title: COMBINE genetics study: the pharmacogenetics of alcoholism treatment response: genes and mechanisms.
abstract: OBJECTIVE
  Partial efficacy of treatment and differences in adverse events across individuals are a challenge and an opportunity in the treatment of alcoholism. Individuation of therapy and understanding origins of differential treatment response may require identification of inherited functional variants of genes. The neurobiology of reward, executive cognitive function, anxiety and dysphoria have been identified as critical domains that may have a genetic basis that could predict treatment response.
  
  
  METHODS
  The COMBINE Study presents a unique opportunity to evaluate specific genetic loci (markers) that affect neurobiology central to addiction and extended withdrawal. The study also addresses variation in drug metabolism and action. Candidate genetic markers are selected for study based on functionality and abundance.
  
  
  RESULTS
  COMT Vall58Met is a common (minor allele frequency 0.42), functional, catecholamine-metabolizing enzyme polymorphism with threefold relevance. Vall58Met alters executive cognitive function, stress and anxiety responses and brain endogenous opioid function. OPRM1 Asn40Asp is a common (minor allele frequency 0.10), functional polymorphism of the mu-opioid receptor, which may serve as a gatekeeper molecule in naltrexone's actions and was recently reported to affect naltrexone response. HTTLPR (minor allele frequency 0.40) alters serotonin transporter function to affect anxiety, dysphoria and obsessional behavior, which are assessed in COMBINE and may be related to relapse and addictive behavior.
  
  
  CONCLUSIONS
  All genetic testing is consented through a separate human research protocol, and the testing is conducted nonclinically, confidentially and apart from the clinical record to protect human research participants who have volunteered for this aspect of COMBINE.
authors.affiliation: Laboratory of Neurogenetics, NIAAA, NIH, 5625 Fishers Lane, Room 3S32, MSC9412, Rockville, Maryland 20852, USA. dgneuro@box-d.nih.gov
authors.forename: David
authors.initials: D
authors.lastname: Goldman
authors.forename: Gabor
authors.initials: G
authors.lastname: Oroszi
authors.forename: Stephanie
authors.initials: S
authors.lastname: O'Malley
authors.forename: Raymond
authors.initials: R
authors.lastname: Anton
mesh_terms: D000077443:Acamprosate; D000426:Alcohol Dehydrogenase / Q000235:genetics*; D000427:Alcohol Deterrents / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy / Q000235:genetics* / Q000628:therapy*; D000483:Alleles; D003131:Combined Modality Therapy; D004358:Drug Therapy / Q000379:methods*; D005819:Genetic Markers; D005838:Genotype; D006239:Haplotypes / Q000235:genetics; D006801:Humans; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D011110:Polymorphism, Genetic / Q000235:genetics; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D017450:Receptors, Opioid, mu / Q000235:genetics; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000427:Alcohol Deterrents; D005819:Genetic Markers; D009292:Narcotic Antagonists; C485764:OPRM1 protein, human; D017450:Receptors, Opioid, mu; D013654:Taurine; D009271:Naltrexone; C489332:ADH1B protein, human; D000426:Alcohol Dehydrogenase; D000077443:Acamprosate