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Barlati S, Minelli A, Nibbio G, Bertoni L, Necchini N, Paolini S, Muscarella A, Ubertino UB, Calzavara-Pinton I, Vita A, Gennarelli M. The role of pharmacogenetics in the treatment of major depressive disorder: a critical review. Front Psychiatry 2023; 14:1307473. [PMID: 38025425 PMCID: PMC10667493 DOI: 10.3389/fpsyt.2023.1307473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Pharmacological therapy represents one of the essential approaches to treatment of Major Depressive Disorder (MDD). However, currently available antidepressant medications show high rates of first-level treatment non-response, and several attempts are often required to find an effective molecule for a specific patient in clinical practice. In this context, pharmacogenetic analyses could represent a valuable tool to identify appropriate pharmacological treatment quickly and more effectively. However, the usefulness and the practical effectiveness of pharmacogenetic testing currently remains an object of scientific debate. The present narrative and critical review focuses on exploring the available evidence supporting the usefulness of pharmacogenetic testing for the treatment of MDD in clinical practice, highlighting both the points of strength and the limitations of the available studies and of currently used tests. Future research directions and suggestions to improve the quality of available evidence, as well as consideration on the potential use of pharmacogenetic tests in everyday clinical practice are also presented.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Minelli
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Paolini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessia Muscarella
- Department of Mental Health and Addiction Services, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ughetta Bosco Ubertino
- Department of Mental Health and Addiction Services, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Massimo Gennarelli
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Tsybko AS, Kondaurova EM, Zalivina EA, Blaginya VO, Naumenko VS. Effects of Chronic Combined Treatment with Ketanserin and Fluoxetine in B6.CBA-D13Mit76C Recombinant Mice with Abnormal 5-HT 1A Receptor Functional Activity. BIOCHEMISTRY. BIOKHIMIIA 2023; 88:758-769. [PMID: 37748872 DOI: 10.1134/s0006297923060044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 09/27/2023]
Abstract
The recombinant B6.CBA-D13Mit76C mouse strain is characterized by an altered sensitivity of 5-HT1A receptors and upregulated 5-HT1A gene transcription. Recently, we found that in B6.CBA-D13Mit76C mice, chronic fluoxetine treatment produced the pro-depressive effect in a forced swim test. Since 5-HT2A receptor blockade may be beneficial in treatment-resistant depression, we investigated the influence of chronic treatment (14 days, intraperitoneally) with selective 5-HT2A antagonist ketanserin (0.5 mg/kg), fluoxetine (20 mg/kg), or fluoxetine + ketanserin on the behavior, functional activity of 5-HT1A and 5-HT2A receptors, serotonin turnover, and transcription of principal genes of the serotonin system in the brain of B6.CBA-D13Mit76C mice. Ketanserin did not reverse the pro-depressive effect of fluoxetine, while fluoxetine, ketanserin, and fluoxetine + ketanserin decreased the functional activity of 5-HT1A receptors and Htr1a gene transcription in the midbrain and hippocampus. All tested drug regimens decreased the mRNA levels of Slc6a4 and Maoa in the midbrain. These changes were not accompanied by a significant shift in the levels of serotonin and its metabolite 5-HIAA. Notably, ketanserin upregulated enzymatic activity of tryptophan hydroxylase 2 (TPH2). Thus, despite some benefits (reduced Htr1a, Slc6a4, and Maoa transcription and increased TPH2 activity), prolonged blockade of 5-HT2A receptors failed to ameliorate the adverse effect of fluoxetine in the case of abnormal functioning of 5-HT1A receptors.
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Affiliation(s)
- Anton S Tsybko
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia.
| | - Elena M Kondaurova
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Elena A Zalivina
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Varvara O Blaginya
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Vladimir S Naumenko
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
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Morris SA, Nguyen DG, Patel JN. Pharmacogenomics in allogeneic hematopoietic stem cell transplantation: Implications on supportive therapies and conditioning regimens. Best Pract Res Clin Haematol 2023; 36:101470. [PMID: 37353294 DOI: 10.1016/j.beha.2023.101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/25/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation mortality has declined over the years, though prevention and management of treatment-related toxicities and post-transplant complications remains challenging. Applications of pharmacogenomic testing can potentially mitigate adverse drug outcomes due to interindividual variability in drug metabolism and response. This review summarizes clinical pharmacogenomic applications relevant to hematopoietic stem cell transplantation, including antifungals, immunosuppressants, and supportive care management, as well as emerging pharmacogenomic evidence with conditioning regimens.
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Affiliation(s)
- Sarah A Morris
- Department of Cancer Pharmacology & Pharmacogenomics Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - D Grace Nguyen
- Department of Cancer Pharmacology & Pharmacogenomics Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - Jai N Patel
- Department of Cancer Pharmacology & Pharmacogenomics Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
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Radosavljevic M, Svob Strac D, Jancic J, Samardzic J. The Role of Pharmacogenetics in Personalizing the Antidepressant and Anxiolytic Therapy. Genes (Basel) 2023; 14:genes14051095. [PMID: 37239455 DOI: 10.3390/genes14051095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Pharmacotherapy for neuropsychiatric disorders, such as anxiety and depression, has been characterized by significant inter-individual variability in drug response and the development of side effects. Pharmacogenetics, as a key part of personalized medicine, aims to optimize therapy according to a patient's individual genetic signature by targeting genetic variations involved in pharmacokinetic or pharmacodynamic processes. Pharmacokinetic variability refers to variations in a drug's absorption, distribution, metabolism, and elimination, whereas pharmacodynamic variability results from variable interactions of an active drug with its target molecules. Pharmacogenetic research on depression and anxiety has focused on genetic polymorphisms affecting metabolizing cytochrome P450 (CYP) and uridine 5'-diphospho-glucuronosyltransferase (UGT) enzymes, P-glycoprotein ATP-binding cassette (ABC) transporters, and monoamine and γ-aminobutyric acid (GABA) metabolic enzymes, transporters, and receptors. Recent pharmacogenetic studies have revealed that more efficient and safer treatments with antidepressants and anxiolytics could be achieved through genotype-guided decisions. However, because pharmacogenetics cannot explain all observed heritable variations in drug response, an emerging field of pharmacoepigenetics investigates how epigenetic mechanisms, which modify gene expression without altering the genetic code, might influence individual responses to drugs. By understanding the epi(genetic) variability of a patient's response to pharmacotherapy, clinicians could select more effective drugs while minimizing the likelihood of adverse reactions and therefore improve the quality of treatment.
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Affiliation(s)
- Milica Radosavljevic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia
| | - Jasna Jancic
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Janko Samardzic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Brown LC, Stanton JD, Bharthi K, Maruf AA, Müller DJ, Bousman CA. Pharmacogenomic Testing and Depressive Symptom Remission: A Systematic Review and Meta-Analysis of Prospective, Controlled Clinical Trials. Clin Pharmacol Ther 2022; 112:1303-1317. [PMID: 36111494 PMCID: PMC9827897 DOI: 10.1002/cpt.2748] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/11/2022] [Indexed: 01/31/2023]
Abstract
Pharmacogenomic (PGx) testing has emerged as a compelling strategy that clinicians can use to inform antidepressant medication selection and dosing, but the clinical efficacy of this strategy has been questioned. We systematically reviewed and meta-analyzed clinical trials for an association between the use of PGx-guided antidepressant therapy and depressive symptom remission in patients with major depressive disorder (MDD). We included prospective, controlled clinical trials published in English up to July 12, 2022. Data extraction and synthesis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each trial was assessed for risk of bias and a random-effects model was used to estimate pooled risk ratios. Thirteen trials comprising 4,767 patients were analyzed, including 10 randomized controlled trials, and three open label trials. Across all included trials, those that received PGx-guided antidepressant therapy (n = 2,395) were 1.41 (95% confidence interval (CI) = 1.15-1.74, P = 0.001) more likely to achieve remission compared with those that received unguided antidepressant therapy (n = 2,372). Pooled risk ratios for randomized controlled trials and open label trials were 1.46 (95% CI: 1.13-1.88) and 1.26 (95% CI = 0.84-1.88), respectively. These results suggest that PGx-guided antidepressant therapy is associated with a modest but significant increase in depressive symptom remission in adults with MDD. Efforts to address the heterogeneity in PGx test composition (i.e., genes and alleles tested) and accompanying prescribing recommendations across trials will likely reduce the uncertainty about the efficacy of PGx-guided antidepressant therapy in the literature.
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Affiliation(s)
| | | | - Kanika Bharthi
- Department of Biological SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Abdullah Al Maruf
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,College of Pharmacy, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada,Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
| | - Daniel J. Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoOntarioCanada,Department of PsychiatryUniversity of TorontoTorontoOntarioCanada,Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental HealthUniversity Hospital of WürzburgWürzburgGermany
| | - Chad A. Bousman
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Departments of Medical Genetics, Psychiatry, Physiology and Pharmacology, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada,Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
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Marcatili M, Borgonovo R, Cimminiello N, Cornaggia RD, Casati G, Pellicioli C, Maggioni L, Motta F, Redaelli C, Ledda L, Pozzi FE, Krivosova M, Pagano J, Nava R, Colmegna F, Dakanalis A, Caldiroli A, Capuzzi E, Benatti B, Dell’Osso B, Bertola F, Villa N, Piperno A, Ippolito S, Appollonio I, Sala C, Conti L, Clerici M. Possible Use of Minocycline in Adjunction to Intranasal Esketamine for the Management of Difficult to Treat Depression following Extensive Pharmacogenomic Testing: Two Case Reports. J Pers Med 2022; 12:jpm12091524. [PMID: 36143309 PMCID: PMC9503866 DOI: 10.3390/jpm12091524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
The advent of intra-nasal esketamine (ESK), one of the first so called fast-acting antidepressant, promises to revolutionize the management of treatment resistant depression (TRD). This NMDA receptor antagonist has proven to be rapidly effective in the short- and medium-term course of the illness, revealing its potential in targeting response in TRD. Although many TRD ESK responders are able to achieve remission, a considerable portion of them undergo a metamorphosis of their depression into different clinical presentations, characterized by instable responses and high recurrence rates that can be considered closer to the concept of Difficult to Treat Depression (DTD) than to TRD. The management of these DTD patients usually requires a further complex multidisciplinary approach and can benefit from the valuable contribution of new personalized medicine tools such as therapeutic drug monitoring and pharmacogenetics. Despite this, these patients usually come with long and complex previous treatments history and, often, advanced and sophisticated ongoing pharmacological schemes that can make the finding of new alternative options to face the current recurrences extremely challenging. In this paper, we describe two DTD patients—already receiving intranasal ESK but showing an instable course—who were clinically stabilized by the association with minocycline, a semisynthetic second-generation tetracycline with known and promising antidepressant properties.
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Affiliation(s)
- Matteo Marcatili
- Psychiatric Department, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Correspondence:
| | - Riccardo Borgonovo
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Noemi Cimminiello
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | | | - Giulia Casati
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Cristian Pellicioli
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Laura Maggioni
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Federico Motta
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Chiara Redaelli
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Luisa Ledda
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Federico Emanuele Pozzi
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Michaela Krivosova
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Jessica Pagano
- National Research Council Neuroscience Institute, 20100 Milan, Italy
| | - Roberto Nava
- Psychiatric Department, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Fabrizia Colmegna
- Psychiatric Department, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Alice Caldiroli
- Psychiatric Department, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Enrico Capuzzi
- Psychiatric Department, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Beatrice Benatti
- Psychiatry Unit, Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20100 Milan, Italy
- CRC “Aldo Ravelli” for Neurotechnology and Experimental Brain Therapeutics, University of Milan, 20100 Milan, Italy
| | - Bernardo Dell’Osso
- Psychiatry Unit, Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20100 Milan, Italy
- CRC “Aldo Ravelli” for Neurotechnology and Experimental Brain Therapeutics, University of Milan, 20100 Milan, Italy
| | - Francesca Bertola
- Cytogenetics and Medical Genetics Unit, Centre for Disorders of Iron Metabolism, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Nicoletta Villa
- Cytogenetics and Medical Genetics Unit, Centre for Disorders of Iron Metabolism, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Alberto Piperno
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
- Cytogenetics and Medical Genetics Unit, Centre for Disorders of Iron Metabolism, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Silvia Ippolito
- Clinical Chemistry Laboratory, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Ildebrando Appollonio
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Carlo Sala
- National Research Council Neuroscience Institute, 20100 Milan, Italy
| | - Luciano Conti
- Laboratory of Stem Cell Biology, Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy
| | - Massimo Clerici
- Psychiatric Department, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
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