title: Sleep Pharmacogenetics: Personalized Sleep-Wake Therapy.
abstract: Research spanning (genetically engineered) animal models, healthy volunteers, and sleep-disordered patients has identified the neurotransmitters and neuromodulators dopamine, serotonin, norepinephrine, histamine, hypocretin, melatonin, glutamate, acetylcholine, γ-amino-butyric acid, and adenosine as important players in the regulation and maintenance of sleep-wake-dependent changes in neuronal activity and the sleep-wake continuum. Dysregulation of these neurochemical systems leads to sleep-wake disorders. Most currently available pharmacological treatments are symptomatic rather than causal, and their beneficial and adverse effects are often variable and in part genetically determined. To evaluate opportunities for evidence-based personalized medicine with present and future sleep-wake therapeutics, we review here the impact of known genetic variants affecting exposure of and sensitivity to drugs targeting the neurochemistry of sleep-wake regulation and the pathophysiology of sleep-wake disturbances. Many functional polymorphisms modify drug response phenotypes relevant for sleep. To corroborate the importance of these and newly identified variants for personalized sleep-wake therapy, human sleep pharmacogenetics should be complemented with pharmacogenomic investigations, research about sleep-wake-dependent pharmacological actions, and studies in mice lacking specific genes. These strategies, together with future knowledge about epigenetic mechanisms affecting sleep-wake physiology and treatment outcomes, may lead to potent and safe novel therapies for the increasing number of sleep-disordered patients (e.g., in aged populations).
authors.affiliation: Institute of Pharmacology and Toxicology and Zürich Center for Interdisciplinary Sleep Research, University of Zürich, CH-8057 Zürich, Switzerland; email: landolt@pharma.uzh.ch.
authors.forename: Sebastian C
authors.initials: SC
authors.lastname: Holst
authors.affiliation: Institute of Pharmacology and Toxicology and Zürich Center for Interdisciplinary Sleep Research, University of Zürich, CH-8057 Zürich, Switzerland; email: landolt@pharma.uzh.ch.
authors.forename: Amandine
authors.initials: A
authors.lastname: Valomon
authors.affiliation: Institute of Pharmacology and Toxicology and Zürich Center for Interdisciplinary Sleep Research, University of Zürich, CH-8057 Zürich, Switzerland; email: landolt@pharma.uzh.ch.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Landolt
mesh_terms: D000818:Animals; D001921:Brain / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D009479:Neuropeptides / Q000378:metabolism; D018377:Neurotransmitter Agents / Q000378:metabolism; D010597:Pharmacogenetics / Q000379:methods; D012890:Sleep / Q000187:drug effects* / Q000235:genetics*; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000235:genetics* / Q000378:metabolism
chemical_list: D009479:Neuropeptides; D018377:Neurotransmitter Agents
keywords: GABA; H3 receptor; NREM sleep; REM sleep; caffeine; circadian; genotype-phenotype; melatonin; orexin; pharmacodynamics; pharmacokinetics; polymorphism