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Aim: The CYP2D6 gene is highly polymorphic and harbors population specific alleles that define its predominant metabolizer phenotype. This study aimed to identify polymorphisms in Indian population owing to scarcity of CYP2D6 data in this population. Materials & methods: The CYP2D6 gene was resequenced in 105 south Indians using next generation sequencing technology and haplotypes were reconstructed. Results & conclusion: Four novel missense variants have been designated as CYP2D6*110, *111, *112 and *113. The most common alleles were CYP2D6*1 (42%), *2 (32%), and *41 (12.3%) and diplotypes were CYP2D6*1/*2 (26%), *1/*1 (11%), *2/*41 (10%) and *1/*41 (7%) accounting for high incidence of extensive metabolizers in Indians.

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Diabetes mellitus is characterized by increased central arterial stiffness and endothelial dysfunction leading to increased risk of cardiovascular complications. The aim of this study is to evaluate the effect of Curcuma longa on arterial stiffness and endothelial dysfunction in patients with type 2 diabetes mellitus. This randomized controlled trial was conducted in 136 patients of type 2 diabetes. Among them, 114 completed at least one follow-up visit and included for data analysis. Arterial stiffness parameters were measured at baseline and every month for 3 months and endothelial dysfunction markers at baseline and after 3 months of treatment with C. longa or placebo. These parameters were compared between the two groups. Both C. longa and placebo groups were comparable at baseline. After 3 months of treatment, C. longa produced significant reduction from baseline in carotid-femoral pulse wave velocity (p = .002), left brachial-ankle pulse wave velocity (p = .001), aortic augmentation pressure (p = .007), aortic augmentation index (p = .007), and aortic augmentation index at heart rate 75 (p = .018) as compared with the placebo group. Three months treatment with C. longa significantly decreases arterial stiffness as compared with placebo in type 2 diabetes mellitus patients.

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AIM: The aim of the study was to compare the dose-adjusted plasma levels of carbamazepine (CBZ) among expressers and nonexpressers of cytochrome P450 3A5 (CYP3A5)* 3 genotypes. SUBJECTS AND METHODS: The study was carried out in 100 epileptic patients who were on CBZ monotherapy. Steady-state plasma CBZ levels were measured using reverse-phase high-performance liquid chromatography method, and genotyping of CYP3A5 was done using real-time polymerase chain reaction method. RESULTS: Patients inheriting CYP3A5*3/*3 variant (nonexpressers) had an increased plasma concentration of CBZ (4.86 µg/ml) when compared to patients inheriting either CYP3A5*1/*1 or CYP3A5*1/*3 (expressers) (4.3 µg/ml, P = 0.004). Nonexpressers had significantly increased plasma concentrations of CBZ when adjusted for dose and weight when compared to expressers (P < 0.002 and P < 0.001, respectively). The frequency of adverse reactions in expressers and nonexpressers was 12% and 9%, respectively. CONCLUSION: There is a significant influence of CYP3A5*3 genetic polymorphism (6986A>G) on dose-adjusted plasma levels of CBZ in epileptic patients in the South Indian population.

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Treatment response to antipsychotic drugs is variable and conflicting results have been obtained while studying the influence of DRD2 and HTR2 genetic variants on antipsychotic drug efficacy. To explore further, the present study aimed to assess the influence of DRD2 -141 C Ins/Del, Taq1A and HTR2A -1438 G/A, 102T/C and HTR2C -759 C/T genetic polymorphisms in response to risperidone in patients with schizophrenia. The study was conducted among the n = 320 South Indian patients with schizophrenia who received risperidone treatment (4-8 mg per day) for a minimum of four weeks. Genotyping was done by real-time PCR. Antipsychotic response was assessed using CGI-I score in cross-sectional group, PANSS score in prospective group at baseline and after receiving the risperidone therapy. DRD2 -141 C Ins/Del (n = 310, Ins/Ins = 177, Ins/Del+ Del/Del = 133, OR 0.70, 95% CI 0.4-1.2 p 0.2), Taq1A (n = 320, AA = 35, AG = 132, GG = 153, p 0.2), HTR2A -1438 G/A (n = 320, AA = 39, AG = 164, GG = 117, p 0.2), HTR2A 102T/C (n = 320, CC = 115, CT = 165, TT = 40, p 0.1) HTR2C -759 C/T (females n = 132, CC = 65, CT+TT = 67, OR 1.3, 95% CI 0.6-2.8, p 0.5; males n = 186, C = 120, T = 66, OR 1.2, 95% CI 0.6-2.4, p 0.4) genetic polymorphisms did not show any association with antipsychotic response to risperidone. DRD2 -141 C Ins/Del, Taq1A, HTR2A -1438 G/A, 102T/C and HTR2C -759 C/T genetic variants are not associated with antipsychotic response to risperidone.

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OBJECTIVE: To determine the adverse drug reaction (ADR) profile of risperidone and their association with dopamine (DRD2 - 141 C Ins/Del/rs1799732) and serotonin receptor (5HTR2C -759 C>T/rs3813929) gene polymorphisms in patients with schizophrenia. MATERIALS AND METHODS: The study was conducted among 289 patients who were diagnosed with schizophrenia and were on treatment with risperidone (4-8 mg/day)-based therapy for a minimum of 4 weeks. Genotyping was carried by real-time quantitative polymerase chain reaction. All the patients were observed for the occurrences of ADRs during the study. Changes in prolactin levels and body weight were analyzed for a subgroup of 102 and 97 patients, respectively. RESULTS: Risperidone-induced extrapyramidal symptoms (EPSs) were seen in 36.7% of patients. Among them, tremors were the most common symptom 31.8%. Risperidone-induced hyperprolactinemia and weight gain were seen in 87.2% and 53.6% in subgroup patients. Adverse effects such as sedation, gastrointestinal effects, and amenorrhea were seen in 9.7% (28/289), 5.1% (15/289), and 6.1% (7/114), respectively. Occurrence of DRD2 - 141 Ins/Del and Del/Del polymorphisms were significantly associated with increased prolactin levels in response to risperidone (odds ratio [OR] = 10.45; 95% confidence interval = 1.29-84.89, P = 0.004). No such association was observed with 5HTR2C (-759 C>T) polymorphism. Weight gain and EPS were not associated with the above genetic polymorphisms. CONCLUSION: Hyperprolactinemia, weight gain, and EPSs (>36.7%) were common adverse effects of risperidone. DRD2 - 141C Ins/Del and Del/Del polymorphisms were significantly associated with increased prolactin levels (OR = 10.45) in response to risperidone.

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PURPOSE: Up to 30-40 % of the major depressive disorder patients do not respond sufficiently to antidepressant treatment. Genetic variations in the serotonin transporter gene have been implicated in modulating treatment response to selective serotonin reuptake inhibitors, and this association is influenced by ethnicity. We investigated the influence of serotonin transporter gene variants 5-HTTLPR and rs25531 in Indian population on fluoxetine response. METHODS: One hundred and two major depressive disorder patients were started on fluoxetine treatment and after 6 weeks, classified as responders (n = 56) and non-responders (n = 46) using Hamilton depression rating scale and genotyped. Fisher's exact test was used to compare genotype frequencies between responders and non-responders. One-way analysis of variance and student t test were used to compare the percentage reduction (week 0-6) in Hamilton depression rating scores between genotype and haplotype groups. RESULTS: We observed a significant association between LL genotype of 5-HTTLPR and fluoxetine treatment response (p = 0.0066, OR (95 %) = 4.0 (1.45-11.03)) but not with the functional groups of 5-HTTLPR -rs25531. However, there was a significant difference in percentage reduction in HAM-D scores (week 0-6) between 5-HTTLPR genotypes (LL vs. LS + SS, p = 0.0036; LL vs. LS, p = 0.0109) as well as the functionally grouped haplotypes of 5-HTTLPR -rs25531 (LALA carriers vs. non-carriers of LALA, p = 0.0118; LALA vs. LAS+ LALG, p = 0.0419). CONCLUSION: The LL genotype and LALA haplotype of SLC6A4 are associated with favorable treatment response to fluoxetine in south Indian major depression patients.

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PURPOSE: Alcohol dependence is a public health problem worldwide, commonly associated with withdrawal symptoms for which diazepam is a frequently used drug. We studied the effect of CYP2C19 gene polymorphisms on diazepam loading dose requirement and time to reversal of acute alcohol withdrawal symptoms. We also studied the influence of the polymorphism in this gene on the persistent symptoms after loading dose of diazepam. METHODS: Sixty-nine patients who reported to the psychiatry department with symptoms of alcohol withdrawal diagnosed by DSM-IV criteria were included for the study. A 10-mg loading dose of diazepam was administered iv after baseline assessment of withdrawal severity using CIWA-Ar scoring. The patients were assessed for improvement of the symptoms every two hourly and 20 mg oral diazepam was given based on improvement of symptoms. Genotyping for CYP2C19*2, CYP2C19*3 and CYP2C19*17 was done by PCR-RFLP and RT-PCR methods. RESULTS: The diazepam dose requirement as well as the time required for reversal of acute symptoms was not statistically different among the different genotype groups. Similarly, the frequency of patients with persistent symptoms after successful treatment of the acute episode was not different among the groups. However, the total diazepam dose requirement was influenced by baseline CIWA-Ar scores (adjusted OR 0.21, p = 0.026). In addition, the odds of treatment with a lower dose (10 mg) of diazepam were higher in smokers (adjusted OR 5.22, p = 0.025) and patients with other addiction (adjusted OR 9.26, p = 0.026). CONCLUSION: We found that CYP2C19 polymorphism did not have any significant effect on the diazepam dose requirement, time duration needed for successful treatment or on the persistent symptoms after loading dose of diazepam in South Indian population. However, diazepam dose requirement was influenced by baseline CIWA-Ar score, smoking status and other comorbid addictions.

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