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Martínez-Pinteño A, Gassó P, Prohens L, Segura AG, Parellada M, Saiz-Ruiz J, Cuesta MJ, Bernardo M, Lafuente A, Mas S, Rodríguez N. Identification of EP300 as a Key Gene Involved in Antipsychotic-Induced Metabolic Dysregulation Based on Integrative Bioinformatics Analysis of Multi-Tissue Gene Expression Data. Front Pharmacol 2021; 12:729474. [PMID: 34483940 PMCID: PMC8414590 DOI: 10.3389/fphar.2021.729474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022] Open
Abstract
Antipsychotics (APs) are associated with weight gain and other metabolic abnormalities such as hyperglycemia, dyslipidemia and metabolic syndrome. This translational study aimed to uncover the underlying molecular mechanisms and identify the key genes involved in AP-induced metabolic effects. An integrative gene expression analysis was performed in four different mouse tissues (striatum, liver, pancreas and adipose) after risperidone or olanzapine treatment. The analytical approach combined the identification of the gene co-expression modules related to AP treatment, gene set enrichment analysis and protein-protein interaction network construction. We found several co-expression modules of genes involved in glucose and lipid homeostasis, hormone regulation and other processes related to metabolic impairment. Among these genes, EP300, which encodes an acetyltransferase involved in transcriptional regulation, was identified as the most important hub gene overlapping the networks of both APs. Then, we explored the genetically predicted EP300 expression levels in a cohort of 226 patients with first-episode psychosis who were being treated with APs to further assess the association of this gene with metabolic alterations. The EP300 expression levels were significantly associated with increases in body weight, body mass index, total cholesterol levels, low-density lipoprotein cholesterol levels and triglyceride concentrations after 6 months of AP treatment. Taken together, our analysis identified EP300 as a key gene in AP-induced metabolic abnormalities, indicating that the dysregulation of EP300 function could be important in the development of these side effects. However, more studies are needed to disentangle the role of this gene in the mechanism of action of APs.
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Affiliation(s)
- Albert Martínez-Pinteño
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Patricia Gassó
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Llucia Prohens
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Alex G Segura
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Jerónimo Saiz-Ruiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Manuel J Cuesta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Miguel Bernardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Amalia Lafuente
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergi Mas
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Rodríguez
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
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Abstract
Ethnic differences may significantly influence the outcome of psychopharmacological treatment, in terms of prescription, adherence, clinical response, emergence of side effects, as well as pharmacokinetics and pharmacodynamics. The purpose of this review was to explore the available literature in order to provide general suggestions to help clinicians in choosing the best therapeutic option for patients, taking into account ethnicity. Although findings are sometimes controversial, the overall published studies suggest that ethnicities other than Caucasians tend to show a lower response to antidepressants and a reduced compliance. Africans tend to be more prescribed with antipsychotics, probably due to cultural stereotypes, except with clozapine, probably for their chronic benign neutropenia. Asians usually require less antipsychotic dosages than Caucasians. The differential response and side effect profile of antidepressants and antipsychotics have been related to individual intrinsic factors, to genetic make-up, but also to cultural and contextual variables. Interestingly, albeit limited data suggest ethnic-related genetic heterogeneity at the level of the serotonin transporters, the cytochromes and some neuroreceptors. Taken together, no conclusive findings are available about the role and impact of ethnicity in psychopharmacology. One of the main problems is that the majority of the studies in psychopharmacology have been conducted on Caucasians, so that there is an urgent need to have data in other populations. Furthermore, in the era of precision medicine, the role of ethnicity may be also supported by genetic analysis.
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Vanwong N, Puangpetch A, Unaharassamee W, Jiratjintana N, Na Nakorn C, Hongkaew Y, Sukasem C. Effect of 5-HT2C receptor gene polymorphism (HTR2C-759C/T) on metabolic adverse effects in Thai psychiatric patients treated with risperidone. Pharmacoepidemiol Drug Saf 2021; 30:806-813. [PMID: 33683783 DOI: 10.1002/pds.5224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The use of Atypical antipsychotics (AAPs) is related to metabolic disturbances, which put psychiatric patients at risk for cardiovascular morbidity and mortality. Evidence is emerging of genetic risk factors. The HTR2C gene is an essential candidate in pharmacogenetic studies of antipsychotic-induced metabolic effects. Nevertheless, there were inconsistent results among studies. OBJECTIVE To investigate the relationship between -759C/T, functional polymorphism of the HTR2C gene and metabolic adverse effects in Thai psychiatric patients treated with risperidone monotherapy. METHOD In this cross-sectional study, 108 psychiatric patients treated with risperidone monotherapy for ≥3 months were recruited. Anthropometric measurements and laboratory tests were obtained upon enrollment and history of treatment was reviewed from medical records. Weight gain was defined as an increase ≥7% of baseline weight. Metabolic syndrome was evaluated according to the 2005 International Diabetes Federation (IDF) Asia criteria. The -759C/T, polymorphism was genotyped. The associations between -759C/T polymorphism and metabolic side effects were analyzed. Multiple logistic regression was used for determining potential confounders. RESULTS Neither weight gain nor metabolic syndrome was significantly associated with -759C/T allelic and genotype variants of HTR2C. However, T allele of -759C/T polymorphism significantly associated with the hypertension. This association was not affected by possible confounding factors such as gender, risperidone dose, duration of treatment and family history of hypertension. CONCLUSION Our findings suggest that psychiatric patients with T allele of -759C/T polymorphism may be at higher risk for hypertension. Further study with prospective design with larger patient groups are needed.
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Affiliation(s)
- Natchaya Vanwong
- Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Apichaya Puangpetch
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | | | - Napa Jiratjintana
- Department of Psychiatry, Somdet Chaopraya Institute of Psychiatry, Bangkok, Thailand
| | - Chalitpon Na Nakorn
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand.,Programme in Translational Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yaowaluck Hongkaew
- Advance Research and Development Laboratory, Bumrungrad International Hospital, Bangkok, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
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Banono NS, Gawel K, De Witte L, Esguerra CV. Zebrafish Larvae Carrying a Splice Variant Mutation in cacna1d: A New Model for Schizophrenia-Like Behaviours? Mol Neurobiol 2021; 58:877-894. [PMID: 33057948 PMCID: PMC7843589 DOI: 10.1007/s12035-020-02160-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022]
Abstract
Persons with certain single nucleotide polymorphisms (SNPs) in the CACNA1D gene (encoding voltage-gated calcium channel subunit alpha 1-D) have increased risk of developing neuropsychiatric disorders such as bipolar, schizophrenia and autism. The molecular consequences of SNPs on gene expression and protein function are not well understood. Thus, the use of animal models to determine genotype-phenotype correlations is critical to understanding disease pathogenesis. Here, we describe the behavioural changes in larval zebrafish carrying an essential splice site mutation (sa17298) in cacna1da. Heterozygous mutation resulted in 50% reduction of splice variants 201 and 202 (haploinsufficiency), while homozygosity increased transcript levels of variant 201 above wild type (WT; gain-of-function, GOF). Due to low homozygote viability, we focused primarily on performing the phenotypic analysis on heterozygotes. Indeed, cacna1dasa17298/WT larvae displayed hyperlocomotion-a behaviour characterised in zebrafish as a surrogate phenotype for epilepsy, anxiety or psychosis-like behaviour. Follow-up tests ruled out anxiety or seizures, however, as neither thigmotaxis defects nor epileptiform-like discharges in larval brains were observed. We therefore focused on testing for potential "psychosis-like" behaviour by assaying cacna1dasa17298/WT larval locomotor activity under constant light, during light-dark transition and in startle response to dark flashes. Furthermore, exposure of larvae to the antipsychotics, risperidone and haloperidol reversed cacna1da-induced hyperactivity to WT levels while valproate decreased but did not reverse hyperactivity. Together, these findings demonstrate that cacna1da haploinsufficiency induces behaviours in larval zebrafish analogous to those observed in rodent models of psychosis. Future studies on homozygous mutants will determine how cacna1d GOF alters behaviour in this context.
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Affiliation(s)
- Nancy Saana Banono
- Chemical Neuroscience Group, Centre for Molecular Medicine Norway (NCMM), Faculty of Medicine, University of Oslo, Gaustadalléen 21, Forskningsparken, 0349, Oslo, Norway
| | - Kinga Gawel
- Chemical Neuroscience Group, Centre for Molecular Medicine Norway (NCMM), Faculty of Medicine, University of Oslo, Gaustadalléen 21, Forskningsparken, 0349, Oslo, Norway
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Jaczewskiego Str. 8b, 20-090, Lublin, Poland
| | - Linus De Witte
- Pharmaceutical and Biological Sciences, AP Hogeschool Antwerpen, Antwerp, Belgium
| | - Camila V Esguerra
- Chemical Neuroscience Group, Centre for Molecular Medicine Norway (NCMM), Faculty of Medicine, University of Oslo, Gaustadalléen 21, Forskningsparken, 0349, Oslo, Norway.
- School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Sem Sælandsvei 24, 0371, Oslo, Norway.
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Arranz MJ, Salazar J, Hernández MH. Pharmacogenetics of antipsychotics: Clinical utility and implementation. Behav Brain Res 2020; 401:113058. [PMID: 33316324 DOI: 10.1016/j.bbr.2020.113058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
Decades of research have produced extensive evidence of the contribution of genetic factors to the efficacy and toxicity of antipsychotics. Numerous genetic variants in genes controlling drug availability or involved in antipsychotic processes have been linked to treatment variability. The complex mechanism of action and multitarget profile of most antipsychotic drugs hinder the identification of pharmacogenetic markers of clinical value. Nevertheless, the validity of associations between variants in CYP1A2, CYP2D6, CYP2C19, ABCB1, DRD2, DRD3, HTR2A, HTR2C, BDNF, COMT, MC4R genes and antipsychotic response has been confirmed in independent candidate gene studies. Genome wide pharmacogenomic studies have proven the role of the glutamatergic pathway in mediating antipsychotic activity and have reported novel associations with antipsychotic response. However, only a limited number of the findings, mainly functional variants of CYP metabolic enzymes, have been shown to be of clinical utility and translated into useful pharmacogenetic markers. Based on the currently available information, actionable pharmacogenetics should be reduced to antipsychotics' dose adjustment according to the genetically predicted metabolic status (CYPs' profile) of the patient. Growing evidence suggests that such interventions will reduce antipsychotics' side-effects and increase treatment safety. Despite this evidence, the use of pharmacogenetics in psychiatric wards is minimal. Hopefully, further evidence on the clinical and economic benefits, the development of clinical protocols based on pharmacogenetic information, and improved and cheaper genetic testing will increase the implementation of pharmacogenetic guided prescription in clinical settings.
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Affiliation(s)
- Maria J Arranz
- Fundació Docència i Recerca Mútua Terrassa, Spain; Centro de investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain; PHAGEX Research Group, Universitat Ramon LLull, Spain.
| | - Juliana Salazar
- Translational Medical Oncology Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain; U705, ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain; PHAGEX Research Group, Universitat Ramon LLull, Spain
| | - Marta H Hernández
- PHAGEX Research Group, Universitat Ramon LLull, Spain; School of Health Sciences Blanquerna. University Ramon Llull, Barcelona, Spain
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Nawaz R, Gul S, Amin R, Huma T, Al Mughairbi F. Overview of schizophrenia research and treatment in Pakistan. Heliyon 2020; 6:e05545. [PMID: 33294688 PMCID: PMC7695967 DOI: 10.1016/j.heliyon.2020.e05545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/12/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
Mental health is the most neglected health sector in Pakistan, and the majority of citizens have limited or no access to primary and secondary psychiatric services. The incidence of schizophrenia (SCZ) has increased at an alarming rate in Pakistan, relative to that of other psychiatric disorders. While numerous studies have investigated SCZ, few have addressed the issue about the Pakistani population. In the present review, the researchers discuss current data integral to the prevalence, pathophysiology, and molecular genetics of SCZ; treatment approaches to the disease; and patient responses to drugs prescribed for SCZ in Pakistan. Most Pakistani patients exhibit poor responses to antipsychotic drugs. Based on our review, the researchers hypothesize that genetic dissimilarities between Pakistani and Western populations contribute to such poor responses. Consequently, an understanding of such genetic differences and the provision of personalized treatment may simultaneously aid in improving SCZ treatment in Pakistan.
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Affiliation(s)
- Rukhsana Nawaz
- Department of Clinical Psychology, College of Medicine & Health Sciences, UAE University 15551 Al Ain, United Arab Emirates
| | - Saima Gul
- Department of Rehabilitation Science, Faculty of Pharmacy & Allied Health Sciences, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Rafat Amin
- Department of Pathology, Institute of Biological, Biochemical and Pharmaceutical Sciences, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan
| | | | - Fadwa Al Mughairbi
- Department of Clinical Psychology, College of Medicine & Health Sciences, UAE University 15551 Al Ain, United Arab Emirates
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Maffioletti E, Valsecchi P, Minelli A, Magri C, Bonvicini C, Barlati S, Sacchetti E, Vita A, Gennarelli M. Association study betweenHTR2Ars6313 polymorphism and early response to risperidone and olanzapine in schizophrenia patients. Drug Dev Res 2020; 81:754-761. [DOI: 10.1002/ddr.21686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Paolo Valsecchi
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Alessandra Minelli
- Department of Molecular and Translational MedicineUniversity of Brescia Brescia Italy
| | - Chiara Magri
- Department of Molecular and Translational MedicineUniversity of Brescia Brescia Italy
| | - Cristian Bonvicini
- Genetics UnitIRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli Brescia Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Emilio Sacchetti
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Antonio Vita
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational MedicineUniversity of Brescia Brescia Italy
- Genetics UnitIRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli Brescia Italy
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8
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Moilanen J, Haapea M, Jääskeläinen E, Veijola J, Isohanni M, Koponen H, Miettunen J. Long-term antipsychotic use and its association with outcomes in schizophrenia – the Northern Finland Birth Cohort 1966. Eur Psychiatry 2020; 36:7-14. [DOI: 10.1016/j.eurpsy.2016.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022] Open
Abstract
AbstractBackgroundDue to the paucity of previous studies, we wanted to elucidate the pharmacoepidemiology of antipsychotics in schizophrenia in a general population sample, and the association between long-term antipsychotic use and outcomes.MethodsThe sample included 53 schizophrenia subjects from the Northern Finland Birth Cohort 1966 with at least ten years of follow-up (mean 18.6 years since illness onset). Data on lifetime medication and outcomes (remission, Clinical Global Impression [CGI], Social and Occupational Functioning Assessment Scale [SOFAS]) were collected from medical records, interviews, and national registers.ResultsDuring the first two years 22 (42%), between two to five years 17 (32%), and between five to ten years 14 (26%) subjects had used antipsychotics less than half of the time. Drug-free periods became rarer during the follow-up. The mean lifetime daily dose of antipsychotics was 319 mg in chlorpromazine equivalents. A high lifetime average and cumulative dose and antipsychotic polypharmacy were associated with a poorer outcome in all measures, whereas having no drug-free periods was associated with a better SOFAS score and a low proportion of time on antipsychotics with a better CGI score.ConclusionsIn our population-based sample, the use of antipsychotics increased during the first five years of illness and was relatively stable after that. Our results suggest that both low dose and proportion of use, and having no drug-free periods, are associated with better outcomes, which concords with current treatment recommendations and algorithms. High long-term doses and polypharmacy may relate to poor outcomes.
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Vita A, Minelli A, Barlati S, Deste G, Giacopuzzi E, Valsecchi P, Turrina C, Gennarelli M. Treatment-Resistant Schizophrenia: Genetic and Neuroimaging Correlates. Front Pharmacol 2019; 10:402. [PMID: 31040787 PMCID: PMC6476957 DOI: 10.3389/fphar.2019.00402] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is a severe neuropsychiatric disorder that affects approximately 0.5–1% of the population. Response to antipsychotic therapy is highly variable, and it is not currently possible to predict those patients who will or will not respond to antipsychotic medication. Furthermore, a high percentage of patients, approximately 30%, are classified as treatment-resistant (treatment-resistant schizophrenia; TRS). TRS is defined as a non-response to at least two trials of antipsychotic medication of adequate dose and duration. These patients are usually treated with clozapine, the only evidence-based pharmacotherapy for TRS. However, clozapine is associated with severe adverse events. For these reasons, there is an increasing interest to identify better targets for drug development of new compounds and to establish better biomarkers for existing medications. The ability of antipsychotics to improve psychotic symptoms is dependent on their antagonist and reverse agonist activities at different neuroreceptors, and some genetic association studies of TRS have focused on different pharmacodynamic factors. Some genetic studies have shown an association between antipsychotic response or TRS and neurodevelopment candidate genes, antipsychotic mechanisms of action (such as dopaminergic, serotonergic, GABAergic, and glutamatergic) or pharmacokinetic factors (i.e., differences in the cytochrome families). Moreover, there is a growing body of literature on the structural and functional neuroimaging research into TRS. Neuroimaging studies can help to uncover the underlying neurobiological reasons for such resistance and identify resistant patients earlier. Studies examining the neuropharmacological mechanisms of antipsychotics, including clozapine, can help to improve our knowledge of their action on the central nervous system, with further implications for the discovery of biomarkers and the development of new treatments. The identification of the underlying mechanisms of TRS is a major challenge for developing personalized medicine in the psychiatric field for schizophrenia treatment. The main goal of precision medicine is to use genetic and brain-imaging information to improve the safety, effectiveness, and health outcomes of patients via more efficiently targeted risk stratification, prevention, and tailored medication and treatment management approaches. The aim of this review is to summarize the state of art of pharmacogenetic, pharmacogenomic and neuroimaging studies in TRS.
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Affiliation(s)
- Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
| | - Edoardo Giacopuzzi
- Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Paolo Valsecchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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10
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Zhou W, Xu Y, Lv Q, Sheng YH, Chen L, Li M, Shen L, Huai C, Yi Z, Cui D, Qin S. Genetic Association of Olanzapine Treatment Response in Han Chinese Schizophrenia Patients. Front Pharmacol 2019; 10:177. [PMID: 30886581 PMCID: PMC6409308 DOI: 10.3389/fphar.2019.00177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/11/2019] [Indexed: 12/30/2022] Open
Abstract
Olanzapine, a second-generation antipsychotic medication, plays a critical role in current treatment of schizophrenia (SCZ). It has been observed that the olanzapine responses in schizophrenia treatment are different across individuals. However, prediction of this individual-specific olanzapine response requires in-depth knowledge of biomarkers of drug response. Here, we performed an integrative investigation on 238 Han Chinese SCZ patients to identify predictive biomarkers that were associated with the efficacy of olanzapine treatment. This study applied HaloPlex technology to sequence 143 genes from 79 Han Chinese SCZ patients. Our result suggested that there were 12 single nucleotide polymorphisms (SNPs) had significant association with olanzapine response in Han Chinese SCZ patients. Using MassARRAY platform, we tested that if these 12 SNPs were also statistically significant in 159 other SCZ patients (independent cohort) and the combined 238 SCZ patients (composed of two tested cohorts). The result of this analysis showed that 2 SNPs were significantly associated with the olanzapine response in both independent cohorts (rs324026, P = 0.023; rs12610827, P = 0.043) and combined SCZ patient population (rs324026, adjust P = 0.014; rs12610827, adjust P = 0.012). Our study provides systematic analyses of genetic variants associated with olanzapine responses of Han Chinese SCZ patients. The discovery of these novel biomarkers of olanzapine-response will facilitate to advance future olanzapine treatment specific for Han Chinese SCZ patients.
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Affiliation(s)
- Wei Zhou
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Xu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Qinyu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Luan Chen
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Mo Li
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Shen
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Cong Huai
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Shengying Qin
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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11
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Werneke U. Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry - Diagnostics and Treatment, Luleå, Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London). Nord J Psychiatry 2018:1-33. [PMID: 30547691 DOI: 10.1080/08039488.2018.1481525] [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: 04/18/2018] [Accepted: 05/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND According to estimates from the European Commission, Europe has experienced the greatest mass movement of people since the Second World War. More than one million refugees and migrants have arrived in the European Union in the past few years. Mental health and primary care professionals are more likely than ever to meet patients from different cultures and backgrounds. AIMS To equip mental health and primary care professionals with transcultural skills to deal with patients from unfamiliar backgrounds. METHOD Lectures and case discussions to explore the latest advances in the diagnosis and treatment of serious mental health problems in a transcultural context. RESULTS Lectures covered transcultural aspects of mental health problems, treatment in different cultural and ethnic contexts, and assessment of risk factors for self-harm and harm in migrant populations. CONCLUSIONS Clinicians require a sound grounding in transcultural skills to confidently and empathically deal with patients from unfamiliar backgrounds.
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Affiliation(s)
- Ursula Werneke
- a Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit , Umeå University , Umeå , Sweden
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12
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Menke A. Precision pharmacotherapy: psychiatry's future direction in preventing, diagnosing, and treating mental disorders. Pharmgenomics Pers Med 2018; 11:211-222. [PMID: 30510440 PMCID: PMC6250105 DOI: 10.2147/pgpm.s146110] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mental disorders account for around one-third of disability worldwide and cause enormous personal and societal burden. Current pharmacotherapies and nonpharmacotherapies do help many patients, but there are still high rates of partial or no response, delayed effect, and unfavorable adverse effects. The current diagnostic taxonomy of mental disorders by the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases relies on presenting signs and symptoms, but does not reflect evidence from neurobiological and behavioral systems. However, in the last decades, the understanding of biological mechanisms underlying mental disorders has grown and can be used for the development of precision medicine, that is, to deliver a patient-tailored individual treatment. Precision medicine may incorporate genetic variants contributing to the mental disorder and the response to pharmacotherapies, but also consider gene ¥ environment interactions, blood-based markers, neuropsychological tests, data from electronic health records, early life adversity, stressful life events, and very proximal factors such as lifestyle, nutrition, and sport. Methods such as artificial intelligence and the underlying machine learning and deep learning approaches provide the framework to stratify patients, initiate specific tailored treatments and thus increase response rates, reduce adverse effects and medical errors. In conclusion, precision medicine uses measurable health parameters to identify individuals at risk of a mental disorder, to improve the diagnostic process and to deliver a patient-tailored treatment.
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Affiliation(s)
- Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg 97080, Germany,
- Comprehensive Heart Failure Center, University Hospital of Wuerzburg, Wuerzburg 97080, Germany,
- Interdisciplinary Center for Clinical Research, University of Wuerzburg, Wuerzburg 97080, Germany,
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13
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Ma L, Zhang X, Xiang Q, Zhou S, Zhao N, Xie Q, Zhao X, Zhou Y, Cui Y. Association between dopamine receptor gene polymorphisms and effects of risperidone treatment: A systematic review and meta-analysis. Basic Clin Pharmacol Toxicol 2018; 124:94-104. [PMID: 30103286 DOI: 10.1111/bcpt.13111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/17/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Lingyue Ma
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Xiaodan Zhang
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Qian Xiang
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Shuang Zhou
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Nan Zhao
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Qiufen Xie
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Xia Zhao
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Ying Zhou
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Yimin Cui
- Department of Pharmacy; Peking University First Hospital; Beijing China
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14
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Huang E, Hettige NC, Zai G, Tomasi J, Huang J, Zai CC, Pivac N, Nikolac Perkovic M, Tiwari AK, Kennedy JL. BDNF Val66Met polymorphism and clinical response to antipsychotic treatment in schizophrenia and schizoaffective disorder patients: a meta-analysis. THE PHARMACOGENOMICS JOURNAL 2018; 19:269-276. [PMID: 30181602 DOI: 10.1038/s41397-018-0041-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 02/01/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) plays an important role in dopaminergic and serotonergic neurotransmission by modulating dopaminergic neuron differentiation and establishment. Multiple studies have analyzed the functional BDNF Val66Met variant in relation to antipsychotic response in schizophrenia (SCZ) patients, yielding mixed results. A meta-analysis was thus performed to examine the relationship between this variant and symptom improvement during antipsychotic treatment. Searches using PubMed, Web of Science, and PsycInfo until October 2017 yielded 11 studies that met inclusion criteria (total n = 3774). These studies investigated the BDNF Val66Met variant and antipsychotic response in patients with SCZ or schizoaffective disorder. Responders to antipsychotics were defined using the original criteria applied in each study. Effect sizes were computed using odds ratios, which were pooled according to the Mantel-Haenszel method. The BDNF Val66Met variant was not associated with the total number of responders and non-responders (p > 0.05) under dominant, recessive, or allelic models. Secondary analyses stratifying for individuals of each ethnicity and drug type also revealed no significant associations. Our findings suggest that the BDNF Val66Met variant is not associated with response to antipsychotics in individuals with SCZ. However, considering the current sample size, small effects cannot be ruled out. Moreover, recent studies have suggested that Val66Met forms haplotypes with other BDNF variants. Future studies should examine the Val66Met variant in conjunction with these other variants in relation to antipsychotic response. Moreover, since illness duration appears to influence BDNF levels in SCZ patients, future studies should aim to control for this potential confounding factor in response analyses.
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Affiliation(s)
- Eric Huang
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nuwan C Hettige
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Gwyneth Zai
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Frederick W. Thompson Anxiety Disorders Centre, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julia Tomasi
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Justin Huang
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Clement C Zai
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Arun K Tiwari
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Psychiatric Neurogenetics Section, Campbell Family Research Institute Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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15
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Abstract
BACKGROUND Ethnopharmacology relates to the study of substances used medicinally by different ethnic or cultural groups or handling of, drugs-based ethnicity or pharmacogenetics. AIMS To review the key aspects of ethnopharmacology. METHOD This lecture gives an overview of the relationship between geography, culture, pharmacogenomics and prescribing. RESULTS Although the majority of antipsychotics, antidepressants and mood-stabilisers are widely and cheaply available in generic forms, prescription rates can vary. Clozapine is one such example with prescribing-rates ranging from less than 10 patients per 100,000 people to nearly 180 patients/100,000 people. Pharmacogenetic studies of antipsychotics and antidepressants concern gene polymorphisms that may affect both, pharmacodynamic or pharmacokinetic properties. Considerable genetic and ethnic variability has been seen for the P450 microsomal enzymes CYP 2D6 and 1A2. CONCLUSIONS With accelerated global mobility and increased understanding of medicinal substances at molecular level, understanding of ethnopharmacology will become increasingly important in routine clinical practice.
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Affiliation(s)
- David M Taylor
- a Pharmacy Department Denmark Hill , Maudsley Hospital , London , UK
- b King's College London Institute of Pharmaceutical Science , London , UK
| | - Ursula Werneke
- c Department of Clinical Sciences, Division of Psychiatry , Sunderby Research Unit, Umeå University , Umeå , Sweden
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16
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Abstract
SummaryThe traditional approach to selecting antipsychotic medication involves little more than trial and error. Recent advances in genetics and molecular science offer the hope of a ‘personalised medicine’ approach to antipsychotic development and prescribing in schizophrenia. Personalised medicine is the practice of tailoring medical treatment to the individual characteristics of each patient. In schizophrenia, this will involve the identification of more homogeneous subsets of patients through the application of genetics, epigenetics, proteomics and metabolomics, neuroimaging and other biomarkers, and the use of these findings to stratify patients according to their response to treatment. In this article, we focus on the emerging evidence in pharmacogenetics and biomarkers for assessing individual response and tolerability of antipsychotic medication in schizophrenia.
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Piatkov I, Caetano D, Assur Y, Lau SL, Coelho M, Jones T, Nguyen T, Boyages S, McLean M. CYP2C19*17 protects against metabolic complications of clozapine treatment. World J Biol Psychiatry 2017; 18:521-527. [PMID: 28664816 DOI: 10.1080/15622975.2017.1347712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Clozapine (CZ) is the most effective drug for managing treatment-resistant schizophrenic disorders. Its use has been limited due to adverse effects, which include weight gain and new-onset diabetes, but the incidence of these varies between patients. METHODS We investigated 187 Clozapine Clinic patients (of whom 137 consented for genotyping) for the presence of CYP2C19*17 and its association with CZ and norclozapine (NCZ) levels, and clinical outcomes. RESULTS Thirty-nine percent of genotyped patients were carriers of the CYP2C 19*17 polymorphism. This group demonstrated significantly higher NCZ serum levels, and significantly lower fasting glucose (5.66 ± 1.19 vs 6.72 ± 3.01 mmol/l, P = 0.009) and Hb1Ac (35.36 ± 4.78 vs 49.40 ± 20.60 mmol/mol, P = 0.006) levels compared to non-carriers of this polymorphism. CZ-treated patients with CYP2C19*17/*17 had a significantly lower prevalence of diabetes as well as a higher likelihood of clinical improvement of their schizophrenia, compared to those without this polymorphism (P = 0.012 and P = 0.031, respectively). CONCLUSIONS Our data suggest that CYP2C19*17 ultra-rapid-metaboliser status is a protective factor against the development of diabetes during clozapine treatment, and increases the likelihood of improvement in schizophrenia. The role of NCZ in treatment response and side effects, including metabolic syndrome, warrants further pharmacogenetic, pharmacokinetic and pharmacodynamic studies.
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Affiliation(s)
- Irina Piatkov
- a Molecular Research Laboratory, Blacktown Clinical School and Research Centre , Blacktown Hospital, WSU/WSLHD , Blacktown , Australia
| | - Dorgival Caetano
- b Western Sydney University School of Medicine , Campbelltown , NSW , Australia.,c Blacktown Mental Health Service , Blacktown Hospital, WSLHD , Blacktown , Australia
| | - Yolinda Assur
- c Blacktown Mental Health Service , Blacktown Hospital, WSLHD , Blacktown , Australia
| | - Sue Lynn Lau
- b Western Sydney University School of Medicine , Campbelltown , NSW , Australia
| | - Micheline Coelho
- a Molecular Research Laboratory, Blacktown Clinical School and Research Centre , Blacktown Hospital, WSU/WSLHD , Blacktown , Australia
| | - Trudi Jones
- a Molecular Research Laboratory, Blacktown Clinical School and Research Centre , Blacktown Hospital, WSU/WSLHD , Blacktown , Australia
| | - Tristan Nguyen
- a Molecular Research Laboratory, Blacktown Clinical School and Research Centre , Blacktown Hospital, WSU/WSLHD , Blacktown , Australia
| | - Steven Boyages
- b Western Sydney University School of Medicine , Campbelltown , NSW , Australia
| | - Mark McLean
- b Western Sydney University School of Medicine , Campbelltown , NSW , Australia
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18
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Freyberg Z, Aslanoglou D, Shah R, Ballon JS. Intrinsic and Antipsychotic Drug-Induced Metabolic Dysfunction in Schizophrenia. Front Neurosci 2017; 11:432. [PMID: 28804444 PMCID: PMC5532378 DOI: 10.3389/fnins.2017.00432] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/13/2017] [Indexed: 12/12/2022] Open
Abstract
For decades, there have been observations demonstrating significant metabolic disturbances in people with schizophrenia including clinically relevant weight gain, hypertension, and disturbances in glucose and lipid homeostasis. Many of these findings pre-date the use of antipsychotic drugs (APDs) which on their own are also strongly associated with metabolic side effects. The combination of APD-induced metabolic changes and common adverse environmental factors associated with schizophrenia have made it difficult to determine the specific contributions of each to the overall metabolic picture. Data from drug-naïve patients, both from the pre-APD era and more recently, suggest that there may be an intrinsic metabolic risk associated with schizophrenia. Nevertheless, these findings remain controversial due to significant clinical variability in both psychiatric and metabolic symptoms throughout patients' disease courses. Here, we provide an extensive review of classic and more recent literature describing the metabolic phenotype associated with schizophrenia. We also suggest potential mechanistic links between signaling pathways associated with schizophrenia and metabolic dysfunction. We propose that, beyond its symptomatology in the central nervous system, schizophrenia is also characterized by pathophysiology in other organ systems directly related to metabolic control.
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Affiliation(s)
- Zachary Freyberg
- Department of Psychiatry, University of PittsburghPittsburgh, PA, United States
- Department of Cell Biology, University of PittsburghPittsburgh, PA, United States
| | - Despoina Aslanoglou
- Department of Psychiatry, University of PittsburghPittsburgh, PA, United States
| | - Ripal Shah
- Department of Psychiatry and Behavioral Sciences, Stanford UniversityStanford, CA, United States
| | - Jacob S. Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford UniversityStanford, CA, United States
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19
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Grillault Laroche D, Gaillard A. Induced Obsessive Compulsive Symptoms (OCS) in schizophrenia patients under Atypical 2 Antipsychotics (AAPs): review and hypotheses. Psychiatry Res 2016; 246:119-128. [PMID: 27690134 DOI: 10.1016/j.psychres.2016.09.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 01/25/2023]
Abstract
The prevalence of OCS and OCD is higher in schizophrenic patients than in the general population. These disorders are sometimes induced by AAPs. There is higher frequency of OCS and greater severity in patients treated with antipsychotics with predominant anti-serotoninergic profiles opposed to those with predominant dopaminergic blockade. Induced OCS may be due to complex neuromodulation involving many serotonin, dopamine and glutamate receptors and several subtypes. Concerning connectivity, AAPs differentially influence the BOLD signal, depending on the intensity of D2 receptor blockade. The OFC could play a significant role, on account of its involvement in inhibitory control. There is a paradox: AAPs are efficient as augmentation to SSRI in treatment resistant OCD, some of them such as risperidone or aripiprazole have favourable effects in schizoptypic OCD, but AAPs cause induced OCS in schizophrenic patients. When prescribing AAPs, we should inform patients about this potential side effect and assess systematically OCS with Y-BOCS assessment after 1 month of treatment. Afterwards there are different strategies: Aripiprazole in combination can reduce OCS induced by clozapine, SSRI are slightly effective and CBT shows a few encouraging results. OCS are sometimes dose-dependent, so we also recommend prescribing the minimum effective dose and gradual introduction.
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Affiliation(s)
- Diane Grillault Laroche
- Hôpital Universitaire Paul Brousse, Service de Psychiatrie et Addictologie, 12 avenue Paul Vaillant-Couturier, 94800 Villejuif, France; UnitéINSERM 1178, Hôpital Universitaire Paul Brousse, France.
| | - Adeline Gaillard
- Hôpital Sainte-Anne, Service Hopitalo-Universitaire, 1, rue Cabanis, 75014 Paris, France
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20
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Cartwright AL, Wilby KJ, Corrigan S, Ensom MHH. Pharmacogenetics of Risperidone: A Systematic Review of the Clinical Effects of CYP2D6 Polymorphisms. Ann Pharmacother 2016; 47:350-60. [DOI: 10.1345/aph.1r333] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To summarize and evaluate the pharmacogenetic literature pertaining to the effects of CYP2D6 polymorphism on clinical outcomes of risperidone therapy. DATA SOURCES A systematic literature search was performed using the search terms risperidone, pharmacogenetics, cytochrome P-450 enzyme system, cytochrome P-450 CYP2D6, and polymorphism (genetic) in MEDLINE (1946-October 2012), EMBASE (1980-October 2012), PubMed (1947-October 2012), International Pharmaceutical Abstracts (1970-October 2012), and Google Scholar. STUDY SELECTION AND DATA EXTRACTION Identified articles were included if they measured the association between CYP2D6 genetic polymorphisms and clinical outcomes in at least 2 patients taking risperidone. The data elements extracted from these articles consisted of study design, number of subjects, indication for risperidone therapy, CYP2D6 phenotype status, mean daily dose of risperidone, and effects on clinical outcomes. DATA SYNTHESIS The identified citations consisted of 10 prospective nonrandomized, uncontrolled cohort studies, 1 retrospective cohort study, 1 prospective case-control study, and 1 retrospective case series. Studies were of variable quality and none provided high-quality evidence; they included heterogeneous patient populations with varying clinical diagnoses and drug therapy regimens. Most studies reported nonsignificant trends but were limited by power to detect statistical significance and short trial duration. However, increased risk of adverse effects (including QT interval prolongation) was observed in patients with inactive alleles. CONCLUSIONS While there were trends toward increased adverse effects in poor metabolizers, most outcomes were not significant. As such, routine genotyping should not be used for screening. Future usefulness cannot be ruled out, as many studies had significant limitations that preclude determination of clinical relevance. Adequately powered clinical and epidemiologic studies are warranted to clarify the role of CYP2D6 genotyping in practice.
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Affiliation(s)
- Andrea L Cartwright
- Andrea L Cartwright BSc(Pharm) ACPR, PharmD Student, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyle J Wilby
- Kyle J Wilby PharmD ACPR, Assistant Professor, College of Pharmacy, Qatar University, Doha, Qatar
| | - Susan Corrigan
- Susan Corrigan PharmD ACPR, Clinical Pharmacy Specialist in Mental Health, Surrey Memorial Hospital, Surrey, British Columbia; Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia
| | - Mary HH Ensom
- Mary HH Ensom PharmD FASHP FCCP FCSHP FCAHS, Professor, Faculty of Pharmaceutical Sciences, and Distinguished University Scholar, The University of British Columbia; Clinical Pharmacy Specialist, Children's and Women's Health Centre of British Columbia
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21
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Lally J, Gaughran F, Timms P, Curran SR. Treatment-resistant schizophrenia: current insights on the pharmacogenomics of antipsychotics. Pharmgenomics Pers Med 2016; 9:117-129. [PMID: 27853387 PMCID: PMC5106233 DOI: 10.2147/pgpm.s115741] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics. They are said to have treatment-resistant schizophrenia (TRS). Clozapine is still the only effective treatment for TRS, although it is underused in clinical practice. Initial use is delayed, it can be hard for patients to tolerate, and clinicians can be uncertain as to when to use it. What if, at the start of treatment, we could identify those patients likely to respond to clozapine - and those likely to suffer adverse effects? It is likely that clinicians would feel less inhibited about using it, allowing clozapine to be used earlier and more appropriately. Genetic testing holds out the tantalizing possibility of being able to do just this, and hence the vital importance of pharmacogenomic studies. These can potentially identify genetic markers for both tolerance of and vulnerability to clozapine. We aim to summarize progress so far, possible clinical applications, limitations to the evidence, and problems in applying these findings to the management of TRS. Pharmacogenomic studies of clozapine response and tolerability have produced conflicting results. These are due, at least in part, to significant differences in the patient groups studied. The use of clinical pharmacogenomic testing - to personalize clozapine treatment and identify patients at high risk of treatment failure or of adverse events - has moved closer over the last 20 years. However, to develop such testing that could be used clinically will require larger, multicenter, prospective studies.
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Affiliation(s)
- John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- National Psychosis Service
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- National Psychosis Service
| | - Philip Timms
- START Team, South London and Maudsley NHS Foundation Trust
- King’s College London
| | - Sarah R Curran
- King’s College London
- South West London and St George’s Mental Health NHS Foundation Trust
- St George’s University of London, London, UK
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Bousman CA, Hopwood M. Commercial pharmacogenetic-based decision-support tools in psychiatry. Lancet Psychiatry 2016; 3:585-90. [PMID: 27133546 DOI: 10.1016/s2215-0366(16)00017-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/11/2016] [Accepted: 01/11/2016] [Indexed: 01/08/2023]
Abstract
Despite a compendium of pharmacotherapies available for treating psychiatric illnesses, suboptimal response to these therapies is typical and thought to be in part a result of genetic variation. This notion has sparked a personalised psychiatry movement, which has in turn led to the development of several commercial pharmacogenetic-based decision support tools marketed to psychiatrists as an alternative to typical, trial-and-error, prescribing. However, there is considerable uncertainty about the validity and usefulness of these tools and whether there is sufficient evidence to support their adoption. In this Personal View, we provide an introduction to these tools and assess their potential usefulness in psychiatry practice. We conclude with clinical considerations and development strategies for improving future pharmacogenetic-based decision support tools for clinical use.
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Affiliation(s)
- Chad A Bousman
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health and Department of General Practice, The University of Melbourne, Parkville, VIC, Australia; Swinburne University of Technology, Centre for Human Psychopharmacology, Hawthorne, VIC, Australia.
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
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23
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MacNeil RR, Müller DJ. Genetics of Common Antipsychotic-Induced Adverse Effects. MOLECULAR NEUROPSYCHIATRY 2016; 2:61-78. [PMID: 27606321 DOI: 10.1159/000445802] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/24/2016] [Indexed: 12/12/2022]
Abstract
The effectiveness of antipsychotic drugs is limited due to accompanying adverse effects which can pose considerable health risks and lead to patient noncompliance. Pharmacogenetics (PGx) offers a means to identify genetic biomarkers that can predict individual susceptibility to antipsychotic-induced adverse effects (AAEs), thereby improving clinical outcomes. We reviewed the literature on the PGx of common AAEs from 2010 to 2015, placing emphasis on findings that have been independently replicated and which have additionally been listed to be of interest by PGx expert panels. Gene-drug associations meeting these criteria primarily pertain to metabolic dysregulation, extrapyramidal symptoms (EPS), and tardive dyskinesia (TD). Regarding metabolic dysregulation, results have reaffirmed HTR2C as a strong candidate with potential clinical utility, while MC4R and OGFR1 gene loci have emerged as new and promising biomarkers for the prediction of weight gain. As for EPS and TD, additional evidence has accumulated in support of an association with CYP2D6 metabolizer status. Furthermore, HSPG2 and DPP6 have been identified as candidate genes with the potential to predict differential susceptibility to TD. Overall, considerable progress has been made within the field of psychiatric PGx, with inroads toward the development of clinical tools that can mitigate AAEs. Going forward, studies placing a greater emphasis on multilocus effects will need to be conducted.
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Affiliation(s)
- Raymond R MacNeil
- Mood Research Laboratory, Department of Psychology, Queen's University, Kingston, Ont., Canada
| | - Daniel J Müller
- Departments of Psychiatry, University of Toronto, Toronto, Ont., Canada; Departments of Pharmacology and Toxicology, University of Toronto, Toronto, Ont., Canada; Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ont., Canada
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24
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Ivanova SA, Loonen AJ, Bakker PR, Freidin MB, Ter Woerds NJ, Al Hadithy AF, Semke AV, Fedorenko OY, Brouwers JR, Bokhan NA, van Os J, van Harten PN, Wilffert B. Likelihood of mechanistic roles for dopaminergic, serotonergic and glutamatergic receptors in tardive dyskinesia: A comparison of genetic variants in two independent patient populations. SAGE Open Med 2016; 4:2050312116643673. [PMID: 27127627 PMCID: PMC4834466 DOI: 10.1177/2050312116643673] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/08/2016] [Indexed: 01/29/2023] Open
Abstract
Objectives: An established theory for the pathogenesis of tardive dyskinesia is disturbed dopaminergic receptor sensitivity and/or dopaminergic intracellular signaling. We examined associations between genetic variants of neurotransmitter receptors and tardive dyskinesia. Methods: We assessed tardive dyskinesia in Caucasian psychiatric inpatients from Siberia (N = 431) and a long-stay population from the Netherlands (N = 168). These patients were genotyped for 43 tag single nucleotide polymorphisms in five neurotransmitter receptor genes, and the results for the two populations were compared. Results: Several significant associations with tardive dyskinesia were identified, but only GRIN2A (rs1345423) was found in both patient populations. This lack of agreement was probably due to the small effect size of the associations, the multiple testing and the small sample size of the Dutch patient population. After reviewing the literature, we propose that the constitutive stimulatory activity of serotonergic type 2 receptors may be relevant. Conclusions: Inactivity of the serotonergic, type 2C receptor or blockade of these receptors by atypical antipsychotic drugs may decrease the vulnerability to develop tardive dyskinesia.
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Affiliation(s)
- Svetlana A Ivanova
- Mental Health Research Institute, Tomsk, Russian Federation; National Research Tomsk Polytechnic University, Tomsk, Russian Federation
| | - Anton Jm Loonen
- Department of Pharmacy, University of Groningen, Groningen, The Netherlands; GGZ Westelijk Noord-Brabant, Bergen op Zoom, The Netherlands
| | - P Roberto Bakker
- Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maxim B Freidin
- Research Institute for Medical Genetics, Tomsk, Russian Federation
| | | | - Asmar Fy Al Hadithy
- Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Parnassia Group, Pharmacy Haaglanden, The Hague, The Netherlands
| | | | - Olga Yu Fedorenko
- Mental Health Research Institute, Tomsk, Russian Federation; National Research Tomsk Polytechnic University, Tomsk, Russian Federation
| | | | - Nikolay A Bokhan
- Mental Health Research Institute, Tomsk, Russian Federation; National Research Tomsk State University, Tomsk, Russian Federation
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Peter N van Harten
- Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bob Wilffert
- Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands
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Chagraoui A, Thibaut F, Skiba M, Thuillez C, Bourin M. 5-HT2C receptors in psychiatric disorders: A review. Prog Neuropsychopharmacol Biol Psychiatry 2016; 66:120-135. [PMID: 26739950 DOI: 10.1016/j.pnpbp.2015.12.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/25/2015] [Accepted: 12/26/2015] [Indexed: 12/26/2022]
Abstract
5-HT2Rs have a different genomic organization from other 5-HT2Rs. 5HT2CR undergoes post-transcriptional pre-mRNA editing generating diversity among RNA transcripts. Selective post-transcriptional editing could be involved in the pathophysiology of psychiatric disorders through impairment in G-protein interactions. Moreover, it may influence the therapeutic response to agents such as atypical antipsychotic drugs. Additionally, 5-HT2CR exhibits alternative splicing. Central serotonergic and dopaminergic systems interact to modulate normal and abnormal behaviors. Thus, 5HT2CR plays a crucial role in psychiatric disorders. 5HT2CR could be a relevant pharmacological target in the treatment of neuropsychiatric disorders. The development of drugs that specifically target 5-HT2C receptors will allow for better understanding of their involvement in the pathophysiology of psychiatric disorders including schizophrenia, anxiety, and depression. Among therapeutic means currently available, most drugs used to treat highly morbid psychiatric diseases interact at least partly with 5-HT2CRs. Pharmacologically, 5HT2CRs, have the ability to generate differentially distinct response signal transduction pathways depending on the type of 5HT2CR agonist. Although this receptor property has been clearly demonstrated, in vitro, the eventual beneficial impact of this property opens new perspectives in the development of agonists that could activate signal transduction pathways leading to better therapeutic efficiency with fewer adverse effects.
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Affiliation(s)
- A Chagraoui
- Inserm U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Normandy University, France; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France.
| | - F Thibaut
- Department of Psychiatry, University Hospital Cochin (site Tarnier), University of Paris-Descartes and INSERM U 894 Laboratory of Psychiatry and Neurosciences, Paris, France
| | - M Skiba
- Inserm U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Normandy University, France
| | - C Thuillez
- Department of Pharmacology, Rouen University Hospital, Rouen, France; INSERM U1096, Laboratory of New Pharmacological Targets for Endothelial Protection and Heart Failure, Institute for Research and Innovation in Biomedicine, Normandy University, France
| | - M Bourin
- EA 3256 Neurobiology of Anxiety and Depression, Faculté de Médecine, BP 53508, 1 rue Gaston Veil, F44035 Nantes Cedex 01, France
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CYP1A2 and CYP2D6 Gene Polymorphisms in Schizophrenic Patients with Neuroleptic Drug-Induced Side Effects. Bull Exp Biol Med 2016; 160:687-90. [DOI: 10.1007/s10517-016-3250-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 02/08/2023]
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Abstract
The study of pharmacogenomics is rapidly growing, particularly in the field of mental health. Understanding pharmacogenomic principles can be a challenge for many clinicians. Most mental health genomic data concentrates on variability (response, side effects) with antidepressants and atypical antipsychotics. Current pharmacogenomic practice and research primarily focuses on two areas: pharmacodynamics and pharmacokinetics. Based on the current literature, genetic polymorphisms of pharmacodynamics and pharmacokinetics parameters likely influence medication efficacy, therefore affecting the therapeutic benefit. Additionally, certain pharmacodynamic and pharmacokinetic polymorphisms have been linked to an elevated risk of side effects and adverse events with these medications. In this review, specific pharmacodynamic and pharmacokinetic polymorphisms related to antidepressants and atypical antipsychotics will be discussed, as well as the potential clinical effect these genomic abnormalities have within psychiatric care.
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Affiliation(s)
- Jonathan F Lister
- PGY2 Psychiatric Pharmacy Resident, Veterans Affairs Tennessee Valley Healthcare System, Murfreesboro, Tennessee,
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The GRM7 gene, early response to risperidone, and schizophrenia: a genome-wide association study and a confirmatory pharmacogenetic analysis. THE PHARMACOGENOMICS JOURNAL 2016; 17:146-154. [DOI: 10.1038/tpj.2015.90] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 08/26/2015] [Accepted: 10/16/2015] [Indexed: 02/07/2023]
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Arranz MJ, Gallego C, Salazar J, Arias B. Pharmacogenetic studies of drug response in schizophrenia. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1140554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nykänen S, Puska V, Tolonen JP, Salo H, Isohanni M, Koponen H, Pirkola S, Penttilä M, Haapea M, Moilanen J, Miettunen J, Jääskeläinen E. Use of psychiatric medications in schizophrenia and other psychoses in a general population sample. Psychiatry Res 2016; 235:160-8. [PMID: 26652841 DOI: 10.1016/j.psychres.2015.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 10/31/2015] [Accepted: 11/09/2015] [Indexed: 11/25/2022]
Abstract
The information on the use of psychiatric medications in general population-based samples is limited. Our aim was to analyse the use of psychiatric medications and factors associated with antipsychotic use in psychoses in a general population sample. Fifty-five persons with schizophrenia, 21 with bipolar psychosis or psychotic depression and 20 with other psychoses from the Northern Finland Birth Cohort 1966 were examined at about 43 years of age. The frequency of use and dosage of psychiatric medication and the factors associated with the use of antipsychotics were analysed. Antipsychotics were used by 85% of schizophrenia, 65% of bipolar psychosis or psychotic depression and 62% of other psychoses cases; antidepressants were used by 22%, 60% and 33%; and benzodiazepines by 42%, 35% and 10%, respectively. In all the diagnostic groups, higher symptom scores and a higher number of hospital days were associated with the use of antipsychotics. In schizophrenia and other psychoses, poorer social and occupational functioning, and in other psychoses, female gender and lower education were also associated with the use of antipsychotics. Our results may partly indicate that, especially in schizophrenia, the effectiveness of antipsychotics is not as good as expected.
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Affiliation(s)
- Salla Nykänen
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Virpi Puska
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Jussi-Pekka Tolonen
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Henri Salo
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Matti Isohanni
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, P.O. Box 26, FIN-90029, Oulu, Finland
| | - Hannu Koponen
- University of Helsinki, Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Sami Pirkola
- Department of Mental Health, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; School of Health Sciences FIN-33014, University of Tampere, Tampere, Finland
| | - Matti Penttilä
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Marianne Haapea
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, FIN-90029, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland; Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Jani Moilanen
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, P.O. Box 26, FIN-90029, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland; Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
| | - Erika Jääskeläinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland; Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland
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Hypothalamic-pituitary-adrenal system, neurotrophic factors and clozapine response: association with FKBP5 and NTRK2 genes. Pharmacogenet Genomics 2015; 25:274-7. [PMID: 25751398 DOI: 10.1097/fpc.0000000000000132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Clozapine is an atypical antipsychotic drug known as being more effective compared with traditional antipsychotics for patients with poor response or resistance to treatment. It has been demonstrated that clozapine modulates hypothalamic-pituitary-adrenal activity and affects central brain-derived neurotrophic factor levels, which could explain part of its therapeutic efficacy. In this study, we investigated the role of genes related to the hypothalamic-pituitary-adrenal axis (FKBP5 and NR3C1) and neurotrophic factors (BDNF and NTRK2) in clinical response to clozapine in 591 schizophrenia patients. We found significant allelic and genotype associations between FKBP5-rs1360780, NTRK2-rs1778929 and NTRK2-rs10465180 polymorphisms and clozapine response. The haplotypes composed of rs1360780-rs3777747-rs17542466-rs2766533 (FKBP5) and rs1619120-rs1778929-rs10465180 (NTRK2) were also nominally significant. Our results suggest that genetic variability in FKBP5 and NTRK2 genes may partially explain clinical response to clozapine. Further studies are needed to clarify the involvement of these genes in clinical response to atypical antipsychotics.
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Association of GRIN1, ABCB1, and DRD4 genes and response to antipsychotic drug treatment in schizophrenia. Psychiatr Genet 2015; 25:135-6. [PMID: 25714447 DOI: 10.1097/ypg.0000000000000079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Grover S, Sarkar S. Antipsychotic Trials in Schizophrenia from India: A Systematic Review and Meta-analysis. Indian J Pharm Sci 2015; 77:771-9. [PMID: 26997707 PMCID: PMC4778239 DOI: 10.4103/0250-474x.174982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 10/30/2015] [Accepted: 12/01/2015] [Indexed: 11/27/2022] Open
Abstract
Ethnic and regional variations have been found in the pharmacological treatment response. Though many efficacy studies have been conducted in India for antipsychotic treatment modalities of schizophrenia, there is a lack meta-analytic data of the existing literature from India. This study aimed to conduct a systematic review and meta-analysis of the antipsychotic treatment trials of schizophrenia in the Indian context. All controlled trials from India evaluating the clinical efficacy of antipsychotics in patients with schizophrenia were evaluated and 28 trials were included in the metanalysis. Effect sizes were computed using Cohen's 'd' and risk of bias was evaluated. Meta analysis revealed superiority of first generation antipsychotics over placebo (mean effect size of 1.387, confidence interval of 1.127 to 1.648). Second generation antipsychotics were marginally better than first generation antipsychotics (effect size 0.106, confidence intervals 0.009 to 0.204). There was improvement in the methodology of the trials over time (Kendall tau=0.289, P=0.049), though no statistically significant increase in trial duration and sample size was noted. There is lack of data on long term efficacy of antipsychotic in schizophrenia from India. First generation antipsychotics have demonstrated benefits over placebo in patients with schizophrenia in the Indian context, though marginally lesser than second generation ones.
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Affiliation(s)
- S. Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012, India
| | - S. Sarkar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605 006, India
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34
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Clotiapine in schizophrenia: a guide to its use. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Lv Z, Rong B, Tong X, Li X, Chen X, Wang X, Li Z. The association between COMT Val158Met gene polymorphism and antipsychotic-induced tardive dyskinesia risk. Int J Neurosci 2015; 126:1044-50. [DOI: 10.3109/00207454.2015.1089504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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36
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Le Clerc S, Taing L, Fond G, Meary A, Llorca PM, Blanc O, Beaune P, Rajagopal K, Jamain S, Tamouza R, Zagury JF, Leboyer M. A double amino-acid change in the HLA-A peptide-binding groove is associated with response to psychotropic treatment in patients with schizophrenia. Transl Psychiatry 2015; 5. [PMID: 26218850 PMCID: PMC5068718 DOI: 10.1038/tp.2015.97] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The choice of an efficient psychotropic treatment for patients with schizophrenia is a key issue to improve prognosis and quality of life and to decrease the related burden and costs. As for other complex disorders, response to drugs in schizophrenia is highly heterogeneous and the underlying molecular mechanisms of this diversity are still poorly understood. In a carefully followed-up cohort of schizophrenic patients prospectively treated with risperidone or olanzapine, we used a specially designed single-nucleotide polymorphism (SNP) array to perform a large-scale genomic analysis and identify genetic variants associated with response to psychotropic drugs. We found significant associations between response to treatment defined by the reduction in psychotic symptomatology 42 days after the beginning of treatment and SNPs located in the chromosome 6, which houses the human leukocyte antigen (HLA). After imputation of the conventional HLA class I and class II alleles, as well as the amino-acid variants, we observed a striking association between a better response to treatment and a double amino-acid variant at positions 62 and 66 of the peptide-binding groove of the HLA-A molecule. These results support the current notion that schizophrenia may have immune-inflammatory underpinnings and may contribute to pave the way for personalized treatments in schizophrenia.
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Affiliation(s)
- S Le Clerc
- Équipe EA4627, Chaire de Bioinformatique, Conservatoire National des Arts et Métiers, Paris, France
| | - L Taing
- Équipe EA4627, Chaire de Bioinformatique, Conservatoire National des Arts et Métiers, Paris, France
| | - G Fond
- INSERM, U955, Psychiatrie Génétique, Créteil, France,Université Paris-Est, Faculté de Médecine, Créteil, France,AP-HP, DHU PePSY, Pôle de Psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France,Fondation FondaMental, Créteil, France
| | - A Meary
- INSERM, U955, Psychiatrie Génétique, Créteil, France,Université Paris-Est, Faculté de Médecine, Créteil, France,AP-HP, DHU PePSY, Pôle de Psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France,Fondation FondaMental, Créteil, France
| | - P-M Llorca
- Fondation FondaMental, Créteil, France,Service de Psychiatrie Adulte, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - O Blanc
- Fondation FondaMental, Créteil, France,Service de Psychiatrie Adulte, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - P Beaune
- INSERM, U775, Centre de recherches Biomédicales, Université Paris Descartes, Paris, France
| | - K Rajagopal
- INSERM, U955, Psychiatrie Génétique, Créteil, France
| | - S Jamain
- INSERM, U955, Psychiatrie Génétique, Créteil, France,Université Paris-Est, Faculté de Médecine, Créteil, France,Fondation FondaMental, Créteil, France
| | - R Tamouza
- Laboratoire Jean Dausset (LabEx Transplantex) et INSERM, U1160, Hôpital Saint Louis, Paris, France,Université Paris Diderot, Sorbonne Paris-Cité, Paris, France
| | - J-F Zagury
- Équipe EA4627, Chaire de Bioinformatique, Conservatoire National des Arts et Métiers, Paris, France,Équipe EA4627, Chaire de Bioinformatique, Conservatoire National des Arts et Métiers, F75003 Paris, France.
| | - M Leboyer
- INSERM, U955, Psychiatrie Génétique, Créteil, France,Université Paris-Est, Faculté de Médecine, Créteil, France,AP-HP, DHU PePSY, Pôle de Psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France,Fondation FondaMental, Créteil, France,INSERM, U955, Psychiatrie Génétique, F94000 Créteil, France. E-mail:
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37
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Polymorphisms of the leptin and HTR2C genes and clozapine-induced weight change and baseline BMI in patients with chronic schizophrenia. Psychiatr Genet 2015; 24:249-56. [PMID: 25304226 DOI: 10.1097/ypg.0000000000000053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated the associations of the LEP-2548A/G and HTR2C-759C/T polymorphisms with long-term clozapine-induced weight changes and baseline BMI in chronic patients with schizophrenia. MATERIALS AND METHODS A total of 113 patients receiving clozapine for at least 1 year were enrolled. Body weight was measured cross-sectionally and data on body weight just before starting clozapine were retrospectively extracted from medical records. RESULTS Clozapine-induced change in BMI was correlated inversely with the baseline BMI (P<0.001, ρ=-0.347). The LEP-2548A/G polymorphism was associated significantly with the change in BMI (F=4.380, P=0.015) during clozapine use; those with the AA genotype had the highest BMI gain (1.4±3.1 kg/m), followed by those with the AG (-0.2±3.3 kg/m) and GG (-1.6±3.4 kg/m) genotypes. We also found a significant association between the leptin genotype and BMI at baseline (F=3.499, P=0.034); those with the AA genotype had the lowest baseline BMI (23.4±4.3 kg/m), followed by those with the AG (24.1±4.4 kg/m) and GG (28.8±7.3 kg/m) genotypes. In the case of the HTR2C-759C/T polymorphism, we found a trend in which T alleles were more prevalent in male patients with up to 7% increase in BMI than in those with a greater than 7% increase in BMI [12/54 (22.7%) vs. 1/27 (3.7%); Fisher's exact test: P=0.051]. CONCLUSION This study shows an inverse correlation between the baseline BMI and change in BMI during long-term clozapine use in patients with schizophrenia, and the LEP-2548A/G polymorphism was associated significantly with both these measures.
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Butcher NJ, Fung WLA, Fitzpatrick L, Guna A, Andrade DM, Lang AE, Chow EWC, Bassett AS. Response to clozapine in a clinically identifiable subtype of schizophrenia. Br J Psychiatry 2015; 206:484-91. [PMID: 25745132 PMCID: PMC4459828 DOI: 10.1192/bjp.bp.114.151837] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/24/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Genetic testing in psychiatry promises to improve patient care through advances in personalised medicine. However, there are few clinically relevant examples. AIMS To determine whether patients with a well-established genetic subtype of schizophrenia show a different response profile to the antipsychotic clozapine than those with idiopathic schizophrenia. METHOD We retrospectively studied the long-term safety and efficacy of clozapine in 40 adults with schizophrenia, half with a 22q11.2 deletion (22q11.2DS group) and half matched for age and clinical severity but molecularly confirmed to have no pathogenic copy number variant (idiopathic group). RESULTS Both groups showed similar clinical improvement and significant reductions in hospitalisations, achieved at a lower median dose for those in the 22q11.2DS group. Most common side-effects were similarly prevalent between the two groups, however, half of the 22q11.2DS group experienced at least one rare serious adverse event compared with none of the idiopathic group. Many were successfully retried on clozapine. CONCLUSIONS Individuals with 22q11.2DS-schizophrenia respond as well to clozapine treatment as those with other forms of schizophrenia, but may represent a disproportionate number of those with serious adverse events, primarily seizures. Lower doses and prophylactic (for example anticonvulsant) management strategies can help ameliorate side-effect risks. This first systematic evaluation of antipsychotic response in a genetic subtype of schizophrenia provides a proof-of-principle for personalised medicine and supports the utility of clinical genetic testing in schizophrenia.
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Affiliation(s)
- Nancy J. Butcher
- Clinical Genetics Research Program, Centre for Addiction and Mental Health and Institute of Medical Science, University of Toronto, Toronto
| | - Wai Lun Alan Fung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto General Research Institute, University Health Network, Toronto, The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome and Department of Psychiatry, University Health Network and Department of Psychiatry, University of Toronto, Toronto
| | - Laura Fitzpatrick
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto
| | - Alina Guna
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto
| | - Danielle M. Andrade
- Division of Neurology, Department of Medicine, University of Toronto, Toronto
| | - Anthony E. Lang
- Institute of Medical Science, University of Toronto, Division of Neurology, Department of Medicine, University of Toronto, Tanz Centre for Research in Neurodegenerative Diseases, Department of Medicine, University of Toronto, Toronto Western Hospital Research Institute, University Health Network and Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto
| | - Eva W. C. Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto
| | - Anne S. Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Institute of Medical Science, University of Toronto, Toronto General Research Institute, University Health Network, The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Department of Medicine and Department of Psychiatry, University Health Network, Department of Psychiatry, University of Toronto, Ontario, Canada
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Harrison PJ. The current and potential impact of genetics and genomics on neuropsychopharmacology. Eur Neuropsychopharmacol 2015; 25:671-81. [PMID: 23528807 DOI: 10.1016/j.euroneuro.2013.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/30/2013] [Accepted: 02/22/2013] [Indexed: 01/19/2023]
Abstract
One justification for the major scientific and financial investments in genetic and genomic studies in medicine is their therapeutic potential, both for revealing novel targets for drugs which treat the disease process, as well as allowing for more effective and safe use of existing medications. This review considers the extent to which this promise has yet been realised within psychopharmacology, how things are likely to develop in the foreseeable future, and the key issues involved. It draws primarily on examples from schizophrenia and its treatments. One observation is that there is evidence for a range of genetic influences on different aspects of psychopharmacology in terms of discovery science, but far less evidence that meets the standards required before such discoveries impact upon clinical practice. One reason is that results reveal complex genetic influences that are hard to replicate and usually of very small effect. Similarly, the slow progress being made in revealing the genes that underlie the major psychiatric syndromes hampers attempts to apply the findings to identify novel drug targets. Nevertheless, there are some intriguing positive findings of various kinds, and clear potential for genetics and genomics to play an increasing and major role in psychiatric drug discovery.
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Affiliation(s)
- Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom.
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40
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»Treatment Resistance« Enigma Resolved by Pharmacogenomics - A Case Study of Clozapine Therapy in Schizophrenia. J Med Biochem 2015; 34:223-227. [PMID: 28356835 PMCID: PMC4922322 DOI: 10.2478/jomb-2014-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/07/2014] [Indexed: 01/31/2023] Open
Abstract
The introduction of antipsychotic medication in the 1950s forever changed the outlook on the treatment of schizophrenia, although there is still a large proportion of patients who do not reach functional recovery. At least 30% of patients do not respond to clozapine, the tricyclic dibenzodiazepine with complex pharmacological actions, which was proven to be more effective than any other antipsychotic in the treatment of schizophrenia. According to most of the therapeutic guidelines for schizophrenia, clozapine is the third line therapy for patients who did not respond to other antipsychotics. Large inter-individual variability exists for clozapine bioavailability and plasma steady-state concentrations and clearance. Clozapine is metabolized by the cytochrome P450 oxidase enzyme family (CYP450). Cytochrome P450 1A2 (CYP1A2), which is polymorphically expressed in humans, is the main enzyme of clozapine metabolism. This case report addresses the influence of CYP1A2*1F genetic polymorphism on clozapine metabolism, explains the primary non-response of a young patient with schizophrenia due to increased gene expression in homozygous genotype *1F/*1F (increased metabolism of clozapine) and underlies the importance of personalizing schizophrenia treatment by means of genetic and other molecular tools, at least in the cases of »treatment resistance«.
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Greenbaum L, Lerer B. Pharmacogenetics of antipsychotic-induced movement disorders as a resource for better understanding Parkinson's disease modifier genes. Front Neurol 2015; 6:27. [PMID: 25750634 PMCID: PMC4335175 DOI: 10.3389/fneur.2015.00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 01/30/2015] [Indexed: 12/05/2022] Open
Abstract
Antipsychotic-induced movement disorders are major side effects of antipsychotic drugs among schizophrenia patients, and include antipsychotic-induced parkinsonism (AIP) and tardive dyskinesia (TD). Substantial pharmacogenetic work has been done in this field, and several susceptibility variants have been suggested. In this paper, the genetics of antipsychotic-induced movement disorders is considered in a broader context. We hypothesize that genetic variants that are risk factors for AIP and TD may provide insights into the pathophysiology of motor symptoms in Parkinson’s disease (PD). Since loss of dopaminergic stimulation (albeit pharmacological in AIP and degenerative in PD) is shared by the two clinical entities, genes associated with susceptibility to AIP may be modifier genes that influence clinical expression of PD motor sub-phenotypes, such as age at onset, disease severity, or rate of progression. This is due to their possible functional influence on compensatory mechanisms for striatal dopamine loss. Better compensatory potential might be beneficial at the early and later stages of the PD course. AIP vulnerability variants could also be related to latent impairment in the nigrostriatal pathway, affecting its functionality, and leading to subclinical dopaminergic deficits in the striatum. Susceptibility of PD patients to early development of l-DOPA induced dyskinesia (LID) is an additional relevant sub-phenotype. LID might share a common genetic background with TD, with which it shares clinical features. Genetic risk variants may predispose to both phenotypes, exerting a pleiotropic effect. According to this hypothesis, elucidating the genetics of antipsychotic-induced movement disorders may advance our understanding of multiple aspects of PD and it clinical course, rendering this a potentially rewarding field of study.
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Affiliation(s)
- Lior Greenbaum
- Department of Neurology, Sheba Medical Center at Tel Hashomer , Ramat Gan , Israel ; The Joseph Sagol Neuroscience Center, Sheba Medical Center at Tel Hashomer , Ramat Gan , Israel
| | - Bernard Lerer
- Biological Psychiatry Laboratory, Department of Psychiatry, Hadassah - Hebrew University Medical Center , Jerusalem , Israel
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Drogemöller BI, Niehaus DJH, Chiliza B, van der Merwe L, Asmal L, Malhotra AK, Wright GEB, Emsley R, Warnich L. Patterns of variation influencing antipsychotic treatment outcomes in South African first-episode schizophrenia patients. Pharmacogenomics 2015; 15:189-99. [PMID: 24444409 DOI: 10.2217/pgs.13.218] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM Many antipsychotic pharmacogenetics studies have been performed examining candidate genes or known variation; however, our understanding of the genetic factors involved in antipsychotic pharmacogenetic traits remains limited. MATERIALS & METHODS A well-characterized cohort of first-episode schizophrenia (FES) patients was used to identify a subset of nonresponders and responders to antipsychotic treatment for exome sequencing (n = 11). The variation observed in the responders and nonresponders was subsequently compared and a prioritization strategy was employed to identify variants for genotyping in the entire FES cohort (n = 103) as well as an additional Xhosa schizophrenia cohort (n = 222). RESULTS Examination of coding variation revealed a potential role for rare loss-of-function variants in treatment response outcomes. One variant, rs11368509, was found to be weakly associated with better treatment outcomes in the FES cohort (p = 0.057) and the Xhosa schizophrenia cohort (p = 0.016). In addition, the majority of the loss-of-function variation that was considered likely to be involved in antipsychotic treatment response was either novel or rare in Asian and European populations. CONCLUSION This pilot study has highlighted the importance of exome sequencing for antipsychotic pharmacogenomics studies, particularly in African individuals. Furthermore, the results emphasize once again the complexity of antipsychotic pharmacogenomics and the need for future research.
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Affiliation(s)
- Britt I Drogemöller
- Department of Genetics, Stellenbosch University, Private Bag XI, Matieland, 7602, Western Cape, South Africa
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Abstract
Over 100 loci are now associated with schizophrenia risk as identified by single nucleotide polymorphisms (SNPs) in genome-wide association studies. These findings mean that 'genes for schizophrenia' have unquestionably been found. However, many questions remain unanswered, including several which affect their therapeutic significance. The SNPs individually have minor effects, and even cumulatively explain only a modest fraction of the genetic predisposition. The remainder likely results from many more loci, from rare variants, and from gene-gene and gene-environment interactions. The risk SNPs are almost all non-coding, meaning that their biological significance is unclear; probably their effects are mediated via an influence on gene regulation, and emerging evidence suggests that some key molecular events occur during early brain development. The loci include novel genes of unknown function as well as genes and pathways previously implicated in the pathophysiology of schizophrenia, e.g. NMDA receptor signalling. Genes in the latter category have the clearer therapeutic potential, although even this will be a challenging process because of the many complexities concerning the genetic architecture and mediating mechanisms. This review summarises recent schizophrenia genetic findings and some key issues they raise, particularly with regard to their implications for identifying and validating novel drug targets.
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Affiliation(s)
- Paul J Harrison
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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44
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[What criteria for an ideal antipsychotic treatment?]. Encephale 2015; 41:39-46. [PMID: 25638050 DOI: 10.1016/j.encep.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/03/2014] [Indexed: 11/24/2022]
Abstract
Antipsychotics are, by definition, drugs to treat all symptomatic dimensions of schizophrenia, even if, following the discovery of chlorpromazine, the effect assessment has been focused on the ability to reduce positive symptoms. Nevertheless, expectations of treatment are no longer limited to only support this one dimension, but integrate the need to treat negative, cognitive and affective symptoms, through long-term modulation of dopamine transmission but also non-dopaminergic pathways. Beyond symptomatic treatment, it is also necessary to have a treatment modifying the evolution course of the disease (disease modifier), acting by a long-term effect on neuropathological and neurochemical abnormalities. The limitation of long-term effect remains the issue of therapeutic observance. Moreover, this concern for efficiency should be at the cost of reduced induction of adverse effects to maximize the benefit/risk ratio. All these dimensions should the components to profile an ideal antipsychotic treatment in 2015.
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Abstract
This review considers pharmacogenetics of the so called 'second-generation' antipsychotics. Findings for polymorphisms replicating in more than one study are emphasized and compared and contrasted with larger-scale candidate gene studies and genome-wide association study analyses. Variants in three types of genes are discussed: pharmacokinetic genes associated with drug metabolism and disposition, pharmacodynamic genes encoding drug targets, and pharmacotypic genes impacting disease presentation and subtype. Among pharmacokinetic markers, CYP2D6 metabolizer phenotype has clear clinical significance, as it impacts dosing considerations for aripiprazole, iloperidone and risperidone, and variants of the ABCB1 gene hold promise as biomarkers for dosing for olanzapine and clozapine. Among pharmacodynamic variants, the TaqIA1 allele of the DRD2 gene, the DRD3 (Ser9Gly) polymorphism, and the HTR2C -759C/T polymorphism have emerged as potential biomarkers for response and/or side effects. However, large-scale candidate gene studies and genome-wide association studies indicate that pharmacotypic genes may ultimately prove to be the richest source of biomarkers for response and side effect profiles for second-generation antipsychotics.
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Affiliation(s)
- Mark D Brennan
- Department of Biochemistry & Molecular Biology, School of Medicine, University of Louisville, Louisville, KY 40292, USA.
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46
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Use of candidate gene markers to guide antipsychotic dosage adjustment. Prog Neuropsychopharmacol Biol Psychiatry 2014; 54:315-20. [PMID: 25016278 DOI: 10.1016/j.pnpbp.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To improve antipsychotic treatment in schizophrenia patients, many studies have investigated genetic polymorphisms associated with antipsychotic metabolizing enzymes and receptors. While these studies have typically focused on drug response, few have investigated genetic influences on antipsychotic dosage. This study set out to analyze the association between 134 SNPs in 38 candidate genes and antipsychotic dosage in schizophrenia patients. METHODS For our analysis, 300 patients with a diagnosis of either schizophrenia or schizoaffective disorder were recruited between the ages of 18 and 75. A cross-sectional assessment was used, in which data were collected from each participant through an interview and self-report questionnaire. Antipsychotic dose was standardized according to the chlorpromazine equivalents, defined daily dose and relative to the maximum dose specified in the product monograph. Participants were genotyped using a Customized Illumina Chip comprising 134 SNPs, and all markers were screened for nominal significance. RESULTS The analysis showed a nominally significant association with the GFRA1 gene. CONCLUSION The common variants investigated in this study had no major influence on the antipsychotic dosage prescribed in study participants. It remains, though, that this strategy may prove valuable clinically and warrants further investigation.
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Klemettilä JP, Kampman O, Seppälä N, Viikki M, Hämäläinen M, Moilanen E, Mononen N, Lehtimäki T, Leinonen E. Association study of the HTR2C, leptin and adiponectin genes and serum marker analyses in clozapine treated long-term patients with schizophrenia. Eur Psychiatry 2014; 30:296-302. [PMID: 25284335 DOI: 10.1016/j.eurpsy.2014.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/15/2014] [Accepted: 08/20/2014] [Indexed: 02/08/2023] Open
Abstract
Clozapine treatment is associated with weight gain and cardio-metabolic consequences among patients with schizophrenia. Polymorphisms of leptin, serotonin receptor HTR2C and adiponectin genes have been associated with antipsychotic-induced weight gain and metabolic comorbidity. However, the results of the studies so far are inconclusive. The aim of the present study was first to test for a possible role of serum leptin and adiponectin levels as a marker of weight gain in association with inflammatory cytokines/adipokines (IL-6, IL-1Ra, hs-CRP and adipsin), and second to study associations between SNPs LEP rs7799039 (-2548 A/G), ADIPOQ rs1501299 and HTR2C rs1414334 and weight gain and levels of leptin and adiponectin, in 190 patients with schizophrenia on clozapine treatment, with retrospectively assessed weight change and cross-sectionally measured cytokine levels. A strong association was found between serum levels of leptin and weight gain and cytokines/adipokines related to metabolic comorbidity, especially among female patients (in women leptin vs. weight gain, IL-6 and IL-1Ra, P<0.001; in men leptin vs. weight gain, P=0.026, leptin vs. IL-1Ra, P<0.001). In male patients low adiponectin level was a more specific marker of clozapine-induced weight gain (P=0.037). The results of the present study do not support a major role of SNPs LEP rs7799039, ADIPOQ rs1501299 and HTR2C rs1414334 in the regulation of weight gain or association of serum levels of leptin and adiponectin and corresponding studied SNPs in patients with schizophrenia on clozapine treatment.
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Affiliation(s)
- J-P Klemettilä
- Department of Psychiatry, Pitkäniemi Hospital, Tampere University Hospital, 33380 Pitkäniemi, Finland.
| | - O Kampman
- School of Medicine, University of Tampere, 33014 Tampere, Finland; Department of Psychiatry, Seinäjoki Hospital District, 60220 Seinäjoki, Finland
| | - N Seppälä
- Department of Psychiatry, Satakunta Hospital District, 28500 Pori, Finland
| | - M Viikki
- School of Medicine, University of Tampere, 33014 Tampere, Finland; Tampere Mental Health Centre, Hallituskatu 8B, 33200 Tampere, Finland
| | - M Hämäläinen
- The Immunopharmacology Research Group, School of Medicine, University of Tampere and Tampere University Hospital, 33014 Tampere, Finland
| | - E Moilanen
- The Immunopharmacology Research Group, School of Medicine, University of Tampere and Tampere University Hospital, 33014 Tampere, Finland
| | - N Mononen
- Fimlab Laboratories, Department of Clinical Chemistry, School of Medicine, University of Tampere, 33014 Tampere, Finland
| | - T Lehtimäki
- Fimlab Laboratories, Department of Clinical Chemistry, School of Medicine, University of Tampere, 33014 Tampere, Finland
| | - E Leinonen
- Department of Psychiatry, Pitkäniemi Hospital, Tampere University Hospital, 33380 Pitkäniemi, Finland; School of Medicine, University of Tampere, 33014 Tampere, Finland
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48
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Ma X, Maimaitirexiati T, Zhang R, Gui X, Zhang W, Xu G, Hu G. HTR2C polymorphisms, olanzapine-induced weight gain and antipsychotic-induced metabolic syndrome in schizophrenia patients: a meta-analysis. Int J Psychiatry Clin Pract 2014; 18:229-42. [PMID: 25152019 DOI: 10.3109/13651501.2014.957705] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To conduct meta-analyses of all published association studies on the HTR2C -759C/T (rs3813829) polymorphism and olanzapine-induced weight gain in schizophrenia patients and on the HTR2C -759C/T, -697G/C (rs518147) and rs1414334:C> G polymorphisms and olanzapine/clozapine/risperidone-induced metabolic syndrome in schizophrenia patients. METHODS Eligible studies were identified by searching PubMed and Web of Science databases. Meta-analyses were performed using Cochrane Review Manager (RevMan, version 5.2) to calculate the pooled odds ratio (OR) and its corresponding 95% confidence interval (CI). RESULTS Our meta-analyses revealed both a significant positive association between the rs1414334 C allele and olanzapine/clozapine/risperidone-induced metabolic syndrome and a marginally significant positive association between the -697C allele and the induced metabolic syndrome in schizophrenia patients, but no significant association between the -759C/T polymorphism and the induced metabolic syndrome in schizophrenia patients. Our analysis further revealed a pronounced trend toward a significant negative association between the -759T allele and high olanzapine-induced weight gain and a trend toward a significant positive association between the -759C allele and high olanzapine-induced weight gain in Caucasian schizophrenia patients. CONCLUSIONS Our results support that HTR2C polymorphisms play a role in antipsychotic-induced metabolic disturbance. More association studies are needed to further elucidate association of different HTR2C polymorphisms and antipsychotic-induced metabolic disturbance.
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Affiliation(s)
- Xiaojie Ma
- Department of Geriatrics, The Fourth People's Hospital of Urumqi City , Urumqi, Xinjiang Province , P. R. China
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Haller CS, Padmanabhan JL, Lizano P, Torous J, Keshavan M. Recent advances in understanding schizophrenia. F1000PRIME REPORTS 2014; 6:57. [PMID: 25184047 PMCID: PMC4108956 DOI: 10.12703/p6-57] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a highly disabling disorder whose causes remain to be better understood, and treatments have to be improved. However, several recent advances have been made in diagnosis, etiopathology, and treatment. Whereas reliability of diagnosis has improved with operational criteria, including Diagnostic and Statistical Manual of Mental Disorders, (DSM) Fifth Edition, validity of the disease boundaries remains unclear because of substantive overlaps with other psychotic disorders. Recent emphasis on dimensional approaches and translational bio-behavioral research domain criteria may eventually help move toward a neuroscience-based definition of schizophrenia. The etiology of schizophrenia is now thought to be multifactorial, with multiple small-effect and fewer large-effect susceptibility genes interacting with several environmental factors. These factors may lead to developmentally mediated alterations in neuroplasticity, manifesting in a cascade of neurotransmitter and circuit dysfunctions and impaired connectivity with an onset around early adolescence. Such etiopathological understanding has motivated a renewed search for novel pharmacological as well as psychotherapeutic targets. Addressing the core features of the illness, such as cognitive deficits and negative symptoms, and developing hypothesis-driven early interventions and preventive strategies are high-priority goals for the field. Schizophrenia is a severe, chronic mental disorder and is among the most disabling disorders in all of medicine. It is estimated by the National Institute of Mental Health (NIMH) that 2.4 million people over the age of 18 in the US suffer from schizophrenia. This illness typically begins in adolescence and derails the formative goals of school, family, and work, leading to considerable suffering and disability and reduced life expectancy by about 20 years. Treatment outcomes are variable, and some people are successfully treated and reintegrated (i.e. go back to work). Despite the effort of many experts in the field, however, schizophrenia remains a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan. Comprehensive treatment entails a multi-modal approach, including psychopharmacology, psychosocial interventions, and assistance with housing and financial sustenance. Research to date suggests a network of genetic, neural, behavioral, and environmental factors to be responsible for its development and course. This article aims to summarize and explain recent advancements in research on schizophrenia, to suggest how these recent discoveries may lead to a better understanding and possible further development of effective therapies, and to highlight the paradigm shifts that have taken place in our understanding of the diagnosis, etiopathology, and treatment.
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Affiliation(s)
- Chiara S. Haller
- Department of Psychology, Harvard University33 Kirkland street, Cambridge, MA 02138USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - Jaya L. Padmanabhan
- Division of Public Psychiatry, Massachusetts Mental Health Center75 Fenwood Road, Boston, MA 02115USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - Paulo Lizano
- Division of Public Psychiatry, Massachusetts Mental Health Center75 Fenwood Road, Boston, MA 02115USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - John Torous
- Division of Public Psychiatry, Massachusetts Mental Health Center75 Fenwood Road, Boston, MA 02115USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - Matcheri Keshavan
- Department of Psychology, Harvard University33 Kirkland street, Cambridge, MA 02138USA
- Harvard Medical SchoolBoston, MA 02115USA
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50
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Kao ACC, Müller DJ. Genetics of antipsychotic-induced weight gain: update and current perspectives. Pharmacogenomics 2014; 14:2067-83. [PMID: 24279860 DOI: 10.2217/pgs.13.207] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Antipsychotic medications are used to effectively treat various symptoms for different psychiatric conditions. Unfortunately, antipsychotic-induced weight gain (AIWG) is a common side effect that frequently results in obesity and secondary medical conditions. Twin and sibling studies have indicated that genetic factors are likely to be highly involved in AIWG. Over recent years, there has been considerable progress in this area, with several consistently replicated findings, as well as the identification of new genes and implicated pathways. Here, we will review the most recent genetic studies related to AIWG using the Medline database (PubMed) and Google Scholar. Among the steadiest findings associated with AIWG are serotonin 2C receptors (HTR2C) and leptin promoter gene variants, with more recent studies implicating MTHFR and, in particular, MC4R genes. Additional support was reported for the HRH1, BDNF, NPY, CNR1, GHRL, FTO and AMPK genes. Notably, some of the reported variants appear to have relatively large effect sizes. These findings have provided insights into the mechanisms involved in AIWG and will help to develop predictive genetic tests in the near future.
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Affiliation(s)
- Amy C C Kao
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, University of Toronto, Toronto, ON, Canada
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