A pharmacogenomic approach to Alzheimer's disease

Acta Neurol Scand Suppl. 2000;176:12-9. doi: 10.1034/j.1600-0404.2000.00302.x.

Abstract

Single nucleotide polymorphisms (susceptibility genetics) and genomic point mutations (mendelian genetics) can be used in Alzheimer's disease (AD) for diagnostic, predictive and therapeutic purposes. Using a matrix genetic model, including APOE, PS1 and PS2 allelic variants, we have studied the distribution of 36 different genotypes in the AD population (N= 479) and the genotype-related cognitive response to a multifactorial therapy in AD patients with mild-to-moderate dementia. The 10 most frequent AD genotypes are the following: 1) E33P112P2 + (17.75%), 2) E33P112P2- (15.55%), 3) E33P111P2+ (10.85%), 4) E34P112P2+ (9.60%), 5) E34P112P2- (7.56%), 6) E33P111P2- (7.10%), 7) E34P111P2+ (4.80%), 8) E33P122P2+ (4.38%), 9) E34P111P2- (4.18%), and 10) E34P122P2+ (3.55%). APOE-4/4-related genotypes represent less than 3% in the following order: E44P112P2 + > E44P111P2+ = E44P111P2- > E44P112P2+ > E44P122P2+ = E44P122P2. Multifactorial therapy with CDP-choline (1,000 mg/day) + piracetam (2,400 mg/day) + anapsos (360 mg/day) did improve mental performance during the first 6-15 months in a genotype-specific fashion. The best responders in the APOE series were patients with APOE-3/4 genotype (r= +0.013), while the worst responders were APOE-4/4 patients (r= -0.93). PS1-related genotypes responded in a similar manner; and patients with a defective PS2 gene exon 5 (PS2+) always showed a poorer therapeutic response than PS2- patients. All these data suggest that the therapeutic outcome in AD exhibits a genotype-specific pattern, and that a pharmacogenomic approach to AD might be a valuable strategy for drug development and monitoring.

Publication types

  • Clinical Trial

MeSH terms

  • Adjuvants, Immunologic / pharmacology*
  • Adjuvants, Immunologic / therapeutic use
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / drug therapy*
  • Alzheimer Disease / genetics*
  • Alzheimer Disease / pathology
  • Apolipoproteins E / genetics*
  • Apolipoproteins E / metabolism
  • Cognition / drug effects*
  • Cytidine Diphosphate Choline / pharmacology*
  • Cytidine Diphosphate Choline / therapeutic use
  • Drug Therapy, Combination
  • Exons
  • Female
  • Genotype
  • Glycosides / pharmacology*
  • Glycosides / therapeutic use
  • Humans
  • Male
  • Membrane Proteins / genetics*
  • Membrane Proteins / metabolism
  • Middle Aged
  • Nootropic Agents / pharmacology*
  • Nootropic Agents / therapeutic use
  • Piracetam / pharmacology*
  • Piracetam / therapeutic use
  • Presenilin-1
  • Presenilin-2
  • Prognosis
  • Treatment Outcome

Substances

  • Adjuvants, Immunologic
  • Apolipoproteins E
  • Glycosides
  • Membrane Proteins
  • Nootropic Agents
  • PSEN1 protein, human
  • PSEN2 protein, human
  • Presenilin-1
  • Presenilin-2
  • Cytidine Diphosphate Choline
  • anapsos
  • Piracetam