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New Insights and Perspectives on the Genetics of Obsessive-Compulsive

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New Insights and Perspectives on the Genetics of Obsessive-Compulsive xxxxxxXXXXXXCopyrightShanmugapriyaPGPG10.1097/YPG.00000000000002307June2019Psychiatric © 2019Genetics Wolters0955-8829Lippincott Kluwer Williams Health, & WilkinsLondon,Inc. All rights UK reserved. Review article Review article 1 New insights and perspectives on the genetics of obsessive-compulsive disorder Gwyneth Zaia,b,c Csaba Bartad, Danielle Cathe,f, Valsamma Eapeng, Daniel Gellerh, and Edna Grünblatti,j,k Psychiatric genetic research has exploded in search of Keywords: epigenetics, genetics, gene–environment interaction, gene–gene interaction, imaging genetics, obsessive-compulsive disorder, polygenic risk factors over the past decade, but because pharmacogenetics of the complexity and heterogeneity of mental illnesses, aNeurogenetics Section, Molecular Brain Science Department, Campbell using the current understanding of the genome has not Family Mental Health Research Institute, Centre for Addiction and Mental reached the conclusion of finding a cause for psychiatric Health, bDepartment of Psychiatry, cInstitute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada, dInstitute of Medical disorders. Obsessive-compulsive disorder is a relatively Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, common and often debilitating neuropsychiatric disorder Budapest, Hungary, eGroningen University and University Medical Center f that has not been the primary focus in psychiatric Groningen, Department of Psychiatry, The Netherlands, Drenthe Mental Health Institute, Department of Specialist Training, The Netherlands, gDepartment of research. Clinicians and researchers who have dedicated Psychiatry, University of New South Wales, Sydney, Australia & Academic Unit to investigate the genetics of obsessive-compulsive of Child Psychiatry South West Sydney, Ingham Institute and Liverpool Hospital, Sydney, Australia, hMassachusetts General Hospital and Harvard University disorder have detected a strong genetic involvement. This Medical School, Boston, MA, USA, iDepartment of Child and Adolescent review will provide an update and a new perspective on Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, j the current understanding of the genetics of obsessive- Switzerland, Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland and kZurich Center for Integrative Human Physiology, University of compulsive disorder, which includes epidemiological data, Zurich, Switzerland family and twins studies, candidate gene studies, genome- Correspondence to Gwyneth Zai, MD, Neurogenetics Section, Molecular Brain wide association studies, copy-number variants, imaging Science Department, Campbell Family Mental Health Research Institute, Centre genetics, epigenetics, and gene–environment interaction. for Addiction and Mental Health, Department of Psychiatry, Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, M5T 1R8, ON, Psychiatr Genet XXX: 00–00 Copyright © 2019 Wolters Canada Kluwer Health, Inc. All rights reserved. Tel: +1 416 535 8501; fax: +1 416 979 4666; e-mail: [email protected] Psychiatric Genetics 2019, XXX:000–000 Received 30 April 2019 Accepted 18 June 2019 Introduction Treatment of OCD consists of two main streams, psy- Obsessive-compulsive disorder (OCD) is a chronic chotherapy and pharmacotherapy. Cognitive behavior and severe neuropsychiatric disorder, affecting 1–3% therapy (CBT) with exposure and response prevention of the overall population (Ruscio et al., 2010). It has a is the first-line psychological treatment of OCD and ser- lifetime prevalence of 2.3% and 12-month prevalence otonergic antidepressants are considered to be the first- of 1.2% (Ruscio et al., 2010) in addition to subclinical line pharmacological treatment of OCD (Koran et al., rates for healthy individuals and individuals with other 2007; Katzman et al., 2014). However, response rate psychiatric disorders ranging from 13 to 17% and 31 to varies ranging from 40 to 60% in medication treatment 49%, respectively (Fullana et al., 2009). OCD is char- (McDougle et al., 1993; Foa et al., 2005) and 70 to 86% acterized by chronic and often debilitating symptoms for CBT (Foa et al., 2005). Furthermore, both treatment of obsessions and compulsions (American Psychiatric options have limitations including side effects from the Association, 2013). Obsessions are irrational, unwanted, medications, commitment time, and access for CBT and intrusive thoughts, images, impulses, and urges that (Sadock et al., 2007). Currently, treatment guideline to generate significant distress, whereas compulsions are differentiate patients according to their response and tol- repetitive rituals and mental acts that cannot be resisted erability to medications and CBT does not exist. Thus, and are performed in order to alleviate distress (American genetic profiling coupled with new knowledge on treat- Psychiatric Association, 2013). ment outcome would provide a substantial leap in the management of OCD. According to the WHO, OCD is one of the top 10 lead- ing causes of disability globally and is the fourth most The underlying etiology of OCD remains largely frequently diagnosed psychiatric disorder. Therefore, unknown and improving the understanding of the bio- improving public awareness in addition to optimizing logical mechanism of OCD will help guide research to assessment and treatment is necessary to reduce the soci- optimize the identification of and treatment for this debil- etal burden of OCD worldwide. itating disease. Genetics has been studied extensively 0955-8829 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/YPG.0000000000000230 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 2 Psychiatric Genetics 2019, Vol XXX No XXX across psychiatric disorders and experts would agree that synaptic cleft in order to bind to postsynaptic receptors, the underpinning of psychiatric disorders is at least partly which lead to the inhibition of its reuptake into the pre- due to polygenic effects. synaptic cells. The target of SSRIs, the serotonin trans- porter coded by the SLC6A4 gene, has consistently been Traditional genetic studies have utilized hypothe- reported to be associated with OCD (Taylor, 2013; Brem sis-driven candidate gene approach. Specific genes were et al., 2014; Walitza et al., 2014; Taylor, 2016). These stud- chosen based on the putative biological mechanisms and ies have detected the L allele of the single nucleotide drug targets of existing psychotropic medications. With A polymorphism (SNP), rs25531, within the serotonin advances in genomic technology and bioinformatics, the transporter-linked polymorphic region (5-HTTLPR) of use of genome-wide association studies (GWAS) has sig- this gene increases the risk for OCD. The serotonin 2A nificantly increased in the past decade, which provided receptor (HTR2A) gene is another commonly studied ways to investigate previously unexplored regions that candidate gene for OCD and based on the most recent may be of great importance in the etiology of OCD. meta-analysis (Taylor, 2013), it showed a nominally signif- This review article will first provide an update on the icant result for the rs6311 SNP [odds ratio (OR) = 1.219; heritability of OCD, followed by results from important 95% confidence interval (CI), 1.037–1.433; P = 0.003]. In human and animal candidate gene studies and GWAS addition to the most consistent findings for 5-HTTLPR (Burton et al., in press). Subsequently, this article will and HTR2A rs6311 in OCD (Sinopoli et al., 2017), mixed summarize studies on rare genetic variants, genetics results of other serotonergic genes with OCD, including of intermediate phenotypes including drug response monoamine oxidase A (MAOA), tryptophan hydroxylase and imaging, epigenetics in addition to gene–gene and (TPH1 and 2), and serotonin 1D-beta receptor (HTR1B), gene–environment interactions (Burton et al., in press). have been reported, which require further replication Finally, this article will end with shared genetic phenom- (Walitza et al., 2004; Liu et al., 2013; Taylor, 2013; Brem et enon: overlap across psychiatric disorders, in light of the al., 2014; Di Nocera et al., 2014; Mas et al., 2014; Sampaio Brainstorm paper (Brainstorm et al., 2018), and future et al., 2015). perspectives on the genetics of OCD. Glutamatergic system genes Heritability and familiality of obsessive-compulsive Evidence has implicated the alteration of the glutamate disorder system as part of the neuropathophysiological etiology of Family studies have shown that the prevalence of OCD OCD, specifically with a disturbance in the cortico-stri- in the relatives of individuals with OCD is higher than the ato-thalamo-cortical (CSTC) circuit (Pauls et al., 2014). general population, 10–12% versus 1–3%, respectively Converging evidence from animal and human studies (Nestadt et al., 2000; Pauls, 2010; Pauls et al., 2014). Twin supports abnormal activation within this circuit, lead- studies have estimated the heritability of OCD ranging ing to hyperactivation of the orbitofrontal-subcortical from 42 to 65% (Pauls et al., 2014) for OCD symptoms, pathway, which in turn mediates exaggerated concerns 27 to 47% for adult-onset OCD, and 45 to 65% for child- related to danger, harm, symmetry, and contamination, hood-onset OCD (van Grootheest et al., 2005; Zilhao et as seen in individuals suffering from OCD (Pauls et al., al., 2019). 2014). Additional rationale of
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