Pharmacogenetics of antipsychotic-induced weight gain.
BACKGROUND
Antipsychotic medications have been associated with considerable weight gain. The degree of inter-individual variability and known genetic contributions to obesity suggest a combination of genetic and environmental factors. In the absence of established mechanisms and valid predictors for this relevant adverse effect, pharmacogenetic studies may provide the basis for the development of individualized treatment and preventive interventions.


OBJECTIVE
The aim of the present review is to analyze the theoretical and empirical knowledge base for the selection of the most promising target genes that may contribute to antipsychotic-induced weight gain.


METHODS
Examination of the preclinical and clinical literature that can inform the rational choice of target genes that may play a role in the development of adverse changes in body composition associated with antipsychotic treatment.


RESULTS
Theoretically, candidate gene selection can be guided by knowledge about molecular pathways associated with obesity, receptors modulated by antipsychotic drugs, and enzymes implicated in their metabolism and bioavailability. While most available data relate to the general mechanisms of obesity and few studies have directly examined the genetic contributions to antipsychotic-induced weight gain, several genes warrant further investigation. These include the 5-HT(2C), pro-opiomelanocortin, leptin, ghrelin, tumor necrosis factor alpha, adiponectin, dopamine D(2) receptor, histamine-H(1) receptor, and alpha(1), beta(2) and beta(3) adrenergic receptor genes.


CONCLUSIONS
Pharmacogenetic studies can provide powerful tools for the pre-treatment identification of individuals at high risk for antipsychotic-induced weight gain, to uncover biological mechanisms that may even generalize to non-drug-induced weight gain, and to isolate novel targets for treatments of weight gain and obesity. To enhance power, future studies should pay close attention to population selection and avoidance/control of confounds, particularly past treatment exposure.
Correll
Christoph U
CU
Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
Malhotra
Anil K
AK
D052242:Adiponectin; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000235:genetics; D008958:Models, Molecular; D009765:Obesity / Q000139:chemically induced / Q000235:genetics / Q000378:metabolism; D036361:Peptide Hormones / Q000235:genetics; D010597:Pharmacogenetics / Q000379:methods; D017983:Receptors, Catecholamine / Q000235:genetics; D015430:Weight Gain / Q000187:drug effects* / Q000235:genetics
D052242:Adiponectin; D014150:Antipsychotic Agents; D036341:Intercellular Signaling Peptides and Proteins; D036361:Peptide Hormones; D017983:Receptors, Catecholamine; D003577:Cytochrome P-450 Enzyme System