Rheumatol Int (2008) 28:685–691 DOI 10.1007/s00296-008-0525-8
O R I G I N A L A R T I CL E
Polymorphisms of the serotonin-2A receptor and catechol-Omethyltransferase genes: a study on Wbromyalgia susceptibility Berna Tander · Sezgin Gunes · Omer Boke · Gamze Alayli · Nurten Kara · Hasan Bagci · Ferhan Canturk
Received: 4 August 2007 / Accepted: 16 December 2007 / Published online: 15 January 2008 © Springer-Verlag 2008
Abstract Genetic and environmental factors are thought to play roles in the etiopathology of Wbromyalgia syndrome (FMS). The objective of this study was to determine the potential eVects of single nucleotide polymorphisms (SNPs) in catechol-O-methyltransferase (COMT) (rs4680) and 5-hydroxytryptamine (serotonin) 2A (5-HT2A) receptor (rs6313 and rs6311) genes on susceptibility to FMS. One hundred seventy-one women (80 FMS, 91 control) were enrolled in the study. Polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) method was used for the genotyping analyses. Genotype and allele frequencies were calculated by the chi-square test. Beck depression inventory, state and trait anxiety inventory and symptom checklist-90 revised (SCL-90-R) tests were applied to both patients and controls. There were no observed diVerences in the frequencies of alleles and genotypes between patients and controls for the COMT, and the two 5-HT2A receptor gene polymorphisms (P > 0.05). Our results suggest that the investigated polymorphisms seem not to be the susceptibility factors in etiology of FMS.
B. Tander (&) · G. Alayli · F. Canturk Department of Physical Medicine and Rehabilitation, Ondokuzmayis University School of Medicine, 55139 Kurupelit, Samsun, Turkey e-mail:
[email protected] S. Gunes · N. Kara · H. Bagci Department of Medical Biology and Genetics, School of Medicine, Ondokuzmayis University, Samsun, Turkey O. Boke Department of Psychiatry, School of Medicine, Ondokuzmayis University, Samsun, Turkey
Keywords Fibromyalgia · Gene polymorphism · 102T/C · 5-HT2A · ¡1438G/A
Introduction Fibromyalgia syndrome (FMS) is a chronic disorder that is estimated to aVect 2–4% of the population; it is characterized by diVuse musculoskeletal pain, sleep disturbance, fatigue, stiVness, and presence of multiple tender points [1, 2]. Investigators have shown that psychiatric disorders such as depression, anxiety, and hypochondriasis are related to FMS [3, 4]. The pathogenesis of FMS is unknown, although it has been postulated that various psychiatric abnormalities that develop in a context of both genetic and environmental factors may play signiWcant roles [5]. Recently, some authors reported a strong familial aggregation in FMS [6, 7]. Researchers studied roles of polymorphism of the genes in the serotoninergic, catecholaminergic, and dopaminergic systems in the etiology of FMS [8–11]. Serotonin (5-hydroxytryptamine, 5-HT) is a key neurotransmitter in the central nervous system. It plays role in sleep cycle, pain responses, vasoconstriction, depression, and anxiety. The eVect of serotonin is mediated by diVerent 5-HT receptor subtypes [12]. The 5-HT2A receptor is located in cortex, caudate nucleus, and all the intestines, and it may play a role in the etiology of several neuropsychiatric diseases and pain perception [13]. Human 5-HT2A is mapped to chromosome 13q14-21 [14]. Recently, a silent polymorphism in the 5-HT2A receptor gene was identiWed, which is deWned by a T to C transition at position 102, and a novel G to A base change at position ¡1438 of the promoter region has been detected, which is in a very strong linkage disequilibrium with the 102T/C polymorphism of 5-HT2A [15]. Although the 102T/C polymorphism does not
123
686
result in alteration of the amino-acid sequence of the protein, a strong association was found between 102T/C polymorphism and some psychiatric illnesses such as mood disorder and schizophrenia [16, 17]. There are conXicting results regarding the association of this polymorphism with FMS [8, 18, 19]. There is no report about the relationship between ¡1438G/A promoter polymorphism of 5-HT2A receptor gene and FMS up to now. Furthermore, it was reported that the ¡1438G/A polymorphisms in the 5-HT2A promoter region may be the susceptibility gene in patients with obsessive-compulsive disorder (OCD) and seasonal aVective disorder [20, 21]. Catechol-O-methyltransferase (COMT) is an enzyme that inactivates catecholamines (dopamine, adrenaline, and noradrenaline) and thereby acting as a key modulator of dopaminergic neurotransmission [22]. Gene that codes COMT is located on 22q11. Various single nucleotide polymorphisms (SNPs) have been shown in COMT gene, and the best studied of them is rs4680 [9]. The COMT gene has been implicated in the pathogenesis of neuropsychiatric disorders such as OCD and schizophrenia [23, 24]. The relationship between the presence of FMS and COMT gene polymorphism has been investigated only in one study so far [9]. Fibromyalgia is a member of the family of the disorders called “aVective spectrum disorder” (ASD). These disorders may have a common heritable pathophysiologic feature. Hudson et al. demonstrated that the forms of ASD frequently occur together within individuals (cooccurrence) and within families (coaggregation) further suggesting that these various forms might all share common etiologic factors and that are possibly heritable [25]. Fibromyalgia and aVective disorders can be due to a common underlying abnormality, which according to the theories of depression, is most probably related to the catecholaminergic or serotonergic neurotransmission [26, 27]. Whether the FMS and some neuropsychiatric disorders share the same etiopathogenesis, or they are separate entities that coincidentally have the same alterations in gene loci are unknown. The aim of this study was to determine the potential eVects of 102T/C and ¡1438G/A polymorphisms of the 5-HT2A receptor and COMT genotypes in patients with FMS and healthy controls in a Turkish population.
Materials and methods Subjects This study was designed as a case–control study. The study was conducted between May 2003 and July 2006 at the outpatient clinics of Physical Medicine and Rehabilitation Department. Eighty women who met the 1990 American
123
Rheumatol Int (2008) 28:685–691
College of Rheumatology criteria [1] for the diagnosis of FMS and 91 age-matched controls were enrolled. Patients and controls were of the same ethnic origin and from the same geographic area (Black Sea Coastal Region). The approval from the Ethical Committee of Human Studies was obtained. Written informed consent was also obtained from all patients as well as the healthy volunteers. Subjects were selected with the following criteria: (1) the symptoms of Wbromyalgia for at least 1 year preceding the study, (2) age > 18 years, (3) at least 5 years of basic education, and (5) no history of another major physical or psychiatric illness that could interfere with the application of the psychological tests such as psychosis and mental retardation. Healthy controls with no history of chronic rheumatologic or psychiatric disease were matched for sex, age, and education. All the patients had normal laboratory tests results regarding erythrocyte sedimentation rate, complete blood cell count, and liver function tests. The patients were questioned about their educational level, habits, social, and marital status. A visual analog scale (VAS) was used to measure perceived pain intensity in all subjects. Tender point examination was carried out by the exertion of a uniform amount of manual Wnger pressure, until Wngernail bed blanches. The patients and controls were evaluated by a single psychiatrist (O.B.) according to Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR) criteria, and patients who had any psychiatric diagnosis were excluded from the study to avoid genetical interference of psychiatric diagnosis and FMS. The patients and controls were also evaluated using psychiatric tests including the Beck depression inventory (BDI), revised symptom checklist-90 (SCL-90 R), and state and trait anxiety inventories (STAI)-I and -II. All patients were able to complete the questionnaires independently alone in a hospital room reserved for them. Revised symptom checklist-90 The revised symptom checklist-90 (SCL-90 R) is a self-report instrument that has previously been used in Wbromyalgia patients and healthy controls. It measures 90 items on a Wve-point scale of distress from 0 to 4 (none–extreme) and contains nine dimensions of psychological distress: somatization, obsessive-compulsive, interpersonal sensivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, as well as global severity index [28, 29]. A Turkish adaptation of the SCL-90-R was used [30]. The Beck depression inventory The depression rate was assessed by the Beck depression inventory (BDI) in all patients and controls (0–63). The test
Rheumatol Int (2008) 28:685–691
consists of 21 questions scaled in a Likert format. The higher score shows increased depression of the subjects. It was shown to be valid and reliable in Turkish patients [31, 32]. State and trait anxiety inventories-I and -II The state and trait anxiety inventories (STAI) consist of 44 items on which subjects rate themselves on four-point scales that assess either the intensity of their angry feelings or the frequency with which anger is experienced, expressed, suppressed, or controlled [33]. The scale has been validated in Turkish population studies with Cronbach’s of subscales ranging between 0.69 and 0.90 [34]. The Wbromyalgia impact questionnaire The Wbromyalgia impact questionnaire (FIQ) is widely used in FMS patients to evaluate both the clinical severity of the disease and the eYcacy of diVerent treatments, and has been found to be valid and reliable in Turkish Wbromyalgia patients [35, 36]. DNA extraction DNA was isolated from the heparinized 4 ml peripheral blood samples from all subjects using the ‘salting out’ method [37]. The 102T/C, ¡1438G/A of 5-HT2A receptor gene, and G/A polymorphism in COMT gene were identiWed from the National Center for Biotechnology Information LocusLink database [38]. The genotypes for restriction fragment length polymorphisms (RFLP) of the 5-HT2A receptor gene and COMT gene were determined by polymerase chain reaction (PCR-RFLP) (Techne Gradient, Cambridge, UK) and enzymatic digestion of the products with MspI and NlaIII restriction enzymes. Genotyping of 5-HT2A (rs6313, rs6311) receptor gene polymorphisms The ¡1438G/A (rs6311) polymorphism in the promoter region of 5-HT2A receptor gene was determined by PCRRFLP as described by Arranz et al. [15]. The following primers (Iontec, Bursa, Turkey) were used in PCR reactions: 5'-AAG CTC CAA GGT AGC AAC AGC-3' forward and 5'-AAC CAA CTT ATT TCC TAC CAC –3' reverse. PCR was carried out in a total volume of 25 l with 50 ng DNA, 20 pmol of each primer, 1.5 mM MgCl2, and 1.0 U Taq polymerase (MBI, Fermentas, Lithuania). The ampliWcation conditions were initial denaturation at 95°C for 2°min; ampliWcation was performed by 35 cycles of denaturation at 95°C for 60 s, annealing at 61°C for 45 s, and
687
extension at 72°C for 45 s. The reaction was terminated by Wnal extension at 72°C for 7 min. The 102T/C (rs6313) polymorphism of the 5-HT2A receptor gene was performed as described previously [21]. A 342-bp region of the 5-HT2A receptor gene was ampliWed using primers (Iontec, Bursa, Turkey) SG1 5'-TCT GCT ACA AGT TCT GGC TT-3' (forward) and SG2 5'CTG CAG CTT TTT CTC TAG GG –3' (reversed). PCR reactions contained 20 pmol of each primers, 0.2 mM dNTPs, 1.5 mM MgCl2, 50 ng DNA, and 1.0 U Taq polymerase (MBI, Fermentas, Lithuania) in a total volume of 25 l. The PCR program was initial denaturation at 95°C for 3 min and 35 cycles of denaturation at 95°C for 45 s, annealing at 60°C for 45 s and extension at 72°C for 60 s. The reaction was terminated by Wnal extention at 72°C for 5 min. Seven microliters of ampliWcation products of both fragments were then digested with 10 U of MspI (MBI, Fermentas, Lithuania) overnight at 37°C. All the digested products were resolved on 2.5% agarose gel. Four hundred and sixty-eight base pair PCR products of ¡1438G/A polymorphism were cut into 244-bp and 224-bp fragments by endonuclease digestion. The genotype was designated as A when the restriction site was absent and as G when the restriction site was present. The three possible genotypes of 102T/C polymorphism distinguished by three distinct banding patterns, depending on the presence or absence of the MspI restriction site: C/C (342 bp), T/C (342, 215, and 126 bp), and C/C (215 and 126 bp); these were analyzed on a 2.5% agarose gel stained with ethidium bromide. Genotyping of COMT (rs4680) gene polymorphism AmpliWcation of the 185-bp fragment encompassing NlaIII polymorphic site was ampliWed using primers sense SG3 5'GGA GTC GGG GGC CTACTG GT-3' and antisense SG4 5'-GGC CCT TTT TCC AGG TCT GAC A-3' (reversed). PCR reactions contained 20 pmol of each primers, 1 mM MgCl2, 100 mM of each dNTP, 50 ng DNA, and 1.25 U Taq polymerase (MBI, Fermentas, Lithuania). Following initial denaturation at 94°C for 3 min, ampliWcation was performed by 35 cycles of denaturation at 94°C for 60 s, annealing at 60°C for 60 s, and extension at 72°C for 60 s. The reaction was terminated by extension at 72°C for 7 min. Ten microliters of the PCR products was digested with 5 U of NlaIII (MBI, Fermentas, Lithuania) at 37°C [9]. All the digested products were resolved on 3.5% agarose (Prona) gel. The three possible genotypes of COMT G/A polymorphism were distinguished by three distinct banding patterns, depending on the presence or absence of the NlaIII restriction site: G/G (114 bp, 36 bp and 35 bp), A/G (114 bp, 96 bp, 36 bp, 35 bp and 18 bp) and A/A (96 bp, 36 bp, 35 bp and 18 bp).
123
688
Rheumatol Int (2008) 28:685–691 Table 2 The results of psychiatric tests in in Wbromyalgia patients and control subjects
Statistical analysis Analysis of data was performed using the computer software SPSS 12.0 (SPSS Inc., Chicago, IL, USA). The normality of the variables was evaluated by the Kolmogorov–Smirnov test. The genotype and allelic frequencies were expressed as a percentage of the total number of genotypes or alleles. Odds ratios (OR) and 95% conWdence intervals (CIs) were used for the assessment of risk factors. 5-HT2A receptor gene and COMT genotypes in patients were compared with those in controls using a chi-square test (two-sided) according to Hardy–Weinberg equilibrium. The expected values were compared with those observed in controls and cases by the chi-square test contingency tables. A probability of less than 0.05 was required for statistical signiWcance.
Fibromyalgia patients (n = 80) BDI
The demographical characteristics of the patients are shown in Table 1. The groups were similar according to demographic data and the level of education (P > 0.05). The mean years of education indicate that ours was a well-educated sample. Mean duration of the disease was 3.69 § 4.08 years. All patients had at least 1-year duration of the disorder. The mean VAS score and number of tender points were 7.26 § 1.60 cm and 14.23 § 2.39, respectively. The mean FIQ score was 61.25 § 10.22 in FMS group. The psychopathological data assessed with the BDI, SCL-90-R, STAI-I, and STAI-II are shown in Table 2. There was no diVerence Table 1 Demographic characteristics of Wbromiyalgia patients and controls
Age (year) 2
BMI (kg/m )
Fibromyalgia patients (n = 80)
Controls (n = 91)
P
39.58 § 9.38
37.28 § 9.15
>0.05
24.91 § 4.57
23.56 § 4.18
>0.05
P values
14.98 § 8.90
8.08 § 6.25
>0.05
Global severity index
0.96 § 0.68
0.49 § 0.40
>0.05
Somatization
1.38 § 0.82
0.69 § 0.61
>0.05
Obsessive-compulsive
1.25 § 0.83
0.79 § 0.65
>0.05
Interpersonal sensivity
0.84 § 0.65
0.57 § 0.51
>0.05
Depression
1.04 § 0.81
0.61 § 0.56
>0.05
Anxiety
0.92 § 0.76
0.44 § 0.44
>0.05
Hostility
0.83 § 0.73
0.35 § 0.44
>0.05
Phobic anxiety
0.53 § 0.59
0.23 § 0.34
>0.05
Paranoid ideation
0.86 § 0.78
0.49 § 0.49
>0.05
SCL-90-R
Psychoticism
Results
Controls (n = 91)
0.48 § 0.60
0.20 § 0.31
>0.05
STAI-I
45.92 § 9.75
40.04 § 8.39
>0.05
STAI-II
48.25 § 9.75
43.20 § 8.65
>0.05
Values are mean § SD BDI beck depression inventory, SCL-90-R symptom checklist 90 revised, STAI-I state and trait anxiety inventory
between the patients with FMS and control subjects according to these tests (P > 0.05). Patients’ genotypes The genotype distributions were in Hardy–Weinberg equilibrium among FMS subjects and controls. Table 3 shows the distribution of ¡1438G/A (A/A, G/A, G/G), 102T/C (C/ C, C/T, T/T), and COMT (A/A, A/G, G/G) genotypes in the study groups. The association analysis showed no overall diVerences in genotype distributions when patients with FMS were compared to controls (Table 3). There were no diVerences in allele frequencies for ¡1438G/A (P = 0.16), 102T/C (P = 0.17), and COMT (P = 0.96) genotypes between FMS patients and control subjects (Table 3).
Marital status (%) Married
67 (83.8)
55 (60.4)
Single
11 (13.8)
31 (34.0)
Widow
2 (2.5)
5 (5.6)
Discussion
Occupational status (%) Housewife
47 (58.7)
Working
27 (33.7)
29 (31.8) 60 (65.9)
Retired
6 (7.6)
2 (2.3)
10.51 § 4.07 (5–15)
11.24 § 4.65 (5–15)
Student Duration of education (year) Values are mean § SD BMI body mass index
123
>0.05
The ethiopathogenesis of FMS is multifactorial. A few groups investigated the association between gene polymorphism and FMS [18, 19, 27]. However, these studies were not speciWc for FMS and were associated with ASD or functional somatic disorders [27]. Almost all of the studies analyzing the relationship between FMS and genetic polymorphisms have been performed on heterogenous groups consisting of patients both with and without psychiatric symptoms. Thus, these studies eliminating the possible eVects of psychological factors are lacking [8, 9, 19]. The
Rheumatol Int (2008) 28:685–691 Table 3 Distribution of overall genotypes and allele frequencies in Wbromyalgia patients and control subjects
689
Genotype
Fibromyalgia patients n = 80 (%)
Controls n = 91 (%)
OR (95% CI)
2
P
¡1438G/A (rs6311) A/A
23 (28.7)
34 (37.3)
1.00 (reference)
0.42
1.00
G/A
30 (37.5)
35 (38.4)
1.27 (0.62–2.60)
2.49
0.52
G/G
27 (33.8)
22 (24.3)
1.81 (0.84–3.93)
0.13
1.44 (0.94–2.21)
0.16
Allele frequency G
0.48
0.55
A
0.52
0.45
C/C
27 (33.8)
20 (21.9)
1.00 (reference)
2.57
1.00
C/T
31 (38.7)
42 (46.3)
0.56 (0.27–1.18)
2.00
0.13
T/T
22 (27.5)
29 (31.8)
0.54 (0.25–1.21)
0.13
T
0.53
0.45
0.72 (0.47–1.11)
0.17
C
0.47
0.55
A/A
22 (27.5)
27 (29.7)
1.00 (reference)
0.15
1.00
A/G
32 (40.0)
34 (37.4)
1.16 (0.55–2.43)
0.02
0.70
G/G
26 (32.5)
30 (32.9)
1.06 (0.49–2.30)
0.88
1.04 (0.68–1.58)
0.96
102T/C (rs6313)
Allele frequency
COMT (rs4680)
Allele frequency OR odds ratio, CI conWdence interval
A
0.48
0.48
G
0.52
0.52
results of the psychiatric tests of the patients and control subjects were statistically similar. This is also the Wrst study investigating three genetic markers with FMS in patients without any measurable psychiatric symptoms. To assess the results of genetic association for both study and control groups, it is important to study ethically homogenous population, because using a genetically homogenous population leads to less potential bias in genetic case–control studies. Some investigators have studied FMS patients of both sexes and diVerent ethnic origin [18, 39]. In contrast to these studies, the current study involved subjects from same ethnic origin and same sex. Serotonin plays an important role in many neuropsychiatric disorders by regulating serotonergic pathways [12]. The possible association of a serotonin transporter gene polymorphism has been frequently discussed in FMS patients as well. Therefore, serotonin gene dysfunction might be the common etiologic factor for the association of FMS and psychiatric problems [8, 19]. Some investigators supported the relationship between serotonin receptor genes and FMS [8, 18, 19]. OVenbaecher et al. showed that S/S genotype occurs more frequently in FMS group than in controls. The S/S subgroup showed higher mean levels of depression and psychological distress [19]. In the study by Cohen et al., a signiWcant relationship has been shown between the anxiety and serotonin transporter gene polymorphism in FMS patients [39]. In another study, Gürsoy
et al. found a signiWcant correlation between T/T genotype of the 5-HT2A receptor gene and the subgroup of the SCL90-R test in patients with FMS [8]. However, we did not detect any relationship between FMS and serotonine genes. Bondy et al. demonstrated that pain severity was signiWcantly higher in T/T genotype of the 102T/C polymorphism of the 5-HT2A receptor gene in FMS patients than the controls [18]. However, in the current study, there was no signiWcant diVerence between patients and controls in the silent 102T/C polymorphism of the 5-HT2A receptor gene in contrast to other studies [8, 18]. Recently, HTR3A and HTR3B genes have been shown to play signiWcant roles in FMS [40]. The authors suggested that mutations of these genes represent the basis for the new pharmacologic treatment on the future. The 5-HT2A receptor gene ¡1438G/A studies are also new and its association with FMS has not been evaluated yet. To the best of our knowledge, this is the Wrst study investigating ¡1438G/A polymorphism of the 5-HT2A receptor gene in this patient group. The Wndings of this study do not support any association of FMS with ¡1438G/ A polymorphism. We found no diVerence of the frequencies of G and A alleles between patients and controls. Two studies have addressed the possible relationship between COMT gene and FMS [9, 41]. Zubieta et al. showed a positive relationship between COMT gene polymorphism and experience of pain [41]. However, Wndings in the current
123
690
study indicated that COMT gene polymorphism is not signiWcantly diVerent in patients and controls. The A/A genotype was signiWcantly lower in FMS patients according to Gürsoy et al. [9]. On the other hand, similar to our study, these authors found that the allele frequencies of COMT gene were not diVerent between patients and controls [9]. Our sample sizes, patients and controls, respectively (80 and 91), are relatively larger than the three studies from Turkey (58 and 58) [8, 9, 42]. However, lack of blood catecholamine levels is the major limitation of this study. Additionally and in contrast with previous studies, this study is unique in that all subjects (patients and controls) had been examined thoroughly by the same psychiatrist (O.B., one of us). In this way, the eVects of psychiatric disorders have been excluded. The current study suggests that two 5-HT2A receptor genes and COMT genes polymorphisms seem not to be associated with FMS. Thus, they do not seem to play a role in pathogenesis of this disorder. It is highly possible that multiple interactions of several diVerent neurotransmitter systems and pathways are involved in FMS. Acknowledgments This study was supported by the Ondokuzmayis University Research Foundation (No. T-368).
References 1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P (1990) The American College of Rheumatology 1990 criteria for the classiWcation Wbromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172 2. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L (1995) The prevalence and characteristics of Wbromyalgia in the general population. Arthritis Rheum 38:19–28 3. Epstein SA, Kay G, Clauw D, Heaton R, Klein D, Krupp L, Kuck J, Leslie V, Masur D, Wagner M, Waid R, Zisook S (1999) Psychiatric disorders in patients with Wbromyalgia. A multicenter investigation. Psychosomatics 40:57–63 4. Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV (2006) Comorbidity of Wbromyalgia and psychiatric disorders. J Clin Psychiatry 67(8):1219–1225 5. Buskila D, Sarzi-Puttini P (2006) Biology and therapy of Wbromyalgia.Genetic aspects of Wbromyalgia syndrome. Arthritis Res Ther 8(5):218 6. Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, Starck LO, Keck PE Jr (2004) Family study of Wbromyalgia. Arthritis Rheum 50:944–952 7. Buskila D, Neumann L, Hazanov I, Carmi R (1996) Familial aggregation in the Wbromyalgia syndrome. Semin Arthritis Rheum 26:605–611 8. Gürsoy S, Erdal E, Herken H, Madenci E, Alasehirli B (2001) Association of T102C polymorphism of the 5HT2A receptor gene with pyschiatric status in Wbromyalgia syndrome. Rheumatol Int 21(2):58–61 9. Gürsoy S, Erdal E, Herken H, Madenci E, Alasehirli B, Erdal N (2003) SigniWcance of catechol-O-methyltransferase gene polymorphism in Wbromyalgia syndrome. Rheumatol Int 23(3):104–107
123
Rheumatol Int (2008) 28:685–691 10. Buskila D, Cohen H, Neumann L, Ebstein RP (2004) An association between Wbromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits. Mol Psychiatry 9(8):730–731 11. Su SY, Chen JJ, Lai CC, Chen CM, Tsai FJ (2007) The association between Wbromyalgia and polymorphism of monoamine oxidase A and interleukin-4. Clin Rheumatol 26(1):12–16 12. GraeV FG (1997) Serotoninergic systems. Psychiatr Clin North Am 20:723–739 13. Tokunaga A, Saika M, Senba E (1998) 5-HT2A receptor subtype is involved in the thermal hyperalgesic mechanism of serotonin in the periphery. Pain 76:349–355 14. Fuentes JA, Lauzurica N, Hurtado A, Escartí A, Barrios V, Morande G, Soriano J, Jauregui I, Gonzalez-Valdemoro MI, GarciaCamba E (2004) Analysis of the ¡1438 G/A polymorphism of the 5-HT2A serotonin receptor gene in bulimia nervosa patients with or without a history of anorexia nervosa. Psychiatr Genet 14(2):107–109 15. Arranz MJ, Munro J, Owen MJ, Spurlock G, Sham PC, Zhao J, Kirov G, Collier DA, Kerwin RW. (1998) Evidence for association between polymorphism in the promoter and coding regions of the 5-HT2A receptor gene and response to clozapine. Mol Psychiatry 3:61–66 16. Williams J, Spurlock G, McGuYn P, Mallet J, Nöthen MM, Gill M, Aschauer H, Nylander PO, Macciardi F, Owen MJ (1996) Association between schizophrenia and T102C polymorphism of the 5-hydroxytrytamine type 2a-receptor gene. European Multicentre Association Study of Schizophrenia (EMASS) Group. Lancet 347:1294–1296 17. Seretti A, Cusin C, Lattuada E, Di Bella D, Catalano M, Smeraldi E (1999) Serotonin transporter gene (5-HTTLPR) is not associated with depressive symptomatology in mood disorders. Mol Psychiatry 4:280–283 18. Bondy B, Spaeth M, OVenbaecher M, Glatzeder K, Stratz T, Schwarz M, de Jonge S, Krüger M, Engel RR, Färber L, Pongratz DE, Ackenheil M (1999) The T102C polymorphism of the 5-HT2Areceptor gen in Wbromyalgia. Neurobiol Dis 6:433–439 19. OVenbaecher M, Bondy B, de Jonge S, Glatzeder K, Krüger M, Schoeps P, Ackenheil M (1999) Possible association of Wbromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheum 42(11):2482–488 20. Enoch MA, Goldman D, Barnett R, Sher L, Mazzanti CM, Rosenthal NE (1999) Association between seasonal aVective disorder and the 5-HT2A promoter polymorphism, ¡1438G/A. Mol Psychiatry 4:89–92 21. Tot S, Erdal E, Yazici K, Yazici AE, Metin O (2003) T102C and ¡1438 G/A polymorphisms of the receptor gene in Turkish patients with obsessive-compulsive disorder. Eur Psychiatry 18:249–254 22. Lachman HM, Papolos DF, Saito T, Yu YM, Szumlanski CL, Weinshilboum RM (1996) Human catechol-O-methyltransferase pharmacogenetics: description of a functional polymorphism and its potential application to neuropsychiatric disorders. Pharmacogenetics 6(3):243–250 23. Erdal ME, Tot S, Yazici K, Yazici A, Herken H, Erdem P, Derici E, Camdeviren H (2003) Lack of association of catechol-O-methyltransferase gene polymorphism in obsessive-compulsive disorder. Depress Anxiety 18(1):41–45 24. Sazci A, Ergul E, Kucukali I, Kilic G, Kaya G, Kara I (2004) Catechol-O-methyltransferase gene Val108/158Met polymorphism, and susceptibility to schizophrenia: association is more signiWcant in women. Brain Res Mol Brain Res 132(1):51–56 25. Hudson JI, Arnold LM, Keck PE, Auchenbach MB, Pope HG (2004) Family study of Wbromyalgia and aVective spectrum disorder. Biol Psychiatry 56:884–891
Rheumatol Int (2008) 28:685–691 26. Ackenheil M (1998) Genetics and pathopsiology of aVective disorders: relationship to Wbromyalgia. Z Rheumatol 57(2):5–7 27. Buskila D (2007) Genetics of chronic pain states. Best Pract Res Clin Rheumatol 21(3):535–547 28. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. The American Psychiatric Association, Washington, DC 29. Derogatis LR (1977) SCL-90-R administration scoring and procedures manual-I for the revised version. Johns Hopkins University School of Medicine, Baltimore 30. Daf à (1991) Belirti Tarama Listesi SCL-90-R’nin üniversite öfrencileri için güvenirlifi geçerlifi. Türk Psikiyatri Dergisi 2:5–12 31. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571 32. Hisli N (1988) The reliability and validity study of the Beck Depression Inventory in a Turkish sample. Psikoloji Dergisi 6:118–122 (in Turkish) 33. Spielberger CD, Gorsuch RL, Lusahene RE (1970) Manual for stait-trait anxiety inventory. California Consulting Psychologist Press, Palo Alto 34. Ozer AK (1994) Sürekli Öfke ve öfke ifade tarz ölçekleri ön çalÂomasÂ. Türk Psikoloji Dergisi 31:26–35 35. Burckhardt CS, Clark SR, Bennett RM (1991) The Wbromyalgia impact questionnaire: development and validation. J Rheumatol 18(5):728–733
691 36. Sarmer S, Ergin S, Yavuzer G (2000) The validity and reliability of the Turkish version of the Wbromyalgia impact questionnaire. Rheumatol Int 20(1):9–12 37. Miller SA, Dykes DD, Polesky HF (1988) A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res 16(3):1215 38. National Center for Biotechnology Information LocusLink Database. http://www.ncbi.nih.gov/LocusLink 39. Cohen H, Buskila D, Neumann L, Ebstein RP (2002) ConWrmation of an association between Wbromyalgia and serotonin transporter promoter region (5-HTTLPR) polymorphism, and the relationship to anxiety related personality traits. Arthritis Rheum 46(3):845–847 40. Frank B, Niesler B, Bondy B, Späth M, Pongratz DE, Ackenheil M, Fischer C, Rappold G (2004) Mutational analysis of serotonin receptor genes: HTR3A and HTR3B in Wbromyalgia patients. Clin Rheumatol 23:338–344 41. Zubieta JK, Heitzeg MM, Smith YR, Bueller JA, Xu K, Xu Y, Koeppe RA, Stohler CS, Goldman D (2003) COMT val158met genotype aVects mu-opioid neurotransmitter responses to a pain stressor. Science 299:1240–1243 42. Gürsoy S (2002) Absence of association of the serotonin transporter gene polymorphism with mentally healthy subset of Wbromyalgia patients. Clin Rheumatol 21:194–197
123
