Molecular genetics of alcohol dependence and related endophenotypes

Association between polygenic risk for tobacco or alcohol consumption and liability to licit and illicit substance use in young Australian adults

BACKGROUND

Co-morbid substance use is very common. Despite a historical focus using genetic epidemiology to investigate comorbid substance use and misuse, few studies have examined substance-substance associations using polygenic risk score (PRS) methods.

METHODS

Using summary statistics from the largest substance use GWAS to date (258,797- 632,802 subjects), GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN), we constructed PRSs for smoking initiation (PRS-SI), age of initiation of regular smoking (PRS-AI), cigarettes per day (PRS-CPD), smoking cessation (PRS-SC), and drinks per week (PRS-DPW). We then estimated the fixed effect of individual PRSs on 22 lifetime substance use and substance use disorder phenotypes collected in an independent sample of 2463 young Australian adults using genetic restricted maximal likelihood (GREML) in Genome-wide Complex Trait Analysis (GCTA), separately in females, males and both sexes together.

RESULTS

After accounting for multiple testing, PRS-SI significantly explained variation in the risk of cocaine (0.67%), amphetamine (1.54%), hallucinogens (0.72%), ecstasy (1.66%) and cannabis initiation (0.97%), as well as DSM-5 alcohol use disorder (0.72%). PRS-DPW explained 0.75%, 0.59% and 0.90% of the variation of cocaine, amphetamine and ecstasy initiation respectively. None of the 22 phenotypes including emergent classes of substance use were significantly predicted by PRS-AI, PRS-CPD, and PRS-SC.

CONCLUSIONS

To our knowledge, this is the first study to report significant genetic overlap between the polygenic risks for smoking initiation and alcohol consumption and the risk of initiating major classes of illicit substances. PRSs constructed from large discovery GWASs allows the detection of novel genetic associations.

Influence of Dopaminergic System Genetic Variation and Lifestyle Factors on Excessive Alcohol Consumption

AIMS

To examine the role of genetic and environmental factors in the pathogenesis of alcohol dependence in a Spanish cohort of women and men.

METHODS

We analyzed the relationship between 56 genetic variants in 7 genes associated with the dopaminergic reward pathway and excessive alcohol consumption. The study sample (N = 1533, of which 746 were women) consisted of 653 heavy consumers and 880 very low consumers from the Spanish subcohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Single nucleotide polymorphisms (SNPs) were genotyped using a customized array. Lifestyle variables were also examined to assess associations between genetic and environmental factors.

RESULTS

No statistically significant differences were found between cases and controls for the allele frequencies in five genes: TH, SLC18A2, DRD1, DRD3 and COMT. Conversely, some alleles of the 12 SNPs from the DRD2 locus and the 5 from the MAOA locus showed significant associations with excessive alcohol consumption. Namely, rs10891556 (DRD2) proved to be the only SNP positively correlated with excessive alcohol consumption in both sexes. DRD2 rs1800497 and rs877138 were significantly associated in men, whereas DRD2 rs17601612 and rs4936271 and MAOA rs5906898 were associated with excessive alcohol consumption in women. A correspondence analysis provided an overall lifestyle profile of excessive drinkers, who were predominantly men who smoked, had large intakes of meat, small intakes of fruit and vegetables, whose jobs did not require high education levels and who engaged in little physical activity.

CONCLUSIONS

It has shown the influence of dopaminergic pathway in the genetics of alcohol dependence with differences between men and women and providing a lifestyle profile of excessive drinkers.

Prevalence and correlates of alcohol abuse and dependence in Lebanon: results from the Lebanese Epidemiologic Survey on Alcohol (LESA)

The current article aimed to determine the 12-month prevalence and correlates of DSM-IV alcohol abuse and dependence in a nationally representative sample of Lebanese adults. One thousand participants collaborated in face-to-face interviews in 2011. Prevalence of 12-month alcohol dependence was 5%, with a higher risk for those who were men, unmarried, the youngest adults (aged between 18 and 34 years old), students, participants with a liberal occupation, participants with a low income, participants with a positive family history of alcohol misuse, and smokers. Prevalence of 12-month alcohol abuse was 6.2%, with a higher risk for those who were men, students, employees, and Druze and Christians compared to Muslims. Current alcohol abuse and dependence were found to be very highly prevalent in Lebanon.

[A genetic view of addiction]

The genetic analyses of addictions recently converted to genome-wide association studies (GWAS) and thanks to national and international consortia, allowed to recruit large cohorts of patients. This approach allowed the identification of the first susceptibility gene in addiction (tobacco), with genes CHRNA5, CHRNA3 and CHRNB4 encoding the α5, α3 and b4 subunits involved in the formation of nicotinic receptors, explaining 14% of the attributable risk for tobacco dependence. Variants of ADH1B and ADH1C genes encoding alcohol dehydrogenases enzymes have also been consistently associated, this time with alcohol dependence (AD). Finally, DRD2 and ANKK1 genes, involved in the dopaminergic pathway, and which were initially associated with AD, are now considered to be involved in a broader phenotype (addiction to psychoactive substances) including opiates. Future directions in molecular study of addiction are gene x environment interactions though the epigenetic approach. Numerous studies already investigated the methylome in addiction, including histone and microRNA modifications.

Pharmacotherapy for alcohol use disorder: current and emerging therapies

Alcohol use disorder is a heterogeneous illness with a complex biology that is controlled by many genes and gene-by-environment interactions. Several efficacious, evidence-based treatments currently exist for treating and managing alcohol use disorder, including a number of pharmacotherapies that target specific aspects of biology that initiate and maintain dangerous alcohol misuse. This article reviews the neurobiological and neurobehavioral foundation of alcohol use disorder, the mechanisms of action and evidence for the efficacy of currently approved medications for treatment, and the literature on other emerging pharmacotherapies.

[Diagnosis and management of alcohol-use disorders]

With the publication of the DSM-5, the alcoholic disease becomes Alcohol-use disorders taking into account dependence and damages according to a gradient of severity. This conceptual evolution should improve the screening of people affected by this chronic and progressive disease associated with a heavy impact on morbidity and mortality. This identification is provided by the clinical interview and examination. Its sensitivity can be improved by questionnaires and biological markers. Damage and related pathologies have to be systematically revealed. In this context, the MoCA test allows the early detection of cognitive disorders. Care management aims for a change in consumption and consists in supporting the patient in his/her approach. Care management should be personalized, appropriated to the patient's informed choice and graded according to disorders' severity. This includes a psychosocial intervention which can be associated with drugs. Abstinence is no longer the only alternative: decreasing consumption with the aim of regulation has been shown interesting in the reduction of harmful consumption. When therapeutic withdrawal turns out to be necessary, use of a treatment should not be systematic. If necessary, benzodiazepines remain the first-line treatment with a limited duration of prescription. According to his/her profile, the patient can receive a long-term treatment to help to maintain abstinence, prevent relapse or reduce consumption. There is evidence that identifying and involving patients in their care significantly improve their health. Effective treatments are available for treating alcohol-use disorders. However, only a relatively small number of patients receive specific management appropriated to their needs and according to concrete goals.

Preconceptional motivational interviewing interventions to reduce alcohol-exposed pregnancy risk

Alcohol exposed pregnancy (AEP) is a leading cause of preventable birth defects. While randomized controlled trials (RCTs) have shown that multi-session motivational interviewing-based interventions reduce AEP risk, a one-session intervention could facilitate broader implementation. The purposes of this study were to: (1) test a one-session motivational AEP prevention intervention for community women and (2) compare outcomes to previous RCTs. Participants at risk for AEP (N=217) were randomized to motivational interviewing+assessment feedback (EARLY), informational video, or informational brochure conditions. Outcomes were drinks per drinking day (DDD), ineffective contraception rate, and AEP risk at 3 and 6 months. All interventions were associated with decreased DDD, ineffective contraception rate, and AEP risk. Participants who received EARLY had larger absolute risk reductions in ineffective contraception and AEP risk, but not DDD. Effect sizes were compared to previous RCTs. The one-session EARLY intervention had less powerful effects than multi-session AEP prevention interventions among community women, but may provide a new option in a continuum of preventive care.

Bipolar disorder and alcohol use disorder: a review

Bipolar disorder and alcohol use disorder represent a significant comorbid population, which is significantly worse than either diagnosis alone in presentation, duration, co-morbidity, cost, suicide rate, and poor response to treatment. They share some common characteristics in relation to genetic background, neuroimaging findings, and some biochemical findings. They can be treated with separate care, or ideally some form of integrated care. There are a number of pharmacotherapy trials, and psychotherapy trials that can aid program development. Post-treatment prognosis can be influenced by a number of factors including early abstinence, baseline low anxiety, engagement with an aftercare program and female gender. The future development of novel therapies relies upon increased psychiatric and medical awareness of the co-morbidity, and further research into novel therapies for the comorbid group.

[Abstinence in alcohol-dependence: critical and updated approach of the 2001 national guidelines]

2001 French guidelines on the modalities of post-detoxification care for alcohol-dependent patients recommend life-long abstinence from alcohol. Though experts of this conference have used a methodological tool based on the analysis of the literature for each specific issue, the recommended goal of abstinence only follows from expert advice and does not seem to be evaluated with the aforementioned methodological tool. Moreover, from 2001, several scientific works of higher level of evidence than expert advice show that a small but significant proportion of alcohol-dependent patients could maintain non-problematic drinking stably in time. The outcome discrepancies between patients could result from social, clinical and biological factors. Today, it seems necessary not to consider alcohol-dependent patients as a homogeneous population anymore, but on the contrary to delimit subgroups with different outcome profiles. Better knowledge about these subgroups of patients could allow the diversifying and personalising of care schemes, including in some cases temporary abstinence or controlled-drinking patterns.

Genetic variations in the dopaminergic system and alcohol use: a system-level analysis

Alcohol use is highly heritable and has been associated with many gene variants, including those related to dopamine (DA). However, single gene association studies have shown inconsistent and small effects. Using a system-level approach, the current study aimed to estimate the overall effect of genetic variations in the DA system on alcohol use among male drinkers. One hundred seventy-six male college students who reported to have ever drunk alcohol were enrolled. Alcohol use was measured using the Alcohol Use Disorders Identification Test. Ninety-eight representative polymorphisms in all major DA neurotransmitter genes were genotyped. Using analysis of variance, we identified six single-nucleotide polymorphisms (SNP)s that made statistically significant contributions to alcohol use. Next, main effects and interactions of these SNPs were assessed using multiple regression. The final model accounted for approximately 20% of the variance for alcohol use. Finally, permutation analyses ascertained the probability of obtaining these findings by chance to be low, p ranging from 0.024 to 0.048. These results confirmed that DA-related gene variants made strong contributions to reported alcohol use and suggest that multiple regression can be a promising way to explore the genetic basis for multi-gene-determined human behaviors.

Genome-wide association study identifies 5q21 and 9p24.1 (KDM4C) loci associated with alcohol withdrawal symptoms

Several genome-wide association (GWA) studies of alcohol dependence (AD) and alcohol-related phenotypes have been conducted; however, little is known about genetic variants influencing alcohol withdrawal symptoms (AWS). We conducted the first GWA study of AWS using 461 cases of AD with AWS and 408 controls in Caucasian population in the Collaborative Study on the Genetics of Alcoholism (COGA) sample. Logistic regression analysis of AWS as a binary trait, adjusted for age and sex, was performed using PLINK. We identified 51 SNPs associated with AWS with p < 10(-4). The first best signal was rs770182 (p = 3.65 × 10(-6)) at 5q21 near EFNA5 gene which was replicated in the Australian twin-family study of 273 families (p = 0.0172). Furthermore, three SNPs (rs10975990, rs10758821 and rs1407862) within KDM4C gene at 9p24.1 showed p < 10(-4) (p = 7.15 × 10(-6), 2.79 × 10(-5) and 4.93 × 10(-5), respectively) in the COGA sample while one SNP rs12001158 within KDM4C with p = 1.97 × 10(-4) in the COGA sample was replicated in the family sample (p = 0.01). Haplotype analysis further supported the associations of single-marker analyses of KDM4C in the COGA sample. Moreover, two SNPs (rs2046593 and rs10497668) near FSIP2 at 2q32.1 with moderate associations with AWS in the COGA sample (p = 2.66 × 10(-4) and 9.48 × 10(-5), respectively) were replicated in the family sample (p = 0.0013 and 0.0162, respectively). In addition, several SNPs in GABRA1, GABRG1, and GABRG3 were associated with AWS (p < 10(-2)) in the COGA sample. In conclusion, we identified several loci associated with AWS. These findings offer the potential for new insights into the pathogenesis of AD and AWS.

A meta-analysis of two genome-wide association studies identifies 3 new loci for alcohol dependence

Family, twin and adoption studies have clearly demonstrated that genetic factors are important in modulating the vulnerability to alcohol dependence. Several genome-wide association (GWA) studies of alcohol dependence have been conducted; however, few loci have been replicated. A meta-analysis was performed on two GWA studies of 1283 cases of alcohol dependence and 1416 controls in Caucasian populations. Through meta-analysis we identified 131 SNPs associated with alcohol dependence with p<10(-4). The best novel signal was rs6701037 (p=1.86 × 10(-7)) at 1q24-q25 within KIAA0040 gene while the second best novel hit was rs1869324 (p=4.71 × 10(-7)) at 2q22.1 within THSD7B. The third novel locus was NRD1 at 1p32.2 (the top SNP was rs2842576 with p=7.90 × 10(-6)). We confirmed the association of PKNOX2 at 11q24.4 with alcohol dependence. The top hit of PKNOX2 (rs750338 with p=1.47 × 10(-6)) in the meta-analysis was replicated with the Australian Twin-Family Study of 778 families (p=1.39 × 10(-2)) Furthermore, several flanking SNPs of the top hits in the meta-analysis demonstrated borderline associations with alcohol dependence in the family sample (top SNPs were rs2269655, rs856613, and rs10496768 with p=4.58 × 10(-3), 2.1 × 10(-4), and 2.86 × 10(-3) for KIAA0040, NRD1 and THSD7B, respectively). In addition, ALK, CASC4, and SEMA5A were strongly associated with alcohol dependence (p<2 × 10(-5)) in the meta-analysis. In conclusion, we identified three new loci (KIAA0040, THSD7B and NRD1) and confirmed the previous association of PKNOX2 with alcohol dependence. These findings offer the potential for new insights into the pathogenesis of alcohol dependence.

Breaking barriers in the genomics and pharmacogenetics of drug addiction

Drug addiction remains a substantial health issue with limited treatment options currently available. Despite considerable advances in the understanding of human genetic architecture, the genetic underpinning of complex disorders remains elusive. On the basis of our current understanding of neurobiology, numerous candidate genes have been implicated in the etiology and response to treatment for different addictions. Genome-wide association (GWA) studies have also identified novel targets. However, replication of these studies is often lacking, and this complicates interpretation. The situation is expected to improve as issues such as phenotypic characterization, the apparent "missing heritability," the identification of functional variants, and possible gene-environment (G × E) interactions are addressed. In addition, there is growing evidence that genetic information can be useful in refining the choice of addiction treatment. As genetic testing becomes more common in the practice of medicine, a variety of ethical and practical challenges, some of which are unique to drug addiction, will also need to be considered.

Association of IL-1B genetic polymorphisms with an increased risk of opioid and alcohol dependence

OBJECTIVE

To examine the association between genetic variability of IL-1B, which encodes for the proinflammatory cytokine IL-1beta and the risk of developing opioid dependence. To confirm a previous study, we also examined the association between the IL-1B genetic polymorphism and alcohol dependence.

METHODS

Genomic DNA was isolated from 60 opioid-dependent, 99 alcohol-dependent patients and 60 healthy nondependent controls. Polymerase chain reaction and restriction fragment length polymorphism were used to determine the presence of single nucleotide polymorphisms at positions -511, -31 and 3954 of IL-1B.

RESULTS

IL-1B -511C and -31T alleles were more frequent in both the opioid-dependent and alcohol-dependent patients compared with the control group: odds ratio (OR, 95% confidence interval) P values corrected for false discovery rate=1.91 (1.14-3.20), P=0.043 and 1.89 (1.19-2.99), P=0.014, respectively, for IL-1B -511C>T; and OR=1.74 (1.02-2.97), P=0.066 and 1.80 (1.13-2.88), P=0.017, respectively, for IL-1B -31T>C. In contrast, no association was observed between opioid dependence and the IL-1B 3954C>T single nucleotide polymorphism [OR=1.60 (0.84-3.02), P=0.15].

CONCLUSION

This study confirms the previous finding that IL-1B polymorphism is associated with altered risk of alcohol dependence. IL-1B single nucleotide polymorphisms at position -511 and -31, which increase IL-1beta production, occur at a higher frequency in opioid-dependent populations and may be associated, albeit weakly, with an increased risk of opioid dependence.

Molecular basis and current treatment for alcoholic liver disease

Alcohol use disorders and alcohol dependency affect millions of individuals worldwide. The impact of these facts lies in the elevated social and economic costs. Alcoholic liver disease is caused by acute and chronic exposure to ethanol which promotes oxidative stress and inflammatory response. Chronic consumption of ethanol implies liver steatosis, which is the first morphological change in the liver, followed by liver fibrosis and cirrhosis. This review comprises a broad approach of alcohol use disorders, and a more specific assessment of the pathophysiologic molecular basis, and genetics, as well as clinical presentation and current modalities of treatment for alcoholic liver disease.

Genetic and environmental influences on ethanol consumption: perspectives from preclinical research

BACKGROUND

Alcohol use disorders (abuse and dependence, AUD) are multifactorial phenomena, depending on the interplay of environmental and genetic variables.

METHOD

This review describes current developments in animal research that may help (a) develop gene therapies for the treatment of alcoholism, (b) understand the permissive role of stress on ethanol intake, and (c) elucidate why exposure to ethanol early in life is associated with a greater risk of AUD.

RESULTS

The polymorphisms found in liver alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) affect the elimination of ethanol and the susceptibility to ethanol intake. A highly active ADH protects against alcoholism, an effect related to a presteady state burst in arterial acetaldehyde. Social stressors, such as repeated early maternal separation or social defeat, exert a permissive effect on ethanol intake, perhaps by altering the normal development of the hypothalamic-pituitary-adrenal axis. Ethanol exposure during gestation, infancy, or adolescence increases the likelihood of AUD later in life. Early perception of ethanol's positive and negative (anti-anxiety) reinforcing effects may play a role in this phenomenon.

CONCLUSIONS

The review underscores the advantages of using preclinical animal models of AUD and highlights points of intersection between the topics to help design a more integrated approach for the study of alcohol-related problems.

Suicidal behavior and alcohol abuse

Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.

A new definition of early age at onset in alcohol dependence

OBJECTIVE

The accurate cut-off of an early onset of alcohol dependence is unknown. The objectives of this analysis are (1) to confirm that ages at onset variability in alcohol dependence is best described as a two subgroups entity, (2) to define the most appropriate cut-off, and (3) to test the relevancy of such distinction.

METHOD

Data were drawn the Epidemiologic Survey on Alcohol and Related Conditions (NESARC). This study focused on the 4782 adults with lifetime alcohol dependence.

RESULTS

The best-fit model distinguished two subgroups of age at onset of alcohol dependence, with a cut-off point at 22 years. Subjects with an earlier onset of alcohol dependence (< or = 22 years old) reported higher lifetime rates of specific phobia, antisocial behaviors and nearly all addictive disorders.

CONCLUSIONS

The early onset of alcohol dependence is best defined as beginning before the age of 22 years.

Changes in gene expression in regions of the extended amygdala of alcohol-preferring rats after binge-like alcohol drinking

The objective of this study was to determine time-course changes in gene expression within two regions of the extended amygdala after binge-like alcohol drinking by alcohol-preferring (P) rats. Adult male P rats were given 1-h access to 15 and 30% ethanol three times daily for 8 weeks. Rats (n = 10/time point for ethanol and n = 6/time point for water) were killed by decapitation 1, 6, and 24 h after the last drinking episode. RNA was prepared from individual micropunch samples of the nucleus accumbens shell (ACB-shell) and central nucleus of the amygdala (CeA); analyses were conducted with Affymetrix Rat Genome 230.2 GeneChips. Ethanol intakes were 1.5-2 g/kg for each of the three sessions. There were no genes that were statistically different between the ethanol and water control groups at any individual time point. Therefore, an overall effect, comparing the water control and ethanol groups, was determined. In the ACB-shell and CeA, there were 276 and 402 probe sets for named genes, respectively, that differed between the two groups. There were 1.5-3.6-fold more genes with increased expression than with decreased expression in the ethanol-drinking group, with most differences between 1.1- and 1.2-fold. Among the differences between the ethanol and water control groups were several significant biological processes categories that were in common between the two regions (e.g., synaptic transmission, neurite development); however, within these categories, there were few genes in common between the two regions. Overall, the results indicate that binge-like alcohol drinking by P rats produces region-dependent changes in the expression of genes that could alter transcription, synaptic function, and neuronal plasticity in the ACB-shell and CeA; within each region, different mechanisms may underlie these alterations because there were few common ethanol-responsive genes between the ACB-shell and CeA.

Genetic contribution to individual variation in binocular rivalry rate

Binocular rivalry occurs when conflicting images are presented in corresponding locations of the two eyes. Perception alternates between the images at a rate that is relatively stable within individuals but that varies widely between individuals. The determinants of this variation are unknown. In addition, slow binocular rivalry has been demonstrated in bipolar disorder, a psychiatric condition with high heritability. The present study therefore examined whether there is a genetic contribution to individual variation in binocular rivalry rate. We employed the twin method and studied both monozygotic (MZ) twins (n = 128 pairs) who are genetically identical, and dizygotic (DZ) twins (n = 220 pairs) who share roughly half their genes. MZ and DZ twin correlations for binocular rivalry rate were 0.51 and 0.19, respectively. The best-fitting genetic model showed 52% of the variance in binocular rivalry rate was accounted for by additive genetic factors. In contrast, nonshared environmental influences accounted for 18% of the variance, with the remainder attributed to measurement error. This study therefore demonstrates a substantial genetic contribution to individual variation in binocular rivalry rate. The results support the vigorous pursuit of genetic and molecular studies of binocular rivalry and further characterization of slow binocular rivalry as an endophenotype for bipolar disorder.