Genome-wide association analyses of symptom severity among clozapine-treated patients with schizophrenia spectrum disorders.

Clozapine is the most effective antipsychotic for patients with treatment-resistant schizophrenia. However, response is highly variable and possible genetic underpinnings of this variability remain unknown. Here, we performed polygenic risk score (PRS) analyses to estimate the amount of variance in symptom severity among clozapine-treated patients explained by PRSs (R2) and examined the association between symptom severity and genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activity. Genome-wide association (GWA) analyses were performed to explore loci associated with symptom severity. A multicenter cohort of 804 patients (after quality control N = 684) with schizophrenia spectrum disorder treated with clozapine were cross-sectionally assessed using the Positive and Negative Syndrome Scale and/or the Clinical Global Impression-Severity (CGI-S) scale. GWA and PRS regression analyses were conducted. Genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activities were calculated. Schizophrenia-PRS was most significantly and positively associated with low symptom severity (p = 1.03 × 10-3; R2 = 1.85). Cross-disorder-PRS was also positively associated with lower CGI-S score (p = 0.01; R2 = 0.81). Compared to the lowest tertile, patients in the highest schizophrenia-PRS tertile had 1.94 times (p = 6.84×10-4) increased probability of low symptom severity. Higher genotype-predicted CYP2C19 enzyme activity was independently associated with lower symptom severity (p = 8.44×10-3). While no locus surpassed the genome-wide significance threshold, rs1923778 within NFIB showed a suggestive association (p = 3.78×10-7) with symptom severity. We show that high schizophrenia-PRS and genotype-predicted CYP2C19 enzyme activity are independently associated with lower symptom severity among individuals treated with clozapine. Our findings open avenues for future pharmacogenomic projects investigating the potential of PRS and genotype-predicted CYP-activity in schizophrenia.

Endothelial nitric oxide synthase G894T, intron 4 VNTR, and T786C polymorphisms in retinopathy of prematurity.

BACKGROUND: Our objective in this study was to assess the association between eNOS gene, that achieves synthesis of nitric oxide especially in the endothelial cells known to have an important role in angiogenesis and vasculogenesis, G894T, intron 4 VNTR (27-bp repeat) and T786C functional polymorphisms and retinopathy of prematurity (ROP), which is an important cause of morbidity in premature or low birth weight babies. METHODS: A total of 139 babies who were followed up in our neonatal intensive care unit because of premature birth in our hospital or admitted to our unit. 69 of them had retinopathy of prematurity and comprised the patients group. The remaining 70 babies who did not have ROP comprised the control group. An additional of 1 ml of blood samples were drawn from babies who were in the study groups during routine laboratory analysis. eNOS gene polymorphisms were determined by using polymerase chain reaction method. RESULTS: eNOS G894T, intron 4 VNTR and T786C gene polymorphisms did not differ between the patient and control groups (p > 0.05). Using logistic regression analysis; while gender did not differ between two groups; gestational age, birth weight, time on mechanical ventilation differ between two groups. After adjustment for variables other than eNOS gene polymorphisms, we found no significant difference in the genotype distribution of eNOS G894T, intron 4 VNTR and T786C polymorphisms (p > 0.05). CONCLUSION: We observed no association between ROP and eNOS gene polymorphisms but needs more investigation.

Relationship between genetic polymorphisms of drug efflux transporter MDR1 (ABCB1) and response to losartan in hypertension patients.

OBJECTIVE: Losartan is a selective angiotensin II receptor type 1 blocker and a substrate of drug efflux transporter MDR1 (ABCB1). MDR1 shows inter-individual variations due to genetic polymorphisms. C3435T, G2677T and C1236T polymorphic alleles of the MDR1 gene encoding the transporter have been shown to alter the transport, bioavailability and efficacy of certain drugs. The purpose of this study was to investigate the relationship between genetic polymorphisms of MDR1 (C3435T, G2677T/A and C1236T) and response to the treatment in newly diagnosed hypertensive patients being treated with losartan. PATIENTS AND METHODS: A total of 74 newly diagnosed hypertension patients were included in the study. Genotyping was performed using PCR-RFLP. Systolic and diastolic mean blood pressure changes of the patients were expressed as a percentage (± SD). Blood pressure values prior to initiation of the treatment and subsequent measurements 6 weeks after starting the treatment were compared. RESULTS: Regarding the C3435T polymorphism, a mean decrease of systolic blood pressure in individuals with CT or TT genotype (n= 55; 11.6% ± 9.7 mmHg) was significantly higher compared with that of the CC genotype (n = 19; 6.7% ± 9.6 mmHg, p = 0.03). No significant systolic blood pressure changes observed in G2677T/A and C1236T genotypes (p = 0.13 and 0.07, respectively). There was not any significant difference in diastolic blood pressure changes between pre- and post-treatment for any of the genotypes with C3435T, G2677T/A, or C1236T variations. CONCLUSIONS: This study revealed that hypotensive response to losartan was significantly affected by the C3435T genetic polymorphism of MDR1 and hypertensive patients with MDR1 3435T allele may present a better response to losartan treatment.

Differential alteration of drug-metabolizing enzyme activities after cyclophosphamide/adriamycin administration in breast cancer patients.

Cyclophosphamide (CPA) and adriamycin (ADR) are widely used drugs for cancer chemotherapy. It has been reported that CPA and ADR singly or in combination could alter activities of a variety of drug-metabolizing enzymes in animals via multiple mechanisms. However, the effects of CPA/ADR on drug metabolism are largely unknown in human beings. Losartan metabolism has been suggested as a marker for determination of CYP2C9 activity. Caffeine is a commonly used probe to assess the metabolic activities of CYP1A2, CYP2A6, N-acetyltransferase 2 (NAT2) and xanthine oxidase (XO). The present study was designed to analyze the effects of CPA/ADR on these drug-metabolizing enzymes by using losartan and caffeine as probe drugs. A single oral dose of 25 mg losartan and a cup of instant coffee was given to 15 breast cancer patients on three occasions (before, and 2-4 h and 3 weeks after the adjuvant CPA/ADR chemotherapy [600 mg CPA/m2/day, 60 mg ADR/m2/day]). Losartan, caffeine and their metabolites were analyzed by using high-pressure liquid chromatography. When compared with baseline, CYP1A2 activity was increased by 20% and CYP2C9 activity was decreased by 315% 3 weeks after the administration of CPA/ADR chemotherapy (p = 0.05). The chemotherapy did not change the activities of CYP2A6, NAT2 or XO. CPA/ADR treatment caused a differential effect on drug-metabolizing enzyme activities, and this may contribute to predicting the efficacy and toxicity of chemotherapeutics, as well as understanding the drug-drug interactions.

Tamoxifen inhibits cytochrome P450 2C9 activity in breast cancer patients.

Tamoxifen has been reported to potentiate the anticoagulant effect of warfarin and also to increase the plasma level of phenytoin, which are mainly metabolized by CYP2C9. The aim of this study was to determine the influence of tamoxifen on CYP2C9 activity in vivo in humans. Thirteen breast cancer patients who would start tamoxifen following cytotoxic chemotherapy were enrolled in the study. A single oral dose of 25 mg losartan was given to the patients 2 days before and 2 weeks after starting tamoxifen therapy. Losartan and E3174 in 8-hour urine samples were measured by HPLC. Tamoxifen significantly increased the average urinary losartan/E3174 ratio from 0.73 (CI 95% = 0.15 - 2.30) to 1.66 (CI 95% = 0.68 - 5.20), after 2 weeks of treatment (p = 0.002). Tamoxifen inhibited CYP2C9 activity in breast cancer patients within two weeks of its administration. The inhibition of CYP2C9 activity may be a possible explanation for the drug-drug interaction of tamoxifen with CYP2C9 substrates.

Variant alleles and genotypes of alcohol dehydrogenase 3 in a Turkish population.

Alcohol dehydrogenase (ADH) is a genetically polymorphic dimeric enzyme that is responsible for the metabolism of alcohol. ADH3 gene encodes for the gamma subunit of dimeric ADH and has an important role in the function of the enzyme. The aim of this study was to determine the frequencies of ADH3 alleles and genotypes in a healthy Turkish population sample. Genotypic assay was carried out in 102 unrelated volunteers. DNA samples were genotyped for the ADH3*2 allele. The ADH3*1 and ADH3*2 allele frequencies were determined as 0.66 (95% confidence interval [CI] = 0.57-0.75) and 0.34 (95% CI = 0.25-0.43), respectively. The genotype frequencies of ADH3*1/*1, *1/*2, and *2/*2 were 39% (95% CI = 30-49), 54% (95% CI = 44-64), and 7% (95% CI = 2-12), respectively. According to our results, the frequencies of variant ADH3 alleles and genotypes are similar to that in the other Caucasian populations.

Antinicotinic activity of some 2-aminotetralin derivatives. A structure-activity relationship study.

The antagonistic potencies of some methoxy-2-aminotetralin derivatives on nicotinic type acetylcholine receptors were compared in rat anococcygeus muscle and frog rectus abdominis muscle preparations. Stimulation of intrinsic non-adrenergic non-cholinergic (NANC) nerves with nicotine (100 mumol/l) produced a 65.7 +/- 3.2% relaxation in phenylephrine (1 mumol/l) precontracted (2.53 +/- 0.20 g) preparations (n = 17). 2-Aminotetralin derivatives inhibited the nicotine-induced relaxations in rat anococcygeus muscle in a concentration-dependent manner with the following order of potency: BDI-60 > BDI-85 > BDI-51. Preincubation of frog rectus abdominis muscles with the test compounds caused noncompetitive antagonism as reflected by significant reductions in the maximum contractions obtained with nicotine. The order of potency according to their pD2' values was BDI-60 > BDI-85 > BDI-51. All three compounds possess antagonistic action with the same order of potency on both neuronal and muscular type nicotinic acetylcholine receptors. It has been concluded that doubling the n-propyl residue on the 2-amino moiety causes an increase in the antagonistic potency on nicotonic type acetylcholine receptors, while shifting of the 8-methoxy residue to the fifth position reduces it.

Comparative study on different responses of vascular and extravascular smooth muscles mounted inside the guinea-pig trachea: effects of ovalbumin sensitization.

The difference between the responses of phenylephrine (1 microM)-precontracted vascular (endothelium-denuded rat or rabbit aortic strips) and nonvascular (rat anococcygeus muscle) smooth muscles to acetylcholine (0.1-100 microM) was investigated when they were mounted co-axially inside the tracheas isolated from normal or ovalbumin-sensitized guinea-pigs. Acetylcholine produced concentration-dependent relaxations in both types of bioassay tissues. These relaxations, previously shown to be due to the release of airway epithelium-derived relaxing factor(s), were significantly attenuated when the epithelial layer of the tracheas was removed mechanically (as confirmed by histological examination). There were no significant differences in responsiveness to acetylcholine between vascular strips mounted inside the epithelium-intact normal or sensitized tracheas. The phenylephrine-induced precontraction was significantly more pronounced in rat anococcygeus muscles mounted inside sensitized tracheas as compared to tissues mounted inside control tracheas. The acetylcholine-induced relaxations were significantly decreased but this effect disappeared when the concentration of phenylephrine was reduced to obtain a similar precontraction level as in tissues mounted inside control tracheas. The responsiveness of both vascular strips and anococcygeus muscles to acetylcholine was attenuated when they were mounted inside sensitized tracheas and incubated with ovalbumin for 20 min, which may be explained by the epithelial damage induced by ovalbumin challenge. This attenuation was absent when co-axial pairs, utilizing normal tracheas, were used. These results indicate a difference in response patterns of the rat anococcygeus muscle and vascular strips in ovalbumin-sensitized tracheas, which should be taken into consideration in co-axial bioassay studies.