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Dopamine Receptor D2 Ser/Cys 311 Variant Is Associated with Delusion

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Dopamine Receptor D2 Ser/Cys 311 Variant Is Associated with Delusion Molecular Psychiatry (2000) 5, 270–274 2000 Macmillan Publishers Ltd All rights reserved 1359-4184/00 $15.00 www.nature.com/mp ORIGINAL RESEARCH ARTICLE Dopamine receptor D2 Ser/Cys 311 variant is associated with delusion and disorganization symptomatology in major psychoses A Serretti, E Lattuada, C Lorenzi, R Lilli and E Smeraldi Istituto Scientifico Ospedale San Raffaele, Department of Neuropsychiatric Sciences, University of Milan School of Medicine, Italy The D2 receptor (DRD2) is a binding site of many psychoactive drugs and it has been pro- posed as a genetic risk factor for psychiatric disorders. The aim of this investigation was to study the DRD2 S311C variant in major psychoses. We studied 1182 inpatients with diagnoses of bipolar disorder (n = 480), major depressive disorder (n = 269), schizophrenia (n = 366), delusional disorder (n = 44), psychotic disorder not otherwise specified (n = 23) and 267 heal- thy controls. Eight hundred and eighty-seven subjects were also scored for their lifetime symptomatology using the the Operational Criteria checklist for psychotic illness (OPCRIT). DRD2 variants were not associated with affected subjects even when possible confounders like gender and onset were considered. When we considered the 887 subjects with the symp- tomatologic analysis, we observed a significant association of the DRD2 S311C variant with both delusion and disorganization features. The association was present independently from diagnoses. Our results do not show that coding variants of the DRD2 S311C play a major role in conferring susceptibility to major psychoses, but they may be connected with disorganized and delusional symptomatology independently from diagnoses. Molecular Psychiatry (2000) 5, 270–274. Keywords: dopamine receptors; linkage disequilibrium; psychopathology; bipolar disorder; schizo- phrenia; depressive disorder; paranoid disorder Disturbances of dopamine transmission have been a genetic risk factor for schizophrenia following the implicated in the pathogenesis of psychiatric dis- observation of an excess of S311C variants among orders. Inhibitors of dopamine reuptake, like schizophrenics.5 Nevertheless a number of replications amineptine, have an antidepressant action; dopamine failed to confirm the initial report,6–14 with only one agonists, such as l-dopa, amphetamine or bromocrip- replication in Caucasian schizophrenics.15 Mood dis- tine have psychotomimetic effects in schizophrenics. orders have also been investigated. An increased den- Conversely, neuroleptics have antipsychotic properties sity has been reported of D2 or D2-like receptors in the and can induce depression in affective patients caudate of bipolar patients with psychotic symptoms, through their blockade of D2 receptors.1 compared with both normal controls and nonpsychotic The D2 receptor is the major binding site of many bipolar patients.16 Moreover in the same chromosomal typical and atypical neuroleptic drugs and its gene has region a translocation has been observed cosegregating been cloned and mapped to 11q22–23.2 Itokawa et al3 with bipolar disorder.17 Knockout studies suggested a reported a polymorphism causing a structural change behavioral activity of DRD2. Balk et al18 used homolo- from Serine to Cysteine at codon 311 of DRD2 (S311C); gous recombination to generate D2-receptor-deficient this substitution occurs in the third intracellular loop mice. Absence of D2 receptors led to animals that were of the receptor. Preliminary results showed that DRD2 akinetic and bradykinetic in behavioral tests and rarer TaqI variants were associated with higher levels showed significantly reduced spontaneous movements. of the monoamine metabolites homovanillic acid and There is, therefore, the possibility that variants of the 3-methoxy-4-hydroxyphenylglycol in lumbar cerebro- DRD2 receptor may elicit symptomatologic effects. spinal fluid in controls.4 S311C has been proposed as Thus, it has been suggested that the influence of DRD2 variants should be analyzed more at the level of symp- toms rather than syndromes.19 Up to now both linkage Correspondence: A Serretti MD, Dept of Neuroscience, Istituto and association studies failed to detect any association Scientifico H San Raffaele, University of Milano School of Medi- of DRD2 with mood disorders.20–28 A small positive cine, Via Luigi Prinetti 29, 20127 Milano, Italy. E-mail: serretti. 29 alessandroȰhsr.it association was reported in a Spanish sample but it Received 28 May 1999; revised 22 November 1999; accepted 19 failed to be replicated and a positive association was December 1999 also found by Arinami et al,19 but only when consider- DRD2 and major psychoses A Serretti et al 271 ing mood disorder subjects with mood incongruent The possible association of DRD2 with symptoms psychotic features. was suggested by the observation of Arinami et al19 that Traditionally the definition of the phenotype has the frequency of individuals with DRD2 variant was been based on categorical diagnoses which do not significantly higher in mood disorders with mood guarantee biological homogeneity and have been con- incongruent psychotic symptoms, but similar in mood sidered reductive of the amount of information avail- disorders without psychotic features when compared able from the whole symptomatologic presentation of with the controls.19 Following this hypothesis, a symp- patients.30–32 Moreover, converging evidence indicates tomatologic analysis has been performed using SADS that susceptibility genes only elicit limited symp- items on a small sample of schizophrenics and no tomatologic effects on psychiatric syndromes.33–35 We association was detected.53 We did not replicate the have, therefore, developed a phenotype definition that finding in a preliminary report using the DRD2 VNTR is based on four symptomatological factors: Excite- marker in a sample of 47 bipolar subjects.54 However, ment, Depression, Delusion and Disorganization.36 Our we reported and confirmed an association of DRD2* results are coherent with previous studies performed S311C with disorganized symptomatology in a large both in schizophrenia and mixed psychotic samples.37–41 sample of 267 schizophrenics and delusional sub- Family studies evidenced a moderate but significant jects.51,52 This association may explain previous con- heritability for all psychopathological factors.42–48 The flicting results where disorganized symptomatology factors are stable over time49 and they are correlated was not considered and a variable rate of disorganized with regional anatomical abnormalities.50 subjects may have influenced DRD2 frequencies. We have previously detected and replicated an In the present article we used a phenotype definition association of the DRD2 S311C variant with disor- that is based on the lifetime excitement, depressive, ganized symptomatology of schizophrenia.51,52 In the delusional and disorganized symptomatology.36 This is present study we investigated the possible influence of an alternative to the traditional use of psychiatric diag- the DRD2 S311C polymorphisms in major psychoses. noses to define the affected phenotype for genetic stud- For DRD2 S311C polymorphism, bipolars, major ies.30,31 However, the use of symptoms for phenotype depressives, schizophrenics and delusionals did not definition may be considered a limitation as symp- show any overall genotypic association (Table 1). tomatologic presentation may vary across illness epi- When considering 2 × 2 tables a trend was observed sodes. We used a lifetime scoring perspective includ- toward an excess of DRD2 S311C among schizo- ing ever-presented symptoms to reduce this bias, and phrenics (␹2 = 4.29; df = 1; P = 0.038) as compared to follow-up studies evidenced that episodes are substan- controls. The association drops to non significance tially stable over time.55 We are currently collecting fol- when corrected for multiple testing. Early age of onset low-up data to further reduce this bias. (Ͻ25 years) and gender did not modify DRD2 variant Ethnic origin is also a cause of stratification bias but frequencies significantly. Control subjects and patients our sample was composed of subjects mainly collected in all diagnostic groups were in Hardy–Weinberg equi- in the North of Italy with Italian antecedents for at least librium. two generations. Although genetic heterogeneity has When we considered the 887 subjects with the symp- been evidenced for some isolated populations (such as tomatologic analysis, we observed a significant associ- Sardinia, not included in our sample), Italy is charac- ation of the DRD2 S311C variant with both delusion terized by a substantial genetic homogeneity.56 Con- and disorganization features (Table 2). The association trols were screened for the absence of mental illnesses. was present independently from diagnoses and gender. Although this may introduce a bias on allelic fre- Severity of illness is directly associated with symptom quencies, association studies comparing very common scores, and this could constitute a bias for the detection diseases like major depression should exclude these of liability factors. Then we repeated the calculation cases from the control sample, as they may obscure including clinical indicators of severity as covariants positive associations. in turn. We considered the age of onset, current age and The use of drugs could bias our ability to detect length of disease. None of those covariates significantly naive symptomatology, but this should not constitute influenced the results (data not shown). a major obstacle.36,57
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