“…Functionally, no evidence has revealed the influence of rs6313 and rs6314 on transcription of the 5-HTR2A gene. On the contrary, rs6311 has been shown to transcriptionally modulate the expression of this gene (Parsons et al, 2004;Myers et al, 2007). Consistently, in silico analysis has found the potential function of the rs6311 A allele due to its possession of a consensus binding site for transcription factor Th1/E47, and allele-specific binding has been reported using an electrophoretic mobility shift assay (Smith et al, 2008).…”
ABSTRACT. Several lines of evidence suggest a molecular role of -1438A/G single nucleotide polymorphism in the 5-HTR2A gene promoter (rs6311) in regulating the expression of this gene, making rs6311 polymorphism a promising candidate for an association study. We looked for a possible association between rs6311 polymorphism and major depressive disorder (MDD) in a northeastern Thai population. We included 180 patients with MDD and 183 unrelated healthy controls in our study. Genotyping was performed using PCR-RFLP. We found no significant differences between the two groups with
“…Functionally, no evidence has revealed the influence of rs6313 and rs6314 on transcription of the 5-HTR2A gene. On the contrary, rs6311 has been shown to transcriptionally modulate the expression of this gene (Parsons et al, 2004;Myers et al, 2007). Consistently, in silico analysis has found the potential function of the rs6311 A allele due to its possession of a consensus binding site for transcription factor Th1/E47, and allele-specific binding has been reported using an electrophoretic mobility shift assay (Smith et al, 2008).…”
ABSTRACT. Several lines of evidence suggest a molecular role of -1438A/G single nucleotide polymorphism in the 5-HTR2A gene promoter (rs6311) in regulating the expression of this gene, making rs6311 polymorphism a promising candidate for an association study. We looked for a possible association between rs6311 polymorphism and major depressive disorder (MDD) in a northeastern Thai population. We included 180 patients with MDD and 183 unrelated healthy controls in our study. Genotyping was performed using PCR-RFLP. We found no significant differences between the two groups with
“…57,58 The antagonistic effect exerted by risperidone on these receptors will inhibit prolactin secretion, therefore counteracting the increase induced by risperidone binding to D2 receptors. The presence of a HTR2A-1438G allele leads to a lower density of these receptors, 37,38 resulting in higher prolactin secretion and increased levels of this hormone in patients homozygous for this allele, and also to a diminished therapy response (as described above). On the other hand, the lack of association with the DRD2 gene, in agreement with earlier studies, 33,59,60 reinforces the idea that the serotonin receptors have a more important function in regulating prolactin secretion induced by risperidone than by other drugs because of the differences in the pharmacodynamic profile between risperidone and other atypicals, such as clozapine and olanzapine.…”
Section: Pharmacogenetics Of Risperidone In Autismmentioning
confidence: 95%
“…35,36 A decrease in promoter activity of the -1438G allele relative to the A allele results in lower density of these receptors in the brain. 37,38 The poorer response to risperidone observed in patients homozygous for the low expression G allele may therefore be explained by a lower availability of the 5-HT2A receptors and consequent decreased effectiveness of the drug. Another polymorphism in this gene, HTR2A 102T4C, has been more extensively studied.…”
Section: Pharmacogenetics Of Risperidone In Autismmentioning
Little has been reported on the factors, genetic or other, that underlie the variability in individual response, particularly for autism. In this study we simultaneously explored the effects of multiple candidate genes on clinical improvement and occurrence of adverse drug reactions, in 45 autistic patients who received monotherapy with risperidone up to 1 year. Candidate genes involved in the pharmacokinetics (CYP2D6 and ABCB1) and pharmacodynamics (HTR2A, HTR2C, DRD2, DRD3, HTR6) of the drug, and the brain-derived neurotrophic factor (BDNF) gene, were analysed. Using the generalized estimating equation method these genes were tested for association with drug efficacy, assessed with the Autism Treatment Evaluation Checklist, and with safety and tolerability measures, such as prolactin levels, body mass index (BMI), waist circumference and neurological adverse effects, including extrapyramidal movements. Our results confirm that risperidone therapy was very effective in reducing some autism symptoms and caused few serious adverse effects. After adjusting for confounding factors, the HTR2A c.-1438G4A, DRD3 Ser9Gly, HTR2C c.995G4A and ABCB1 1236C4T polymorphisms were predictors for clinical improvement with risperidone therapy. The HTR2A c.-1438G4A, HTR2C c.68G4C (p.C33S), HTR6 c.7154-2542C4T and BDNF c.196G4A (p.V66M) polymorphisms influenced prolactin elevation. HTR2C c.68G4C and CYP2D6 polymorphisms were associated with risperidone-induced increase in BMI or waist circumference. We thus identified for the first time several genes implicated in risperidone efficacy and safety in autism patients. Although association results require replication, given the small sample size, the study makes a preliminary contribution to the personalized therapy of risperidone in autism.
“…121,126,127 A second study did not find differences in expression between both alleles, but found that the À1438-G allele was associated with decreased promoter activity when expressed in combination with a À783-G variant in the same gene. 172 The G allele tends to be associated with poorer response, suggesting that a lower expression of the receptor protein may decrease the efficacy of the dopamine-serotonin regulation exerted by antipsychotics. An amino-acid substitution in the same gene, His452Tyr, was also found to be associated with clozapine response.…”
The last decade of research into the pharmacogenetics of antipsychotics has seen the development of genetic tests to determine the patients' metabolic status and the first attempts at personalization of antipsychotic treatment. The most significant results are the association between drug metabolic polymorphisms, mainly in cytochrome P450 genes, with variations in drug metabolic rates and side effects. Patients with genetically determined CYP2D6 poor metabolizer (PMs) status may require lower doses of antipsychotic. Alternatively, CYP2D6 ultrarapid matabolizers (UMs) will need increased drug dosage to obtain therapeutic response. Additionally, polymorphisms in dopamine and serotonin receptor genes are repeatedly found associated with response phenotypes, probably reflecting the strong affinities that most antipsychotics display for these receptors. In particular, there is important evidence suggesting association between dopamine 2 receptor (D2) polymorphisms (Taq I and À141-C Ins/Del) and a dopamine 3 receptor (D3) polymorphism (Ser9Gly) with antipsychotic response and drug-induced tardive dyskinesia. Additionally, there is accumulating evidence indicating the influence of a 5-HT2C polymorphism (À759ÀT/C) in antipsychotic-induced weight gain. Application of this knowledge to clinical practice is slowly gathering pace, with pretreatment determination of individual's drug metabolic rates, via CYP genotyping, leading the field. Genetic determination of patients' metabolic status is expected to bring clinical benefits by helping to adjust therapeutic doses and reduce adverse reactions. Genetic tests for the pretreatment prediction of antipsychotic response, although still in its infancy, have obvious implications for the selection and improvement of antipsychotic treatment. These developments can be considered as successes, but the objectives of bringing pharmacogenetic and pharmacogenomic research in psychiatric clinical practice are far from being realized. Further development of genetic tests is required before the concept of tailored treatment can be applied to psychopharmatherapy. This review aims to summarize the key findings from the last decade of research in the field. Current knowledge on genetic prediction of drug metabolic status, general response and drug-induced side effects will be reviewed and future pharmacogenomic and epigenetic research will be discussed.
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