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Meng Q, Zhu Y, Yuan Y, Yang L, Liu J, Zhang X, Bu J. Resting-state electroencephalography theta predicts neurofeedback treatment 4-month follow-up response in nicotine addiction. Gen Psychiatr 2023; 36:e101091. [PMID: 37663053 PMCID: PMC10471848 DOI: 10.1136/gpsych-2023-101091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background The high rate of long-term relapse is a major cause of smoking cessation failure. Recently, neurofeedback training has been widely used in the treatment of nicotine addiction; however, approximately 30% of subjects fail to benefit from this intervention. Our previous randomised clinical trial (RCT) examined cognition-guided neurofeedback and demonstrated a significant decrease in daily cigarette consumption at the 4-month follow-up. However, significant individual differences were observed in the 4-month follow-up effects of decreased cigarette consumption. Therefore, it is critical to identify who will benefit from pre-neurofeedback. Aims We examined whether the resting-state electroencephalography (EEG) characteristics from pre-neurofeedback predicted the 4-month follow-up effects and explored the possible mechanisms. Methods This was a double-blind RCT. A total of 60 participants with nicotine dependence were randomly assigned to either the real-feedback or yoked-feedback group. They underwent 6 min closed-eye resting EEG recordings both before and after two neurofeedback sessions. A follow-up assessment was conducted after 4 months. Results The frontal resting-state theta power spectral density (PSD) was significantly altered in the real-feedback group after two neurofeedback visits. Higher theta PSD in the real-feedback group before neurofeedback was the only predictor of decreased cigarette consumption at the 4-month follow-up. Further reliability analysis revealed a significant positive correlation between theta PSD pre-neurofeedback and post-neurofeedback. A leave-one-out cross-validated linear regression of the theta PSD pre-neurofeedback demonstrated a significant correlation between the predicted and observed reductions in cigarette consumption at the 4-month follow-up. Finally, source analysis revealed that the brain mechanisms of the theta PSD predictor were located in the orbital frontal cortex. Conclusions Our study demonstrated changes in the resting-state theta PSD following neurofeedback training. Moreover, the resting-state theta PSD may serve as a prognostic marker of neurofeedback effects. A higher resting-state theta PSD predicts a better long-term response to neurofeedback treatment, which may facilitate the selection of individualised interventions. Trial registration number ChiCTR-IPR-17011710.
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Affiliation(s)
- Qiujian Meng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
- Department of Psychology, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Ying Zhu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Ye Yuan
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Li Yang
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Jiafang Liu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Xiaochu Zhang
- Department of Psychology, School of Humanities & Social Science, University of Science & Technology of China, Hefei, Anhui, China
- Department of Radiology, the First Affiliated Hospital of USTC, Hefei National Research Center for Physical Sciences at the Microscale and School of Life Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
- Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science & Technology of China, Hefei, Anhui, China
- Institute of Health and Medicine, Hefei Comprehensive Science Center, Hefei, Anhui, China
| | - Junjie Bu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
- Department of Psychology, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
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Schwartz EKC, Palmisano AN, Gueorguieva R, DeVito EE, Sofuoglu M. Examining racial differences in smoking outcomes among smokers enrolled in an intravenous nicotine infusion study. Addict Behav 2023; 140:107615. [PMID: 36640662 PMCID: PMC9911383 DOI: 10.1016/j.addbeh.2023.107615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Large racial disparities exist in the prevention and treatment of smoking-related diseases, and minoritized populations carry a heavier burden of smoking-related morbidity and mortality. To date, most studies investigating smoking-related illnesses have been conducted in samples in which the majority, or totality, self-identified as White or Caucasian. While Black individuals who smoke tend to have a lower rate of nicotine clearance, in part due to the use of mentholated cigarettes, less is known about how slower clearance affects their acute subjective and physiologic responses in response to either overnight abstinence or subsequent nicotine administration. This study aimed to investigate differences between the experiences of Black and White individuals who smoke across these outcomes after a period of short-term abstinence and after IV nicotine infusion. METHODS The study included 206 smokers (N = 103 Black, N = 103 White, by self-report). The study investigated self-report, physiological, and biochemical smoking-related outcomes following confirmed overnight abstinence followed by IV nicotine infusion. The outcome measures were separately analyzed with repeated-measures mixed-models. RESULTS Black individuals had lower rates of nicotine clearance and were more likely to smoke mentholated cigarettes than White individuals. Despite these differences, no differences in withdrawal, cravings, or physiological outcomes were observed between the two groups. There were some trends toward differences in subjective experiences, in that an interaction with trend level significance between race and dose was observed for negative subjective drug effects, with White smokers trending towards endorsing higher levels of negative affect after abstinence and nicotine infusion. We also observed that Black individuals trended towards experiencing more negative drug effects in response to initial nicotine delivery than to saline, whereas White individuals had no differences in negative drug effects across saline or nicotine doses. CONCLUSIONS Despite slower nicotine clearance, Black participants exhibited withdrawal and urges to smoke as severe as White participants, and did not have blunted physiological responses to overnight abstinence or administration of nicotine, which were contrary to our hypotheses. Our findings suggest minimal differences across races in the acute pharmacologic effects of nicotine. We observed trend-level differences in subjective and affective responses to nicotine. Greater insight into these differences may lead to improved prevention and treatment strategies for smoking-related illnesses for Black individuals who smoke.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Alexandra N Palmisano
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Yale School of Public Health, Department of Biostatistics, New Haven, CT, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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Siegel SD, Tindle HA, Bergen AW, Tyndale RF, Schnoll R. The Use of Biomarkers to Guide Precision Treatment for Tobacco Use. ADDICTION NEUROSCIENCE 2023; 6. [PMID: 37089247 PMCID: PMC10121195 DOI: 10.1016/j.addicn.2023.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This review summarizes the evidence to date on the development of biomarkers for personalizing the pharmacological treatment of combustible tobacco use. First, the latest evidence on FDA-approved medications is considered, demonstrating that, while these medications offer real benefits, they do not contribute to smoking cessation in approximately two-thirds of cases. Second, the case for using biomarkers to guide tobacco treatment is made based on the potential to increase medication effectiveness and uptake and reduce side effects. Next, the FDA framework of biomarker development is presented along with the state of science on biomarkers for tobacco treatment, including a review of the nicotine metabolite ratio, electroencephalographic event-related potentials, and other biomarkers utilized for risk feedback. We conclude with a discussion of the challenges and opportunities for the translation of biomarkers to guide tobacco treatment and propose priorities for future research.
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Kim GH, Kim JM, Jee SH, Jung KJ. Associations of biomarkers for exposure to tobacco smoke with lung cancer risk in Korea. Cancer Biomark 2022; 35:409-417. [PMID: 36373307 DOI: 10.3233/cbm-220023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nicotine metabolite ratio (NMR) can be used to predict total nicotine clearance. However, it is unknown whether NMR could be used as a marker of lung cancer risk. OBJECTIVE To evaluate the blood metabolites of nicotine relating to the risk of developing lung cancer and investigate the combined effects of NMR and cigarette per day on the risk of lung cancer. METHODS Among the 1,054 eligible subjects from the Korean Cancer Prevention Study-II biobank cohort, those with cotinine values below 0 ng/ml were excluded. Slow and fast metabolizer groups were defined using the median value of the NMR, calculated with the control group data, as the cut-point. RESULTS The multivariable Cox proportional hazard models demonstrated that, the fast metabolizer group had a significantly higher risk of lung cancer than the slow metabolizer group (Adjusted HR: 2.02, 95% CI: 1.32-3.10). Fast metabolizers who smoked more than 15 cigarettes per day had an even higher risk of lung cancer (Adjusted HR: 3.51, 95% CI: 1.96-6.29) than the slow metabolizers who smoked less than 15 cigarettes per day. CONCLUSIONS In summary, the NMR may be an effective marker for estimating tobacco-related disease risks such as lung cancer.
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Affiliation(s)
- Guen Hui Kim
- Department of Epidemiology and Health Promotion and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Joyce Mary Kim
- Department of Occupational and Environmental Medicine, Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Korea.,Department of Occupational and Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Keum Ji Jung
- Department of Epidemiology and Health Promotion and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
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Arens Y, Bilker WB, Han X, Plankey M, Ware D, Friedman MR, D'Souza G, Stosor V, Shoptaw S, Schnoll RA, Tyndale RF, Ashare R, Gross R. Brief Report: HIV Infection Does Not Explain Higher Nicotine Metabolism in People Living With HIV. J Acquir Immune Defic Syndr 2022; 91:497-501. [PMID: 36083509 PMCID: PMC9649853 DOI: 10.1097/qai.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Smoking contributes to significant morbidity and mortality in people with HIV. People with HIV have relatively high nicotine metabolism rates, as measured by the nicotine metabolite ratio (NMR, 3-hydroxycotinine/cotinine). A higher NMR is associated with difficulty quitting smoking. We hypothesized that HIV infection might upregulate nicotine metabolism. SETTING A retrospective study of male current smokers in the Multicenter AIDS Cohort Study who HIV seroconverted between 1985 and 1993. METHODS Eligibility included having plasma stored before and after confirmed HIV seroconversion and current tobacco use. Samples were selected from the closest available visits before (median 3.3 months) and after (median 9.4 months) seroconversion. Antiretroviral therapy use was exclusionary. Cotinine and 3-hydroxycotinine were measured using liquid chromatography-tandem mass spectrometry. We compared NMR from plasma pre-HIV and post-HIV infection using signed-rank tests. We targeted a sample size of 71 pairs to achieve 80% power to detect a 0.1 unit increase in NMR with P = 0.05. RESULTS We analyzed paired samples from 78 participants; the median age was 34.5 years [interquartile range (IQR 29-40 years)]. The median NMR pre-HIV and post-HIV was 0.45 (IQR 0.32-0.54) and 0.46 (IQR 0.34-0.56), respectively. The median change in NMR postseroconversion was +0.01 (IQR -0.05, +0.09), P = 0.25. Stratification of median change in NMR by timing between samples or time since HIV seroconversion did not alter this finding. CONCLUSIONS Acquiring HIV had no measurable effect on NMR. We postulate that upregulation of the NMR may be due to direct pharmacologic effects of HIV medications or metabolic changes in response to HIV infection.
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Affiliation(s)
- Yotam Arens
- Division of Infectious Diseases, Departments of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Warren B Bilker
- Departments of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Xiaoyan Han
- Departments of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Gypsyamber D'Souza
- Department of Epidemology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA
| | - Robert A Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA
| | - Rachel F Tyndale
- Departments of Pharmacology and Toxicology, and Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY; and
| | - Robert Gross
- Division of Infectious Diseases, Departments of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Departments of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Bien-Gund CH, Bilker W, Schnoll RA, Tyndale RF, Ho JI, Bremner R, Ashare RL, Gross R. Brief Report: Nicotine Metabolism Ratio Increases in HIV-Positive Smokers on Effective Antiretroviral Therapy: A Cohort Study. J Acquir Immune Defic Syndr 2022; 89:428-432. [PMID: 34879005 PMCID: PMC8881327 DOI: 10.1097/qai.0000000000002880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND People with HIV (PWH) smoke tobacco at much higher rates than the general population. Previous research has shown that PWH have faster nicotine metabolism than HIV-uninfected individuals, which may underlie this disparity, but the cause is unknown. We investigated whether higher nicotine metabolite ratio (NMR; 3-hydroxycotinine:cotinine), a validated biomarker of nicotine metabolism through CYP2A6, was associated with antiretroviral use among HIV-infected smokers. METHODS We conducted a retrospective cohort study of HIV-positive smokers in the University of Pennsylvania Center for AIDS Research cohort. We compared the NMR before viral suppression (>10,000 copies/mL) and after viral suppression on antiretroviral therapy (<200 copies/mL). We used mixed-effects linear regression to analyze the change in NMR after viral suppression and assessed for effect modification by efavirenz use. RESULTS Eighty-nine individuals were included in the study. We observed effect modification by efavirenz use (interaction term for efavirenz use, P < 0.001). Among those on nonefavirenz regimens, the mean NMR increased by 0.14 (95% confidence interval: 0.05 to 0.23, P = 0.002). Among those on efavirenz-containing regimens, the mean NMR increased by 0.53 (95% confidence interval: 0.39-0.66, P < 0.001). CONCLUSIONS We observed a clinically and statistically significant increase in NMR after viral suppression among smokers with HIV, which more than doubled among those on efavirenz-based regimens. Higher NMR among HIV-positive smokers on antiretroviral therapy may help explain the higher rates of tobacco use and lower quit rates among PWH in care. These findings suggest that regimen choice and other modifiable factors may be targets for future attempts to increase success rates for tobacco cessation among PWH.
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Affiliation(s)
- Cedric H. Bien-Gund
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Warren Bilker
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Robert A. Schnoll
- Department of Psychiatry and the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Rachel F. Tyndale
- Department of Pharmacology and Toxicology & Psychiatry, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Canada
| | - Joshua I. Ho
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Remy Bremner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Rebecca L. Ashare
- Department of Psychiatry and the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Psychology, State University of New York at Buffalo, NY
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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Verplaetse TL, Peltier MR, Roberts W, Moore KE, Pittman BP, McKee SA. Associations Between Nicotine Metabolite Ratio and Gender With Transitions in Cigarette Smoking Status and E-Cigarette Use: Findings Across Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res 2020; 22:1316-1321. [PMID: 32152625 DOI: 10.1093/ntr/ntaa022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/20/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Nicotine metabolite ratio (NMR), the ratio of trans 3'-hydroxycotinine to cotinine, is a biomarker of nicotine metabolism. Discrepant findings among clinical trials and population-based studies warrant replication on whether higher NMR, or faster nicotine metabolism, is associated with quitting cigarette smoking. Associations of NMR and e-cigarette use are largely unknown, as well as the relationship between NMR and gender on quitting cigarette smoking or e-cigarette use. METHODS The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative, longitudinal cohort study assessing tobacco use in the US population. In the current study, the PATH (waves 1 and 2; adult interviews) was used to evaluate longitudinal predictions in relationships among NMR and gender and their association with transitions (quit vs. current stable) in cigarette smoking status and e-cigarette use status across waves 1 and 2 of the PATH study. RESULTS NMR and gender were not significantly associated with quit behavior for combustible cigarettes. Regarding e-cigarettes, a significant two-way interaction demonstrated that women with higher NMR were less likely to quit e-cigarette use compared to women with lower NMR (odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.02-0.57; p = .01). CONCLUSIONS Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism across waves 1 and 2 of the PATH study. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. IMPLICATIONS Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. Establishing parameters for NMR collection and for the use of NMR as a biomarker for cigarette smoking behavior and e-cigarette use is an important next step, and may have implications for early intervention and treatment for cessation.
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Affiliation(s)
| | | | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Kelly E Moore
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Yang J, Hashemi S, Han W, Lee C, Kang Y, Lim Y. Korean male active smokers: quantifying their smoking habits and the transformation factor among biomarkers in urine and blood. Biomarkers 2020; 25:659-669. [PMID: 32912026 DOI: 10.1080/1354750x.2020.1797879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the correlations within the levels of biomarkers in different biological matrices, along with smoking topography variables, among active male smokers in Korea. Accordingly, we defined a transformation factor to convert level of tobacco smoke exposure and impact biomarkers from different biometrics. METHODS We examined smoking topography of recruited volunteers using a self-reporting survey. The level of tobacco smoke exposure and impact biomarkers in subjects' urine and blood were analysed. Results were used to assess the correlations between the topography survey items with biomarkers in biological matrices. The relationship between the biomarkers in urine and blood was analysed. Accordingly, we defined a transformation factor as the ratio of different biomarkers in urine and blood matrices. RESULTS Significant correlations among smoking topography variables and biomarkers were found. Besides, a strong significant association was found among urine and blood cotinine (ρ = 0.817) and NMR (ρ = 0.905). Urine vs blood cotinine and NMR transformation factors were calculated to be 6.17 L-Blood/g-Creatinine and 10.2, respectively. CONCLUSIONS The validated transformation factor connects epidemiological cohort studies with tobacco smoking exposure risk assessment. Hence, this study might be beneficial for further habit-based smoking risk assessments to obtain successful regional cession policies.
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Affiliation(s)
- Jiyeon Yang
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shervin Hashemi
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonseok Han
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chaelin Lee
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Younseok Kang
- Environment Testing Division, Eurofins Korea Analytic Service Co., Ltd, Anyang, Republic of Korea
| | - Youngwook Lim
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Stancil SL, Pearce RE, Tyndale RF, Kearns GL, Vyhlidal CA, Leeder JS, Abdel-Rahman S. Evaluating metronidazole as a novel, safe CYP2A6 phenotyping probe in healthy adults. Br J Clin Pharmacol 2019; 85:960-969. [PMID: 30706508 DOI: 10.1111/bcp.13884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 01/18/2023] Open
Abstract
AIMS CYP2A6 is a genetically polymorphic enzyme resulting in differential substrate metabolism and health behaviours. Current phenotyping probes for CYP2A6 exhibit limitations related to procurement (deuterated cotinine), toxicity (coumarin), specificity (caffeine) and age-appropriate administration (nicotine, NIC). In vitro, CYP2A6 selectively forms 2-hydroxymetronidazole (2HM) from metronidazole (MTZ). The purpose of this study was to evaluate MTZ as a CYP2A6 phenotyping probe drug in healthy adults against the well-established method of measuring trans-3-hydroxycotinine (3HC)/cotinine (COT). METHODS A randomized, cross-over, pharmacokinetic study was completed in 16 healthy, nonsmoking adults. Separated by a washout period of at least 2 weeks, MTZ 500 mg and NIC gum 2 mg were administered and plasma was sampled over 48 hours and 8 hours, respectively. Correlations of plasma metabolite/parent ratios (2HM/MTZ; 3HC/COT) were assessed by Pearson coefficient. CYP2A6 genotyping was conducted and incorporated as a variable of plasma ratio response. RESULTS Correlations between the plasma ratio 2HM/MTZ and 3HC/COT were ≥ 0.9 at multiple time points (P < 0.001), demonstrating a wide window during which 2HM/MTZ can be queried post-MTZ dose. CYP2A6 genotype had significant impacts on both MTZ and NIC phenotyping ratios with decreased activity predicted phenotypes demonstrating 2HM/MTZ ratios ≤58% and 3HC/COT ratios ≤56% compared with extensive activity predicted phenotypes at all time points examined in the study (P < 0.05). No adverse events were reported in the MTZ arm while 38% (n = 6) of participants reported mild adverse events in the NIC arm. CONCLUSIONS Metronidazole via 2HM/MTZ performed well as a novel, safe phenotyping probe for CYP2A6 in healthy adults.
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Affiliation(s)
- Stephani L Stancil
- Division of Adolescent Medicine, Children's Mercy Kansas City, MO, USA.,Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, MO, USA.,Division of Pharmacology & Toxicology, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Robin E Pearce
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, MO, USA
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Departments of Pharmacology & Toxicology, and Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gregory L Kearns
- Arkansas Children's Research Institute and the Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Carrie A Vyhlidal
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, MO, USA
| | - J Steven Leeder
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, MO, USA
| | - Susan Abdel-Rahman
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, MO, USA
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Shahab L, Bauld L, McNeill A, Tyndale RF. Does the nicotine metabolite ratio moderate smoking cessation treatment outcomes in real-world settings? A prospective study. Addiction 2019; 114:304-314. [PMID: 30276911 PMCID: PMC6492100 DOI: 10.1111/add.14450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/18/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In smoking treatment trials comparing varenicline with transdermal nicotine replacement therapy (NRT), stratified by nicotine metabolite (3-hydroxycotinine/cotinine) ratio (NMR), the relative benefit of varenicline is greater among normal rather than slow metabolizers. This study tested if the relative effectiveness of varenicline and NRT is associated with NMR status in a natural treatment setting. A secondary aim was to test if this relationship is moderated by behavioural support. DESIGN Prospective observational multi-centre study with 4-week and 52-week follow-up. SETTING Nine English Stop Smoking Services (SSS). PARTICIPANTS Data came from 1556 smokers (aged ≥ 16 years) attending SSS between March 2012 and March 2013. INTERVENTIONS Participants received pharmacotherapy together with behavioural support. MEASUREMENTS The primary outcome was carbon monoxide-verified continuous abstinence at both follow-up times. Main explanatory variables were (1) NMR status [slow (NMR < 0.31, n = 451) versus normal (NMR ≥ 0.31, n = 1105) metabolizers]; (2) pharmacotherapy (varenicline versus NRT) and (3) behavioural support (individual versus group-based treatment). Analyses adjusted for baseline socio-demographic, SSS, mental/physical health and smoking characteristics. FINDINGS Of participants, 44.2% [95% confidence interval (CI) = 41.7-46.6%] and 8.0% (95% CI = 6.8-9.5%) were continuously abstinent at 4 and 52 weeks. Varenicline was more effective than NRT at 4 weeks (P < 0.001) but only marginally so at 52 weeks (P = 0.061). There was no or inclusive evidence that NMR status moderated relative efficacy of varenicline and NRT at 4- [P = 0.60, Bayes factor (BF) = 0.25] or 52-week follow-ups (P = 0.74, BF = 0.73). However, this relationship was moderated by behavioural support (p = 0.012): the relative benefit of varenicline over NRT at 52-week follow-up was greater in slow, not normal, metabolizers receiving group rather than individual support (P = 0.012). CONCLUSIONS In a real-world setting, the nicotine metabolite ratio status of treatment-seeking smokers does not appear to contribute substantially to the differential effectiveness of varenicline and nicotine replacement therapy in Stop Smoking Services, when both pharmacotherapy and behavioural support are self-selected.
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Affiliation(s)
- Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
| | - Linda Bauld
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
- Addictions DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) and Departments of Psychiatry and Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
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11
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Bierut LJ, Tyndale RF. Preparing the Way: Exploiting Genomic Medicine to Stop Smoking. Trends Mol Med 2018; 24:187-196. [PMID: 29307500 DOI: 10.1016/j.molmed.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 12/15/2022]
Abstract
Clinical medicine of the future is poised to use an individual's genomic data to predict disease risk and guide clinical care. The treatment of cigarette smoking and tobacco use disorder represents a prime area for genomics implementation. The genes CHRNA5 and CYP2A6 are strong genomic contributors that alter the risk of heaviness of smoking, tobacco use disorder, and smoking-related diseases in humans. These biomarkers have proven analytical and clinical validity, and evidence for their clinical utility continues to grow. We propose that these biomarkers harbor the potential of enabling the identification of elevated disease risk in smokers, personalizing smoking cessation treatments, and motivating behavioral changes. We must prepare for the integration of genomic applications into clinical care of patients who smoke.
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Affiliation(s)
- Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) and Departments of Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Ontario, Canada
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12
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Shahab L, Mortimer E, Bauld L, McGowan JA, McNeill A, Tyndale RF. Characterising the nicotine metabolite ratio and its association with treatment choice: A cross sectional analysis of Stop Smoking Services in England. Sci Rep 2017; 7:17613. [PMID: 29242560 PMCID: PMC5730579 DOI: 10.1038/s41598-017-17994-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022] Open
Abstract
Pharmacotherapy provision based on Nicotine Metabolite Ratio (NMR) status (slow/normal metabolism) may improve smoking cessation rates. However, it is unclear whether NMR status is consistent across patient characteristics and current treatment choice. Data come from 1,826 participants attending Stop Smoking Services (SSS) across England in 2012/13. Sociodemographic, mental/physical health, smoking and treatment characteristics (nicotine replacement therapy vs. other pharmacotherapy; group vs. one-to-one behavioural support) were assessed. Salivary nicotine metabolites were measured and NMR (3-hydroxycotinine/cotinine) computed, characterising smokers as slow (NMR < 0.31) or normal (NMR ≥ 0.31) metabolisers. Normal metabolisers were older than slow metabolisers (Odds Ratio (OR) = 1.49, 95% Confidence Interval (CI) = 1.32-1.69) but no other characteristics were associated with NMR status. Overall, predictors accounted for only 7.3% of NMR variance. In adjusted analysis, pharmacotherapy type was not associated with NMR status, but normal metabolisers were less likely to use group support (OR = 0.67, 95% CI = 0.51-0.89). NMR status does not vary substantially across sociodemographic characteristics. Given its impact on pharmacotherapy efficacy, the lack of an association with pharmacotherapy choice suggests there is scope to use NMR status to optimise the selection and efficacy of smoking cessation pharmacotherapy. The unexpected association of NMR status with behavioural support should be explored further.
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Affiliation(s)
- Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK.
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK.
| | - Emily Mortimer
- Department of Behavioural Science and Health, University College London, London, UK
| | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- School of Health Sciences, University of Stirling, Scotland, Stirling, UK
| | - Jennifer A McGowan
- Department of Behavioural Science and Health, University College London, London, UK
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) and Departments of Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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13
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Kranzler HR, Smith RV, Schnoll R, Moustafa A, Greenstreet-Akman E. Precision medicine and pharmacogenetics: what does oncology have that addiction medicine does not? Addiction 2017; 112:2086-2094. [PMID: 28431457 PMCID: PMC5650957 DOI: 10.1111/add.13818] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/08/2017] [Accepted: 03/08/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Precision, personalized or stratified medicine, which promises to deliver the right treatment to the right patient, is a topic of international interest in both the lay press and the scientific literature. A key aspect of precision medicine is the identification of biomarkers that predict the response to medications (i.e. pharmacogenetics). We examined why, despite the great strides that have been made in biomarker identification in many areas of medicine, only in oncology has there been substantial progress in their clinical implementation. We also considered why progress in this effort has lagged in addiction medicine. METHODS We compared the development of pharmacogenetic biomarkers in oncology, cardiovascular medicine (where developments are also promising) and addictive disorders. RESULTS The first major reason for the success of oncologic pharmacogenetics is ready access to tumor tissue, which allows in-vitro testing and insights into cancer biology. The second major reason is funding, with cancer research receiving, by far, the largest allocation by the National Institutes of Health (NIH) during the past two decades. The second largest allocation of research funding has gone to cardiovascular disease research. Addictions research received a much smaller NIH funding allocation, despite the major impact that tobacco use, alcohol consumption and illicit drug use have on the public health and healthcare costs. CONCLUSIONS Greater support for research on the personalized treatment of addictive disorders can be expected to yield disproportionately large benefits to the public health and substantial reductions in healthcare costs.
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Affiliation(s)
- Henry R. Kranzler
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
- Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA 19104
| | - Rachel V. Smith
- Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA 19104
| | - Robert Schnoll
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Afaf Moustafa
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Emma Greenstreet-Akman
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
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14
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Allenby CE, Boylan KA, Lerman C, Falcone M. Precision Medicine for Tobacco Dependence: Development and Validation of the Nicotine Metabolite Ratio. J Neuroimmune Pharmacol 2016; 11:471-83. [PMID: 26872457 PMCID: PMC5479354 DOI: 10.1007/s11481-016-9656-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
Quitting smoking significantly reduces the risk of tobacco-related morbidity and mortality, yet there is a high rate of relapse amongst smokers who try to quit. Phenotypic biomarkers have the potential to improve smoking cessation outcomes by identifying the best available treatment for an individual smoker. In this review, we introduce the nicotine metabolite ratio (NMR) as a reliable and stable phenotypic measure of nicotine metabolism that can guide smoking cessation treatment among smokers who wish to quit. We address how the NMR accounts for sources of variation in nicotine metabolism including genotype and other biological and environmental factors such as estrogen levels, alcohol use, body mass index, or menthol exposure. Then, we highlight clinical trials that validate the NMR as a biomarker to predict therapeutic response to different pharmacotherapies for smoking cessation. Current evidence supports the use of nicotine replacement therapy for slow metabolizers, and non-nicotine treatments such as varenicline for normal metabolizers. Finally, we discuss future research directions to elucidate mechanisms underlying NMR associations with treatment response, and facilitate the implementation of the NMR as biomarker in clinical practice to guide smoking cessation.
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Affiliation(s)
- Cheyenne E Allenby
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Kelly A Boylan
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Caryn Lerman
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Mary Falcone
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA.
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15
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Falcone M, Cao W, Bernardo L, Tyndale RF, Loughead J, Lerman C. Brain Responses to Smoking Cues Differ Based on Nicotine Metabolism Rate. Biol Psychiatry 2016; 80:190-7. [PMID: 26805583 PMCID: PMC5625335 DOI: 10.1016/j.biopsych.2015.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/22/2015] [Accepted: 11/18/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inherited differences in the rate of metabolism of nicotine, the addictive chemical in tobacco, affect smoking behavior and quitting success. The nicotine metabolite ratio (3'-hydroxycotinine/cotinine) is a reliable measure of nicotine clearance and a well-validated predictive biomarker of response to pharmacotherapy. To clarify the mechanisms underlying these associations, we investigated the neural responses to smoking cues in normal and slow nicotine metabolizers. METHODS Treatment-seeking smokers (N = 69; 30 slow metabolizers and 39 normal metabolizers) completed a visual cue reactivity task during functional magnetic resonance imaging on two separate occasions: once during smoking satiety and once after 24 hours of smoking abstinence. RESULTS In whole-brain analysis, normal (compared with slow) metabolizers exhibited heightened abstinence-induced neural responses to smoking cues in the left caudate, left inferior frontal gyrus, and left frontal pole. These effects were more pronounced when extreme groups of slow and normal metabolizers were examined. Greater activation in the left caudate and left frontal pole was associated with abstinence-induced subjective cravings to smoke. CONCLUSIONS Inherited differences in rate of nicotine elimination may drive neural responses to smoking cues during early abstinence, providing a plausible mechanism to explain differences in smoking behaviors and response to cessation treatment. Normal metabolizers may benefit from adjunctive behavioral smoking cessation treatments, such as cue exposure therapy.
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Affiliation(s)
- Mary Falcone
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104
| | - Wen Cao
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104
| | - Leah Bernardo
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Departments of Psychiatry, and Pharmacology & Toxicology, University of Toronto, Canada M5S 1A8
| | - James Loughead
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104
| | - Caryn Lerman
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.
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16
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Baurley JW, Edlund CK, Pardamean CI, Conti DV, Krasnow R, Javitz HS, Hops H, Swan GE, Benowitz NL, Bergen AW. Genome-Wide Association of the Laboratory-Based Nicotine Metabolite Ratio in Three Ancestries. Nicotine Tob Res 2016; 18:1837-1844. [PMID: 27113016 PMCID: PMC4978985 DOI: 10.1093/ntr/ntw117] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/12/2016] [Indexed: 12/29/2022]
Abstract
Introduction: Metabolic enzyme variation and other patient and environmental characteristics influence smoking behaviors, treatment success, and risk of related disease. Population-specific variation in metabolic genes contributes to challenges in developing and optimizing pharmacogenetic interventions. We applied a custom genome-wide genotyping array for addiction research (Smokescreen), to three laboratory-based studies of nicotine metabolism with oral or venous administration of labeled nicotine and cotinine, to model nicotine metabolism in multiple populations. The trans-3′-hydroxycotinine/cotinine ratio, the nicotine metabolite ratio (NMR), was the nicotine metabolism measure analyzed. Methods: Three hundred twelve individuals of self-identified European, African, and Asian American ancestry were genotyped and included in ancestry-specific genome-wide association scans (GWAS) and a meta-GWAS analysis of the NMR. We modeled natural-log transformed NMR with covariates: principal components of genetic ancestry, age, sex, body mass index, and smoking status. Results: African and Asian American NMRs were statistically significantly (P values ≤ 5E-5) lower than European American NMRs. Meta-GWAS analysis identified 36 genome-wide significant variants over a 43 kilobase pair region at CYP2A6 with minimum P = 2.46E-18 at rs12459249, proximal to CYP2A6. Additional minima were located in intron 4 (rs56113850, P = 6.61E-18) and in the CYP2A6-CYP2A7 intergenic region (rs34226463, P = 1.45E-12). Most (34/36) genome-wide significant variants suggested reduced CYP2A6 activity; functional mechanisms were identified and tested in knowledge-bases. Conditional analysis resulted in intergenic variants of possible interest (P values < 5E-5). Conclusions: This meta-GWAS of the NMR identifies CYP2A6 variants, replicates the top-ranked single nucleotide polymorphism from a recent Finnish meta-GWAS of the NMR, identifies functional mechanisms, and provides pan-continental population biomarkers for nicotine metabolism. Implications: This multiple ancestry meta-GWAS of the laboratory study-based NMR provides novel evidence and replication for genome-wide association of CYP2A6 single nucleotide and insertion–deletion polymorphisms. We identify three regions of genome-wide significance: proximal, intronic, and distal to CYP2A6. We replicate the top-ranking single nucleotide polymorphism from a recent GWAS of the NMR in Finnish smokers, identify a functional mechanism for this intronic variant from in silico analyses of RNA-seq data that is consistent with CYP2A6 expression measured in postmortem lung and liver, and provide additional support for the intergenic region between CYP2A6 and CYP2A7.
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Affiliation(s)
| | | | | | | | | | | | | | - Gary E Swan
- Stanford University School of Medicine , Stanford , CA
| | - Neal L Benowitz
- University of California, San Francisco School of Medicine , San Francisco , CA
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