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Nalls V, Galik E, Klinedinst NJ, Barr E, Brandt N, Lerner N, Resnick B. Racial Differences in Antidepressant Use in Nursing Facility Residents With Moderate to Severe Cognitive Impairment. Sr Care Pharm 2022; 37:448-457. [PMID: 36039002 DOI: 10.4140/tcp.n.2022.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To describe and compare the use of antidepressants between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment. Design This was a secondary data analysis using baseline data from the Function and Behavior Focused Care for Nursing Facility Residents with Dementia randomized control trial. Setting Participants were recruited from 10 urban and two rural nursing facilities from Maryland. Methods Participants had to be 55 years of age or older, English-speaking, reside in long-term care at time of recruitment, and score a 15 or less on the Mini Mental-State Examination. A total of 336 residents participated at baseline. Data were collected by a research evaluator through observation, proxy report from staff caring for the resident the day of testing, and patient charts. Main Outcomes A significant difference of antidepressant use between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment would be noted when controlling for depression, age, gender, functional status, agitation, and number of co-morbidities. Results In adjusted models, Black or African descent residents were less likely to be prescribed antidepressants compared with White residents. Conclusion Racial differences were noted regarding antidepressant use among nursing facility residents with moderate to severe cognitive impairment, but it is unknown if race could impact prescribing practices when indications for use are known. Further research is needed to ascertain if knowing the specific indications for use might contribute to racial disparities with antidepressant prescribing in nursing facility residents with moderate to severe cognitive impairment.
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Affiliation(s)
- Victoria Nalls
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Elizabeth Galik
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | | | - Erik Barr
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Nicole Brandt
- 2 School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Nancy Lerner
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Barbara Resnick
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
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Wu M, Lin L, Wu Y, Zheng Y, Chen H. Correlation between 5-HTTLPR gene polymorphism and cognitive function of traumatic stress in Chinese Han children. Transl Pediatr 2022; 11:1251-1260. [PMID: 35958016 PMCID: PMC9360820 DOI: 10.21037/tp-22-289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a trauma-related psychological disorder with serious social and familial impacts. The involvement of 5-hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR) in numerous mental disorders has been documented. This study explored the correlation between 5-HTTLPR gene polymorphism and cognitive function in Chinese Han children with PTSD. METHODS A total of 60 PTSD children treated from December 2019 to December 2021 were selected as study participants, with another 60 healthy children selected as controls. We assessed the cognitive function of participants using the Mini-Mental State Examination (MMSE). Additionally, the PTSD level was estimated by the Children's Revised Impact of Event Scale (CRIES). The 5-HTTLPR gene polymorphism was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR). The genotype and allele frequency were evaluated via case-control association analysis. RESULTS Children in the PTSD group showed low MMSE scores and high CRIES scores. In terms of genotype, cases of LL, LS, and SS in PTSD children were 4 (6.67%), 20 (33.3%), and 36 (60.00%), and 18 (30.00%), 28 (46.67%), and 14 (23.33%) cases in healthy controls. In terms of allele gene frequency, incidences of L and S were 23.33% and 76.67% in PTSD children, respectively, and were 53.33% and 46.67% in healthy controls, respectively. Moreover, the CRIES and MMSE scores of LS and SS genotypes were evidently different from those of LL genotype in PTSD children. CONCLUSIONS Polymorphism of the 5-HTTLPR gene is correlated with cognitive dysfunction in Chinese Han children with PTSD.
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Affiliation(s)
- Ming Wu
- Department of Pediatrics, The Fourth People's Hospital of Haikou, Haikou, China
| | - Lufei Lin
- Department of Pediatrics, The Fourth People's Hospital of Haikou, Haikou, China
| | - Yuebiao Wu
- Department of Pediatrics, The Fourth People's Hospital of Haikou, Haikou, China
| | - Yu Zheng
- Department of Pediatrics, The Fourth People's Hospital of Haikou, Haikou, China
| | - Haidan Chen
- Department of Pediatrics, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
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Blair LM, Pickler RH, Gugiu PC, Ford JL, Munro CL, Anderson CM. Genetic Risk Factors for Poor Cognitive Development in Children With Low Birth Weight. Biol Res Nurs 2020; 22:5-12. [PMID: 31409118 PMCID: PMC7068752 DOI: 10.1177/1099800419869507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Low birth weight is an ongoing public health problem with severe consequences for those affected, including early morbidity and mortality and elevated risk for lifelong deficits in cognitive function. These deficits can be ameliorated by early intervention in many cases. To contribute to criteria for earlier identification of at-risk children prior to the onset of delays or deficits, we examined relationships between three gene candidates-SLC6A4, BDNF, COMT-and cognitive outcomes at school age in a secondary analysis of existing data from a nationally representative cohort. Single nucleotide polymorphism rs4074134, a variant of BDNF, and a rare insertion/deletion in the intron region of SLC6A4 were significant predictors of cognitive performance. Our final model predicted 17% of the variance in composite cognitive test scores among children with low birth weight at school age (F = 96.36, p < .001, R2 = .17). Specifically, children homozygous for cytosine at rs4074134 scored .62 standard deviations higher on a measure of global cognition than children with one or more thymine. Similarly, children with an extra-long copy number variant of SLC6A4 scored .88 standard deviations higher than children who had one or more short forms of the gene. These findings support the potential for an approach to identifying children with low birth weights who are most at need of early intervention services. Future research should focus on validation of these findings in an independent sample and confirmation of the biological mechanisms through which these genes influence cognitive development.
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Affiliation(s)
- Lisa M. Blair
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Rita H. Pickler
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - P. Cristian Gugiu
- College of Education and Human Ecology, The Ohio State University, Columbus,
OH, USA
| | - Jodi L. Ford
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Cindy L. Munro
- School of Nursing and Health Studies, University of Miami, Florida, FL,
USA
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Murphy E, Gangwisch JE, Matsunaga JT, Ottman R. Familial aggregation of major depressive disorder in an African-American community. Depress Anxiety 2018; 35:674-684. [PMID: 29782058 PMCID: PMC6035763 DOI: 10.1002/da.22775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND African Americans (AAs) with major depressive disorder (MDD) experience more impairment and poorer treatment outcomes relative to Whites, yet are underrepresented in family studies of MDD. This is the first study to investigate the familial aggregation of major depression among AAs. METHODS Participants' reports of depression from clinical and family history (FH) interviews were used to examine depression rates among 435 first-degree relatives and half-siblings of 63 depressed cases and 222 relatives of 33 nondepressed controls. Binary logistic regression was used to compute odds ratios (ORs) for FH of MDD and level of trauma exposure (high and low) in cases versus controls. Poisson regression models with generalized estimating equations were used to assess MDD in relatives of cases versus relatives of controls. RESULTS Cases and controls did not differ in either FH of MDD (OR = 1.2, 95% confidence interval [CI] = 0.5-2.9), or prevalence of MDD in relatives (relative risk [RR] = 1.5, 95% CI = 0.8-2.5). However, exposure to high trauma was associated with increased risk of MDD (OR = 3.0, 95% CI = 1.22-7.17) and the combined effect of FH and trauma was greater than expected under an additive model. Similarly, the RR for MDD among relatives of cases with high-trauma levels was 2.2 (1.24-4.2), compared to relatives of controls with low trauma. CONCLUSION The effect of FH of MDD appears to be exacerbated among individuals exposed to high trauma. Replication and further research on the chronology and subtypes of trauma and MDD, and their interactions, remain essential in AA populations.
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Affiliation(s)
- Eleanor Murphy
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032,Corresponding Author. ;
| | - James E. Gangwisch
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032
| | - Janet T. Matsunaga
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032
| | - Ruth Ottman
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032,G.H. Sergievsky Center and Departments of Epidemiology and Neurology, Columbia University, 630 W. 168 Street, P&S Box 16, New York, NY 10032
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Shah RR, Gaedigk A. Precision medicine: does ethnicity information complement genotype-based prescribing decisions? Ther Adv Drug Saf 2018; 9:45-62. [PMID: 29318005 PMCID: PMC5753996 DOI: 10.1177/2042098617743393] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 12/16/2022] Open
Abstract
Inter-ethnic differences in drug response are all too well known. These are underpinned by a number of factors, including pharmacogenetic differences across various ethnic populations. Precision medicine relies on genotype-based prescribing decisions with the aim of maximizing efficacy and mitigating the risks. When there is no access to genotyping tests, ethnicity is frequently regarded as a proxy of the patient's probable genotype on the basis of overall population-based frequency of genetic variations in the ethnic group the patient belongs to, with some variations being ethnicity-specific. However, ever-increasing transcontinental migration of populations and the resulting admixing of populations have undermined the utility of self-identified ethnicity in predicting the genetic ancestry, and therefore the genotype, of the patient. An example of the relevance of genetic ancestry of a patient is the inadequate performance of European-derived pharmacogenetic dosing algorithms of warfarin in African Americans, Brazilians and Caribbean Hispanics. Consequently, genotyping a patient potentially requires testing for all known clinically actionable variants that the patient may harbour, and new variants that are likely to be identified using state-of the art next-generation sequencing-based methods. Furthermore, self-identified ethnicity is associated with a number of ethnicity-related attributes and non-genetic factors that potentially influence the risk of phenoconversion (genotype-phenotype discordance), which may adversely impact the success of genotype-based prescribing decisions. Therefore, while genotype-based prescribing decisions are important in implementing precision medicine, ethnicity should not be disregarded.
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Affiliation(s)
- Rashmi R. Shah
- Pharmaceutical Consultant, 8 Birchdale, Gerrards Cross, Buckinghamshire, SL9 7JA, UK
| | - Andrea Gaedigk
- Director, Pharmacogenetics Core Laboratory, Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children’s Mercy-Kansas City, Kansas City, MO and School of Medicine, University of Missouri-Kansas City, MO, USA
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Latent trajectories of adolescent antisocial behavior: Serotonin transporter linked polymorphic region (5-HTTLPR) genotype influences sensitivity to perceived parental support. Dev Psychopathol 2016; 29:185-201. [DOI: 10.1017/s0954579416000031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractAlthough prevailing theories of antisocial behavior (ASB) emphasize distinct developmental trajectories, few studies have explored gene–environment interplay underlying membership in empirically derived trajectories. To improve knowledge about the development of overt (e.g., aggression) and covert (e.g., delinquency) ASB, we tested the association of the 44-base pair promoter polymorphism in the serotonin transporter linked polymorphic region gene (5-HTTLPR), perceived parental support (e.g., closeness and warmth), and their interaction with ASB trajectories derived using latent class growth analysis in 2,558 adolescents followed prospectively into adulthood from the National Longitudinal Study of Adolescent Health. Three distinct trajectories emerged for overt (low desisting, adolescent peak, and late onset) and covert ASB (high stable, low stable, and nonoffending). Controlling for sex, parental support inversely predicted membership in the adolescent-peak overt ASB trajectory (vs. low desisting), but was unrelated to class membership for covert ASB. Furthermore, the 5-HTTLPR genotype significantly moderated the association of parental support on overt ASB trajectory membership. It is interesting that the pattern of Gene × Environment interaction differed by trajectory class: whereas short allele carriers were more sensitive to parental support in predicting the late-onset trajectory, the long/long genotype functioned as a potential “plasticity genotype” for the adolescent-peak trajectory group. We discuss these preliminary findings in the context of the differential susceptibility hypothesis and discuss the need for future studies to integrate gene–environment interplay and prospective longitudinal designs.
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7
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Yun I, Kim SG. Bullying Among South Korean Adolescents: Prevalence and Association With Psychological Adjustment. VIOLENCE AND VICTIMS 2015; 31:167-184. [PMID: 26645381 DOI: 10.1891/0886-6708.vv-d-13-00138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study assessed the prevalence rates of physical, verbal, relational, property, and cyber bullying among a sample of South Korean middle school students. Associations between bullying and a list of psychopathological symptoms were also examined. Finally, whether a link between bullying and psychopathological symptoms is modified by the level of parental attachment was examined. Results show that, contrary to Western studies, girls were more likely than boys to be involved in school bullying. Significant interaction effects between parental attachment and bully/victim status on depression were also discovered.
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8
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Arpawong TE, Lee J, Phillips DF, Crimmins EM, Levine ME, Prescott CA. Effects of Recent Stress and Variation in the Serotonin Transporter Polymorphism (5-HTTLPR) on Depressive Symptoms: A Repeated-Measures Study of Adults Age 50 and Older. Behav Genet 2015; 46:72-88. [PMID: 26330209 DOI: 10.1007/s10519-015-9740-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/21/2015] [Indexed: 12/16/2022]
Abstract
Depending on genetic sensitivity to it, stress may affect depressive symptomatology differentially. Applying the stress-diathesis hypothesis to older adults, we postulate: (1) recent stress will associate with increased depressive symptom levels and (2) this effect will be greater for individuals with at least one short allele of the serotonin transporter gene promoter region (5-HTTLPR). Further, we employ a design that addresses specific limitations of many prior studies that have examined the 5-HTTLPR × SLE relation, by: (a) using a within-person repeated-measures design to address fluctuations that occur within individuals over time, increase power for detecting G × E, and address GE correlation; (b) studying reports of exogenous stressful events (those unlikely to be caused by depression) to help rule out reverse causation and negativity bias, and in order to assess stressors that are more etiologically relevant to depressive symptomatology in older adults. The sample is drawn from the Health and Retirement Study, a U.S. population-based study of older individuals (N = 28,248; mean age = 67.5; 57.3 % female; 80.7 % Non-Hispanic White, 14.9 % Hispanic/Latino, 4.5 % African American; genetic subsample = 12,332), from whom measures of depressive symptoms and exogenous stressors were collected biannually (1994-2010). Variation in the 5-HTTLPR was characterized via haplotype, using two single nucleotide polymorphisms (SNPs). Ordered logit models were constructed to predict levels of depressive symptoms from 5-HTTLPR and stressors, comparing results of the most commonly applied statistical approaches (i.e., comparing allelic and genotypic models, and continuous and categorical predictors) used in the literature. All models were stratified by race/ethnicity. Overall, results show a main effect of recent stress for all ethnic groups, and mixed results for the variation in 5-HTTLPR × stress interaction, contingent upon statistical model used. Findings suggest there may be a differential effect of stressors and 5-HTTLPR on depressive symptoms by ethnicity, but further research is needed, particularly when using a haplotype to characterize variation in 5-HTTLPR in population-based sample with a diverse ethnic composition.
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Affiliation(s)
- Thalida E Arpawong
- Department of Psychology, University of Southern California, 3620 South McClintock Ave, SGM 501 MC 1061, Los Angeles, CA, 90089-1061, USA.
| | - Jinkook Lee
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Drystan F Phillips
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Morgan E Levine
- Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carol A Prescott
- Department of Psychology, University of Southern California, 3620 South McClintock Ave, SGM 501 MC 1061, Los Angeles, CA, 90089-1061, USA.,Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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9
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Shah RR. Inter-ethnic differences in drug response: Implications for drug development and complying with drug regulation. ACTA ACUST UNITED AC 2015. [DOI: 10.3109/10601333.2015.1064131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Liu Y, Garrett ME, Dennis MF, Green KT, Ashley-Koch AE, Hauser MA, Beckham JC, Kimbrel NA. An examination of the association between 5-HTTLPR, combat exposure, and PTSD diagnosis among U.S. veterans. PLoS One 2015; 10:e0119998. [PMID: 25793742 PMCID: PMC4368771 DOI: 10.1371/journal.pone.0119998] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 01/19/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To examine the association between the 5-HTTLPR polymorphism of the serotonin transporter (SLC6A4) gene, combat exposure, and posttraumatic stress disorder (PTSD) diagnosis and among two samples of combat-exposed veterans. Method The first sample included 550 non-Hispanic Black (NHB) combat-exposed veterans. The second sample included 555 non-Hispanic White (NHW) combat-exposed veterans. Participants were genotyped for the 5-HTTLPR/rs25531 variants of the SLC6A4 gene. A structured clinical interview was used to diagnose PTSD. Combat and civilian trauma exposure were assessed with validated self-report instruments. Logistic regression was used to test for main effects of 5-HTTLPR on PTSD diagnosis as well as gene x environment (GxE) interactions after adjusting for sex, ancestry proportion scores, civilian trauma exposure, and combat exposure. Results Within the NHB sample, a significant additive effect was observed for 5-HTTLPR (OR = 1.502, p = .0025), such that the odds of having a current diagnosis of PTSD increased by 1.502 for each additional S’ allele. No evidence for an association between 5-HTTLPR and PTSD was observed in the NHW sample. In addition, no evidence for combat x 5-HTTLPR effects were observed in either sample. Conclusion The present study suggests that there may be an association between 5-HTTLPR genotype and PTSD diagnosis among NHB veterans; however, no evidence for the hypothesized 5-HTTLPR x combat interaction was found.
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Affiliation(s)
- Yutao Liu
- Department of Cellular Biology and Anatomy, Georgia Regents University, Augusta, Georgia, United States of America
| | - Melanie E. Garrett
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Michelle F. Dennis
- Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kimberly T. Green
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Allison E. Ashley-Koch
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Michael A. Hauser
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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11
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Serotonin transporter polymorphism (5-HTTLPR) in Croatian population. Mol Biol Rep 2014; 42:553-8. [PMID: 25374429 DOI: 10.1007/s11033-014-3800-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
Serotonin transporter polymorphism (5-HTTLPR) is a well-studied polymorphism in psychiatric research. The function of serotonin transporter is to control neural stimulation and maintain homeostasis of serotonin in other cells like platelets and enterochromaffin cells. Considering serotonin function in human behavior, and the role of serotonin transporter, 5-HTTLPR has been associated with depression related disorders, anxiety related personality traits, and adverse response to psychotherapy. However, many studies failed to replicate the association of 5-HTTLPR polymorphism with mentioned disorders. The aim of our study was to assess genotype frequencies in Croatian physically and psychologically healthy population and compare our results with previously published data. Genotype distribution in our research was similar to previous studies on Caucasian population regardless of inclusion criteria. Genotype distribution was as follows: LL 38 %; LS 45 %; SS 17 % and allele frequencies for L and S allele were 61 and 39 %, respectively. Obtained results were in an agreement with the Hardy-Weinberg equilibrium. Comparing inclusion criteria from different studies, we noticed a difference in population selection from one study to another. Increased possibility for selection bias, population stratification and complexity of psychiatric disorders might present a source of possible errors in genetic association studies.
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12
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Ficks CA, Waldman ID. Candidate genes for aggression and antisocial behavior: a meta-analysis of association studies of the 5HTTLPR and MAOA-uVNTR. Behav Genet 2014; 44:427-44. [PMID: 24902785 DOI: 10.1007/s10519-014-9661-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 04/29/2014] [Indexed: 12/13/2022]
Abstract
Variation in central serotonin levels due to genetic mutations or experimental modifications has been associated with the manifestation of aggression in humans and animals. Many studies have examined whether common variants in serotonergic genes are implicated in aggressive or antisocial behaviors (ASB) in human samples. The two most commonly studied polymorphisms have been the serotonin transporter linked polymorphic region of the serotonin transporter gene (5HTTLPR) and the 30 base pair variable number of tandem repeats of the monoamine oxidase A gene (MAOA-uVNTR). Despite the aforementioned theoretical justification for these polymorphisms, findings across studies have been mixed and are thus difficult to interpret. A meta-analysis of associations of the 5HTTLPR and MAOA-uVNTR with ASB was conducted to determine: (1) the overall magnitude of effects for each polymorphism, (2) the extent of heterogeneity in effect sizes across studies and the likelihood of publication bias, and (3) whether sample-level or study-level characteristics could explain observed heterogeneity across studies. Both the 5HTTLPR and the MAOA-uVNTR were significantly associated with ASB across studies. There was also significant and substantial heterogeneity in the effect sizes for both markers, but this heterogeneity was not explained by any sample-level or study-level characteristics examined. We did not find any evidence for publication bias across studies for the MAOA-uVNTR, but there was evidence for an oversampling of statistically significant effect sizes for the 5HTTLPR. These findings provide support for the modest role of common serotonergic variants in ASB. Implications regarding the role of serotonin in antisocial behavior and the conceptualization of antisocial and aggressive phenotypes are discussed.
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Affiliation(s)
- Courtney A Ficks
- Psychology Department, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA,
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Murphy E, Hou L, Maher BS, Woldehawariat G, Kassem L, Akula N, Laje G, McMahon FJ. Race, genetic ancestry and response to antidepressant treatment for major depression. Neuropsychopharmacology 2013; 38:2598-606. [PMID: 23827886 PMCID: PMC3828530 DOI: 10.1038/npp.2013.166] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 11/09/2022]
Abstract
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study revealed poorer antidepressant treatment response among black compared with white participants. This racial disparity persisted even after socioeconomic and baseline clinical factors were taken into account. Some studies have suggested genetic contributions to this disparity, but none have attempted to disentangle race and genetic ancestry. Here we used genome-wide single-nucleotide polymorphism (SNP) data to examine independent contributions of race and genetic ancestry to citalopram response. Secondary data analyses included 1877 STAR*D participants who completed an average of 10 weeks of citalopram treatment and provided DNA samples. Participants reported their race as White (n=1464), black (n=299) or other/mixed (n=114). Genetic ancestry was estimated by multidimensional scaling (MDS) analyses of about 500 000 SNPs. Ancestry proportions were estimated by STRUCTURE. Structural equation modeling was used to examine the direct and indirect effects of observed and latent predictors of response, defined as change in the Quick Inventory of Depressive Symptomatology (QIDS) score from baseline to exit. Socioeconomic and baseline clinical factors, race, and anxiety significantly predicted response, as previously reported. However, direct effects of race disappeared in all models that included genetic ancestry. Genetic African ancestry predicted lower treatment response in all models. Although socioeconomic and baseline clinical factors drive racial differences in antidepressant response, genetic ancestry, rather than self-reported race, explains a significant fraction of the residual differences. Larger samples would be needed to identify the specific genetic mechanisms that may be involved, but these findings underscore the importance of including more African-American patients in drug trials.
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Affiliation(s)
- Eleanor Murphy
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Liping Hou
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Brion S Maher
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Girma Woldehawariat
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Layla Kassem
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Nirmala Akula
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Gonzalo Laje
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Francis J McMahon
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
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Genotyping serotonin transporter polymorphisms 5-HTTLPR and rs25531 in European- and African-American subjects from the National Institute of Mental Health's Collaborative Center for Genomic Studies. Transl Psychiatry 2013; 3:e307. [PMID: 24064711 PMCID: PMC3784769 DOI: 10.1038/tp.2013.80] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/12/2013] [Accepted: 07/15/2013] [Indexed: 12/16/2022] Open
Abstract
A number of studies have suggested DNA sequence variability in the serotonin transporter gene (SLC6A4) between European-American (EA) and African-American (AA) populations, which could be clinically important, given the central role SLC6A4 has in serotonin transmission. However, these studies have had relatively small samples, used self-reported measures of race, and have only tested the promoter-linked polymorphism 5-HTTLPR. Here we genotype 5-HTTLPR and rs25531, a neighboring functional polymorphism, in 954 AA and 2622EA subjects from a National Institute of Mental Health repository sample. Genotyping was performed using fragment analysis by capillary electrophoresis. AA, as compared with EA, groups had lower frequencies of the S allele (0.25 vs 0.43) and SS genotype (0.06 vs 0.19) at 5-HTTLPR, and higher rates of the G allele at rs25531 (0.21 vs 0.075). A rare xL variant at 5-HTTLPR was also more common among AAs (0.017 vs 0.008). When the polymorphisms were redefined into a high- and low-transcription haplotypes, the AA group showed significantly fewer low-transcription variants (χ(2)=4.8, P=0.03). No genotypes were associated with major depression, any anxiety disorder, or neuroticism in either EA or AA populations. This is the largest study to show SLC6A4 genotype differences between EA and AA populations, and the first to include rs25531. Lack of associations with clinical outcomes may reflect untested moderating environmental influences.
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Barnes JC, Beaver KM, Boutwell BB. A functional polymorphism in a serotonin transporter gene (5-HTTLPR) interacts with 9/11 to predict gun-carrying behavior. PLoS One 2013; 8:e70807. [PMID: 24015179 PMCID: PMC3756025 DOI: 10.1371/journal.pone.0070807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/17/2013] [Indexed: 01/11/2023] Open
Abstract
On September 11, 2001, one of the deadliest terrorist attacks in US history took place on American soil and people around the world were impacted in myriad ways. Building on prior literature which suggests individuals are more likely to purchase a gun for self-protection if they are fearful of being victimized, the authors hypothesized that the terrorist attacks of 9/11 would lead to an increase in gun carrying among US residents. At the same time, a line of research has shown that a polymorphism in the 5-HTT gene (i.e., 5-HTTLPR) interacts with environmental stressors to predict a range of psychopathologies and behaviors. Thus, it was hypothesized that 9/11 and 5-HTTLPR would interact to predict gun carrying. The results supported both hypotheses by revealing a positive association between 9/11 and gun carrying (b = .426, odds ratio = 1.531, standard error for b = .194, z = 2.196, p = .028) in the full sample of respondents (n = 15,052) and a statistically significant interaction between 9/11 and 5-HTTLPR in the prediction of gun carrying (b = −1.519, odds ratio = .219, standard error for b = .703, z = −2.161, p = .031) in the genetic subsample of respondents (n = 2,350). This is one of the first studies to find an association between 9/11 and gun carrying and, more importantly, is the first study to report a gene-environment interaction (GxE) between a measured gene and a terrorist attack.
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Affiliation(s)
- J. C. Barnes
- School of Economic, Political and Policy Sciences, The University of Texas at Dallas, Richardson, Texas, United States of America
- * E-mail:
| | - Kevin M. Beaver
- College of Criminology and Criminal Justice, Florida State University, Tallahassee, Florida, United States of America
- Center for Social and Humanities Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Brian B. Boutwell
- College of Criminal Justice, Sam Houston State University, Huntsville, Texas, United States of America
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Poland RE, Lesser IM, Wan YJY, Gertsik L, Yao J, Raffel LJ, Lin KM, Myers HF. Response to citalopram is not associated with SLC6A4 genotype in African-Americans and Caucasians with major depression. Life Sci 2013; 92:967-70. [PMID: 23562852 PMCID: PMC3786570 DOI: 10.1016/j.lfs.2013.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 01/27/2023]
Abstract
AIMS Ethnic differences in genotype frequency provide a natural condition for assessing the contribution of gene variations to the causes and treatments of disease. Accordingly, the purpose of this study was to determine whether ethnic variations in allele frequencies of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) of the SLC6A4 gene were related to the response to the treatment of depression. MAIN METHODS African-Americans (n=101) and Caucasians (n=100) with major depressive disorder were treated with the antidepressant citalopram (20-60mg/day) for 8weeks. Genotyping for the long (L) and short (s) alleles (LL, Ls, and ss) of the SLC6A4 gene was performed and the association between genotype and treatment response was assessed. KEY FINDINGS Subjects in both ethnic groups showed a significant reduction in depression scores over time (p<.0001). However, in spite of a significantly greater frequency of the L allele in African-Americans as compared to Caucasians, a comparable clinical response between the two groups was found with 5-HTTLPR polymorphism not significantly associated with clinical response in either ethnic group. SIGNIFICANCE The results are consistent with a previous finding and in accord with most of the results obtained in Caucasian subjects that SLC6A4 genotype is not related, at least by itself, to a response to treatment in either ethnic group to any clinically significant degree.
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Affiliation(s)
- Russell E Poland
- Department of Psychiatry, Meharry Medical College, Nashville, TN, United States.
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17
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Failla MD, Burkhardt JN, Miller MA, Scanlon JM, Conley YP, Ferrell RE, Wagner AK. Variants of SLC6A4 in depression risk following severe TBI. Brain Inj 2013; 27:696-706. [DOI: 10.3109/02699052.2013.775481] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Large inter-individual variability in drug response and toxicity, as well as in drug concentrations after application of the same dosage, can be of genetic, physiological, pathophysiological, or environmental origin. Absorption, distribution and metabolism of a drug and interactions with its target often are determined by genetic differences. Pharmacokinetic and pharmacodynamic variations can appear at the level of drug metabolizing enzymes (e.g., the cytochrome P450 system), drug transporters, drug targets or other biomarker genes. Pharmacogenetics or toxicogenetics can therefore be relevant in forensic toxicology. This review presents relevant aspects together with some examples from daily routines.
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Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Glatt CE, Latoussakis V, Kelly RE, Kanellopoulos D, Klimstra S, Lim KO, Young RC, Hoptman MJ. Serotonin transporter polymorphisms, microstructural white matter abnormalities and remission of geriatric depression. J Affect Disord 2009; 119:132-41. [PMID: 19375170 PMCID: PMC2796561 DOI: 10.1016/j.jad.2009.03.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 03/03/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared microstructural abnormalities in depressed elders and controls and studied the association of the serotonin transporter gene status to white matter abnormalities and to remission of depression. METHODS The subjects were Caucasians with non-psychotic major depression and normal elders. Depressed subjects received escitalopram 10 mg daily for 12 weeks. Remission was defined as a HDRS score of 7 or below for 2 consecutive weeks. Diffusion tensor imaging was performed and voxel-based analysis of fractional anisotropy (FA) was conducted using age and mean diffusivity as covariates. RESULTS Depressed elders (N=27) had lower FA than controls (N=27) in several frontolimbic areas. Depressed elderly S-allele carriers also had lower FA than L homozygotes in frontolimbic brain areas, including the dorsal and rostral anterior cingulate, posterior cingulate, dorsolateral prefrontal and medial prefrontal regions, thalamus, and in other regions. S-allele carriers had a lower remission rate than L homozygotes. LIMITATIONS Small number of subjects, lack of random sampling, fixed antidepressant dose, short follow-up. CONCLUSIONS Lower FA was observed in several frontolimbic and other regions in depressed elders compared to controls. Depressed S-allele carriers had both microstructural white matter abnormalities in frontolimbic networks and a low remission rate. It remains unclear whether the risk for chronicity of geriatric depression in S-allele carriers is mediated by frontolimbic compromise. However, these observations set the stage for studies aiming to identify the relationship of S allele to impairment in specific frontolimbic functions interfering with response of geriatric depression to antidepressants.
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Affiliation(s)
| | | | | | - Charles E. Glatt
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | | | - Robert E. Kelly
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Dora Kanellopoulos
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Sibel Klimstra
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | | | - Robert C. Young
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research,Department of Psychiatry, New York University School of Medicine
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20
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Kohen R, Jarrett ME, Cain KC, Jun SE, Navaja GP, Symonds S, Heitkemper MM. The serotonin transporter polymorphism rs25531 is associated with irritable bowel syndrome. Dig Dis Sci 2009; 54:2663-70. [PMID: 19125330 PMCID: PMC2937164 DOI: 10.1007/s10620-008-0666-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 12/08/2008] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome is a frequent gastrointestinal disorder of unknown etiology. The serotonin transporter regulates the intensity and duration of serotonin signaling in the gut and is, therefore, an attractive candidate gene for irritable bowel syndrome. Previous studies investigating the 5-HTTLPR and Stin2 VNTR polymorphisms of the serotonin transporter have proved inconclusive. In this exploratory study we therefore expanded the search for a possible association of the serotonin transporter with irritable bowel syndrome to include not only the 5-HTTLPR and Stin2 VNTR length polymorphisms, but also the functional single nucleotide polymorphism rs25531. We genotyped 186 patients with irritable bowel syndrome and 50 healthy control subjects raging in age from 18 to 70 years. Carriers of the rare G allele of rs25531 had approximately threefold increased odds of irritable bowel syndrome compared with healthy controls (OR 3.3, 95% CI 1.1-9.6). Our findings suggest that further investigation of the possible role of the serotonin transporter in the etiology of IBS is warranted.
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Affiliation(s)
- Ruth Kohen
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA; Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA
| | - Monica E. Jarrett
- Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA 98195-7226, USA
| | - Kevin C. Cain
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA 98195-7230, USA
| | - Sang-Eun Jun
- Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA 98195-7226, USA
| | - Grace P. Navaja
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA
| | - Sarah Symonds
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA
| | - Margaret M. Heitkemper
- Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA 98195-7226, USA
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21
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Racial and ethnic differences in willingness to participate in psychiatric genetic research. Psychiatr Genet 2009; 19:186-94. [PMID: 19593860 DOI: 10.1097/ypg.0b013e32832cec89] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The National Institute of Mental Health's effort to rectify the underrepresentation of American Blacks in the genetic studies of psychiatric disorders has met with mixed success. This study was designed to understand some of the barriers to recruitment. METHODS Men and women, who were of Black, White or Hispanic race/ethnicity, aged 18-79 years (N= 353), were recruited from clinical and community settings in New York City. Participants responded to a survey that was designed to measure willingness to participate and attitudes toward genetic research. Principal components analyses generated eight factors including perceived benefits, concerns about, and drawbacks of genetic research, and beliefs about genetic or environmental contributions to psychopathology. Analysis of variance assessed within-ethnic group differences on factor scores, as they related to willingness to participate in genetic research. RESULTS Ethnic groups did not differ significantly in stated willingness to participate in genetic research; more than 70% in each group were willing to participate. Among Blacks and Hispanics, mistrust and wariness, and stigma were significantly increased in those unwilling to participate; for Whites, perceived benefit to society and perceived importance for knowledge/education were associated with willingness to participate. For Blacks and Hispanics, youth (aged 18-29 years) and college education reduced, but did not eliminate the association between wariness and mistrust and willingness to participate. CONCLUSION Findings suggest that recruitment efforts aimed at increasing the representation of Blacks should be aware of the barriers among those who are less educated, and involve interactive community collaborations, to fully address the mistrust in this population.
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22
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Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Glatt CE, Latoussakis V, Kelly RE, Kanellopoulos D, Klimstra S, Lim KO, Young RC, Hoptman MJ. Serotonin transporter polymorphisms, microstructural white matter abnormalities and remission of geriatric depression. J Affect Disord 2009. [PMID: 19375170 DOI: 10.1016/j.jad] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study compared microstructural abnormalities in depressed elders and controls and studied the association of the serotonin transporter gene status to white matter abnormalities and to remission of depression. METHODS The subjects were Caucasians with non-psychotic major depression and normal elders. Depressed subjects received escitalopram 10 mg daily for 12 weeks. Remission was defined as a HDRS score of 7 or below for 2 consecutive weeks. Diffusion tensor imaging was performed and voxel-based analysis of fractional anisotropy (FA) was conducted using age and mean diffusivity as covariates. RESULTS Depressed elders (N=27) had lower FA than controls (N=27) in several frontolimbic areas. Depressed elderly S-allele carriers also had lower FA than L homozygotes in frontolimbic brain areas, including the dorsal and rostral anterior cingulate, posterior cingulate, dorsolateral prefrontal and medial prefrontal regions, thalamus, and in other regions. S-allele carriers had a lower remission rate than L homozygotes. LIMITATIONS Small number of subjects, lack of random sampling, fixed antidepressant dose, short follow-up. CONCLUSIONS Lower FA was observed in several frontolimbic and other regions in depressed elders compared to controls. Depressed S-allele carriers had both microstructural white matter abnormalities in frontolimbic networks and a low remission rate. It remains unclear whether the risk for chronicity of geriatric depression in S-allele carriers is mediated by frontolimbic compromise. However, these observations set the stage for studies aiming to identify the relationship of S allele to impairment in specific frontolimbic functions interfering with response of geriatric depression to antidepressants.
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Affiliation(s)
- George S Alexopoulos
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry, United States.
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Role of variation in the serotonin transporter protein gene (SLC6A4) in trait disturbances in the ventral anterior cingulate in bipolar disorder. Neuropsychopharmacology 2009; 34:1301-10. [PMID: 19037205 PMCID: PMC2826628 DOI: 10.1038/npp.2008.204] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Bipolar disorder (BD) is associated with abnormalities of the ventral anterior cingulate cortex (vACC) and its connection sites, including the amygdala, which are key components of a corticolimbic neural system that subserves emotional regulation. Decreased functional connectivity from the vACC to the amygdala in healthy individuals is associated with the short 's' allele--as opposed to the long 'l' allele--of a well-known serotonin transporter promoter polymorphism (5-HTTLPR, locus SLC6A4), as are features of BD. This study tests the hypothesis that the s allele influences dysfunction in the vACC-amygdala neural system in BD. A total of 30 euthymic individuals with BD (20 s carriers, 10 ll) and 48 healthy comparison (HC) participants (34 s, 14 ll) participated in an event-related functional magnetic resonance imaging scan while processing fearful, happy, or neutral faces. During fear and happy face processing, vACC activation was significantly lower in the BD compared to the HC group, and in s carriers compared to ll individuals within both the HC and BD groups, such that BD s carriers exhibited the greatest magnitude of vACC dysfunction. No significant differences were detected in amygdala activation. The findings suggest that the 5-HTTLPR s allele may contribute to a trait-related, genetically derived, neurobiological subgroup within BD characterized by prominent vACC dysfunction. Future treatment may be optimized for this BD subgroup by targeting the serotonergic system and the vACC.
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Abstract
With increasing emphasis on understanding genetic contribution to disease, inclusion of all racial and ethnic groups in molecular genetic research is necessary to ensure parity in distribution of research benefits. Blacks are underrepresented in large-scale genetic studies of psychiatric disorders. In an effort to understand the reasons for the underrepresentation, this study explored black participants' attitudes towards genetic research of psychiatric disorders. Twenty-six adults, the majority of whom were black (n = 18) were recruited from a New York City community to participate in six 90-minute focus groups. This paper reports findings about respondents' understanding of genetics and genetic research, and opinions about psychiatric genetic research. Primary themes revealed participants' perceived lack of knowledge about genetics, concerns about potentially harmful study procedures, and confidentiality surrounding mental illness in families. Participation incentives included provision of treatment or related service, monetary compensation, and reporting of results to participants. These findings suggest that recruitment of subjects into genetic studies should directly address procedures, privacy, benefits and follow-up with results. Further, there is critical need to engage communities with education about genetics and mental illness, and provide opportunities for continued discussion about concerns related to genetic research.
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Affiliation(s)
- Eleanor Murphy
- New York State Psychiatric Institute, Division of Epidemiology in Psychiatry, Columbia University College of Physicians and Surgeons, Department of Psychiatry, USA.
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25
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Mellman TA, Alim T, Brown DD, Gorodetsky E, Buzas B, Lawson WB, Goldman D, Charney DS. Serotonin polymorphisms and posttraumatic stress disorder in a trauma exposed African American population. Depress Anxiety 2009; 26:993-7. [PMID: 19842167 PMCID: PMC2963151 DOI: 10.1002/da.20627] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Genetic polymorphisms that influence serotonin (5-hydroxytryptamine, 5HT) neurotransmission are candidates for contributing to susceptibility to posttraumatic stress disorder (PTSD). The objective of our study was to determine if a variable length polymorphism for the promoter regions of the 5HT transporter (5HTTLPR), and/or a substitution polymorphism in the promoter region for the 5HT2A receptor, would be associated with PTSD in a trauma exposed population of adult African-Americans. METHODS Using a case control design, 118 participants recruited from the primary care clinics and the campus of a historically black university who met inclusion criteria including trauma exposure provided blood samples for genomic DNA. PTSD criteria were determined by the Clinician Assessment of PTSD Scale (CAPS) and criteria for other psychiatric disorders by the Structured Clinical Interview for DSM-IV (SCID). 5HTTLPR and 5HT2A-1438A/G were genotyped using established methods. Associations of genotypes with lifetime PTSD, and models testing associations of allele "dose", were analyzed. RESULTS Fifty-five (47%) participants met lifetime criteria for PTSD and 26 (22%) met criteria for (mostly comorbid) major depression. The 5HT2A (lower expressing) G allele was significantly associated with PTSD. We did not find significant associations with 5HTTLPR. CONCLUSIONS Our findings suggest a relationship between genetic variation in the 5HT2A promoter region and PTSD.
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Affiliation(s)
- Thomas A. Mellman
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia,Correspondence to: Thomas A. Mellman, Department of Psychiatry, Howard University Hospital, 2041 Georgia Ave., Washington, DC 20060.
| | - Tanya Alim
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia
| | - Denver D. Brown
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia
| | - Elena Gorodetsky
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - Beata Buzas
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - William B. Lawson
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia
| | - David Goldman
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
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Esau L, Kaur M, Adonis L, Arieff Z. The 5-HTTLPR polymorphism in South African healthy populations: a global comparison. J Neural Transm (Vienna) 2008; 115:755-60. [PMID: 18193379 DOI: 10.1007/s00702-007-0012-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 11/19/2007] [Indexed: 12/16/2022]
Abstract
The serotonin transporter promoter length polymorphism (5-hydroxytryptamine transporter length polymorphism, 5-HTTLPR) in serotonin transporter gene has been implicated in numerous psychiatric disorders. Having a high affinity for the neurotransmitter serotonin (5-hydroxytryptamine, 5-HT), serotonin transporter controls the duration, availability and signaling capacity of 5-HT in the synapse. Association studies have focused extensively on this polymorphic region as the frequencies of long- and short-alleles of this gene differ greatly amongst populations and association studies have either reported conflicting results or nothing significant at all. In this study, the genotype and allele frequencies of 5-HTTLPR polymorphism were determined in the healthy South African (SA) individuals belonging to diverse ethnic backgrounds. Cheek cell samples were collected from the three major ethnic groups namely: Caucasians, Africans and coloreds/Mixed population. The DNA was extracted and genotyped for the 5-HTTLPR. Genotypes were compared amongst the three major ethnic groups from SA as well as to that of other studies around the world. This is the first study to report significant differences in the 5-HTTLPR genotype and allelic frequencies among various ethnic groups in SA. Future studies will target larger population groups and the estimation of frequency of these alleles in individuals with autism.
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Affiliation(s)
- Luke Esau
- Department of Biotechnology, University of the Western Cape, Bellville, Cape Town, South Africa
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Lavretsky H, Siddarth P, Kumar A, Reynolds CF. The effects of the dopamine and serotonin transporter polymorphisms on clinical features and treatment response in geriatric depression: a pilot study. Int J Geriatr Psychiatry 2008; 23:55-9. [PMID: 17621383 DOI: 10.1002/gps.1837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors examined the role of dopamine and serotonin transporter genetic polymorphisms in clinical and cognitive features of subjects with late-life depression, and in preferential treatment response to the combination of methylphenidate and citalopram. METHOD The authors studied fifteen outpatients with major depression in a pilot ten-week double-blind trial of methylphenidate combined with citalopram and compared to citalopram and placebo. Response was defined as a score on the Hamilton Depression Rating Scale (24-item) of less than 10. All underwent genotyping to determine the dopamine (DAT VNTR) and serotonin (5HTTLPR) transporter polymorphisms. RESULTS Subjects with DAT VNTR 10/10 genotype had greater cognitive executive dysfunction at baseline compared to others. However, they responded preferentially to methylphenidate added to citalopram with a greater reduction in depression severity over time compared to other subjects. CONCLUSIONS DAT VNTR 10/10 genotype may be associated with an endophenotype of late-life depression with executive dysfunction that responds preferentially to methylphenidate added to a selective serotonin reuptake inhibitor, which warrants replication in a large sample.
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Affiliation(s)
- Helen Lavretsky
- UCLA School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
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28
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Abstract
OBJECTIVES This secondary analysis of data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study compared rates of remission and response for blacks (n = 495), whites (n = 1853), and Hispanics (n = 327) with nonpsychotic major depressive disorder who were treated with citalopram. METHODS STAR*D included representative outpatients treated in 23 psychiatric and 18 primary care centers. Participants received flexible doses of citalopram for up to 14 weeks, with dosage adjustments based on routine clinical assessments. Efforts were made to achieve remission, using a measurement-based care approach with adjustments based on symptoms and side effects assessed at each visit. RESULTS There were significant differences among groups on many baseline demographic, sociocultural, and clinical variables. Blacks and Hispanics were more socially disadvantaged and had more comorbidity than whites. Before adjusting for differences, blacks had lower remission rates than whites, with Hispanics intermediate between the 2. After adjustments, remission rates for groups were not significantly different on the 17-item Hamilton Rating Scale for Depression (HRSD), but remained lower for blacks compared with whites with the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR). Blacks took longer to achieve remission or response, though this did not remain after adjusting for baseline differences. CONCLUSIONS Overall, black and to a lesser extent Hispanic participants had a poorer response to citalopram. After adjusting for baseline differences, the remission rates seemed to be more similar on the HRSD, but remained worse for blacks on the QIDS-SR. We discuss the possible biologic and sociocultural factors that may underlie these findings.
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Saghafi R, Brown C, Butters MA, Cyranowski J, Dew MA, Frank E, Gildengers A, Karp JF, Lenze EJ, Lotrich F, Martire L, Mazumdar S, Miller MD, Mulsant BH, Weber E, Whyte E, Morse J, Stack J, Houck PR, Bensasi S, Reynolds CF. Predicting 6-week treatment response to escitalopram pharmacotherapy in late-life major depressive disorder. Int J Geriatr Psychiatry 2007; 22:1141-6. [PMID: 17486678 PMCID: PMC3579589 DOI: 10.1002/gps.1804] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately half of older patients treated for major depressive disorder (MDD) do not achieve symptomatic remission and functional recovery with first-line pharmacotherapy. This study aims to characterize sociodemographic, clinical, and neuropsychologic correlates of full, partial, and non-response to escitalopram monotherapy of unipolar MDD in later life. METHODS One hundred and seventy-five patients aged 60 and older were assessed at baseline on demographic variables, depression severity, hopelessness, anxiety, cognitive functioning, co-existing medical illness burden, social support, and quality of life (disability). Subjects received 10 mg/d of open-label escitalopram and were divided into full (n = 55; 31%), partial (n = 75; 42.9%), and non-responder (n = 45; 25.7%) groups based on Hamilton depression scores at week 6. Univariate followed by multivariate analyses tested for differences between the three groups. RESULTS Non-responders to treatment were found to be more severely depressed and anxious at baseline than both full and partial responders, more disabled, and with lower self-esteem than full responders. In general partial responders resembled full responders more than they resembled non-responders. In multivariate models, more severe anxiety symptoms (both psychological and somatic) and lower self-esteem predicted worse response status at 6 weeks. CONCLUSION Among treatment-seeking elderly persons with MDD, higher anxiety symptoms and lower self-esteem predict poorer response after six weeks of escitalopram treatment.
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Affiliation(s)
- Ramin Saghafi
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Charlotte Brown
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Meryl A. Butters
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jill Cyranowski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Mary Amanda Dew
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Ellen Frank
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Ariel Gildengers
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jordan F. Karp
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Eric J. Lenze
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Francis Lotrich
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Lynn Martire
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Sati Mazumdar
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Mark D. Miller
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Benoit H. Mulsant
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
- Centre for Addiction and Mental Health, University of Toronto, Canada
| | - Elizabeth Weber
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Ellen Whyte
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jennifer Morse
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jacqueline Stack
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Patricia R. Houck
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Salem Bensasi
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Charles F. Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
- Correspondence to: Dr C. F. Reynolds, III, 3811 O’Hara Street, Pittsburgh, PA 15213, USA.
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Scheid JM, Holzman CB, Jones N, Friderici KH, Nummy KA, Symonds LL, Sikorskii A, Regier MK, Fisher R. Depressive symptoms in mid-pregnancy, lifetime stressors and the 5-HTTLPR genotype. GENES BRAIN AND BEHAVIOR 2007; 6:453-64. [PMID: 16965382 DOI: 10.1111/j.1601-183x.2006.00272.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Few studies of gene-environment interactions for the serotonin transporter promoter polymorphism (5-HTTLPR), life stressors and depression have considered women separately or examined specific types of stressful life events. None have looked at depression during pregnancy. In the Pregnancy Outcomes and Community Health (POUCH) Study, women were queried about history of stressful life events and depressive symptoms at the time of enrollment (15-27 weeks gestation). Stressful life events were grouped a priori into "subconstructs" (e.g. economic, legal, abuse, loss) and evaluated by subconstruct, total subconstruct score and total stressful life event score. The effect of genotype on the association between stressful life events and elevated depressive symptoms was assessed in 568 white non-Hispanic participants. The relationship between exposure to abuse and elevated depressive symptoms was more pronounced in the s/s group (OR = 24.5) than in the s/l group (OR = 3.0) and the l/l group (OR = 7.7), but this significant interaction was detected only after excluding 73 (13%) women with recent use of psychotropic medications. There was no evidence of gene-environment interaction in analytic models with other stressful life events subconstructs, total subconstruct score or total stressful life events score. These data offer modest support to other reports of gene-environment interaction and highlight the importance of considering specific stressful life events.
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Affiliation(s)
- J M Scheid
- Department of Psychiatry, Michigan State University, East Lansing, MI 48824, USA.
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Enoch MA, Shen PH, Xu K, Hodgkinson C, Goldman D. Using ancestry-informative markers to define populations and detect population stratification. J Psychopharmacol 2006; 20:19-26. [PMID: 16785266 DOI: 10.1177/1359786806066041] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A serious problem with case-control studies is that population subdivision, recent admixture and sampling variance can lead to spurious associations between a phenotype and a marker locus, or indeed may mask true associations. This is also a concern in therapeutics since drug response may differ by ethnicity. Population stratification can occur if cases and controls have different frequencies of ethnic groups or in admixed populations, different fractions of ancestry, and when phenotypes of interest such as disease, drug response or drug metabolism, also differ between ethnic groups. Although most genetic variation is inter-individual, there is also significant inter-ethnic variation. The International HapMap Project has provided allele frequencies for approximately three million single nucleotide polymorphisms (SNPs) in Africans, Europeans and East Asians. SNP variation is greatest in Africans. Statistical methods for the detection and correction of population stratification, principally Structured Association and Genomic Control, have recently become freely available. These methods use marker loci spread throughout the genome that are unlinked to the candidate locus to estimate the ancestry of individuals within a sample, and to test for and adjust the ethnic matching of cases and controls. To date, few case-control association studies have incorporated testing for population stratification. This paper will focus on the debate about the quantity and methods for selection of highly informative marker loci required to characterize populations that vary in substructure or the degree of admixture, and will discuss how these theoretically desirable approaches can be effectively put into practice.
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Affiliation(s)
- Mary-Anne Enoch
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
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Abstract
Because of the heterogeneity in symptoms and diagnostic findings, patients with irritable bowel syndrome (IBS) remain a challenge to treat and to study. This difficulty stems from lack of understanding of the pathophysiology of this disorder. Environmental factors likely play an important role in the pathogenesis and clinical manifestations of IBS. Several recent studies suggest a genetic basis for IBS, either in etiology or predicting response to therapy. Because of interest in studying the genetic contributors to this and other functional gastrointestinal disorders, we review the literature on genetic risk factors that might explain the familial clustering of IBS. Familial aggregation studies and twin studies suggest a modest contribution of genetics to the development of IBS. Pharmacogenomic and association studies provide stronger, although far from conclusive, evidence for genetic variants that affect expression of IBS. Together, these studies suggest that a multidisciplinary approach with clinical and psychological tools, epidemiologic methods, and genetic techniques might help elucidate the molecular components leading to the common symptoms of IBS and result in better treatments for those with IBS.
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Affiliation(s)
- Yuri A Saito
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
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Kraft JB, Slager SL, McGrath PJ, Hamilton SP. Sequence analysis of the serotonin transporter and associations with antidepressant response. Biol Psychiatry 2005; 58:374-81. [PMID: 15993855 DOI: 10.1016/j.biopsych.2005.04.048] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 04/12/2005] [Accepted: 04/26/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND The serotonin transporter is the molecular target of many antidepressants, and the gene (SLC6A4) encoding this protein has been associated with response to selective serotonin reuptake inhibitors (SSRIs). We sought to test further the hypothesis that SLC6A4 is associated with SSRI response by resequencing this gene in subjects with major depression. METHODS The sequence of all exons, parts of all introns, and the promoter region containing a polymorphic repeat polymorphism (HTTLPR) previously associated with SSRI response was determined for 96 subjects, and variants were tested for association to treatment response with fluoxetine. RESULTS We screened a total of 712 kilobases of sequence and found 27 SLC6A4 variants, 21 of which were previously undescribed. Seventeen were seen on one chromosome each, including three of the five exonic variants. One polymorphism (rs25531), just upstream of the HTTLPR, showed evidence of an association with treatment response, and biochemical experiments showed this polymorphism altered binding of nuclear extracts to a consensus sequence for the activator protein 2 transcription factor, which is believed to be a critical factor in regulating neural gene expression in mammals. CONCLUSIONS These results support an association between response to SSRIs and deoxyribonucleic acid variation at the serotonin transporter locus. We have also identified a potentially important functional variant that contributes to this association and a possible biologic mechanism that could mediate its effect.
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Affiliation(s)
- Jeffrey B Kraft
- Department of Psychiatry and Center for Human Genetics, University of California-San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143-0984, USA
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Mannelli P, Patkar AA, Murray HW, Certa K, Peindl K, Mattila-Evenden M, Berrettini WH. Polymorphism in the serotonin transporter gene and response to treatment in African American cocaine and alcohol-abusing individuals. Addict Biol 2005; 10:261-8. [PMID: 16109588 DOI: 10.1080/13556210500235540] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The serotonin transporter (5-HTT) regulates serotonin transmission and modulates behavioral effects of drug of abuse. A polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) yielding a short (S) and long (L) allele has been associated with severity of substance abuse. The aims of the study were to investigate whether 5-HTTLPR genotypes differed in their response to treatment in cocaine- and alcohol-abusing patients. Polymerase chain reaction-based genotyping of a 44 base pair insertion/deletion polymorphism was performed in 141 African American cocaine-dependent patients with concurrent alcohol use who were entering a 12-week behaviorally oriented outpatient treatment program. In treatment, end of treatment and 6-month follow-up outcome measures included changes in Addiction Severity Index (ASI) scores, urine drug screens, days in treatment, individual/group sessions, dropout and completion rates. As expected, there was a reduction in substance abuse by the end of treatment and follow-up (F = 5.15, p = 0.000). However, there were no differences in the reduction in cocaine use across the LL, LS and SS genotypes. Interestingly, individuals with the S allele showed greater severity of alcohol use at admission (F = 4.84, p = 0.03), and the SS genotype showed less improvement in alcohol measures than the LL at follow-up (F = 3.68, p = 0.03), after controlling for baseline variables. While we found no association of the 5-HTTLPR variants with severity of cocaine abuse or any cocaine-related outcome measures, the data suggested that the 5-HTTLPR polymorphism may distinguish responders from non-responders to behavioral treatment in terms of alcohol use. Further investigations are required to determine the role of the 5-HTTLPR polymorphism in influencing treatment - outcome among substance abusers.
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Affiliation(s)
- Paolo Mannelli
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27704, USA
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Shah RR. Pharmacogenetics in drug regulation: promise, potential and pitfalls. Philos Trans R Soc Lond B Biol Sci 2005; 360:1617-38. [PMID: 16096112 PMCID: PMC1569525 DOI: 10.1098/rstb.2005.1693] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Pharmacogenetic factors operate at pharmacokinetic as well as pharmacodynamic levels-the two components of the dose-response curve of a drug. Polymorphisms in drug metabolizing enzymes, transporters and/or pharmacological targets of drugs may profoundly influence the dose-response relationship between individuals. For some drugs, although retrospective data from case studies suggests that these polymorphisms are frequently associated with adverse drug reactions or failure of efficacy, the clinical utility of such data remains unproven. There is, therefore, an urgent need for prospective data to determine whether pre-treatment genotyping can improve therapy. Various regulatory guidelines already recommend exploration of the role of genetic factors when investigating a drug for its pharmacokinetics, pharmacodynamics, dose-response relationship and drug interaction potential. Arising from the global heterogeneity in the frequency of variant alleles, regulatory guidelines also require the sponsors to provide additional information, usually pharmacogenetic bridging data, to determine whether data from one ethnic population can be extrapolated to another. At present, sponsors explore pharmacogenetic influences in early clinical pharmacokinetic studies but rarely do they carry the findings forward when designing dose-response studies or pivotal studies. When appropriate, regulatory authorities include genotype-specific recommendations in the prescribing information. Sometimes, this may include the need to adjust a dose in some genotypes under specific circumstances. Detailed references to pharmacogenetics in prescribing information and pharmacogenetically based prescribing in routine therapeutics will require robust prospective data from well-designed studies. With greater integration of pharmacogenetics in drug development, regulatory authorities expect to receive more detailed genetic data. This is likely to complicate the drug evaluation process as well as result in complex prescribing information. Genotype-specific dosing regimens will have to be more precise and marketing strategies more prudent. However, not all variations in drug responses are related to pharmacogenetic polymorphisms. Drug response can be modulated by a number of non-genetic factors, especially co-medications and presence of concurrent diseases. Inappropriate prescribing frequently compounds the complexity introduced by these two important non-genetic factors. Unless prescribers adhere to the prescribing information, much of the benefits of pharmacogenetics will be squandered. Discovering highly predictive genotype-phenotype associations during drug development and demonstrating their clinical validity and utility in well-designed prospective clinical trials will no doubt better define the role of pharmacogenetics in future clinical practice. In the meantime, prescribing should comply with the information provided while pharmacogenetic research is deservedly supported by all concerned but without unrealistic expectations.
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Lotrich FE, Pollock BG. Candidate genes for antidepressant response to selective serotonin reuptake inhibitors. Neuropsychiatr Dis Treat 2005; 1:17-35. [PMID: 18568127 PMCID: PMC2426818 DOI: 10.2147/nedt.1.1.17.52301] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) can safely and successfully treat major depression, although a substantial number of patients benefit only partially or not at all from treatment. Genetic polymorphisms may play a major role in determining the response to SSRI treatment. Nonetheless, it is likely that efficacy is determined by multiple genes, with individual genetic polymorphisms having a limited effect size. Initial studies have identified the promoter polymorphism in the gene coding for the serotonin reuptake transporter as moderating efficacy for several SSRIs. The goal of this review is to suggest additional plausible polymorphisms that may be involved in antidepressant efficacy. These include genes affecting intracellular transductional cascades; neuronal growth factors; stress-related hormones, such as corticotropin-releasing hormone and glucocorticoid receptors; ion channels and synaptic efficacy; and adaptations of monoaminergic pathways. Association analyses to examine these candidate genes may facilitate identification of patients for targeted alternative therapies. Determining which genes are involved may also assist in identifying future, novel treatments.
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Affiliation(s)
- Francis E Lotrich
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Department of Psychiatry Pittsburgh, PA, USA.
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