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ABCB1 gene polymorphisms are associated with fatal intoxications involving venlafaxine but not citalopram

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Abstract

P-glycoprotein (P-gp), encoded by the ABCB1/MDR1 gene, is a drug transporter at the blood–brain barrier. Several polymorphisms in the ABCB1 gene are known to affect the activity and/or expression of P-gp, thereby influencing the treatment response and toxicity of P-gp substrates like citalopram and venlafaxine. In this study, we aimed to investigate the frequency of ABCB1 genotypes in forensic autopsy cases involving these two antidepressants. Further, the distribution of ABCB1 genotypes in deaths related to intoxication was compared to cases not associated to drug intoxication. The study included 228 forensic autopsy cases with different causes and manners of deaths. The ABCB1 single nucleotide polymorphisms (SNPs) G1199A, C1236T, C3435T and G2677T/A for these individuals were determined. The SNPs C1236T and C3435T in venlafaxine-positive cases were significantly different between the intoxication cases and non-intoxications. This was not seen for cases involving citalopram, indicating that the effect of genetic variants might be substrate specific. This novel finding should, however, be confirmed in future studies with larger number of cases.

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References

  1. Ahlner J, Zackrisson AL, Lindblom B, Bertilsson L (2010) CYP2D6, serotonin and suicide. Pharmacogenomics 11:903–905

    Article  PubMed  CAS  Google Scholar 

  2. Andresen H, Augustin C, Streichert T (2012) Toxicogenetics-cytochrome P450 microarray analysis in forensic cases focusing on morphine/codeine and diazepam. Int J Legal Med. doi:10.1007/s00414-012-0759-6

    PubMed  Google Scholar 

  3. Musshoff F, Stamer UM, Madea B (2010) Pharmacogenetics and forensic toxicology. Forensic Sci Int 203:53–62

    Article  PubMed  CAS  Google Scholar 

  4. Sajantila A, Palo JU, Ojanpera I, Davis C, Budowle B (2010) Pharmacogenetics in medico-legal context. Forensic Sci Int 203:44–52

    Article  PubMed  CAS  Google Scholar 

  5. Druid H, Holmgren P, Carlsson B, Ahlner J (1999) Cytochrome P450 2D6 (CYP2D6) genotyping on postmortem blood as a supplementary tool for interpretation of forensic toxicological results. Forensic Sci Int 99:25–34

    Article  PubMed  CAS  Google Scholar 

  6. Holmgren P, Carlsson B, Zackrisson AL, Lindblom B, Dahl ML, Scordo MG, Druid H, Ahlner J (2004) Enantioselective analysis of citalopram and its metabolites in postmortem blood and genotyping for CYP2D6 and CYP2C19. J Anal Toxicol 28:94–104

    PubMed  CAS  Google Scholar 

  7. Kingbäck M, Karlsson L, Zackrisson AL, Carlsson B, Josefsson M, Bengtsson F, Ahlner J, Kugelberg FC (2012) Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood. Forensic Sci Int 214:124–134

    Article  PubMed  Google Scholar 

  8. Koski A, Sistonen J, Ojanpera I, Gergov M, Vuori E, Sajantila A (2006) CYP2D6 and CYP2C19 genotypes and amitriptyline metabolite ratios in a series of medicolegal autopsies. Forensic Sci Int 158:177–183

    Article  PubMed  CAS  Google Scholar 

  9. Levo A, Koski A, Ojanpera I, Vuori E, Sajantila A (2003) Post-mortem SNP analysis of CYP2D6 gene reveals correlation between genotype and opioid drug (tramadol) metabolite ratios in blood. Forensic Sci Int 135:9–15

    Article  PubMed  CAS  Google Scholar 

  10. Wong SH, Wagner MA, Jentzen JM, Schur C, Bjerke J, Gock SB, Chang CC (2003) Pharmacogenomics as an aspect of molecular autopsy for forensic pathology/toxicology: does genotyping CYP 2D6 serve as an adjunct for certifying methadone toxicity? J Forensic Sci 48:1406–1415

    PubMed  CAS  Google Scholar 

  11. Zackrisson AL, Lindblom B, Ahlner J (2010) High frequency of occurrence of CYP2D6 gene duplication/multiduplication indicating ultrarapid metabolism among suicide cases. Clin Pharmacol Ther 88:354–359

    Article  PubMed  CAS  Google Scholar 

  12. Cordon-Cardo C, O’Brien JP, Casals D, Rittman-Grauer L, Biedler JL, Melamed MR, Bertino JR (1989) Multidrug-resistance gene (P-glycoprotein) is expressed by endothelial cells at blood–brain barrier sites. Proc Natl Acad Sci U S A 86:695–698

    Article  PubMed  CAS  Google Scholar 

  13. Doran A, Obach RS, Smith BJ, Hosea NA, Becker S, Callegari E et al (2005) The impact of P-glycoprotein on the disposition of drugs targeted for indications of the central nervous system: evaluation using the MDR1A/1B knockout mouse model. Drug Metab Dispos 33:165–174

    Article  PubMed  CAS  Google Scholar 

  14. Karlsson L, Hiemke C, Carlsson B, Josefsson M, Ahlner J, Bengtsson F, Schmitt U, Kugelberg FC (2011) Effects on enantiomeric drug disposition and open-field behavior after chronic treatment with venlafaxine in the P-glycoprotein knockout mice model. Psychopharmacology (Berl) 215:367–377

    Article  CAS  Google Scholar 

  15. Karlsson L, Schmitt U, Josefsson M, Carlsson B, Ahlner J, Bengtsson F, Kugelberg FC, Hiemke C (2010) Blood–brain barrier penetration of the enantiomers of venlafaxine and its metabolites in mice lacking P-glycoprotein. Eur Neuropsychopharmacol 20:632–640

    Article  PubMed  CAS  Google Scholar 

  16. Kirschbaum KM, Henken S, Hiemke C, Schmitt U (2008) Pharmacodynamic consequences of P-glycoprotein-dependent pharmacokinetics of risperidone and haloperidol in mice. Behav Brain Res 188:298–303

    Article  PubMed  CAS  Google Scholar 

  17. Uhr M, Grauer MT (2003) abcb1ab P-glycoprotein is involved in the uptake of citalopram and trimipramine into the brain of mice. J Psychiatr Res 37:179–185

    Article  PubMed  Google Scholar 

  18. Uhr M, Grauer MT, Holsboer F (2003) Differential enhancement of antidepressant penetration into the brain in mice with abcb1ab (mdr1ab) P-glycoprotein gene disruption. Biol Psychiatry 54:840–846

    Article  PubMed  CAS  Google Scholar 

  19. Uhr M, Grauer MT, Yassouridis A, Ebinger M (2007) Blood–brain barrier penetration and pharmacokinetics of amitriptyline and its metabolites in p-glycoprotein (abcb1ab) knock-out mice and controls. J Psychiatr Res 41:179–188

    Article  PubMed  Google Scholar 

  20. Uhr M, Steckler T, Yassouridis A, Holsboer F (2000) Penetration of amitriptyline, but not of fluoxetine, into brain is enhanced in mice with blood–brain barrier deficiency due to mdr1a P-glycoprotein gene disruption. Neuropsychopharmacology 22:380–387

    Article  PubMed  CAS  Google Scholar 

  21. Vetulani J, Nalepa I (2000) Antidepressants: past, present and future. Eur J Pharmacol 405:351–363

    Article  PubMed  CAS  Google Scholar 

  22. Callen DF, Baker E, Simmers RN, Seshadri R, Roninson IB (1987) Localization of the human multiple drug resistance gene, MDR1, to 7q21.1. Hum Genet 77:142–144

    Article  PubMed  CAS  Google Scholar 

  23. Hoffmeyer S, Burk O, von Richter O, Arnold HP, Brockmoller J, Johne A, Cascorbi I, Gerloff T, Roots I, Eichelbaum M, Brinkmann U (2000) Functional polymorphisms of the human multidrug-resistance gene: multiple sequence variations and correlation of one allele with P-glycoprotein expression and activity in vivo. Proc Natl Acad Sci U S A 97:3473–3478

    Article  PubMed  CAS  Google Scholar 

  24. Kim RB, Leake BF, Choo EF, Dresser GK, Kubba SV, Schwarz UI, Taylor A, Xie HG, McKinsey J, Zhou S, Lan LB, Schuetz JD, Schuetz EG, Wilkinson GR (2001) Identification of functionally variant MDR1 alleles among European Americans and African Americans. Clin Pharmacol Ther 70:189–199

    Article  PubMed  CAS  Google Scholar 

  25. Tanabe M, Ieiri I, Nagata N, Inoue K, Ito S, Kanamori Y, Takahashi M, Kurata Y, Kigawa J, Higuchi S, Terakawa N, Otsubo K (2001) Expression of P-glycoprotein in human placenta: relation to genetic polymorphism of the multidrug resistance (MDR)-1 gene. J Pharmacol Exp Ther 297:1137–1143

    PubMed  CAS  Google Scholar 

  26. Evans WE, McLeod HL (2003) Pharmacogenomics—drug disposition, drug targets, and side effects. N Engl J Med 348:538–549

    Article  PubMed  CAS  Google Scholar 

  27. Marzolini C, Paus E, Buclin T, Kim RB (2004) Polymorphisms in human MDR1 (P-glycoprotein): recent advances and clinical relevance. Clin Pharmacol Ther 75:13–33

    Article  PubMed  CAS  Google Scholar 

  28. Uhr M, Tontsch A, Namendorf C, Ripke S, Lucae S, Ising M, Dose T, Ebinger M, Rosenhagen M, Kohli M, Kloiber S, Salyakina D, Bettecken T, Specht M, Putz B, Binder EB, Muller-Myhsok B, Holsboer F (2008) Polymorphisms in the drug transporter gene ABCB1 predict antidepressant treatment response in depression. Neuron 57:203–209

    Article  PubMed  CAS  Google Scholar 

  29. Bozina N, Kuzman MR, Medved V, Jovanovic N, Sertic J, Hotujac L (2008) Associations between MDR1 gene polymorphisms and schizophrenia and therapeutic response to olanzapine in female schizophrenic patients. J Psychiatr Res 42:89–97

    Article  PubMed  Google Scholar 

  30. Kato M, Fukuda T, Serretti A, Wakeno M, Okugawa G, Ikenaga Y, Hosoi Y, Takekita Y, Mandelli L, Azuma J, Kinoshita T (2008) ABCB1 (MDR1) gene polymorphisms are associated with the clinical response to paroxetine in patients with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 32:398–404

    Article  PubMed  CAS  Google Scholar 

  31. Sarginson JE, Lazzeroni LC, Ryan HS, Ershoff BD, Schatzberg AF, Murphy GM Jr (2010) ABCB1 (MDR1) polymorphisms and antidepressant response in geriatric depression. Pharmacogenet Genomics 20:467–475

    Article  PubMed  CAS  Google Scholar 

  32. Buchard A, Linnet K, Johansen SS, Munkholm J, Fregerslev M, Morling N (2010) Postmortem blood concentrations of R- and S-enantiomers of methadone and EDDP in drug users: influence of co-medication and p-glycoprotein genotype. J Forensic Sci 55:457–463

    Article  PubMed  CAS  Google Scholar 

  33. Neuvonen AM, Palo JU, Sajantila A (2011) Post-mortem ABCB1 genotyping reveals an elevated toxicity for female digoxin users. Int J Legal Med 125:265–269

    Article  PubMed  Google Scholar 

  34. Drummer OH (2007) Post-mortem toxicology. Forensic Sci Int 165:199–203

    Article  PubMed  CAS  Google Scholar 

  35. Druid H, Holmgren P (1997) A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci 42:79–87

    PubMed  Google Scholar 

  36. Jones AW, Schuberth J (1989) Computer-aided headspace gas chromatography applied to blood-alcohol analysis: importance of online process control. J Forensic Sci 34:1116–1127

    PubMed  CAS  Google Scholar 

  37. Endres CJ, Hsiao P, Chung FS, Unadkat JD (2006) The role of transporters in drug interactions. Eur J Pharm Sci 27:501–517

    Article  PubMed  CAS  Google Scholar 

  38. Gex-Fabry M, Eap CB, Oneda B, Gervasoni N, Aubry JM, Bondolfi G, Bertschy G (2008) CYP2D6 and ABCB1 genetic variability: influence on paroxetine plasma level and therapeutic response. Ther Drug Monit 30:474–482

    PubMed  CAS  Google Scholar 

  39. Laika B, Leucht S, Steimer W (2006) ABCB1 (P-glycoprotein/MDR1) gene G2677T/a sequence variation (polymorphism): lack of association with side effects and therapeutic response in depressed inpatients treated with amitriptyline. Clin Chem 52:893–895

    Article  PubMed  CAS  Google Scholar 

  40. Mihaljevic Peles A, Bozina N, Sagud M, Rojnic Kuzman M, Lovric M (2008) MDR1 gene polymorphism: therapeutic response to paroxetine among patients with major depression. Prog Neuropsychopharmacol Biol Psychiatry 32:1439–1444

    Article  PubMed  CAS  Google Scholar 

  41. Perlis RH, Fijal B, Dharia S, Heinloth AN, Houston JP (2010) Failure to replicate genetic associations with antidepressant treatment response in duloxetine-treated patients. Biol Psychiatry 67:1110–1113

    Article  PubMed  CAS  Google Scholar 

  42. Lin KM, Chiu YF, Tsai IJ, Chen CH, Shen WW, Liu SC, Lu SC, Liu CY, Hsiao MC, Tang HS, Liu SI, Chang LH, Wu CS, Tsou HH, Tsai MH, Chen CY, Wang SM, Kuo HW, Hsu YT, Liu YL (2011) ABCB1 gene polymorphisms are associated with the severity of major depressive disorder and its response to escitalopram treatment. Pharmacogenet Genomics 21:163–170

    PubMed  CAS  Google Scholar 

  43. Nikisch G, Eap CB, Baumann P (2008) Citalopram enantiomers in plasma and cerebrospinal fluid of ABCB1 genotyped depressive patients and clinical response: a pilot study. Pharmacol Res 58:344–347

    Article  PubMed  CAS  Google Scholar 

  44. Menu P, Gressier F, Verstuyft C, Hardy P, Becquemont L, Corruble E (2009) Antidepressants and ABCB1 gene C3435T functional polymorphism: a naturalistic study. Neuropsychobiology 62:193–197

    Article  Google Scholar 

  45. Peters EJ, Slager SL, Kraft JB, Jenkins GD, Reinalda MS, McGrath PJ, Hamilton SP (2008) Pharmacokinetic genes do not influence response or tolerance to citalopram in the STAR*D sample. PLoS One 3:e1872

    Article  PubMed  Google Scholar 

  46. Buckley NA, McManus PR (2002) Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data. BMJ 325:1332–1333

    Article  PubMed  Google Scholar 

  47. Jönsson A, Holmgren P, Ahlner J (2004) Fatal intoxications in a Swedish forensic autopsy material during 1992–2002. Forensic Sci Int 143:53–59

    Article  PubMed  Google Scholar 

  48. Kelly CA, Dhaun N, Laing WJ, Strachan FE, Good AM, Bateman DN (2004) Comparative toxicity of citalopram and the newer antidepressants after overdose. J Toxicol Clin Toxicol 42:67–71

    Article  PubMed  CAS  Google Scholar 

  49. Whyte IM, Dawson AH, Buckley NA (2003) Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. QJM 96:369–374

    Article  PubMed  CAS  Google Scholar 

  50. Launiainen T, Rasanen I, Vuori E, Ojanpera I (2011) Fatal venlafaxine poisonings are associated with a high prevalence of drug interactions. Int J Legal Med 125:349–538

    Article  PubMed  Google Scholar 

  51. Launiainen T, Vuori E, Ojanpera I (2009) Prevalence of adverse drug combinations in a large post-mortem toxicology database. Int J Legal Med 123:109–115

    Article  PubMed  Google Scholar 

  52. Jones AW, Kugelberg FC, Holmgren A, Ahlner J (2011) Drug poisoning deaths in Sweden show a predominance of ethanol in mono-intoxications, adverse drug-alcohol interactions and poly-drug use. Forensic Sci Int 206:43–51

    Article  PubMed  CAS  Google Scholar 

  53. Koski A, Vuori E, Ojanpera I (2005) Newer antidepressants: evaluation of fatal toxicity index and interaction with alcohol based on Finnish postmortem data. Int J Legal Med 119:344–348

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors express their gratitude to Anita Holmgren for assistance with database processing. This original work has been supported by grants from the National Board of Forensic Medicine in Sweden (HG, ALZ, JA, FCK) and the Swedish Research Council (HG, FB, JA, FCK).

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Correspondence to F. C. Kugelberg.

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Karlsson, L., Green, H., Zackrisson, A.L. et al. ABCB1 gene polymorphisms are associated with fatal intoxications involving venlafaxine but not citalopram. Int J Legal Med 127, 579–586 (2013). https://doi.org/10.1007/s00414-013-0849-0

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