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Master's Dissertation
DOI
Document
Author
Full name
Bruna Valim de Nicola
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Gattaz, Wagner Farid (President)
Oliva, Samara Urban de
Rave, Cintia Fridman
Vallada Filho, Homero Pinto
Title in Portuguese
Farmacogenética do lítio: marcadores de refratariedade em pacientes com transtorno bipolar
Keywords in Portuguese
Farmacogenética
Lítio
Polimorfismo de nucleotídeo único
Refratariedade
Transtorno bipolar
Abstract in Portuguese
Os sais de lítio são utilizados no tratamento dos transtornos do humor há mais de 50 anos. É a principal medicação prescrita para pacientes com diagnóstico de transtorno bipolar (TB), No entanto, aproximadamente 70% dos pacientes não respondem satisfatoriamente, ou seja, são refratários ao tratamento com lítio. Tendo em vista a importância do uso do lítio no tratamento de TB e a influência de fatores genéticos na variabilidade da biodisponibilidade do medicamento e em seus efeitos (95%), é de extrema importância esclarecer o papel da farmacogenética envolvida na resposta ao lítio. O objetivo deste trabalho foi detectar possíveis marcadores genéticos em pacientes com TB para melhor predição da resposta à terapia medicamentosa Para tanto, estudamos os polimorfismos dos genes relacionados ao mecanismo de ação do lítio: glicogênio- sintase quinase 3 - beta (GSK3-Beta), fator neurotrófico derivado do cérebro (BDNF), Receptor neurotrófico de tirosina quinase tipo 2 (NTRK2) e proteína ligada ao elemento de resposta cAMP (CREB) em pacientes bipolares respondedores e refratários ao tratamento com lítio com fenótipo determinado por escalas HDRS e YMRS, e análise dos prontuários, e escala ALDA. Na nossa amostra, os polimorfismos CREB1-1H (G > A), CREB1-7H (C > T), BDNF (rs6265 - G > A) e NTRK2 (rs1387923 - T > C) não apresentaram associação significativa dos genótipos com a resposta à terapia com lítio. Para os resultados obtidos na análise genotípica correspondente ao polimorfismo rs334558 (C > T) do gene GSK3-Beta, verificamos maior incidência do genótipo heterozigoto CT em pacientes respondedores e maior incidência do genótipo polimórfico homozigoto TT em pacientes refratários. Para a metodologia ALDA, não obtivemos diferenças que relacionassem os polimorfismos selecionados a refratariedade ao lítio. Acreditamos que o pequeno número amostral incluídos em nosso estudo pode ter prejudicado a determinação desses polimorfismos na resposta ao lítio
Title in English
Pharmacogenetics of lithium: markers of refractoriness in patients with bipolar disorder
Keywords in English
Bipolar disorder
Lithium
Pharmacogenetics
Polymorphism single nucleotide
Refractoriness
Abstract in English
Lithium salts have been used in the treatment of mood disorders for more than 50 years. It is the main medication prescribed for patients diagnosed with bipolar disorder (BD). However, approximately 70% of the patients do not respond satisfactorily, that is, they are refractory to treatment with lithium. Given the importance of using lithium in the treatment of BD and the influence of genetic factors on the variability of the bioavailability of the drug and its effects (95%), it is extremely important to clarify the role of pharmacogenetics involved in the lithium response. The goal of this study was to detect possible genetic markers in BD patients to better predict the response to drug therapy. In order to do so, we studied the polymorphisms of genes related to the mechanism of action of lithium: glycogen synthase kinase 3 - beta (GSK3-Beta), brain-derived neutrophic factor (BDNF) tyrosine kinase type 2 neurotrophic receptor (NTRK2) and cAMP response element-binding protein (CREB) in responders and refractory bipolar patients that used lithium in the treatment. The phenotype was determined by HDRS and YMRS scales, and analysis of charts, and ALDA scale. In our sample, the polymorphisms CREB1-1H (G > A), CREB1-7H (C > T), BDNF (rs6265 - G > A) and NTRK2 (rs1387923 - T > C) had no significant association of genotypes with the response to lithium therapy. For the results obtained in the genotype analysis corresponding to the polymorphism rs334558 (C > T) of the GSK3-Beta gene, we verified a higher incidence of the heterozygous CT genotype in responding patients and a higher incidence of the polymorphic homozygous TT genotype in refractory patients. For the ALDA methodology, we did not obtain differences that related the selected polymorphisms to refractoriness to lithium. We believe that the small sample size included in our study may have impaired the determination of these polymorphisms in lithium response
 
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Publishing Date
2019-05-23
 
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