迟发性运动障碍与单胺受体基因多态性的关联分析

背景 中国汉族男性服用第一代抗精神病药物所致迟发性运动障碍( tardive dyskinesia ,TD)是否同样与遗传因素有关? 目的探讨五羟色胺 2C受体和多巴胺 D3受体功能基因多态性以及多巴胺 D2受体 TaqI A多态性与精神分裂症伴发 TD的相关性及其对 TD严重程度的影响. 设计以诊断为依据的病例对照研究. 地点与对象收集 2000-01/2001-01江苏扬州五台山医院长期住院的 326例男性精神分裂症 (schizophrenia,SCH)患者,均符合<中国精神疾病分类方案与诊断标准>,住院时间至少 8年,住院期间一直服用第一代抗精神病药物,全部患者为江苏籍贯. 方法使用异常不自主运动量表评定精神分裂症患者有无 TD及 TD的严重程度,并采用简明精神病评定量表评定患者临床精神症状;应用 PCR-限制性片段长度多态性技术分析精神分裂症患者中 TD组和非 TD组各候选基因的等位基因和 (或 )基因型分布频率及对异常不自主运动量表总分值的影响. 主要结局观察指标 TD组与非 TD组患者的人口学和临床学资料分析. Hardy-Weinberg平衡定律的吻合度检验.各候选基因的基因型和等位基因频率在 TD组和非 TD组的比较. 结果①各候选基因在精神分裂症患者组以及 TD和非 TD组基因型分布均符合 Hardy-Weinberg平衡定律.② TD组五羟色胺 2C受体基因-697C(突变型 )半合子频率高于非 TD组,差异有显著性意义 (P< 0. 05).③多巴胺 D3受体基因 Ser9Gly和多巴胺 D2受体基因 TaqI A1/ A2等位基因频率和基因型分布在 TD组与非 TD组之间差异均无显著性意义 (均 P >0.05).④各单胺受体基因结合型基因型相比,差异均无显著性意义 (P >0.05).⑤上述各候选基因不同等位基因和 (或 )基因型亚组间的临床学资料和异常不自主运动量表总分值 (TD组 )差异均无显著性意义 (均 P >0.05). 结论五羟色胺 2C受体基因启动子区-697G→ C单碱基置换可能是中国汉族男性精神分裂症患者 TD发生的易感因素;而 DRD3基因 Ser9Gly和多巴胺 D2受体基因 TaqI Al/ A2多态性均不是中国汉族男性精神分裂症患者发生 TD的主要危险因子.     

迟发性运动障碍与单胺受体基因多态性的关联分析

背景：中国汉族男性服用第一代抗精神病药物所致迟发性运动障(tardive dyskinesia，TD)是否同样与遗传因素有关?目的：探讨五羟色胺2C受体和多巴胺D3受体功能基因多态性以及巴胺D2受体TaqIA多态性与精神分裂症伴发TD的相关性及其对TD严重程度的影响。设计：以诊断为依据的病例对照研究。地点与对象：收集2000-01／2001-01江苏扬州五台山医院长期住院326例男性精神分裂症(schizophrenia，SCH）患者，均符合《中国精神疾分类方案与诊断标准》，住院时间至少8年，住院期间一直服用第一抗精神病药物，全部患者为江苏籍贯。方法：使用异常不自主运动量表评定精神分裂症患者有无TD及TD严重程度，并采用简明精神病评定量表评定患者临床精神症状；应用PCR-限制性片段长度多态性技术分析精神分裂症患者中TD组和TD组各候选基因的等位基因和(或)基因型分布频率及对异常不自运动量表总分值的影响。主要结局观察指标：TD组与非TD组患者的人口学和临床学资料析。Hardy—Weinberg平衡定律的吻合度检验。各候选基因的基因型和位基因频率在TD组和非TD组的比较。结果：①各候选基因在精神分裂症患者组以及TD和非TD组基因型分均符合Hardyr—Weinberg平衡定律。②TD组五羟色胺2C受体基因-697C(突变型)半合子频率高于非TD组，差异有显著性意义(P&;lt;0．05）。③巴胺D3受体基因SergGly和多巴胺D2受体基因TaqIA1／A2等位基因频率和基因型分布在TD组与非TD组之间差异均无显著性意义(均P&;gt;0．05)。④各单胺受体基因结合型基因型相比，差异均无显著性意义(P&;gt;0．05)。⑤上述各候选基因不同等位基因和(或)基因型亚组间的临床学资料和异常不自主运动量表总分值(TD组)差异均无显著性意义(均P&;gt;0．05)。结论：五羟色胺2C受体基因启动子区-697G→C单碱基置换可能是中国汉族男性精神分裂症患者TD发生的易感因素；而DRD3基因Ser9Gly和多巴胺D2受体基因TaqI A1／A2多态性均不是中国汉族男性精神分裂症患者发生TD的主要危险因子。     

DRD2和DAT基因启动子区CpG岛甲基化状态与双相情感障碍的关联研究

目的探讨多巴胺受体D2型(DRD2)和多巴胺转运体(DAT)基因启动子区CpG岛甲基化状态与双相情感障碍的关联。方法运用甲基化特异性PCR和直接测序法对103例双相情感障碍患者(病例组)和100例健康体检者(对照组)DRD2和DAT基因启动子区甲基化状态进行检测,分析两组DRD2和DAT基因甲基化状态差异。结果双相情感障碍患者和正常人DRD2和DAT基因启动子区甲基化阳性率差异无统计学意义(χ2分别=0.63、0.35,P均>0.05);两组间DRD2和DAT基因启动子区甲基化率差异无统计学意义(t分别=1.54、1.52,P均>0.05)。双相情感障碍患者DRD2基因启动子区CpG岛内位点甲基化率在性别、年龄、家族史和临床分型中之间差异无统计学意义(t分别=0.66、1.09、1.65、1.67,P均>0.05);DAT基因启动子区CpG岛内位点甲基化率在性别、年龄、家族史和临床分型中之间差异无统计学意义(t分别=1.09、1.35、1.15、0.62,P均>0.05)。结论 DRD2和DAT基因启动子区CpG岛甲基化状态和双相情感障碍可能无明显关联。     

DRD3基因Ser9Gly多态性与中国帕金森病抑郁的关系

目的探讨多巴胺D3受体(DRD3)基因Ser9Gly多态性与中国帕金森病抑郁的相关性。方法 2016年6月至2018年6月,散发帕金森病患者312例根据汉密尔顿抑郁量表评分分为抑郁组(n=132)和非抑郁组(n=180)。同时招募性别和年龄匹配的健康体检者252例为对照组。留取外周血提取基因组DNA,采用限制性片段长度多态性-聚合酶链反应和限制性酶切方法检测DRD3基因Ser9Gly多态位点。结果三组DRD3基因Ser9Gly位点基因型和等位基因型分布无显著性差异(χ~2=3.095,χ~2=2.627, P 0.05)。结论 DRD3基因Ser9Gly多态性并非中国帕金森病抑郁人群的遗传易感因素。     

急性应激障碍与多巴胺受体基因多态性的相关研究

目的:探讨多巴胺受体D2(dopaminereceptorD2,DRD2)TaqⅠ多态性与急性应激障碍(acutestressdisorder,ASD)遗传易患性的关系。方法:应用PCR-RFLP技术,对23例ASD患者的TaqⅠA多态性进行检测。对照组为41例经历过严重交通或其他意外事故的创伤幸存者。结果:对照组的A1等位基因频率(fA1)为24.4%,ASD组为43.5%,两者有显著性差异(χ2=4.998,P<0.05);对照组的A1等位基因携带率(pA1)为43.9%,ASD组为73.9%,两者差异显著(χ2=5.355,P<0.05)。结论:DRD2TaqⅠ多态性与急性应激障碍相关,A1等位基因的携带者可能对急性应激障碍易感。     

DRD4 exon Ⅲ基因多态性与精神分裂症患者攻击行为及精神症状的关联研究

目的了解多巴胺D4受体(DRD4)基因第3外显子48 bp可重复序列多态性(DRD4exonⅢ48 bp VNTR)与精神分裂症攻击行为及精神症状之间的关系。方法选取符合国际疾病分类第10版(ICD-10)精神分裂症诊断标准的患者302例,按修改版外显攻击行为量表(MOAS)得分进行分组,分别进行一般人口学资料、阳性和阴性症状量表(PANSS)测定,采用聚合酶链反应(PCR)等位基因分型技术检测DRD4 exonⅢ48 bp VNTR多态位点。用SHEsis软件进行基因型Hardy-Weinberg遗传平衡度检验及组间基因型频率的差异,用χ2检验和t检验分析DRD4基因与精神分裂症攻击行为及精神症状之间的关系。结果两组间一般人口学资料差异无统计学意义(P>0.05)。两组DRD4基因型频率均符合Hardy-Weinberg遗传平衡定律(P>0.05)。共检测到DRD4exonⅢ48 bp VNTR的6种等位基因和8种基因型,两组最常见的是4次重复等位基因。两组DRD4基因的基因型及等位基因的频率分布的差异有统计学意义(P<0.05)。研究组携带长重复等位基因组(49例)与短重复等位基因组(85例)PANSS分量表分和因子分比较,PANSS分量表分差异均无统计学意义(P>0.05),因子分中思维障碍和攻击性差异有统计学意义(P<0.05),长重复等位基因组高于短重复等位基因组。结论 (1)DRD4 exonⅢ48 bp VNTR与精神分裂症攻击行为之间存在关联。(2)DRD4 exonⅢ48 bp VNTR与精神分裂症攻击行为患者思维障碍和攻击性存在关联,携带长重复等位基因患者的症状可能较严重。     

迟发性运动障碍(Tardive Dyskinesia, TD)及其冶疗

迟发性运动障碍(TD)是抗精神病药物引起的一种椎体外系副反应,临床表现为不自主、不规则,无目的、刻板式的异常动作。一九五九年由Sigwald首先加以描述和命名。其发生率在0.5～56％之间,一般为20％左右。抗精神病药物是引起TD最主要的原因,70年代以来发现抗抑郁药、抗帕金森氏症药、抗癫痫药、抗组胺药、降压药、降糖药及止吐药等均可引起TD。TD发生的机制认为是:①、黑质纹状体通路突触后神经元多巴胺(DA)受体长期被阻滞后,出现“去神经增敏状态”;②、DA受体代偿性增多。由于上述两方面原因,使中枢神经系统DA能活动亢进,而乙酰硷(Ach)能相对减弱,以致DA能和Ach能平衡失调。临床上表现为TD。其表现形式为:①口舌     

急性应激障碍与多巴胺受体基因多态性的相关研究

目的：探讨多巴胺受体D2(dopamine receptor D2，DRD2)TaqⅠ多态性与急性应激障碍(acute stress disorder，ASD)遗传易患性的关系。方法：应用PCR—RFLP技术，对23例ASD患者的TaqⅠA多态性进行检测。对照组为41例经历过严重交通或其他意外事故的创伤幸存者。结果：对照组的A1等位基因频率(fA1)为24．4％，ASD组为43．5％，两者有显著性差异(x^2=4．998，P&;lt;0．05)；对照组的A1等位基因携带率(pA1)为43．9％，ASD组为73．9％，两者差异显著(x^2=5．355，P&;lt;0．05)。结论：DRD2 TaqⅠ多态性与急性应激障碍相关，A1等位基因的携带者可能对急性应激障碍易感。     

抽动秽语综合征的多巴胺D4受体基因多态性分析

目的　探讨我国汉族儿童和青少年中抽动秽语综合征 (TS)与多巴胺D4受体基因多态性的关系。方法采用少量血提取DNA和进行聚合酶链反应 ,对 6 7例患儿及 72名正常青少年进行TS与多巴胺D4受体基因 48bp可变串联重复序列 (VNTR)多态性的关联分析。结果　所测人群中的 48bpVNTR多态性表现为 2～ 7次重复 ;其中以 4次重复最为常见。病例组 48bpVNTR 7重复等位基因(DRD4 7R)频率为 3% ,显著高于正常对照组 (P <0 0 5 )。结论　DRD4基因 48bpVNTR多态性主要集中于 4次重复序列片段 ,DRD4 7R等位基因与TS存在关联 ,可能影响TS的易感性。     

心血管受体学说的进展

近年来,心血管受体学说进展很快,许多新的受体激动剂与阻滞剂已广泛应用于临床。本文对心血管的α、β受体,5羟色胺、组织胺受体与多巴胺受休的有关情况作一综述。 心血管α与β受体 自1948年Ahlguist发现肾上腺素能α与β受体以后,人们已确定这两种受体在血管平滑肌上的存在,并对其功能的认识不断加深。对于心肌细胞膜过去认为只有β受体,但最近发现也存在α受体。α受体为α_1与α_2两种,通常α_1受体分布于突触后膜;α_2受体分布于突触前膜,但少数α_2受体也分     

Migraine patients show an increased density of dopamine D3 and D4 receptors on lymphocytes

Recent studies have revealed peculiar functional and genetic features of dopamine receptors in migraine. As peripheral blood lymphocytes (PBL) may represent a tool for peripheral detection of neuroreceptors, we compared the expression of dopamine D3 (DRD3) and D4 (DRD4) receptors on PBL in migraine patients and in healthy controls using radioligand binding assay techniques in the presence of antidopamine D2-like receptor antibodies. The dopamine D2-like receptor agonist [3H]7-OH-DPAT was used as a radioligand. An increased density of both DRD3 (P=0.0006) and DRD4 (P=0.002) on PBL was observed in migraineurs compared with controls. This up-regulation might reflect central and/or peripheral dopamine receptor hypersensitivity due to hypofunction of the dopaminergic system. These findings support the view that dopamine D2-like receptors are involved in the determination of the so-called migraine trait, which may help to elucidate several clinical features of the disease.     

Influence from genetic variability on opioid use for cancer pain: a European genetic association study of 2294 cancer pain patients

Cancer pain patients need variable opioid doses. Preclinical and clinical studies suggest that opioid efficacy is related to genetic variability. However, the studies have small samples, findings are not replicated, and several candidate genes have not been studied. Therefore, a study of genetic variability with opioid doses in a large population using a confirmatory validation population was warranted. We recruited 2294 adult European patients using a World Health Organization (WHO) step III opioid and analyzed single nucleotide polymorphisms (SNPs) in genes with a putative influence on opioid mechanisms. The patients' mean age was 62.5 years, and the average pain intensity was 3.5. The patients' primary opioids were morphine (n=830), oxycodone (n=446), fentanyl (n=699), or other opioids (n=234). Pain intensity, time on opioids, age, gender, performance status, and bone or CNS metastases predicted opioid dose and were included as covariates. The patients were randomly divided into 1 development sample and 1 validation sample. None of 112 SNPs in the 25 candidate genes OPRM1, OPRD1, OPRK1, ARRB2, GNAZ, HINT1, Stat6, ABCB1, COMT, HRH1, ADRA2A, MC1R, TACR1, GCH1, DRD2, DRD3, HTR3A, HTR3B, HTR2A, HTR3C, HTR3D, HTR3E, HTR1, or CNR1 showed significant associations with opioid dose in both the development and the validation analyzes. These findings do not support the use of pharmacogenetic analyses for the assessed SNPs to guide opioid treatment. The study also demonstrates the importance of validating findings obtained in genetic association studies to avoid reporting spurious associations as valid findings. To elicit knowledge about new genes that influence pain and the need for opioids, strategies other than the candidate gene approach is needed.     

Dopamine receptor genes and migraine with and without aura: an association study

OBJECTIVE: To investigate the role of the dopamine receptor genes, DRD1, DRD3, and DRD5 in the pathogenesis of migraine. BACKGROUND: Migraine is a chronic debilitating disorder affecting approximately 12% of the white population. The disease shows strong familial aggregation and presumably has a genetic basis, but at present, the type and number of genes involved is unclear. The study of candidate genes can prove useful in the identification of genes involved in complex diseases such as migraine, especially if the contribution of the gene to phenotypic expression is minor. Genes coding for proteins involved in dopamine metabolism have been implicated in a number of neurologic conditions and may play a contributory role in migraine. Hence, genes that code for enzymes and receptors modulating dopaminergic activity are good candidates for investigation of the molecular genetic basis of migraine. METHODS: We tested 275 migraineurs and 275 age- and sex-matched individuals free of migraine. Genotypic results were determined by restriction endonuclease digestion of polymerase chain reaction products to detect DRD1 and DRD3 alleles and by Genescan analysis after polymerase chain reaction using fluorescently labelled oligonucleotide primers for the DRD5 marker. RESULTS: Results of chi-square statistical analyses indicated that the allele distribution for migraine cases compared to controls was not significantly different for any of the three tested gene markers (chi2 = 0.1, P =.74 for DRD1; chi2 = 1.8, P =.18 for DRD3; and chi2 = 20.3, P =.08 for DRD5). CONCLUSIONS: These findings offer no evidence for allelic association between the tested dopamine receptor gene polymorphisms and the more prevalent forms of migraine and, therefore, do not support a role for these genes in the pathogenesis of the disorder.     

Dopamine and migraine: a review of pharmacological, biochemical, neurophysiological, and therapeutic data

The dopamine theory of migraine pathogenesis, first proposed by F. Sicuteri in 1977, has attracted renewed interest after an increased frequency of the dopamine D2 receptor (DRD2) gene allele Nco I C was found in patients with migraine with aura. Therefore we reviewed the relevant literature. The most compelling argument favoring an interictal hypersensitivity of dopamine receptors in migraineurs stems from pharmacologic studies of the gastric and autonomic effects of dopaminergic agents such as apomorphine, but none of these studies was blinded and placebo-controlled. Various DRD2 antagonists abort migraine attacks after parenteral administration, while there is circumstantial evidence that dopamine agonists may be useful for prophylaxis. Most drugs used in these trials, however, lack selectivity for dopamine receptors. Both in pharmacological and therapeutic studies most patients had migraine without aura. We conclude that data suggesting a primary role for the dopaminergic system in migraine pathogenesis are unconvincing. Based on well established interactions between central amines, a reduced release of serotonin between attacks could lower dopamine release which would lead to receptor hvpersensitivity.     

Molecular variation within the dopamine receptor DRD2 gene in migraine

Molecular genetics offers a novel approach to the understanding and management of migraine since the disorder is known to have a strong genetic component. In recent studies, polymorphisms in the genes for dopamine receptors have been evaluated. Both positive and negative association studies have been reported. In particular, these data suggest that activation of the DRD2 receptor plays a modifying role in the pathophysiology of migraine. As a result, existing data provide a molecular rationale for the documented efficacy of dopamine D2 receptor antagonists in the treatment of migraine. Therefore, at the present time, molecular genetic data provide support for the hypothesis that susceptibility to migraine may be modified, in part, by variations in dopamine DRD2 receptor function.     

Association study between clinical response to rizatriptan and some candidate genes

The aim of this study was to test genetic differences in the clinical response to rizatriptan in patients affected by migraine without aura. These genetic differences could be explained by various genes, the HTR1B, encoding the 5-HT₁ receptor subtype, MAOA gene that encodes the monoamino-oxidase, the main metabolic enzyme of this triptan, SLC6A4 (gene encoding the serotonin transporter) and DRD₂ (gene encoding the D₂ receptor), both involved in the pathogenesis of migraine. Fifty unrelated patients affected by migraine without aura (IHS) were included. Patients were divided into two groups (responders and non-responders) according to clinical response. Thirty-one out of fifty patients responded to rizatriptan. A significant difference among the two groups was observed in both allele (p=0.02) and genotype distribution (p=0.03) of DRD2/NcoI. The significant association with the DRD2/NcoI polymorphism in responders suggested that the DRD2/NcoI C allele may be considered a susceptibility factor heralding a good response to rizatriptan.     

Dopamine (DRD2) and Serotonin (HTR2A, 2C) Receptor Gene Polymorphisms do not influence early response to Risperidone in South Indian Patients with Schizophrenia

Treatment response to antipsychotic drugs is variable and conflicting results have been obtained while studying the influence of DRD2 and HTR2 genetic variants on antipsychotic drug efficacy. To explore further, the present study aimed to assess the influence of DRD2 ‐141 C Ins/Del, Taq1A and HTR2A ‐1438 G/A, 102T/C and HTR2C ‐759 C/T genetic polymorphisms in response to risperidone in patients with schizophrenia. The study was conducted among the n = 320 South Indian patients with schizophrenia who received risperidone treatment (4–8 mg per day) for a minimum of four weeks. Genotyping was done by real‐time PCR. Antipsychotic response was assessed using CGI‐I score in cross‐sectional group, PANSS score in prospective group at baseline and after receiving the risperidone therapy. DRD2 ‐141 C Ins/Del (n = 310, Ins/Ins = 177, Ins/Del+ Del/Del = 133, OR 0.70, 95% CI 0.4–1.2 p 0.2), Taq1A (n = 320, AA = 35, AG = 132, GG = 153, p 0.2), HTR2A ‐1438 G/A (n = 320, AA = 39, AG = 164, GG = 117, p 0.2), HTR2A 102T/C (n = 320, CC = 115, CT = 165, TT = 40, p 0.1) HTR2C ‐759 C/T (females n = 132, CC = 65, CT+TT = 67, OR 1.3, 95% CI 0.6–2.8, p 0.5; males n = 186, C = 120, T = 66, OR 1.2, 95% CI 0.6–2.4, p 0.4) genetic polymorphisms did not show any association with antipsychotic response to risperidone. DRD2 ‐141 C Ins/Del, Taq1A, HTR2A ‐1438 G/A, 102T/C and HTR2C ‐759 C/T genetic variants are not associated with antipsychotic response to risperidone.     

Acute intravenous synaptamine complex variant KB220™ "normalizes" neurological dysregulation in patients during protracted abstinence from alcohol and opiates as observed using quantitative electroencephalographic and genetic analysis for reward polymorphisms: part 1, pilot study with 2 case reports

It is well established that in both food- and drug-addicted individuals, there is dopamine resistance due to an association with the DRD2 gene A1 allele. Evidence is emerging whereby the potential of utilizing a natural, nonaddicting, safe, putative D2 agonist may find its place in recovery from reward deficiency syndrome (RDS) in patients addicted to psychoactive chemicals. Utilizing quantitative electroencephalography (qEEG) as an imaging tool, we show the impact of Synaptamine Complex Variant KB220? as a putative activator of the mesolimbic system. We demonstrate for the first time that its intravenous administration reduces or "normalizes" aberrant electrophysiological parameters of the reward circuitry site. For this pilot study, we report that the qEEGs of an alcoholic and a heroin abuser with existing abnormalities (ie, widespread theta and widespread alpha activity, respectively) during protracted abstinence are significantly normalized by the administration of 1 intravenous dose of Synaptamine Complex Variant KB220?. Both patients were genotyped for a number of neurotransmitter reward genes to determine to what extent they carry putative dopaminergic risk alleles that may predispose them for alcohol or heroin dependence, respectively. The genes tested included the dopamine transporter (DAT1, locus symbol SLC6A3), dopamine D4 receptor exon 3 VNTR (DRD4), DRD2 TaqIA (rs1800497), COMT val158 met SNP (rs4680), monoamine oxidase A upstream VNTR (MAOA-uVNTR), and serotonin transporter-linked polymorphic region (5HTTLPR, locus symbol SLC6A4). We emphasize that these are case studies, and it would be unlikely for all individuals to carry all putative risk alleles. Based on previous research and our qEEG studies (parts 1 and 2 of this study), we cautiously suggest that long-term activation of dopaminergic receptors (ie, DRD2 receptors) will result in their proliferation and lead to enhanced "dopamine sensitivity" and an increased sense of happiness, particularly in carriers of the DRD2 A1 allele. This is supported by a clinical trial on Synaptamine Complex Variant KB220? using intravenous administration in > 600 alcoholic patients, resulting in significant reductions in RDS behaviors. It is also confirmed by the expanded oral study on Synaptose Complex KB220Z?, published as part 2 of this study. Future studies must await both functional magnetic resonance imaging and positron emission tomography scanning to determine the acute and chronic effects of oral KB220? on numbers of D2 receptors and direct interaction at the nucleus accumbens. Confirmation of these results in large, population-based, case-controlled experiments is necessary. These studies would provide important information that could ultimately lead to significant improvement in recovery for those with RDS and dopamine deficiency as a result of a multiple neurotransmitter signal transduction breakdown in the brain reward cascade.