Endophenotypes for Nicotine- Dependence Risk at Or Before Initial Nicotine Exposure
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8 Endophenotypes for Nicotine- Dependence Risk at or before Initial Nicotine Exposure Janet Audrain-McGovern, Joel T. Nigg, and Kenneth A. Perkins Characteristics present before or at the time of nicotine exposure may play a key role in identifying individuals at genetic risk for nicotine dependence. This chapter examines the evidence base for several candidate endophenotypes for nicotine-dependence risk at or before smoking and nicotine exposure, including the following: ■ Approach-related smoking risk variables based on psychological traits such as impulsivity, novelty seeking, and extraversion, using laboratory measures for aspects of reinforcement and reward ■ Avoidance-related smoking risk variables based on psychological factors such as neuroticism, stress, depression, and anxiety, using laboratory measures including personality trait measures, peripheral nervous system (PNS) effects, and neuroendocrine response to cortisol ■ Control-related smoking risk based on psychological variables such as attention deficit hyperactivity disorder (ADHD), conduct disorders, aggression, and hostility, using laboratory measures including response inhibition, event-related potential (ERP) P300 amplitude, attention, and alertness ■ Measures of initial response to nicotine exposure, including reinforcement and reward measures of initial sensitivity to nicotine, as well as initial sensitivity to affective and mood responses to nicotine Although available evidence shows a link between many of these variables and smoking behavior, further research is needed to establish possible nicotine-dependence endophenotypes from a standpoint of predictive validity, biological plausibility, reliability, and heritability. The analyses described herein were supported in part by National Institute of Health grants AA12217, CA096836, CA109250, DA05807, DA19478, and DA021032. 339 8. Endophenotypes for Nicotine Dependence Risk Introduction Endophenotypes This chapter examines potential An explanatory gap between candidate genes endophenotypes for risk for (1) initiating and the presence of symptoms of nicotine and progressing in smoking and dependence necessitates new approaches (2) responding to the initial nicotine to identifying genetic liability markers. exposure. First, it briefly surveys major Smoking risk is an area of study overlapping within-person risk factors for smoking with numerous complex disorders and initiation and progression. It then assesses traits with which it is correlated. Therefore, these from the perspective of potential a useful strategy may be to identify valid endophenotypes via a conceptual model and reliable intervening constructs to link of neural circuits that may be relevant candidate genes and nicotine dependence, to smoking initiation and progression, as has been suggested for behavioral particularly with regard to a general risk traits and disorders generally.5–8 The fi eld pathway. A general risk pathway indicates holds relative consensus that genetic and a vulnerability that may be shared between environmental risk for substance use nicotine and other drugs; hence, some includes a general risk factor (not specifi c overlap can be expected in the domains of to one drug) and drug-specifi c factors.9 interest here with those being studied for Intervening constructs need to be identifi ed other drugs such as alcohol. This approach both at the general level (where they will is well justified in view of behavioral be shared among several drugs) and at the genetic evidence of shared genetic liability nicotine-specifi c level. to the misuse of nicotine, alcohol, and other drugs,1–3 although the degree of These intervening constructs, referred to as shared genetic factors may vary with age.4 endophenotypes, can be neurophysiological, However, some endophenotypes may be biochemical, endocrinological, relatively more general and linked to initial neuroanatomical, cognitive, behavioral, attraction to many types of substances or neuropsychological, as long as the (e.g., reward dependence), and others may endophenotype ultimately enhances the have greater specificity to trying nicotine genetic signal for the disorder’s causal (e.g., attentional dysfunction). processes.10 Most behavioral measures, although providing useful clues, are usually The second part of this chapter considers considered less parsimonious than most processes occurring in the early stages of cognitive or biological endophenotypes given nicotine exposure that may increase the the (presumed) extra steps needed to link likelihood of further exposure to nicotine them to genes or the proteins for which they and subsequent nicotine dependence; code. Further, because genes infl uencing it looks at potential endophenotypes behavioral and addictive disorders are at that inflection point, shifting to a presumed to operate in the brain, and to be pharmacological response model and a detectable by probes of brain activity (such more drug-specific pathway. A drug-specifi c as cognition), cognitive and physiological model is justified at this infl ection point measures that can be validated in relation to by evidence that pharmacological response neural systems are attractive candidates. may influence selection of drug use over time. The final section of the chapter Consequently, a neural networks discusses the state of the research and offers perspective is useful to analyze potential recommendations for future investigation. endophenotypes. Such a model can be 340 Monograph 20. Phenotypes and Endophenotypes adopted to examine behavioral, cognitive, endophenotype.7,10,13 The criteria used to and physiological endophenotypes that may evaluate a potential endophenotype for be related to smoking initiation discussed in nicotine dependence include (1) predictive the first half of this chapter. Nicotine is not validity; that is, it is related to a smoking a drug of universal exposure. Thus, factors phenotype of interest (initiation or that differentially influence initiation of use, progression); (2) biological plausibility; including genetics, are critical. At the same that is, it can be linked to specifi c neural time, once smoking has been initiated, the pathways or actions, which can relate pharmacological response to the nicotine directly to candidate genes; (3) reliability; presumably becomes a key factor in an and (4) heritability. Bivariate heritability is adolescent’s subsequent smoking behavior not evaluated in this chapter because data are and progression to nicotine dependence. lacking on its relation to smoking initiation Therefore, the second part of this chapter and progression. For more discussion of the moves to a lower (more molecular) level of criteria for an endophenotype, see Waldman analysis and considers a pharmacological and colleagues.13,14 perspective on smoking progression in conjunction with trait measures. This chapter derives its concept of “endophenotype,” which has been Assuming an endophenotype can be criticized as underspecified, from other validated, it can provide a potentially studies. For example, Szatmari and powerful tool for identifying individuals colleagues15 suggest that responses at genetic risk of initial nicotine use that are often considered as potential and of going on to nicotine dependence endophenotypes can be conceptualized (becoming nicotine dependent and as one of three “subtypes,” only two of staying nicotine dependent), and it can which would be true endophenotypes: also clarify phenotypic heterogeneity.11 (1) component phenotype, (2) intermediate That is, complex traits such as smoking phenotype, and (3) covariate.15 Component and nicotine dependence are probably phenotypes capture only one aspect of a due to numerous genes in several multidimensional disorder of interest; pathways, interacting with each other and they may or may not be a necessary part of the environment. Endophenotypes are the disorder, but they are not a suffi cient intended to represent more defi ned and determinant (i.e., alone they do not fully quantifiable measures that are thought to capture the disorder). Building on the logic involve fewer genes and fewer interacting of these authors, component phenotypes pathways, which ultimately result in the can be viewed as a portion of the disorder activation of a narrower set of neuronal phenotype but not part of the causal chain circuits.11 Because endophenotypes, when to it. Intermediate phenotypes, by contrast, valid, are more proximal biologically refer to a mechanism believed to be part to the putative genetic infl uences, they of the causal chain to the disorder; this is may be more sensitive measures for the original meaning of “endophenotype” genetic studies of nicotine dependence.12 provided by Gottesman.10 An intermediate No endophenotypes have been validated phenotype is expected to refl ect a for smoking risk; this chapter examines predisposition for the disorder in unaffected candidate markers that may hold promise family members as well as in those already as potential endophenotypes. affected. The third subtype, covariates, are really not endophenotypes at all; they are Several criteria have been advanced factors related to the disorder of interest to evaluate the validity of a putative but not components of it and certainly not 341 8. Endophenotypes for Nicotine Dependence Risk causal. Part of the goal of research in this influences the likelihood of becoming area is to determine into which of these nicotine dependent and the rate of subtype categories a candidate measure progression in nicotine dependence actually