
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Erica N Grodin
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lara A Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA.,University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA.,University of California Los Angeles, Brain Research Institute, Los Angeles, CA, USA
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Hansson AC, Gründer G, Hirth N, Noori HR, Spanagel R, Sommer WH. Dopamine and opioid systems adaptation in alcoholism revisited: Convergent evidence from positron emission tomography and postmortem studies. Neurosci Biobehav Rev 2019; 106:141-164. [DOI: 10.1016/j.neubiorev.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/08/2018] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
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Blum K, Gondré-Lewis MC, Modestino EJ, Lott L, Baron D, Siwicki D, McLaughlin T, Howeedy A, Krengel MH, Oscar-Berman M, Thanos PK, Elman I, Hauser M, Fried L, Bowirrat A, Badgaiyan RD. Understanding the Scientific Basis of Post-traumatic Stress Disorder (PTSD): Precision Behavioral Management Overrides Stigmatization. Mol Neurobiol 2019; 56:7836-7850. [PMID: 31124077 DOI: 10.1007/s12035-019-1600-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a severe polygenic disorder triggered by environmental factors. Many polymorphic genes, particularly the genetic determinants of hypodopaminergia (low dopamine function), associate with a predisposition to PTSD as well as substance use disorder. Support from the National Institutes of Health for neuroimaging research and molecular, genetic applied technologies has improved understanding of brain reward circuitry functions that have inspired the development of new innovative approaches to their early diagnosis and treatment of some PTSD symptomatology and addiction. This review presents psychosocial and genetic evidence that vulnerability or resilience to PTSD can theoretically be impacted by dopamine regulation. From a neuroscience perspective, dopamine is widely accepted as a major neurotransmitter. Questions about how to modulate dopamine clinically in order to treat and prevent PTSD and other types of reward deficiency disorders remain. Identification of genetic variations associated with the relevant genotype-phenotype relationships can be characterized using the Genetic Addiction Risk Score (GARS®) and psychosocial tools. Development of an advanced genetic panel is under study and will be based on a new array of genes linked to PTSD. However, for now, the recommendation is that enlistees for military duty be given the opportunity to voluntarily pre-test for risk of PTSD with GARS, before exposure to environmental triggers or upon return from deployment as part of PTSD management. Dopamine homeostasis may be achieved via customization of neuronutrient supplementation "Precision Behavioral Management" (PBM™) based on GARS test values and other pro-dopamine regulation interventions like exercise, mindfulness, biosensor tracking, and meditation.
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Affiliation(s)
- Kenneth Blum
- Graduate School of Biomedical Sciences, Western University Health Sciences, Pomona, CA, USA. .,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary. .,Department of Psychiatry, Boonshoft School of Medicine, Wright University, Dayton, OH, USA. .,Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA. .,Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, USA. .,Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA. .,Division of Neuroscience & Addiction Research, Pathway Healthcare, LLC., Burmingham, AL, USA.
| | - M C Gondré-Lewis
- Department of Anatomy, Developmental Neuropsychopharmacology Laboratory, Howard University College of Medicine, Washington, DC, USA
| | - E J Modestino
- Department of Psychology, Curry College, Milton, MA, USA
| | - L Lott
- Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA
| | - D Baron
- Graduate School of Biomedical Sciences, Western University Health Sciences, Pomona, CA, USA
| | - D Siwicki
- Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA.,Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA
| | - T McLaughlin
- Center for Psychiatric Medicine, Lawrence, MA, USA
| | - A Howeedy
- Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, USA
| | - M H Krengel
- Department of Neurology, Boston University School of Medicine and VA Boston Healthcare System, Boston, MA, USA
| | - M Oscar-Berman
- Department of Neurology, Boston University School of Medicine and VA Boston Healthcare System, Boston, MA, USA
| | - P K Thanos
- Behavioral Neuropharmacology & Neuroimaging Laboratory on Addiction, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - I Elman
- Department of Psychiatry, Cooper University School of Medicine, Camden, NJ, USA
| | - M Hauser
- Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA
| | - L Fried
- Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA.,Transformations Treatment Center, Delray Beach, FL, USA
| | - A Bowirrat
- Division of Anatomy, Biochemistry and Genetics Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - R D Badgaiyan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Blum K, Modestino EJ, Gondre-Lewis M, Chapman EJ, Neary J, Siwicki D, Baron D, Hauser M, Smith DE, Roy AK, Thanos PK, Steinberg B, McLaughlin T, Fried L, Barh D, Dunston GA, Badgaiyan RD. The Benefits of Genetic Addiction Risk Score (GARS ™) Testing in Substance Use Disorder (SUD). INTERNATIONAL JOURNAL OF GENOMICS AND DATA MINING 2018; 2018. [PMID: 30198022 DOI: 10.29014/ijgd-115.000015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Following 25 years of extensive research by many scientists worldwide, a panel of ten reward gene risk variants, called the Genetic Addiction Risk Score (GARS), has been developed. In unpublished work, when GARS was compared to the Addiction Severity Index (ASI), which has been used in many clinical settings, GARS significantly predicted the severity of both alcohol and drug dependency. In support of early testing for addiction and other RDS subtypes, parents caught up in the current demographic of 127 people, both young and old, dying daily from opiate/opioid overdose, need help. In the past, families would have never guessed that their loved ones would die or could be in real danger due to opiate addiction. Author, Bill Moyers, in Parade Magazine, reported that as he traveled around the United States, he found many children with ADHD and other spectrum disorders like Autism, and noted that many of these children had related conditions like substance abuse. He called for better ways to identify these children and treat them with approaches other than addictive pharmaceuticals. To our knowledge, GARS is the only panel of genes with established polymorphisms reflecting the Brain Reward Cascade (BRC), which has been correlated with the ASI-MV alcohol and drug risk severity score. While other studies are required to confirm and extend the GARS test to include other genes and polymorphisms that associate with an hypodopaminergic trait, these results provide clinicians with a non-invasive genetic test. Genomic testing, such as GARS, can improve clinical interactions and decision-making. Knowledge of precise polymorphic associations can help in the attenuation of guilt and denial, corroboration of family gene-o-grams; assistance in risk-severity-based decisions about appropriate therapies, including pain medications and risk for addiction; choice of the appropriate level of care placement (i.e., inpatient, outpatient, intensive outpatient, residential); determination of the length of stay in treatment; determination of genetic severity-based relapse and recovery liability and vulnerability; determination of pharmacogenetic medical monitoring for better clinical outcomes (e.g., the A1 allele of the DRD2 gene reduces the binding to opioid delta receptors in the brain, thus, reducing Naltrexone's clinical effectiveness); and supporting medical necessity for insurance scrutiny.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Psychiatry and Behavioral Sciences, Keck Medicine University of Southern California, Los Angeles, CA, USA.,Division of Applied Clinical Research & Education, Dominion Diagnostics, LLC, North Kingstown, RI, USA.,Department of Neurogenetics, Igene, LLC, Austin, TX, USA.,Division of Neuroscience Based Addiction Therapy, The Shores Treatment & Recovery Center, Port Saint Lucie, FL, USA.,Eötvös Loránd University, Institute of Psychology, Budapest, Hungary.,Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Center, Dayton, OH (IE), USA.,Division of Precision Medicine, Geneus Health, LLC, USA.,Department of Psychiatry, Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine, Burlington, VT, USA.,Center for Genomics and Applied Gene Technology, Institute of Integrative Omics and applied Biotechnology (IIOAB), Nonakuri, Purbe Medinpur, West Bengal, India.,NeuroPsychoSocial Genomics Core, National Human Genome Center, Howard University, Washington, DC, USA
| | | | - Marjorie Gondre-Lewis
- NeuroPsychoSocial Genomics Core, National Human Genome Center, Howard University, Washington, DC, USA.,Developmental Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washington, DC, USA.,Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, DC, USA
| | - Edwin J Chapman
- Department of Medicine, Howard University College of Medicine, Washington, DC, USA
| | | | - David Siwicki
- Division of Precision Medicine, Geneus Health, LLC, USA
| | - David Baron
- Department of Psychiatry and Behavioral Sciences, Keck Medicine University of Southern California, Los Angeles, CA, USA
| | - Mary Hauser
- Division of Applied Clinical Research & Education, Dominion Diagnostics, LLC, North Kingstown, RI, USA
| | - David E Smith
- David E. Smith Associates, San Francisco, CA, & Institute of Health & Aging University of California, San Francisco, CA, USA
| | | | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | | | | | - Lyle Fried
- Division of Neuroscience Based Addiction Therapy, The Shores Treatment & Recovery Center, Port Saint Lucie, FL, USA
| | - Debmalya Barh
- Center for Genomics and Applied Gene Technology, Institute of Integrative Omics and applied Biotechnology (IIOAB), Nonakuri, Purbe Medinpur, West Bengal, India
| | - Georgia A Dunston
- NeuroPsychoSocial Genomics Core, National Human Genome Center, Howard University, Washington, DC, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Psychiatry and Behavioral Sciences, Keck Medicine University of Southern California, Los Angeles, CA, USA.,Division of Applied Clinical Research & Education, Dominion Diagnostics, LLC, North Kingstown, RI, USA.,Department of Neurogenetics, Igene, LLC, Austin, TX, USA.,Division of Neuroscience Based Addiction Therapy, The Shores Treatment & Recovery Center, Port Saint Lucie, FL, USA.,Eötvös Loránd University, Institute of Psychology, Budapest, Hungary.,Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Center, Dayton, OH (IE), USA.,Division of Precision Medicine, Geneus Health, LLC, USA.,Department of Psychiatry, Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine, Burlington, VT, USA.,Center for Genomics and Applied Gene Technology, Institute of Integrative Omics and applied Biotechnology (IIOAB), Nonakuri, Purbe Medinpur, West Bengal, India.,Department of Psychology, Curry College, Milton, MA, USA.,NeuroPsychoSocial Genomics Core, National Human Genome Center, Howard University, Washington, DC, USA.,Developmental Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washington, DC, USA.,Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, DC, USA.,Department of Medicine, Howard University College of Medicine, Washington, DC, USA.,David E. Smith Associates, San Francisco, CA, & Institute of Health & Aging University of California, San Francisco, CA, USA.,Addiction Recovery Resources, Inc. New Orleans, LA, USA.,Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA.,Center for Psychiatric Medicine Lawrence, MA, USA
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11
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Blum K, Gondré-Lewis MC, Baron D, Thanos PK, Braverman ER, Neary J, Elman I, Badgaiyan RD. Introducing Precision Addiction Management of Reward Deficiency Syndrome, the Construct That Underpins All Addictive Behaviors. Front Psychiatry 2018; 9:548. [PMID: 30542299 PMCID: PMC6277779 DOI: 10.3389/fpsyt.2018.00548] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 10/12/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kenneth Blum
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, United States.,Department of Psychiatry, Boonshoft School of Medicine, Dayton VA Medical Center, Wright State University, Dayton, OH, United States.,University of Vermont College of Medicine, Burlington, VM, United States.,Division of Addictive Services, Dominion Diagnostics, LLC, North Kingston, RI, United States.,Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Institute of Psychology, University of Eötvös Loránd, Budapest, Hungary.,Department of Clinical Neurology, Path Foundation, New York, NY, United States.,Division of Neuroscience and Addiction Therapy, Summit Estate Recovery Center, Los Gatos, CA, United States.,Department of Neurogenetics Research and Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, United States.,National Human Genome Center, Howard University, Washington, DC, United States
| | - Marjorie C Gondré-Lewis
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Department of Anatomy, Howard University College of Medicine, Washington, DC, United States.,Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical and Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - David Baron
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, United States.,Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States
| | - Panayotis K Thanos
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical and Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States.,Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Eric R Braverman
- Department of Clinical Neurology, Path Foundation, New York, NY, United States
| | - Jennifer Neary
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States
| | - Igor Elman
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Rajendra D Badgaiyan
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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12
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Abstract
Animal models provide rapid, inexpensive assessments of an investigational drug's therapeutic potential. Ideally, they support the plausibility of therapeutic efficacy and provide a rationale for further investigation. Here, I discuss how the absence of clear effective-ineffective categories for alcohol use disorder (AUD) medications and biases in the clinical and preclinical literature affect the development of predictive preclinical alcohol dependence (AD) models. Invoking the analogical argument concept from the philosophy of science field, I discuss how models of excessive alcohol drinking support the plausibility of clinical pharmacotherapy effects. Even though these models are not likely be completely discriminative, they are sensitive to clinically effective medications and have revealed dozens of novel medication targets. In that context, I discuss recent preclinical work on GLP-1 receptor agonists, phosphodiesterase inhibitors, glucocorticoid receptor antagonists, nociception agonists and antagonists, and CRF1 antagonists. Clinically approved medications are available for each of these drug classes. I conclude by advocating a translational approach in which drugs are evaluated highly congruent preclinical models and human laboratory studies. Once translation is established, I suggest the burden is to develop hypothesis-based therapeutic interventions maximizing the impact of the confirmed pharmacotherapeutic effects in the context of additional variables falling outside the model.
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Affiliation(s)
- Mark Egli
- Division of Neuroscience and Behavior, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
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13
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Sun X, Luquet S, Small DM. DRD2: Bridging the Genome and Ingestive Behavior. Trends Cogn Sci 2017; 21:372-384. [PMID: 28372879 DOI: 10.1016/j.tics.2017.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/10/2017] [Accepted: 03/06/2017] [Indexed: 12/26/2022]
Abstract
Recent work highlights the importance of genetic variants that influence brain structure and function in conferring risk for polygenic obesity. The neurotransmitter dopamine (DA) has a pivotal role in energy balance by integrating metabolic signals with circuits supporting cognitive, perceptual, and appetitive functions that guide feeding. It has also been established that diet and obesity alter DA signaling, leading to compulsive-like feeding and neurocognitive impairments. This raises the possibility that genetic variants that influence DA signaling and adaptation confer risk for overeating and cognitive decline. Here, we consider the role of two common gene variants, FTO and TaqIA rs1800497 in driving gene × environment interactions promoting obesity, metabolic dysfunction, and cognitive change via their influence on DA receptor subtype 2 (DRD2) signaling.
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Affiliation(s)
- Xue Sun
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Serge Luquet
- Université Paris Diderot, Sorbonne Paris Cité, BFA CNRS UMR 8251, Paris, France; Modern Diet and Physiology Research Center, New Haven, CT, USA
| | - Dana M Small
- Modern Diet and Physiology Research Center, New Haven, CT, USA; The John B. Pierce Laboratory, 290 Congress Avenue, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA.
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14
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Blum K, Febo M, Fahlke C, Archer T, Berggren U, Demetrovics Z, Dushaj K, Badgaiyan RD. Hypothesizing Balancing Endorphinergic and Glutaminergic Systems to Treat and Prevent Relapse to Reward Deficiency Behaviors: Coupling D-Phenylalanine and N-Acetyl-L-Cysteine (NAC) as a Novel Therapeutic Modality. ACTA ACUST UNITED AC 2015; 2. [PMID: 26900600 PMCID: PMC4760695 DOI: 10.23937/2378-3656/1410076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kenneth Blum
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA; Division of Nutrigenomics, LaVita RDS, LLC, Draper, UT, USA; Division of Applied Clinical Research & Education, Dominion Diagnostics, LLC, North Kingstown, RI, USA; Division of Neuroscience-Based Therapy, Summit Estate Recovery Center, Los Gatos, CA, USA; Division of Clinical Neurology, PATH Foundation NY, New York, NY, USA; Departments of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Marcelo Febo
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Claudia Fahlke
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Trevor Archer
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - U Berggren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Zsolt Demetrovics
- Department of Clinical Psychology and Addiction, Eotvos Lorand University, Budapest, Hungary
| | - Kristina Dushaj
- Division of Clinical Neurology, PATH Foundation NY, New York, NY, USA
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15
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Ilhan M, Kahraman OT, Turan S, Turgut S, Karaman O, Zeybek U, Shukurov S, Yaylim I, Tasan E. Does DRD2 polymorphism influence the clinical characteristics of prolactinoma? ANNALES D'ENDOCRINOLOGIE 2015; 76:614-9. [PMID: 26514951 DOI: 10.1016/j.ando.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Genetic alterations explaining the clinical variability of prolactinomas still could not be clarified and dopamine D2 receptor (DRD2) polymorphism is a putative candidate for the variable response to dopaminergic treatment. The present study was conducted to investigate the influence of DRD2 TaqI A polymorphism on initial and follow-up characteristics of prolactinoma. PATIENTS AND METHODS Seventy-two patients with prolactinoma and 98 age and gender matched control subjects were recruited to the case-control study. Serum prolactin levels were assessed by enzyme-linked immunosorbent assay and DRD2 polymorphism was determined by polymerase chain reaction and restriction length polymorphism analysis. RESULTS Decrease of prolactin levels and the tumor shrinkage after cabergoline treatment were 93.9±5.9% and 58.3±33.1% in microadenomas and 96.1±6.1% and 51.7±29.3 in macroadenomas (P=0.02 and P>0.05, respectively). We observed no significant difference for DRD2 genotypes and the alleles between the patients and healthy group (P>0.05). Prolactin levels before treatment were correlated with tumor diameter before and after treatment and the percentage of prolactin decrease with treatment (P<0.001 r=0.58, P<0.001 r=0.40 and P<0.001 r=0.47, respectively). Tumor diameter before the treatment was also correlated with the tumor diameter after the treatment (P<0.001 r=0.64) and the percentage of prolactin decrease (P=0.01 r=0.30). However, no significant association was found between characteristics of prolactinoma and DRD2 genotypes and alleles (P>0.05). CONCLUSION This study revealed that DRD2 TaqI A receptor polymorphism was not associated with the development of prolactinoma and its clinical characteristics. Future studies are needed to clarify the clinical implications of genetic alterations in prolactinoma.
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Affiliation(s)
- Muzaffer Ilhan
- Bezmialem University, Department of Endocrinology and Metabolism, Vatan Caddesi, 34093 Istanbul, Turkey.
| | - Ozlem Timirci Kahraman
- The Institute of Experimental Medicine, Department of Molecular Medicine, Millet Caddesi, Capa, Istanbul University, Istanbul, Turkey
| | - Saime Turan
- The Institute of Experimental Medicine, Department of Molecular Medicine, Millet Caddesi, Capa, Istanbul University, Istanbul, Turkey
| | - Seda Turgut
- Bezmialem University, Internal Medicine Department, Vatan Caddesi, 34093 Istanbul, Turkey
| | - Ozcan Karaman
- Bezmialem University, Department of Endocrinology and Metabolism, Vatan Caddesi, 34093 Istanbul, Turkey
| | - Umit Zeybek
- The Institute of Experimental Medicine, Department of Molecular Medicine, Millet Caddesi, Capa, Istanbul University, Istanbul, Turkey
| | - Samir Shukurov
- Bezmialem University, Department of Endocrinology and Metabolism, Vatan Caddesi, 34093 Istanbul, Turkey
| | - Ilhan Yaylim
- The Institute of Experimental Medicine, Department of Molecular Medicine, Millet Caddesi, Capa, Istanbul University, Istanbul, Turkey
| | - Ertugrul Tasan
- Bezmialem University, Department of Endocrinology and Metabolism, Vatan Caddesi, 34093 Istanbul, Turkey
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16
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Blum K, Thanos PK, Oscar-Berman M, Febo M, Baron D, Badgaiyan RD, Gardner E, Demetrovics Z, Fahlke C, Haberstick BC, Dushaj K, Gold MS. Dopamine in the Brain: Hypothesizing Surfeit or Deficit Links to Reward and Addiction. ACTA ACUST UNITED AC 2015; 1:95-104. [PMID: 27398406 PMCID: PMC4936401 DOI: 10.17756/jrds.2015-016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recently there has been debate concerning the role of brain dopamine in reward and addiction. David Nutt and associates eloquently proposed that dopamine (DA) may be central to psycho stimulant dependence and some what important for alcohol, but not important for opiates, nicotine or even cannabis. Others have also argued that surfeit theories can explain for example cocaine seeking behavior as well as non-substance-related addictive behaviors. It seems prudent to distinguish between what constitutes “surfeit” compared to” deficit” in terms of short-term (acute) and long-term (chronic) brain reward circuitry responsivity. In an attempt to resolve controversy regarding the contributions of mesolimbic DA systems to reward, we review the three main competing explanatory categories: “liking”, “learning”, and “wanting”. They are (a) the hedonic impact -liking reward, (b) the ability to predict rewarding effects-learning and (c) the incentive salience of reward-related stimuli -wanting. In terms of acute effects, most of the evidence seems to favor the “surfeit theory”. Due to preferential dopamine release at mesolimbic-VTA-caudate-accumbens loci most drugs of abuse and Reward Deficiency Syndrome (RDS) behaviors have been linked to heightened feelings of well-being and hyperdopaminergic states.The “dopamine hypotheses” originally thought to be simple, is now believed to be quite complex and involves encoding the set point of hedonic tone, encoding attention, reward expectancy, and incentive motivation. Importantly, Willuhn et al. shows that in a self-administration paradigm, (chronic) excessive use of cocaine is caused by decreased phasic dopamine signaling in the striatum. In terms of chronic addictions, others have shown a blunted responsivity at brain reward sites with food, nicotine, and even gambling behavior. Finally, we are cognizant of the differences in dopaminergic function as addiction progresses and argue that relapse may be tied to dopamine deficiency. Vulnerability to addiction and relapse may be the result of the cumulative effects of dopaminergic and other neurotransmitter genetic variants and elevated stress levels. We therefore propose that dopamine homeostasis may be a preferred goal to combat relapse.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry and McKnight Brain Institute, University of Florida, College of Medicine, Gainesville, FL, USA; Division of Nutrigenomics, La Vita RDS, Salt Lake City, UT, USA
| | - Peter K Thanos
- Research Institute on Addictions, University of Buffalo, State University of New York, Buffalo, NY, USA
| | - Marlene Oscar-Berman
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, USA
| | - Marcelo Febo
- Department of Psychiatry and McKnight Brain Institute, University of Florida, College of Medicine, Gainesville, FL, USA
| | - David Baron
- Departments of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Eliot Gardner
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Zsolt Demetrovics
- Eotvos Lorand University, Institute of Psychology, Department of Clinical Psychology and Addiction, Izabella utca 46., H-1064, Budapest, Hungary
| | - Claudia Fahlke
- Department of Psychology, University of Gothenburg, Sweden
| | - Brett C Haberstick
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Kristina Dushaj
- Department of Neurological Research, Path Foundation NY, USA
| | - Mark S Gold
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, USA; Department of Psychiatry, Washington University School of Medicine. St. Louis, MO, USA
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17
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Patriquin MA, Bauer IE, Soares JC, Graham DP, Nielsen DA. Addiction pharmacogenetics: a systematic review of the genetic variation of the dopaminergic system. Psychiatr Genet 2015; 25:181-93. [PMID: 26146874 PMCID: PMC4549168 DOI: 10.1097/ypg.0000000000000095] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Substance use disorders have significant personal, familial, and societal consequences. Despite the serious consequences of substance use, only a few therapies are effective in treating substance use disorders, thus highlighting a need for improved treatment practices. Substance use treatment response depends on multiple factors such as genetic, biological, and social factors. It is essential that each component is represented in treatment plans. The dopaminergic system plays a critical role in the pharmacotherapy for addictions, and an understanding of the role of variation of genes involved in this system is essential for its success. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guidelines. A computerized literature search was conducted using PubMed and Scopus (all databases). Articles published up to April 2015 that examined the role of dopaminergic gene variation in the pharmacotherapy of alcohol, opioid, and cocaine use disorders were reviewed. Search terms were dopamine, gene, polymorphism, substance abuse, treatment, and response. Polymorphisms of the DRD2, ANKK1, DAT1, DBH, and DRD4 genes have been found to moderate the effects of pharmacotherapy of alcohol, opioid, and cocaine use disorders. The integration of genetic information with clinical data will inform health professionals of the most efficacious pharmacotherapeutic intervention for substance use disorders. More studies are needed to confirm and extend these findings.
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Affiliation(s)
- Michelle A. Patriquin
- The Menninger Clinic, Baylor College of Medicine, Houston, TX USA
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - Isabelle E. Bauer
- Department of Psychiatry and Behavioral Science, University of Texas Health Sciences Center, Houston, TX USA
| | - Jair C. Soares
- Department of Psychiatry and Behavioral Science, University of Texas Health Sciences Center, Houston, TX USA
| | - David P. Graham
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
- Michael E. DeBakey Veterans Affairs Medical Center; Houston, TX USA
| | - David A. Nielsen
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
- Michael E. DeBakey Veterans Affairs Medical Center; Houston, TX USA
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18
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Blum K, Simpatico T, Badgaiyan RD, Demetrovics Z, Fratantonio J, Agan G, Febo M, Gold MS. Coupling Neurogenetics (GARS™) and a Nutrigenomic Based Dopaminergic Agonist to Treat Reward Deficiency Syndrome (RDS): Targeting Polymorphic Reward Genes for Carbohydrate Addiction Algorithms. JOURNAL OF REWARD DEFICIENCY SYNDROME 2015; 1:75-80. [PMID: 27617300 PMCID: PMC5013730 DOI: 10.17756/jrds.2015-012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Earlier work from our laboratory, showing anti-addiction activity of a nutraceutical consisting of amino-acid precursors and enkephalinase inhibition properties and our discovery of the first polymorphic gene (Dopamine D2 Receptor Gene [DRD2]) to associate with severe alcoholism serves as a blue-print for the development of "Personalized Medicine" in addiction. Prior to the later genetic finding, we developed the concept of Brain Reward Cascade, which continues to act as an important component for stratification of addiction risk through neurogenetics. In 1996 our laboratory also coined the term "Reward Deficiency Syndrome (RDS)" to define a common genetic rubric for both substance and non-substance related addictive behaviors. Following many reiterations we utilized polymorphic targets of a number of reward genes (serotonergic, Opioidergic, GABAergic and Dopaminergic) to customize KB220 [Neuroadaptogen- amino-acid therapy (NAAT)] by specific algorithms. Identifying 1,000 obese subjects in the Netherlands a subsequent small subset was administered various KB220Z formulae customized according to respective DNA polymorphisms individualized that translated to significant decreases in both Body Mass Index (BMI) and weight in pounds. Following these experiments, we have been successfully developing a panel of genes known as "Genetic Addiction Risk Score" (GARSpDX)™. Selection of 10 genes with appropriate variants, a statistically significant association between the ASI-Media Version-alcohol and drug severity scores and GARSpDx was found A variant of KB220Z in abstinent heroin addicts increased resting state functional connectivity in a putative network including: dorsal anterior cingulate, medial frontal gyrus, nucleus accumbens, posterior cingulate, occipital cortical areas, and cerebellum. In addition, we show that KB220Z significantly activates, above placebo, seed regions of interest including the left nucleus accumbens, cingulate gyrus, anterior thalamic nuclei, hippocampus, pre-limbic and infra-limbic loci. KB220Z demonstrates significant functional connectivity, increased brain volume recruitment and enhanced dopaminergic functionality across the brain reward circuitry. We propose a Reward Deficiency System Solution that promotes early identification and stratification of risk alleles by utilizing GARSDx, allowing for customized nutrigenomic targeting of these risk alleles by altering KB220Z ingredients as an algorithmic function of carrying these polymorphic DNA-SNPS, potentially yielding the first ever nutrigenomic solution for addiction and pain.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Nutrigenomics, RD Solutions Inc., Salt Lake City, UT, USA
- Department of Addiction Research & Therapy, Malibu Beach Recovery Center, Malibu Beach, CA, USA
- Department of Psychiatry, Human Integrated Services Unit, University of Vermont Center for Clinical & Translational Science, University of Vermont College of Medicine, Burlington, VT, USA
- Department of Personalized Addiction Medicine IGENE, LLC, Austin, TX, USA
- Division of Applied Research & Education and Addition Services, Dominion Diagnostics, LLC., North Kingstown RI, USA
- Department of Nutrigenetic & Nutrigenomic Research, Victory Nutrition International, Austin, TX, USA
- Department of Personalized Medicine, Path Foundation, NY, USA
| | - Thomas Simpatico
- Department of Addiction Research & Therapy, Malibu Beach Recovery Center, Malibu Beach, CA, USA
- Division of Applied Research & Education and Addition Services, Dominion Diagnostics, LLC., North Kingstown RI, USA
| | | | - Zsolt Demetrovics
- Eotvos Lorand University, Institute of Psychology, Department of Clinical Psychology and Addiction, Izabella utca, Budapest, Hungary
| | - James Fratantonio
- Division of Applied Research & Education and Addition Services, Dominion Diagnostics, LLC., North Kingstown RI, USA
| | - Gozde Agan
- Division of Applied Research & Education and Addition Services, Dominion Diagnostics, LLC., North Kingstown RI, USA
| | - Marcelo Febo
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mark S. Gold
- Departments of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
- Department of Psychiatry, Washington University School of Medicine. St. Louis, MO, USA
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Roussotte FF, Jahanshad N, Hibar DP, Thompson PM. Altered regional brain volumes in elderly carriers of a risk variant for drug abuse in the dopamine D2 receptor gene (DRD2). Brain Imaging Behav 2015; 9:213-22. [PMID: 24634060 PMCID: PMC4276548 DOI: 10.1007/s11682-014-9298-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dopamine D2 receptors mediate the rewarding effects of many drugs of abuse. In humans, several polymorphisms in DRD2, the gene encoding these receptors, increase our genetic risk for developing addictive disorders. Here, we examined one of the most frequently studied candidate variant for addiction in DRD2 for association with brain structure. We tested whether this variant showed associations with regional brain volumes across two independent elderly cohorts, totaling 1,032 subjects. We first examined a large sample of 738 elderly participants with neuroimaging and genetic data from the Alzheimer's Disease Neuroimaging Initiative (ADNI1). We hypothesized that this addiction-related polymorphism would be associated with structural brain differences in regions previously implicated in familial vulnerability for drug dependence. Then, we assessed the generalizability of our findings by testing this polymorphism in a non-overlapping replication sample of 294 elderly subjects from a continuation of the first ADNI project (ADNI2) to minimize the risk of reporting false positive results. In both cohorts, the minor allele-previously linked with increased risk for addiction-was associated with larger volumes in various brain regions implicated in reward processing. These findings suggest that neuroanatomical phenotypes associated with familial vulnerability for drug dependence may be partially mediated by DRD2 genotype.
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Affiliation(s)
- Florence F Roussotte
- Imaging Genetics Center, Institute for Neuroimaging and Informatics Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
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Nutt DJ, Lingford-Hughes A, Erritzoe D, Stokes PRA. The dopamine theory of addiction: 40 years of highs and lows. Nat Rev Neurosci 2015; 16:305-12. [PMID: 25873042 DOI: 10.1038/nrn3939] [Citation(s) in RCA: 350] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
For several decades, addiction has come to be viewed as a disorder of the dopamine neurotransmitter system; however, this view has not led to new treatments. In this Opinion article, we review the origins of the dopamine theory of addiction and discuss the ability of addictive drugs to elicit the release of dopamine in the human striatum. There is robust evidence that stimulants increase striatal dopamine levels and some evidence that alcohol may have such an effect, but little evidence, if any, that cannabis and opiates increase dopamine levels. Moreover, there is good evidence that striatal dopamine receptor availability and dopamine release are diminished in individuals with stimulant or alcohol dependence but not in individuals with opiate, nicotine or cannabis dependence. These observations have implications for understanding reward and treatment responses in various addictions.
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Affiliation(s)
- David J Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK
| | - Anne Lingford-Hughes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK
| | - David Erritzoe
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK
| | - Paul R A Stokes
- 1] Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK. [2] Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
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Blum K, Chen TJH, Morse S, Giordano J, Chen ALC, Thompson J, Allen C, Smolen A, Lubar J, Stice E, Downs BW, Waite RL, Madigan MA, Kerner M, Fornari F, Braverman ER. Overcoming qEEG Abnormalities and Reward Gene Deficits during Protracted Abstinence in Male Psychostimulant and Polydrug Abusers Utilizing Putative Dopamine D2Agonist Therapy: Part 2. Postgrad Med 2015; 122:214-26. [DOI: 10.3810/pgm.2010.11.2237] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Miller DK, Bowirrat A, Manka M, Miller M, Stokes S, Manka D, Allen C, Gant C, Downs BW, Smolen A, Stevens E, Yeldandi S, Blum K. Acute Intravenous Synaptamine Complex Variant KB220™ “Normalizes” Neurological Dysregulation in Patients during Protracted Abstinence from Alcohol and Opiates as Observed Using Quantitative Electroencephalographic and Genetic Analysis for Reward Polymorphisms: Part 1, Pilot Study with 2 Case Reports. Postgrad Med 2015; 122:188-213. [DOI: 10.3810/pgm.2010.11.2236] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Blum K, Febo M, Thanos PK, Baron D, Fratantonio J, Gold M. Clinically Combating Reward Deficiency Syndrome (RDS) with Dopamine Agonist Therapy as a Paradigm Shift: Dopamine for Dinner? Mol Neurobiol 2015; 52:1862-1869. [PMID: 25750061 PMCID: PMC4586005 DOI: 10.1007/s12035-015-9110-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/21/2015] [Indexed: 01/23/2023]
Abstract
Everyday, there are several millions of people that are increasingly unable to combat their frustrating and even fatal romance with getting high and/or experiencing “normal” feelings of well-being. In the USA, the FDA has approved pharmaceuticals for drug and alcohol abuse: tobacco and nicotine replacement therapy. The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) remarkably continue to provide an increasing understanding of the intricate functions of brain reward circuitry through sophisticated neuroimaging and molecular genetic applied technology. Similar work is intensely investigated on a worldwide basis with enhanced clarity and increased interaction between not only individual scientists but across many disciplines. However, while it is universally agreed that dopamine is a major neurotransmitter in terms of reward dependence, there remains controversy regarding how to modulate its role clinically to treat and prevent relapse for both substance and non-substance-related addictive behaviors. While the existing FDA-approved medications promote blocking dopamine, we argue that a more prudent paradigm shift should be biphasic—short-term blockade and long-term upregulation, enhancing functional connectivity of brain reward circuits.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry and McKnight Brain Institute, College of Medicine, University of Florida, P. O. Box 100256, Gainesville, FL 32610-0256 USA
- Human Integrated Services Unit, Center for Clinical and Translational Science, Department of Psychiatry, College of Medicine, University of Vermont, Burlington, VT USA
- Division of Applied Clinical Research, Dominion Diagnostics, LLC, North Kingstown, RI USA
- Department of Addiction Research and Therapy, Malibu Beach Recovery Center, Malibu, CA USA
| | - Marcelo Febo
- Department of Psychiatry and McKnight Brain Institute, College of Medicine, University of Florida, P. O. Box 100256, Gainesville, FL 32610-0256 USA
| | - Panayotis K. Thanos
- Behavior Neuropharmacology and Neuroimaging Laboratory, Department of Psychology, SUNY at Stony Brook, Stony Brook, NY USA
| | - David Baron
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - James Fratantonio
- Division of Applied Clinical Research, Dominion Diagnostics, LLC, North Kingstown, RI USA
| | - Mark Gold
- Department of Psychiatry and McKnight Brain Institute, College of Medicine, University of Florida, P. O. Box 100256, Gainesville, FL 32610-0256 USA
- Department of Research, Rivermernd Health, Atlanta, GA USA
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Jones JD, Comer SD, Kranzler HR. The pharmacogenetics of alcohol use disorder. Alcohol Clin Exp Res 2015; 39:391-402. [PMID: 25703505 PMCID: PMC4348335 DOI: 10.1111/acer.12643] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/24/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Annually, the use and abuse of alcohol contributes to millions of deaths and billions of dollars in societal costs. To determine the impact of genetic variation on the susceptibility to the disorder and its response to treatment, studies have been conducted to assess the contribution of a variety of candidate genetic variants. These variants, which we review here, were chosen based upon their observed or hypothesized functional relevance to alcohol use disorder (AUD) risk or to the mechanism by which medications used to treat the disorder exert their effects. METHODS This qualitative review examines studies in which candidate polymorphisms were tested as moderator variables to identify pharmacogenetic effects on either the subjective response to alcohol or the outcomes of pharmacotherapy. RESULTS Although findings from these studies provide evidence of a number of clinically relevant pharmacogenetic effects, the literature is limited and there are conflicting findings that require resolution. CONCLUSIONS Pharmacogenetic studies of AUD treatment that use greater methodological rigor and better statistical controls, such as corrections for multiple testing, may help to resolve inconsistent findings. These procedures could also lead to the discovery of more robust and clinically meaningful moderator effects. As the field evolves through methodological standardization and the use of larger study samples, pharmacogenetic research has the potential to inform clinical care by enhancing therapeutic effects and personalizing treatments. These efforts may also provide insights into the mechanisms by which medications reduce heavy drinking or promote abstinence in patients with an AUD.
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Affiliation(s)
- Jermaine D Jones
- Division on Substance Abuse , New York State Psychiatric Institute & Columbia University College of Physicians and Surgeons, New York, New York
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Ma H, Zhu G. The dopamine system and alcohol dependence. SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 26:61-8. [PMID: 25092951 PMCID: PMC4120286 DOI: 10.3969/j.issn.1002-0829.2014.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/20/2014] [Indexed: 11/25/2022]
Abstract
Alcohol dependence is a common mental disorder that is associated with substantial disease burden. Current efforts at prevention and treatment of alcohol dependence are of very limited effectiveness. A better understanding of the biological mechanisms underlying dependence is essential to improving the outcomes of treatment and prevention initiatives. To date, most of the efforts have focused on the key role of the dopamine system in the complex etiological network of alcohol dependence. This review summarizes current research about the relationships between alcohol consumption and the dopaminergic system. We find that many of the currently available studies have contradictory results, presumably due to differences in methodology, non-linear dosage effects, use of different samples, and the possible confounding effects of other neurotransmitter systems.
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Affiliation(s)
- Hui Ma
- Center for Mental Health, Yanshan University, Qinhuangdao, Hebei Province, China ; Department of Psychiatry, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Gang Zhu
- Department of Psychiatry, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Blum K, Oscar-Berman M, Badgaiyan RD, Palomo T, Gold MS. Hypothesizing dopaminergic genetic antecedents in schizophrenia and substance seeking behavior. Med Hypotheses 2014; 82:606-14. [PMID: 24636783 PMCID: PMC4039414 DOI: 10.1016/j.mehy.2014.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 01/05/2023]
Abstract
The dopamine system has been implicated in both substance use disorder (SUD) and schizophrenia. A recent meta-analysis suggests that A1 allele of the DRD2 gene imposes genetic risk for SUD, especially alcoholism and has been implicated in Reward Deficiency Syndrome (RDS). We hypothesize that dopamine D2 receptor (DRD2) gene Taq1 A2 allele is associated with a subtype of non-SUD schizophrenics and as such may act as a putative protective agent against the development of addiction to alcohol or other drugs of abuse. Schizophrenics with SUD may be carriers of the DRD2 Taq1 A1 allele, and/or other RDS reward polymorphisms and have hypodopaminergic reward function. One plausible mechanism for alcohol seeking in schizophrenics with SUD, based on previous research, may be a deficiency of gamma type endorphins that has been linked to schizophrenic type psychosis. We also propose that alcohol seeking behavior in schizophrenics, may serve as a physiological self-healing process linked to the increased function of the gamma endorphins, thereby reducing abnormal dopaminergic activity at the nucleus accumbens (NAc). These hypotheses warrant further investigation and cautious interpretation. We, therefore, encourage research involving neuroimaging, genome wide association studies (GWAS), and epigenetic investigation into the relationship between neurogenetics and systems biology to unravel the role of dopamine in psychiatric illness and SUD.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA; Department of Clinical Neurology, Path Research Foundation, New York, NY, USA; Department of Genomics, IGENE, LLC, Austin, TX, USA; Department of Psychiatry, Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine, Burlington, VT, USA; Dominion Diagnostics, LLC, North Kingstown, RI, USA; Department of Addiction Research & Therapy, Malibu Beach Recovery Center, Malibu Beach, CA, USA; RD Solutions, LLC, Research Center, Austin, TX, USA; Department of Nutrigenomics, RD Solutions, LLC, La Jolla, CA, USA.
| | - Marlene Oscar-Berman
- Departments of Psychiatry and Anatomy & Neurobiology, Boston University School of Medicine and Boston VA Healthcare System, Boston, MA, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry and Neuroimaging Laboratory, SUNY-at Buffalo, Buffalo, NY, USA
| | - Tomas Palomo
- Unidad de Alcoholismo y Patología Dual, Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, Madrid E-28041, Spain
| | - Mark S Gold
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
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Blum K, Schoenthaler SJ, Oscar-Berman M, Giordano J, Madigan MA, Braverman ER, Han D. Drug abuse relapse rates linked to level of education: can we repair hypodopaminergic-induced cognitive decline with nutrient therapy? PHYSICIAN SPORTSMED 2014; 42:130-45. [PMID: 24875980 DOI: 10.3810/psm.2014.05.2065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is well known that athletes and other individuals who have suffered painful injuries are at increased risk for all reward deficiency syndrome (RDS) behaviors, including substance use disorder (SUD). Comparing patient demographics and relapse rates in chemical dependence programs is pertinent because demographics may affect outcomes. Increased risk for relapse and lower academic achievement were found to have a significant association in recent outcome data from a holistic treatment center (HTC) located in North Miami Beach, FL. Relapse outcomes from the Drug Addiction Treatment Outcome Study (DATOS; n = 1738) and HTC (n = 224) were compared for a 12-month period. Post-discharge relapse was reported by 26% of HTC patients and 58% of patients in DATOS. When broken out by education level-less than high school, high school diploma, college degree, and graduate degree-HTC patient relapse was 50%, 36%, 33%, and 16%, respectively, and demonstrated an inverse linear association (F = 5.702; P = 0.017). Looking at DATOS patient relapse rates broken down by educational grades/years completed, patients who attended school between 7th grade and 4 years of college also demonstrated an inverse linear association (F = 5.563; P = 0.018). Additionally, the lowest performers, patients who reported their academic performance as "not so good," had the highest relapse (F = 4.226; P = 0.04). Albeit certain limitations, compared with DATOS patients, HTC patients produced significantly larger net differences in relapse rates (X 2 = 84.09; P = 0.0001), suggesting that other variables, such as the treatment model may also affect patient relapse. Our results implicate the use of vitamin and mineral supplements coupled with a well-researched natural dopamine agonist nutrient therapy; both have been shown to improve cognition and behavior, and thus academic achievement. That relapse is highest among addicts who have less education and who report lower grades is a factor that can be useful when considering treatment type and controlled for when comparing treatment outcomes.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry and McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL.
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Nielsen DA, Nielsen EM, Dasari T, Spellicy CJ. Pharmacogenetics of addiction therapy. Methods Mol Biol 2014; 1175:589-624. [PMID: 25150877 DOI: 10.1007/978-1-4939-0956-8_15] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Drug addiction is a serious relapsing disease that has high costs to society and to the individual addicts. Treatment of these addictions is still in its nascency, with only a few examples of successful therapies. Therapeutic response depends upon genetic, biological, social, and environmental components. A role for genetic makeup in the response to treatment has been shown for several addiction pharmacotherapies. For several addiction pharmacotherapies, response to treatment varies based on individual genetic makeup. In this chapter, we discuss the role of genetics in pharmacotherapies, specifically for cocaine, alcohol, and opioid dependences. The elucidation of the role of genetics should aid in the development of new treatments and increase the efficacy of existing treatments.
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Affiliation(s)
- David A Nielsen
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,
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Blum K, Oscar-Berman M, Jacobs W, McLaughlin T, Gold MS. Buprenorphine Response as a Function of Neurogenetic Polymorphic Antecedents: Can Dopamine Genes Affect Clinical Outcomes in Reward Deficiency Syndrome (RDS)? ACTA ACUST UNITED AC 2014; 5. [PMID: 25664200 DOI: 10.4172/2155-6105.1000185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
There is a plethora of research indicating the successful treatment of opioid dependence with either buprenorphine alone or in combination with naloxone (Suboxone®). However, we encourage caution in long-term maintenance with these drugs, albeit, lack of any other FDA approved opioid maintenance compound to date. Our concern has been supported by severe withdrawal (even with tapering of the dosage of for example Suboxone® which is 40 times more potent than morphine) from low dose of buprenorphine (alone or with naloxone). In addition our findings of a long-term flat affect in chronic Suboxone® patients amongst other unwanted side effects including diversion and suicide attempts provides impetus to reconsider long-term utilization. However, it seems prudent to embrace genetic testing to reveal reward circuitry gene polymorphisms especially those related to dopaminergic pathways as well as opioid receptor(s) as a way of improving treatment outcomes. Understanding the interaction of reward circuitry involvement in buprenorphine effects and respective genotypes provide a novel framework to augment a patient's clinical experience and benefits during opioid replacement therapy.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA ; Human Integrated Services Unit University of Vermont Centre for Clinical & Translational Science, College of Medicine, Burlington, VT, USA ; Department of Addiction Research & Therapy, Malibu Beach Recovery Centre, Malibu Beach, CA, USA ; Dominion Diagnostics, LLC, North Kingstown, RI, USA ; Institute of Integrative Omics and Applied Biotechnology, Nonakuri, Purba Medinipur, West Bengal, India ; IGENE, LLC, Austin, Texas, USA
| | - Marlene Oscar-Berman
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, 02118, USA
| | - William Jacobs
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Mark S Gold
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
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Blum K, Simpaatico T, Waite RL, Blum SH, Dushaj K, Madigan MA, Braverman ER, Oscar-Bermanm M. Hypothesizing “Reward” Gene Polymorphisms May Predict High Rates of Injury and Addiction in the Workforce: A Nutrient and Electrotherapeutic Based Solution. Health (London) 2014. [DOI: 10.4236/health.2014.616262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kavanagh DJ, Statham DJ, Feeney GF, Young RM, May J, Andrade J, Connor JP. Measurement of alcohol craving. Addict Behav 2013; 38:1572-1584. [PMID: 23142210 DOI: 10.1016/j.addbeh.2012.08.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/14/2012] [Accepted: 08/15/2012] [Indexed: 11/24/2022]
Abstract
Despite considerable research activity and application in treatment, the construct of craving remains poorly understood. We propose that cravings and urges are cognitive-emotional events in time, characterised by frequency, duration, intensity and salience. Commonly used measures of alcohol craving are reviewed, and their strengths and weaknesses identified. Most measures confound craving with behaviours, or with separable cognitive phenomena such as expectancies, intentions, or perceived behavioural control. These confounds have limited our advances in understanding the determinants and consequences of craving. Based on the criteria applied in this review, among the better performing multi-item measures are the Penn Alcohol Craving Scale and Obsessive subscale of the Obsessive-Compulsive Drinking Scale. Optimal assessment strategies are likely to involve daily assessments of peak intensity of cravings, desires or urges and of the frequency and duration of craving episodes. Of particular interest are measures of intensity at times when individuals are at risk of drinking or of other functional impacts from craving.
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Blum K, Oscar-Berman M, Stuller E, Miller D, Giordano J, Morse S, McCormick L, Downs WB, Waite RL, Barh D, Neal D, Braverman ER, Lohmann R, Borsten J, Hauser M, Han D, Liu Y, Helman M, Simpatico T. Neurogenetics and Nutrigenomics of Neuro-Nutrient Therapy for Reward Deficiency Syndrome (RDS): Clinical Ramifications as a Function of Molecular Neurobiological Mechanisms. ACTA ACUST UNITED AC 2013; 3:139. [PMID: 23926462 DOI: 10.4172/2155-6105.1000139] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In accord with the new definition of addiction published by American Society of Addiction Medicine (ASAM) it is well-known that individuals who present to a treatment center involved in chemical dependency or other documented reward dependence behaviors have impaired brain reward circuitry. They have hypodopaminergic function due to genetic and/or environmental negative pressures upon the reward neuro-circuitry. This impairment leads to aberrant craving behavior and other behaviors such as Substance Use Disorder (SUD). Neurogenetic research in both animal and humans revealed that there is a well-defined cascade in the reward site of the brain that leads to normal dopamine release. This cascade has been termed the "Brain Reward Cascade" (BRC). Any impairment due to either genetics or environmental influences on this cascade will result in a reduced amount of dopamine release in the brain reward site. Manipulation of the BRC has been successfully achieved with neuro-nutrient therapy utilizing nutrigenomic principles. After over four decades of development, neuro-nutrient therapy has provided important clinical benefits when appropriately utilized. This is a review, with some illustrative case histories from a number of addiction professionals, of certain molecular neurobiological mechanisms which if ignored may lead to clinical complications.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry, University of Florida, McKnight Brain Institute, Gainesville, Fl, 100183, USA ; Department of Nutrigenomic, LifeGen, Inc. San Diego, CA, 92101, USA ; Department of Holistic Medicine, G&G Holistic Addiction Treatment Center, North Miami Beach, Fl, 33162, USA ; Center for Genomics and Applied Gene Technology, Institute of Integrative Omics and applied Biotechnology (IIOAB), Nonakuri, Purbe Medinpur, West Bengal, 721172, India ; Path Foundation NY, New York, 10001, New York USA ; Malibu Beach Recovery Center, Malibu Beach, California, 9026, USA ; Dominion Diagnostics, North Kingstown Rhode Island, 02852, USA ; Global Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine, Burlington, VT, USA
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Miller M, Chen ALC, Stokes SD, Silverman S, Bowirrat A, Manka M, Manka D, Miller DK, Perrine K, Chen TJH, Bailey JA, Downs W, Waite RL, Madigan MA, Braverman ER, Damle U, Kerner M, Giordano J, Morse S, Oscar-Berman M, Barh D, Blum K. Early intervention of intravenous KB220IV--neuroadaptagen amino-acid therapy (NAAT) improves behavioral outcomes in a residential addiction treatment program: a pilot study. J Psychoactive Drugs 2012; 44:398-409. [PMID: 23457891 PMCID: PMC4074362 DOI: 10.1080/02791072.2012.737727] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Substance use disorders (SUD) are inheritable and the culprit is hypodopaminergic function regulated by reward genes. We evaluated a natural dopaminergic agonist; KB220 intravenous (IV) and oral variants, to improve dopaminergic function in SUD. Our pilot experiment found a significant reduction of chronic symptoms, measured by the Chronic Abstinence Symptom Severity (CASS) Scale. The combined group (IV and oral) did significantly better than the oral-only group over the first week and 30-day follow-up period. Next, the combination was given to 129 subjects and three factors; Emotion, Somatic, and Impaired Cognition, with eigenvalues greater than one were extracted for baseline CASS-Revised (CASS-R) variables. Paired sample t-tests for pre and post-treatment scales showed significant declines (p = .00001) from pre- to post-treatment: t = 19.1 for Emotion, t = 16.1 for Somatic, and t = 14.9 for Impaired Cognition. In a two-year follow-up of 23 subjects who underwent KB220IV therapy (at least five IV treatments over seven days) plus orals for 30+ days: 21 (91%) were sober at six months, 19 (82%) having no relapse; 19 (82%) were sober at one year, 18 (78%) having no relapse; and 21 (91%) were sober two-years post-treatment, 16(70%) having no relapse. We await additional research and advise caution in interpreting these encouraging results.
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Blum K, Gardner E, Oscar-Berman M, Gold M. "Liking" and "wanting" linked to Reward Deficiency Syndrome (RDS): hypothesizing differential responsivity in brain reward circuitry. Curr Pharm Des 2012; 18:113-8. [PMID: 22236117 DOI: 10.2174/138161212798919110] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 11/11/2011] [Indexed: 11/22/2022]
Abstract
In an attempt to resolve controversy regarding the causal contributions of mesolimbic dopamine (DA) systems to reward, we evaluate the three main competing explanatory categories: "liking,""learning," and "wanting" [1]. That is, DA may mediate (a) the hedonic impact of reward (liking), (b) learned predictions about rewarding effects (learning), or (c) the pursuit of rewards by attributing incentive salience to reward-related stimuli (wanting). We evaluate these hypotheses, especially as they relate to the Reward Deficiency Syndrome (RDS), and we find that the incentive salience or "wanting" hypothesis of DA function is supported by a majority of the evidence. Neuroimaging studies have shown that drugs of abuse, palatable foods, and anticipated behaviors such as sex and gaming affect brain regions involving reward circuitry, and may not be unidirectional. Drugs of abuse enhance DA signaling and sensitize mesolimbic mechanisms that evolved to attribute incentive salience to rewards. Addictive drugs have in common that they are voluntarily selfadministered, they enhance (directly or indirectly) dopaminergic synaptic function in the nucleus accumbens (NAC), and they stimulate the functioning of brain reward circuitry (producing the "high" that drug users seek). Although originally believed simply to encode the set point of hedonic tone, these circuits now are believed to be functionally more complex, also encoding attention, reward expectancy, disconfirmation of reward expectancy, and incentive motivation. Elevated stress levels, together with polymorphisms of dopaminergic genes and other neurotransmitter genetic variants, may have a cumulative effect on vulnerability to addiction. The RDS model of etiology holds very well for a variety of chemical and behavioral addictions.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA.
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Swagell CD, Lawford BR, Hughes IP, Voisey J, Feeney GF, van Daal A, Connor JP, Noble EP, Morris CP, Young RM. DRD2 C957T and TaqIA Genotyping Reveals Gender Effects and Unique Low-Risk and High-Risk Genotypes in Alcohol Dependence. Alcohol Alcohol 2012; 47:397-403. [DOI: 10.1093/alcalc/ags047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The anticonvulsant levetiracetam potentiates alcohol consumption in non-treatment seeking alcohol abusers. J Clin Psychopharmacol 2012; 32:269-72. [PMID: 22367657 DOI: 10.1097/jcp.0b013e318248ba69] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Levetiracetam (Keppra) is a commonly prescribed anticonvulsant that has been shown to attenuate alcohol consumption in an open-label study of treatment-seeking, alcohol-dependent subjects. METHODS Here we performed a 42-day placebo-controlled, double-blind, randomized crossover trial to evaluate the effects of levetiracetam on moderate to heavy drinkers receiving either a low (500-1000 g/d) or a moderate (1000-2000 g/d) dose. Electronic diaries were used to monitor daily ethanol intake. RESULTS Across the entire group, there was no effect of levetiracetam on drinking irrespective of dose, treatment order, family history, ethnicity, sex, or adverse effects. However, a median split of the data based on the number of drinks consumed while taking placebo revealed that levetiracetam significantly increased drinking in the lower drinking subjects (n = 23, P = 0.05, t = 2.07) while having no effect on drinking in the higher half (n = 23, P = 0.75, t = 0.32). Preliminary stratification based on common polymorphisms associated with alcoholism and impulsivity indicated that subjects with alcoholism-associated alleles may drink even more while taking levetiracetam. CONCLUSIONS Our data suggest that levetiracetam is not an appropriate treatment for non-treatment seeking alcohol abusers and can, in fact, increase their consumption of alcohol.
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Lawford BR, Barnes M, Connor JP, Heslop K, Nyst P, Young RM. Alcohol Use Disorders Identification Test (AUDIT) scores are elevated in antipsychotic-induced hyperprolactinaemia. J Psychopharmacol 2012; 26:324-9. [PMID: 21262859 DOI: 10.1177/0269881110393051] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hyperprolactinaemia in antipsychotic treated patients with schizophrenia is a consequence of D2 receptor (DRD2) blockade. Alcohol use disorder is commonly comorbid with schizophrenia and low availability of striatal DRD2 may predispose individuals to alcohol use. In this pilot study we investigated whether hyperprolactinaemia secondary to pharmacological DRD2 blockade was associated with alcohol use disorder in 219 (178 males and 41 females) patients with schizophrenia. Serum prolactin determinations were made in patients diagnosed with schizophrenia and maintained on antipsychotic agents. Clinical assessment included demographics, family history and administration of the AUDIT (Alcohol Use Disorders Identification Test). Higher AUDIT scores were associated with prolactin-raising antipsychotic medication (n=106) compared with prolactin-sparing medication (n=113). Risperidone (n=63) treated patients had higher AUDIT scores and prolactin levels than those on other atypical antipsychotics (n = 113). Across the entire sample, patients with a prolactin greater than 800 mIU/L had higher AUDIT scores and were more likely to exceed the cut-off score for harmful and hazardous alcohol use. These differences were not explained by potential confounds related to clinical features and demographics, comorbidity or medication side-effects. These data suggest that by lowering dosage, or switching to another antipsychotic agent, the risk for alcohol use disorder in those with schizophrenia may be reduced. This hypothesis requires testing using a prospective methodology.
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Affiliation(s)
- Bruce R Lawford
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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Blum K, Bailey J, Gonzalez AM, Oscar-Berman M, Liu Y, Giordano J, Braverman E, Gold M. Neuro-Genetics of Reward Deficiency Syndrome (RDS) as the Root Cause of "Addiction Transfer": A New Phenomenon Common after Bariatric Surgery. JOURNAL OF GENETIC SYNDROMES & GENE THERAPY 2011; 2012:S2-001. [PMID: 23483116 PMCID: PMC3593106 DOI: 10.4172/2157-7412.s2-001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Now after many years of successful bariatric (weight-loss) surgeries directed at the obesity epidemic clinicians are reporting that some patients are replacing compulsive overeating with newly acquired compulsive disorders such as alcoholism, gambling, drugs, and other addictions like compulsive shopping and exercise. This review article explores evidence from psychiatric genetic animal and human studies that link compulsive overeating and other compulsive disorders to explain the phenomenon of addiction transfer. Possibly due to neurochemical similarities, overeating and obesity may act as protective factors reducing drug reward and addictive behaviors. In animal models of addiction withdrawal from sugar induces imbalances in the neurotransmitters, acetylcholine and dopamine, similar to opiate withdrawal. Many human neuroimaging studies have supported the concept of linking food craving to drug craving behavior. Previously our laboratory coined the term Reward Deficiency Syndrome (RDS) for common genetic determinants in predicting addictive disorders and reported that the predictive value for future RDS behaviors in subjects carrying the DRD2 Taq A1 allele was 74%. While poly genes play a role in RDS, we have also inferred that disruptions in dopamine function may predispose certain individuals to addictive behaviors and obesity. It is now known that family history of alcoholism is a significant obesity risk factor. Therefore, we hypothesize here that RDS is the root cause of substituting food addiction for other dependencies and potentially explains this recently described Phenomenon (addiction transfer) common after bariatric surgery.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry, Mcknight Brain Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
- Department of Holistic Medicine, G & G Holistic Addiction Treatment Center, North Miami Beach, Florida, USA
- Department of Clinical Neurology, PATH Foundation NY, New York, USA
| | - John Bailey
- Department of Psychiatry, Mcknight Brain Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Anthony M Gonzalez
- Department of General and Bariatric Surgery, South Miami Hospital, Miami, Florida, USA
| | - Marlene Oscar-Berman
- Department of Veterans Affairs Healthcare System, and Boston University School of Medicine, Boston, MA, USA
| | - Yijun Liu
- Department of Psychiatry, Mcknight Brain Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - John Giordano
- Department of Holistic Medicine, G & G Holistic Addiction Treatment Center, North Miami Beach, Florida, USA
| | - Eric Braverman
- Department of Clinical Neurology, PATH Foundation NY, New York, USA
- Department of Neurosurgery, Weill Cornell College of Medicine, New York, USA
| | - Mark Gold
- Department of Psychiatry, Mcknight Brain Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
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Sturgess JE, George TP, Kennedy JL, Heinz A, Müller DJ. Pharmacogenetics of alcohol, nicotine and drug addiction treatments. Addict Biol 2011; 16:357-76. [PMID: 21362114 DOI: 10.1111/j.1369-1600.2010.00287.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The numerous premature deaths, medical complications and socio-economic repercussions of drug and alcohol addiction suggest that improvements in treatment strategies for addictive disorders are warranted. The use of pharmacogenetics to predict response to medication, side effects and appropriate dosages is relatively new in the field of drug addiction. However, increasing our understanding of the genetic factors influencing these processes may improve the treatment of addiction in the future. We examined the available scientific literature on pharmacogenetic advancements in the field of drug addiction with a focus on alcohol and tobacco to provide a summary of genes implicated in the effectiveness of pharmacotherapy for addiction. In addition, we reviewed pharmacogenetic research on cocaine and heroin dependence. Thus far, the most promising results were obtained for polymorphisms in the OPRM1 and CYP2A6 genes, which have been effective in predicting clinical response to naltrexone in alcoholism and nicotine replacement therapy in smoking, respectively. Opinions differ as to whether pharmacogenetic testing should be implemented in the clinic at this time because clinical utility and cost-effectiveness require further investigation. However, the data summarized in this review demonstrate that pharmacogenetic factors play a role in response to addiction pharmacotherapy and have the potential to aid in the personalization of addiction treatments. Such data may lead to improved cessation rates by allowing physicians to select medications for individuals based, at least in part, on genetic factors that predispose to treatment success or failure rather than on a trial and error basis.
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Affiliation(s)
- Jessica E Sturgess
- Centre for Addiction and Mental Health, Pharmacogenetics Research Clinic, 250 College Street, Toronto, Ontario, Canada
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40
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Chen TJ, Blum K, Chen AL, Bowirrat A, Downs WB, Madigan MA, Waite RL, Bailey JA, Kerner M, Yeldandi S, Majmundar N, Giordano J, Morse S, Miller D, Fornari F, Braverman ER. Neurogenetics and Clinical Evidence for the Putative Activation of the Brain Reward Circuitry by a Neuroadaptagen: Proposing an Addiction Candidate Gene Panel Map. J Psychoactive Drugs 2011; 43:108-27. [DOI: 10.1080/02791072.2011.587393] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Diana M. The dopamine hypothesis of drug addiction and its potential therapeutic value. Front Psychiatry 2011; 2:64. [PMID: 22144966 PMCID: PMC3225760 DOI: 10.3389/fpsyt.2011.00064] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/02/2011] [Indexed: 01/28/2023] Open
Abstract
Dopamine (DA) transmission is deeply affected by drugs of abuse, and alterations in DA function are involved in the various phases of drug addiction and potentially exploitable therapeutically. In particular, basic studies have documented a reduction in the electrophysiological activity of DA neurons in alcohol, opiate, cannabinoid, and other drug-dependent rats. Further, DA release in the Nucleus accumbens (Nacc) is decreased in virtually all drug-dependent rodents. In parallel, these studies are supported by increments in intracranial self stimulation (ICSS) thresholds during withdrawal from alcohol, nicotine, opiates, and other drugs of abuse, thereby suggesting a hypofunction of the neural substrate of ICSS. Accordingly, morphological evaluations fed into realistic computational analysis of the medium spiny neuron of the Nacc, post-synaptic counterpart of DA terminals, show profound changes in structure and function of the entire mesolimbic system. In line with these findings, human imaging studies have shown a reduction of dopamine receptors accompanied by a lesser release of endogenous DA in the ventral striatum of cocaine, heroin, and alcohol-dependent subjects, thereby offering visual proof of the "dopamine-impoverished" addicted human brain. The lasting reduction in physiological activity of the DA system leads to the idea that an increment in its activity, to restore pre-drug levels, may yield significant clinical improvements (reduction of craving, relapse, and drug-seeking/taking). In theory, it may be achieved pharmacologically and/or with novel interventions such as transcranial magnetic stimulation (TMS). Its anatomo-physiological rationale as a possible therapeutic aid in alcoholics and other addicts will be described and proposed as a theoretical framework to be subjected to experimental testing in human addicts.
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Affiliation(s)
- Marco Diana
- 'G. Minardi' Cognitive Neuroscience Laboratory, Department of Drug Sciences, University of Sassari Sassari, Italy
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Filopanti M, Lania AG, Spada A. Pharmacogenetics of D2 dopamine receptor gene in prolactin-secreting pituitary adenomas. Expert Opin Drug Metab Toxicol 2010; 6:43-53. [PMID: 19929252 DOI: 10.1517/17425250903352501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Dopamine-agonists are the treatment of choice of prolactin-secreting pituitary adenomas (PRL-omas). Their actions on D2 dopamine receptor (DRD2) and the clinical outcome may be affected by polymorphisms. AREAS COVERED IN THIS REVIEW PRL-omas are well-differentiated endocrine tumors expressing DRD2. The dopamine-agonist cabergoline (CB), normalizes prolactin and reduces tumor size in about 80 - 90% of patients. DRD2 polymorphisms correlate with neuropsychiatric disorders, in particular alcoholism and schizophrenia. This review describes the DRD2 polymorphisms, their functional effects, and their impact on susceptibility and response to dopamine-agonists treatment. Searching PubMed database for pertinent articles we found that some DRD2 polymorphisms, particularly TaqIA, TaqIB and NcoI, are associated with different receptor binding in brain areas. One study carried out in patients with PRL-omas found a correlation between NcoI and TaqIA and resistance to CB. In particular, resistant patients had higher prevalence of NcoI-T allele than the responsive patients, while the commonest haplotype (having TaqIA2 allele) was associated with better response. WHAT THE READER WILL GAIN This review deals with the connection between DRD2 polymorphisms and PRL-oma treatment and suggests hypotheses for further studies. TAKE HOME MESSAGE Only one study was carried out to analyze the role of DRD2 polymorphisms in PRLomas response to CB. Further studies, including pituitary and hypothalamus in vivo determination of DRD2 binding according to DRD2 genotypes, investigation of possible post-receptorial mechanisms involved, as well as population studies in collaboration with psychiatrists and neurologists, are needed.
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Affiliation(s)
- M Filopanti
- Fondazione IRCCS Policlinico Mangiagalli Regina Elena, Unit of Endocrinology and Diabetology, Milan, Italy
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Kranzler HR, Edenberg HJ. Pharmacogenetics of alcohol and alcohol dependence treatment. Curr Pharm Des 2010; 16:2141-8. [PMID: 20482509 PMCID: PMC4142701 DOI: 10.2174/138161210791516387] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 04/29/2010] [Indexed: 11/22/2022]
Abstract
In this article, we review studies of genetic moderators of the response to medications to treat alcohol dependence, the acute response to alcohol, and the response to the psychotherapeutic treatment of heavy drinking. We consider four neurotransmitter systems: opioidergic, dopaminergic, GABAergic, and glutamatergic and focus on one receptor protein in each: OPRM1 (the micro;-opioid receptor gene), DRD4 (the D(4) dopamine receptor gene), GABRA2 (GABA(A) receptor alpha-2 subunit gene), and GRIK1 (the kainite receptor GluR5 subunit gene). We conclude that because parallel developments in alcoholism treatment and the genetics of alcohol dependence are beginning to converge, using genotypic information, it may be possible to match patients with specific treatments. Of greatest clinical relevance is the finding that the presence of an Asp40 allele in OPRM1 modestly predicts a better response to naltrexone treatment. Promising findings include the observations that a polymorphism in GABRA2 predicts the response to specific psychotherapies; a polymorphism in DRD4 predicts the effects of the antipsychotic olanzapine on craving for alcohol and drinking behavior; and a polymorphism in GRIKI predicts adverse events resulting from treatment with the anticonvulsant topiramate. Although variants in other genes have been associated with the risk for alcohol dependence, they have not been studied as moderators of the response either to treatment or acute alcohol administration. We recommend that, whenever possible, treatment trials include the collection of DNA samples to permit pharmacogenetic analyses, and that such analyses look broadly for relevant genetic variation.
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Affiliation(s)
- Henry R. Kranzler
- Departments of Psychiatry and Genetics and Developmental Biology University of Connecticut Health Center 263 Farmington Ave. Farmington, CT 06030-2103
| | - Howard J. Edenberg
- Department of Biochemistry and Molecular Biology Indiana University School of Medicine Medical Science Building, Room 4063 635 Barnhill Drive Indianapolis, Indiana 46202-5122 Telephone: 317-274-2353 Facsimile: 317-274-4686
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Lingford-Hughes A, Watson B, Kalk N, Reid A. Neuropharmacology of addiction and how it informs treatment. Br Med Bull 2010; 96:93-110. [PMID: 21044987 DOI: 10.1093/bmb/ldq032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Our knowledge about the neuropharmacology of addiction is increasing and is leading to more informed development of pharmacotherapy. Although the dopaminergic mesolimbic system plays a central role in 'liking', reward and motivation, medications directly targeting it have not proved a very fruitful approach to treating addictions. A review of the literature was performed to find articles relating current and developing pharmacological treatments in the clinic and their underlying neuropharmacology. We focussed on the most common addictions for which pharmacology plays an important role. By characterizing what neurotransmitters modulate this dopaminergic pathway, new medications are now in the clinic and being successfully applied to treat a variety of addictions. In addition to modulating this reward pathway, alternative approaches in the future will target learning and memory, improving impulse control and decision-making.
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Affiliation(s)
- Anne Lingford-Hughes
- Department of Experimental Medicine, Imperial College, Burlington Danes Building, Hammersmith Hospital Site, 160 Du Cane Road, London, UK.
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Do dopaminergic gene polymorphisms affect mesolimbic reward activation of music listening response? Therapeutic impact on Reward Deficiency Syndrome (RDS). Med Hypotheses 2009; 74:513-20. [PMID: 19914781 DOI: 10.1016/j.mehy.2009.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 10/08/2009] [Indexed: 11/22/2022]
Abstract
Using fMRI, Menon and Levitin [9] clearly found for the first time that listening to music strongly modulates activity in a network of mesolimbic structures involved in reward processing including the nucleus accumbens (NAc) and the ventral tegmental area (VTA), as well as the hypothalamus, and insula, which are thought to be involved in regulating autonomic and physiological responses to rewarding and emotional stimuli. Importantly, responses in the NAc and VTA were strongly correlated pointing to an association between dopamine release and NAc response to music. Listing to pleasant music induced a strong response and significant activation of the VTA-mediated interaction of the NAc with the hypothalamus, insula, and orbitofrontal cortex. Blum et al. [10] provided the first evidence that the dopamine D2 receptor gene (DRD2) Taq 1 A1 allele significantly associated with severe alcoholism whereby the author's suggested that they found the first "reward gene" located in the mesolimbic system. The enhanced functional and effective connectivity between brain regions mediating reward, autonomic, and cognitive processing provides insight into understanding why listening to music is one of the most rewarding and pleasurable human experiences. However, little is known about why some people have a more or less powerful mesolimbic experience when they are listening to music. It is well-known that music may induce an endorphinergic response that is blocked by naloxone, a known opioid antagonist (Goldstein [19]). Opioid transmission in the NAc is associated with dopamine release in the VTA. Moreover, dopamine release in the VTA is linked to polymorphisms of the DRD2 gene and even attention-deficit hyperactivity disorder (ADHD), whereby carriers of the DRD2 A1 allele show a reduced NAc release of dopamine (DA). Thus it is conjectured that similar mechanisms in terms of adequate dopamine release and subsequent activation of reward circuitry by listening to music might also be affected by an individual's D2 density in the VTA mediated interaction of the NAc. It is therefore hypothesized that carriers of DRD2 A1 allele may respond significantly differently to carriers of the DRD2 A2 genotype. In this regard, carriers of the D2 A1 allele have a blunted response to glucose and monetary rewards. In contrast powerful D2 agonists like bromocryptine show a heightened activation of the reward circuitry only in DRD2 A1 allele carriers. If music causes a powerful activation in spite of the DRD2 A1 allele due to a strong DA neuronal release which subsequently impinges on existing D2 receptors, then it is reasonable to assume that music is a strong indirect D2 agonist (by virtue of DA neuronal release in the NAc) and may have important therapeutic applicability in Reward Deficiency Syndrome (RDS) related behaviors including Substance Use Disorder (SUD). Ross et al. [18] found that music therapy appears to be a novel motivational tool in a severely impaired inpatient sample of patients with co-occurring mental illness and addiction.
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Blum K, Chen TJ, Downs BW, Bowirrat A, Waite RL, Braverman ER, Madigan M, Oscar-Berman M, DiNubile N, Gold M. Neurogenetics of dopaminergic receptor supersensitivity in activation of brain reward circuitry and relapse: proposing "deprivation-amplification relapse therapy" (DART). Postgrad Med 2009; 121:176-96. [PMID: 19940429 PMCID: PMC3656125 DOI: 10.3810/pgm.2009.11.2087] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND HYPOTHESIS It is well known that after prolonged abstinence, individuals who use their drug of choice experience a powerful euphoria that often precipitates relapse. While a biological explanation for this conundrum has remained elusive, we hypothesize that this clinically observed "supersensitivity" might be tied to genetic dopaminergic polymorphisms. Another therapeutic conundrum relates to the paradoxical finding that the dopaminergic agonist bromocriptine induces stronger activation of brain reward circuitry in individuals who carry the DRD2 A1 allele compared with DRD2 A2 allele carriers. Because carriers of the A1 allele relative to the A2 allele of the DRD2 gene have significantly lower D2 receptor density, a reduced sensitivity to dopamine agonist activity would be expected in the former. Thus, it is perplexing that with low D2 density there is an increase in reward sensitivity with the dopamine D2 agonist bromocriptine. Moreover, under chronic or long-term therapy with D2 agonists, such as bromocriptine, it has been shown in vitro that there is a proliferation of D2 receptors. One explanation for this relates to the demonstration that the A1 allele of the DRD2 gene is associated with increased striatal activity of L-amino acid decarboxylase, the final step in the biosynthesis of dopamine. This appears to be a protective mechanism against low receptor density and would favor the utilization of an amino acid neurotransmitter precursor like L-tyrosine for preferential synthesis of dopamine. This seems to lead to receptor proliferation to normal levels and results in significantly better treatment compliance only in A1 carriers. PROPOSAL AND CONCLUSION We propose that low D2 receptor density and polymorphisms of the D2 gene are associated with risk for relapse of substance abuse, including alcohol dependence, heroin craving, cocaine dependence, methamphetamine abuse, nicotine sensitization, and glucose craving. With this in mind, we suggest a putative physiological mechanism that may help to explain the enhanced sensitivity following intense acute dopaminergic D2 receptor activation: "denervation supersensitivity." Rats with unilateral depletions of neostriatal dopamine display increased sensitivity to dopamine agonists estimated to be 30 to 100 x in the 6-hydroxydopamine (6-OHDA) rotational model. Given that mild striatal dopamine D2 receptor proliferation occurs (20%-40%), it is difficult to explain the extent of behavioral supersensitivity by a simple increase in receptor density. Thus, the administration of dopamine D2 agonists would target D2 sensitization and attenuate relapse, especially in D2 receptor A1 allele carriers. This hypothesized mechanism is supported by clinical trials utilizing amino acid neurotransmitter precursors, enkephalinase, and catechol-O-methyltransferase (COMT) enzyme inhibition, which have resulted in attenuated relapse rates in reward deficiency syndrome (RDS) probands. If future translational research reveals that dopamine agonist therapy reduces relapse in RDS, it would support the proposed concept, which we term "deprivation-amplification relapse therapy" (DART). This term couples the mechanism for relapse, which is "deprivation-amplification," especially in DRD2 A1 allele carriers with natural D2 agonist therapy utilizing amino acid precursors and COMT and enkepalinase inhibition therapy.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry, School of Medicine, University of Florida, Gainesville, FL
- Department of Nutrigenomics, LifeGen, Inc., San Diego, CA and Lederach, PA
| | - Thomas J.H. Chen
- Department of Health and Occupational Safety, Chang Jung Christian University, Taiwan, Republic of China
| | - B. William Downs
- Department of Nutrigenomics, LifeGen, Inc., San Diego, CA and Lederach, PA
| | - Abdalla Bowirrat
- Clinical Neuroscience & Population Genetics, Ziv Government Medical Center, Israel
| | - Roger L. Waite
- Department of Nutrigenomics, LifeGen, Inc., San Diego, CA and Lederach, PA
| | - Eric R. Braverman
- Department of Neurosurgery, Weill Cornell College of Medicine, New York, NY
| | - Margaret Madigan
- Department of Nutrigenomics, LifeGen, Inc., San Diego, CA and Lederach, PA
| | | | - Nicholas DiNubile
- Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mark Gold
- Department of Psychiatry, School of Medicine, University of Florida, Gainesville, FL
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Downs BW, Chen ALC, Chen TJH, Waite RL, Braverman ER, Kerner M, Braverman D, Rhoades P, Prihoda TJ, Palomo T, Oscar-Berman M, Reinking J, Blum SH, DiNubile NA, Liu HH, Blum K. Nutrigenomic targeting of carbohydrate craving behavior: can we manage obesity and aberrant craving behaviors with neurochemical pathway manipulation by Immunological Compatible Substances (nutrients) using a Genetic Positioning System (GPS) Map? Med Hypotheses 2009; 73:427-34. [PMID: 19450935 DOI: 10.1016/j.mehy.2009.02.037] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 01/29/2009] [Accepted: 02/01/2009] [Indexed: 11/16/2022]
Abstract
Genetic mediated physiological processes that rely on both pharmacological and nutritional principles hold great promise for the successful therapeutic targeting of reduced carbohydrate craving, body-friendly fat loss, healthy body recomposition, and overall wellness. By integrating an assembly of scientific knowledge on inheritable characteristics and environmental mediators of gene expression, we review the relationship of genes, hormones, neurotransmitters, and nutrients as they correct unwanted weight gain coupled with unhappiness. In contrast to a simple one-locus, one-mechanism focus on pharmaceuticals alone, we hypothesize that the use of nutrigenomic treatment targeting multi-physiological neurological, immunological, and metabolic pathways will enable clinicians to intercede in the process of lipogenesis by promoting lipolysis while attenuating aberrant glucose cravings. In turn, this approach will enhance wellness in a safe and predictable manner through the use of a Genetic Positioning System (GPS) Map. The GPS Map, while presently incomplete, ultimately will serve not only as a blueprint for personalized medicine in the treatment of obesity, but also for the development of strategies for reducing many harmful addictive behaviors and promoting optimal health by using substances compatible with the body's immune system.
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Affiliation(s)
- B William Downs
- Department of Nutrigenomics and Personalized Medicine, LifeGen, Inc., La Jolla, CA, USA
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Abstract
Drug dependence is a chronic, relapsing disorder in which compulsive drug-seeking and drug-taking behaviours persist despite serious negative consequences. Addictive substances, such as opioids, ethanol, psychostimulants and nicotine, induce pleasant states or relieve distress, effects that contribute to their recreational use. Dopamine is critically involved in drug addiction processes. However, the role of the various dopaminergic receptor subtypes has been difficult to delineate. Here, we will review the information collected implicating the receptors of the D1 family (DRD1 and DRD5) and of the D2 family (DRD2, DRD3 and DRD4) in drug addiction. We will summarize the distribution of these receptors in the brain, the preclinical experiments carried out with pharmacological and transgenic approaches and the genetic studies carried out linking genetic variants of these receptors to drug addiction phenotypes. A meta-analysis of the studies carried out evaluating DRD2 and alcohol dependence is also provided, which indicates a significant association. Overall, this review indicates that different aspects of the addiction phenotype are critically influenced by dopaminergic receptors and that variants of those genes seem to influence some addiction phenotypes in humans.
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49
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Blum K, Chen ALC, Chen TJH, Braverman ER, Reinking J, Blum SH, Cassel K, Downs BW, Waite RL, Williams L, Prihoda TJ, Kerner MM, Palomo T, Comings DE, Tung H, Rhoades P, Oscar-Berman M. Activation instead of blocking mesolimbic dopaminergic reward circuitry is a preferred modality in the long term treatment of reward deficiency syndrome (RDS): a commentary. Theor Biol Med Model 2008; 5:24. [PMID: 19014506 PMCID: PMC2615745 DOI: 10.1186/1742-4682-5-24] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Accepted: 11/12/2008] [Indexed: 12/22/2022] Open
Abstract
Background and hypothesis Based on neurochemical and genetic evidence, we suggest that both prevention and treatment of multiple addictions, such as dependence to alcohol, nicotine and glucose, should involve a biphasic approach. Thus, acute treatment should consist of preferential blocking of postsynaptic Nucleus Accumbens (NAc) dopamine receptors (D1-D5), whereas long term activation of the mesolimbic dopaminergic system should involve activation and/or release of Dopamine (DA) at the NAc site. Failure to do so will result in abnormal mood, behavior and potential suicide ideation. Individuals possessing a paucity of serotonergic and/or dopaminergic receptors, and an increased rate of synaptic DA catabolism due to high catabolic genotype of the COMT gene, are predisposed to self-medicating any substance or behavior that will activate DA release, including alcohol, opiates, psychostimulants, nicotine, gambling, sex, and even excessive internet gaming. Acute utilization of these substances and/or stimulatory behaviors induces a feeling of well being. Unfortunately, sustained and prolonged abuse leads to a toxic" pseudo feeling" of well being resulting in tolerance and disease or discomfort. Thus, a reduced number of DA receptors, due to carrying the DRD2 A1 allelic genotype, results in excessive craving behavior; whereas a normal or sufficient amount of DA receptors results in low craving behavior. In terms of preventing substance abuse, one goal would be to induce a proliferation of DA D2 receptors in genetically prone individuals. While in vivo experiments using a typical D2 receptor agonist induce down regulation, experiments in vitro have shown that constant stimulation of the DA receptor system via a known D2 agonist results in significant proliferation of D2 receptors in spite of genetic antecedents. In essence, D2 receptor stimulation signals negative feedback mechanisms in the mesolimbic system to induce mRNA expression causing proliferation of D2 receptors. Proposal and conclusion The authors propose that D2 receptor stimulation can be accomplished via the use of Synapatmine™, a natural but therapeutic nutraceutical formulation that potentially induces DA release, causing the same induction of D2-directed mRNA and thus proliferation of D2 receptors in the human. This proliferation of D2 receptors in turn will induce the attenuation of craving behavior. In fact as mentioned earlier, this model has been proven in research showing DNA-directed compensatory overexpression (a form of gene therapy) of the DRD2 receptors, resulting in a significant reduction in alcohol craving behavior in alcohol preferring rodents. Utilizing natural dopaminergic repletion therapy to promote long term dopaminergic activation will ultimately lead to a common, safe and effective modality to treat Reward Deficiency Syndrome (RDS) behaviors including Substance Use Disorders (SUD), Attention Deficit Hyperactivity Disorder (ADHD), Obesity and other reward deficient aberrant behaviors. This concept is further supported by the more comprehensive understanding of the role of dopamine in the NAc as a "wanting" messenger in the meso-limbic DA system.
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Affiliation(s)
- Kenneth Blum
- Department of Physiology & Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, USA .
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Connor JP, Young RM, Saunders JB, Lawford BR, Ho R, Ritchie TL, Noble EP. The A1 allele of the D2 dopamine receptor gene region, alcohol expectancies and drinking refusal self-efficacy are associated with alcohol dependence severity. Psychiatry Res 2008; 160:94-105. [PMID: 18514919 DOI: 10.1016/j.psychres.2007.06.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 06/28/2007] [Accepted: 06/30/2007] [Indexed: 11/28/2022]
Abstract
Psychological risk and genetic risk for alcohol dependence are rarely examined in concert. The current study used path analysis (via structural equation modelling) to explore the relationship between the A(1) allele of the D2 dopamine receptor DRD2 gene region, age of problem drinking onset, alcohol expectancy and drinking refusal self-efficacy towards alcohol consumption and dependence severity. One hundred and forty-three (93 male, 50 female) alcohol dependent inpatients provided an extensive clinical history, including age of onset of problem drinking and quantity and frequency of alcohol consumption. The Drinking Expectancy Profile and the Alcohol Dependence Scale were completed, and 10 milliliters of blood were obtained for genetic analysis. The results showed that the posited model fitted the data set well and support the pattern of direct (allele status to drinking) and indirect (allele status influenced by psychosocial variables) relationships hypothesised for the model. A formal test of mediation showed some support for a psychosocial mediational model. The results are discussed in terms of a possible developmental trajectory that involves both genetic risk that influences brain dopamine activity and reinforcement expectancies that both operate via diminished drinking refusal self-efficacy. The prevention and treatment possibilities that arise from understanding this trajectory are examined.
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Affiliation(s)
- Jason P Connor
- Discipline of Psychiatry, The University of Queensland, Brisbane, Queensland, Australia.
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