# Patent

## Title
Clinical indications for genotyping polymorphic variants of G-protein coupled receptors

## Abstract

The invention provides compositions and methods for screening individuals for the presence of G-protein coupled receptor (GPCR) variants. The compositions and methods are useful for determining clinical outcome of drug therapy or for tailoring drug therapy for the individual based upon the presence or absence of one or more GPCR variants in the subject.

## Background
RELATED APPLICATIONS
This application claims the benefit of priority of application Ser. Nos. 60/308,037, filed Jul. 25, 2001; 60/323,206, filed Sep. 12, 2001; 60/347,053, filed Jan. 8, 2002; 60/348,633, filed Jan. 14, 2002; and 60/372,703, filed Apr. 15, 2002.


FIELD OF THE INVENTION
The invention relates to G-protein coupled receptor (GPCR) genes. More particularly, the invention relates to the discovery of physiologically relevant functional differences between genetic variants of G-protein coupled receptor (GPCR) genes.
BACKGROUND OF THE INVENTION
When physicians treat patients with a drug, significant clinical variability is often observed. This variability is manifested in both the frequency of response to treatment, as well as the frequency and nature of possible adverse “side effects.” Because of this well documented heterogeneity in clinical responses to drug treatment, physicians often must empirically adjust clinical dosages of the therapeutic agents used, or discontinue the use of a drug and switch to an alternative treatment to successfully treat a given medical indication. This variability in response to pharmacotherapy results in significantly increased health care costs, and delays in successful treatment. Clearly, there exists a need to identify patients who will respond positively to a particular medication, as well as those who are more prone to adverse side effects.
Similarly, the susceptibility to a given disease, as well as the rate of a disease's clinical progression varies across human populations. This is particularly true for human diseases where a complex interaction of genetics and environment are necessary for disease manifestation. In some individuals the clinical course of disease may be very benign, abrogating the need for intensive treatment that may expose that individual to adverse side effects. Conversely, the clinical course may be very severe, emphasizing the risk benefit ratio for aggressive and early intervention in disease treatment. Consequently, it is important to identify patients who exhibit increased risk of disease, or to identify individuals who will display either a severe or benign clinical course, as this will provide valuable information to clinicians to help tailor therapeutic decisions, and optimize the diagnosis and treatment of human disease.
Variability in clinical response to therapeutic drugs is determined in large part by genetic heterogeneity across human populations. For any given therapeutic drug, inter-individual variation in factors such as absorption, distribution, drug/target interactions, and elimination can all create variability in treatment response. Processes such as absorption, distribution, and elimination can all be easily assessed in the clinical setting by determining serum levels of a given therapeutic drug. However, variability in drug/target molecules has yet to be routinely considered in the clinical variability of drug treatment responses.
Similarly, variability in disease progression and susceptibility is determined in large part by genetic heterogeneity across human populations. Particular genes may be directly pathophysiological in a particular disease state, or may serve a modulatory role, where alterations in gene function may be modifying factors in the clinical manifestation and course of an individual's illness. The knowledge that a particular genetic variant is functionally altered can enable that genetic variant to be a marker for disease susceptibility and progression, even in a setting where the precise role of that gene and gene product are currently not understood.
Drug target genes, specifically the large gene families of receptor proteins (GPCR's) that transduce information by coupling to guanine nucleotide binding proteins, not only mediate the physiological effects of exogenously administered pharmaceutical agents, they also sub-serve critical roles in a diverse set of physiological processes. As such, genetic variants of these genes, in particular those variants that alter receptor function, are candidates to not only determine clinical responses to therapeutic drugs, but to modify disease susceptibility and progression.
Most mammalian genes, including drug target genes, are highly polymorphic across human populations. The most common form of polymorphism is the single nucleotide polymorphism (SNP), where a single nucleotide of DNA differs between individuals in a population. SNPs occur within both intergenic sequences, as well as in regulatory, and both exonic and intronic regions of human genes. In addition, any given individual may harbor multiple SNPs within a given genomic region, resulting in a multitude of different possible combinations of SNPs termed a haplotype. Of those SNPs that occur within exonic regions of genes, some are termed synonymous, in that they do not change the amino acid sequence of the resulting protein, and are unlikely to affect protein function. However, some of these coding region SNP's are non-synonymous (nscSNP), in that the single base change in the DNA does change the amino acid at that corresponding position in the protein. Significantly, SNPs are surprisingly frequent across the human genome (current estimates suggest 10 million total SNPs), and although most of these SNPs will have little or no functional consequences, others may affect protein function. Therefore, the identification of SNPs that alter protein function provides the genetic basis of the biological and pharmacological differences between individuals with respect to pharmacological treatment outcomes and disease susceptibility and progression. In addition, identification of functionally altered polymorphic variants of a given drug target gene can be generalized to define the genetic haplotypes associated with altered clinical outcomes.
SUMMARY OF THE INVENTION
The present invention provides compositions and methods for screening individuals for GPCR variants as clinical indications. Such clinical indications include predicting clinical response to any drug whose actions are mediated in full or in part by GPCR activation or inactivation. Such clinical indications also include predicting susceptibility or resistance to adverse side effects to any drug whose actions are mediated in full or in part by GPCR activation or inactivation. Additionally, the invention compositions and methods are useful for screening individuals for disease related susceptibility or disease related progression factors that are mediated by GPCR activation or inactivation. The invention therefore provides methods for screening a subject for the presence of a variant GPCR. In one embodiment, a method includes providing a subject or sample from a subject; andassaying the subject or the sample from the subject for the presence of a GPCR variant selected from: alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 78 or a haplotype linked with a cysteine residue at amino acid position 78, or a serine residue at amino acid position 200 or a haplotype linked with a serine residue at amino acid position 200; beta 3 adrenergic receptor having a leucine residue at amino acid position 78 or a haplotype linked with a leucine residue at amino acid position 78; dopamine D1 receptor having a proline at amino acid position 37 or a haplotype linked with a proline at amino acid position 37, or an arginine at amino acid position 37 or a haplotype linked with an arginine at amino acid position 37, or a serine at amino acid position 79 or a haplotype linked with a serine at amino acid position 79, or an alanine at amino acid position 199 or a haplotype linked with an alanine at amino acid position 199; dopamine D2 receptor having an arginine at amino acid position 40 or a haplotype linked with an arginine at amino acid position 40, or a leucine at amino acid position 208 or a haplotype linked to a leucine at amino acid position 208; dopamine D3 receptor having a leucine at amino acid position 50 or a haplotype linked with a leucine at amino acid position 50; histamine H1 receptor having a glycine at amino acid position 216 or a haplotype linked to a glycine at amino acid position 216, or a proline at amino acid position 226 or a haplotype linked to a proline at amino acid position 226; histamine H2 receptor having an asparagine at amino acid 175 or a haplotype linked to an asparagine at amino acid 175, or a glycine at amino acid position 215 or a haplotype linked to a glycine at amino acid position 215, or an arginine at amino acid position 231 or a haplotype linked to an arginine at amino acid 231; serotonin 1A receptor having a valine at amino acid position 50 or a haplotype linked to a valine at amino acid position 50, or an isoleucine at amino acid position 172 or a haplotype linked to an isoleucine at amino acid position 172, or a phenylalanine at amino acid position 381 or a haplotype linked to a phenylalanine at amino acid position 381; serotonin 1B receptor having an asparagine at amino acid position 221 or a haplotype linked to an asparagine at amino acid position 221; serotonin 1D receptor having a leucine at amino acid position 53 or a haplotype linked to a leucine at amino acid position 53, or a glycine at amino acid position 366 or a haplotype linked to a glycine at amino acid position 366; serotonin 1E receptor having a threonine at amino acid position 44 or a haplotype linked to a threonine at amino acid position 44, or a phenylalanine at amino acid position 262 or a haplotype linked to a phenylalanine at amino acid position 262; serotonin 2B receptor having a tryptophan at amino acid position 388 or a haplotype linked to a tryptophan at amino acid position 388; serotonin 7 receptor having a lysine at amino acid position 92 or a haplotype linked to a lysine at amino acid position 92, or a proline at amino acid position 421 or a haplotype linked to a proline at amino acid position 421; angiotensin II type 1 receptor having an arginine at amino acid position 45 or a haplotype linked to an arginine at amino acid position 45, or a serine at amino acid position 204 or a haplotype linked to a serine at amino acid position 204, or a tryptophan at amino acid position 289 or a haplotype linked to a tryptophan at amino acid position 289; CB1 cannabinoid receptor having a leucine at amino acid position 200 or a haplotype linked to a leucine at amino acid position 200; cholecystokinin B receptor having a glutamine at amino acid position 224 or a haplotype linked to a glutamine at amino acid position 224; gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a haplotype linked to a leucine at amino acid position 93, or a proline at amino acid position 452 or a haplotype linked to a proline at amino acid position 452; thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a haplotype linked to a glutamic acid at amino acid position, 80, a valine at amino acid position 94 or a haplotype linked to a valine at amino acid position 94, or a glutamic acid at amino acid position 176 or a haplotype linked to a glutamic acid at amino acid position 176; or a neuropeptide Y1 receptor having a proline at amino acid position 298, or a haplotype linked to a proline at amino acid position 298. Detecting the presence of a GPCR variant indicates the presence of the GPCR variant in the subject.
The invention also provides methods for identifying a subject having a clinical indication associated with a variant GPCR. In one embodiment, a method includes providing a subject or sample from a subject; and assaying the subject or the sample from the subject for the presence of a GPCR variant selected from: alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 78 or a haplotype linked with a cysteine residue at amino acid position 78, or a serine residue at amino acid position 200 or a haplotype linked with a serine residue at amino acid position 200; beta 3 adrenergic receptor having a leucine residue at amino acid position 78 or a haplotype linked with a leucine residue at amino acid position 78; dopamine D1 receptor having a proline at amino acid position 37 or a haplotype linked with a proline at amino acid position 37, or an arginine at amino acid position 37 or a haplotype linked with an arginine at amino acid position 37, or a serine at amino acid position 79 or a haplotype linked with a serine at amino acid position 79, or an alanine at amino acid position 199 or a haplotype linked with an alanine at amino acid position 199; dopamine D2 receptor having an arginine at amino acid position 40 or a haplotype linked with an arginine at amino acid position 40, or a leucine at amino acid position 208 or a haplotype linked to a leucine at amino acid position 208; dopamine D3 receptor having a leucine at amino acid position 50 or a haplotype linked with a leucine at amino acid position 50; histamine H1 receptor having a glycine at amino acid position 216 or a haplotype linked to a glycine at amino acid position 216, or a proline at amino acid position 226 or a haplotype linked to a proline at amino acid position 226; histamine H2 receptor having an asparagine at amino acid 175 or a haplotype linked to an asparagine at amino acid 175, or a glycine at amino acid position 215 or a haplotype linked to a glycine at amino acid position 215, or an arginine at amino acid position 231 or a haplotype linked to an arginine at amino acid 231; serotonin 1A receptor having a valine at amino acid position 50 or a haplotype linked to a valine at amino acid position 50, or an isoleucine at amino acid position 172 or a haplotype linked to an isoleucine at amino acid position 172, or a phenylalanine at amino acid position 381 or a haplotype linked to a phenylalanine at amino acid position 381; serotonin 1B receptor having an asparagine at amino acid position 221 or a haplotype linked to an asparagine at amino acid position 221; serotonin 1D receptor having a leucine at amino acid position 53 or a haplotype linked to a leucine at amino acid position 53, or a glycine at amino acid position 366 or a haplotype linked to a glycine at amino acid position 366; serotonin 1E receptor having a threonine at amino acid position 44 or a haplotype linked to a threonine at amino acid position 44, or a phenylalanine at amino acid position 262 or a haplotype linked to a phenylalanine at amino acid position 262; serotonin 2B receptor having a tryptophan at amino acid position 388 or a haplotype linked to a tryptophan at amino acid position 388; serotonin 7 receptor having a lysine at amino acid position 92 or a haplotype linked to a lysine at amino acid position 92, or a proline at amino acid position 421 or a haplotype linked to a proline at amino acid position 421; angiotensin II type 1 receptor having an arginine at amino acid position 45 or a haplotype linked to an arginine at amino acid position 45, or a serine at amino acid position 204 or a haplotype linked to a serine at amino acid position 204, or a tryptophan at amino acid position 289 or a haplotype linked to a tryptophan at amino acid position 289; CB1 cannabinoid receptor having a leucine at amino acid position 200 or a haplotype linked to a leucine at amino acid position 200; cholecystokinin B receptor having a glutamine at amino acid position 224 or a haplotype linked to a glutamine at amino acid position 224; gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a haplotype linked to a leucine at amino acid position 93, or a proline at amino acid position 452 or a haplotype linked to a proline at amino acid position 452; thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a haplotype linked to a glutamic acid at amino acid position 80, a valine at amino acid position 94 or a haplotype linked to a valine at amino acid position 94, or a glutamic acid at amino acid position 176 or a haplotype linked to a glutamic acid at amino acid position 176; or a neuropeptide Y1 receptor having a proline at amino acid position 298, or a haplotype linked to a proline at amino acid position 298. Detecting the presence of a GPCR variant identifies the subject as having a clinical indication associated with the variant GPCR.
Clinical indications associated with the presence of the variant GPCR include, for example, increased or decreased sensitivity or insensitivity to a beneficial physiological effect of an agonist or antagonist of the GPCR variant; increased or decreased sensitivity or insensitivity to an adverse side effect of an agonist or antagonist of the GPCR variant; increased or decreased resistance or susceptibility to, or benign disease progression in, a pathophysiological state in which the GPCR receptor agonist or antagonist activity is therapeutically useful.
Subjects include human subjects and further include subjects that are being treated or are candidates for treatment with an agent that affects an activity of one or more of the GPCR variants. In particular aspects, the agent is selected from: dobutamine hydrochloride, ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine, epinephrine bitartrate, epinephrine hydrochloride, mephentermine sulfate, metaraminol bitartrate, methoxamine hydrochloride, midodrine hydrochloride, norepinephrine bitartrate, phenylephrine hydrochloride, psuedoephedrine hydrochloride, psuedoephedrine sulfate, dihydroergotamine mesylate, ergotamine tartrate, doxazosin mesylate, ergoloid mesylates, phenoxyb enz amine hydrochloride, phentolamine mesylate, labetalol hydrochloride, prazosin hydrochloride, terazosin hydrochloride, tolazoline hydrochloride, chlorpromazine, risperidone, amitriptyline, desipramine; albuterol, carvedilol, esmolol hydrochloride, isoproterenol hydrochloride, metoprolol succinate, metoprolol tartrate, pindolol, propranolol hydrochloride; L-748,328, L-742,791, L-748,337, fenoldopam, dopexamine, pergolide, bromocriptine, SCH23390, dopamine hydrochloride, bromocriptine mesylate, ergonovine maleate, methylergonovine maleate, trihexyphenidyl hydrochloride, pramipexole, ropinirole, haloperidol, thiothixene, clozapine, respiridone, olanzapine, quetiapine, amoxapine, buspirone, amitriptyline, nortriptyline, imipramine, prochlorperazine edisylate, prochlorperazine maleate, meclizine hydrochloride, thiethylperazine malate, thiethylperazine maleate, loperamide hydrochloride, histamine, lisuride, acrivastine, azatadine maleate, brompheniramine maleate, dexbrompheniramine maleate, carbinoxamine maleate, cetrizine hydrochloride, chlorpheniramine maleate, clemastine fumarate, cyproheptadine hydrochloride, diphenhydramine hydrochloride, doxylamine succinate, fexofenadine hydrochloride, loratadine, promethazine hydrochloride, tripelennamine hydrochloride, triprolidine hydrochloride, azelastine hydrochloride, emedastine hydrochloride, ketotifen fumarate, levoclabastine hydrochloride, olopatadine hydrochloride, dimenhydrinate, trimethobenzamide hydrochloride, cimetidine hydrochloride, famotidine, nizatidine ranitidine hydrochloride, buspirone hydrochloride, gepirone, ipsaperone, sumatriptan succinate, serotonin, oxymetazoline hydrochloride, rizatriptan benzoate, naratriptan hydrochloride, zolmitriptan, and eletriptan, perlapine, cis-flupenthixol, ocaperidone, tefludazine, triflouperazine hydrochloride, timolol maleate, methysergide maleate, desipramine hydrochloride, nortriptyline hydrochloride, fluoxetine hydrochloride, fluvoxamine maleate, mirtazepine, loxapine hydrochloride, loxapine succinate, mesioridazine besylate, serotonin hydrochloride, dihydroergotamine methanosulfate, dihydroergotamine mesylate, modafinil, protryptiline hydrochloride, amoxapine, trazodone hydrochloride, fluphenazine, fluspirilene, ziprasidone, chlorpromazine hydrochloride, angiotensin II, valsartan, irbesartan, candesartan, eprosartan, zolasartan, tasosartan, telmisartan, olmesartan, fonsartan, embusartan, saprisartan, losartan potassium, dronabinol, nabilone, sincalide, CCK-4, CCK-8, gastrin, C1988, L265260; baclofen, thromboxane A2, sulotroban, vapiprost, NPY and PYY.
The invention further provides polynucleotides that specifically hybridize to nucleic acid sequence encoding a variant GPCR, variant GPCR polypeptides and antibodies that specifically bind to the variant GPCR polypeptides. In one embodiment, a nucleic acid sequence encoding a variant GPCR is selected from: Alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 43 or a serine at amino acid position 200; Beta 3 adrenergic receptor having a leucine residue at amino acid position 78; D1 dopamine receptor having a proline at amino acid position 37 or an arginine at amino acid position 37 or a serine at amino acid position 79 or an alanine at amino acid position 199; D2 dopamine receptor having an arginine at amino acid position 40 or a leucine at amino acid position 208; D3 dopamine receptor having a leucine at amino acid position 50; H1 histamine receptor having a glycine at amino acid position 216 or a proline at amino acid 226; H2 histamine receptor having an asparagine at amino acid position 175 or a glycine at amino acid position 215 or an arginine at amino acid position 231; 1A serotonin receptor having a valine at amino acid position 50 or an isoleucine at amino acid position 172 or a phenylalanine at amino acid position 381; 1B serotonin receptor having an asparagine at amino acid position 221; 1D serotonin receptor having a leucine at amino acid position 53 or a glycine at amino acid position 366; 1E serotonin receptor having a threonine at amino acid position 44 or a phenylalanine at amino acid position 262; 2B serotonin receptor having a tryptophan at amino acid position 388; serotonin 7 receptor having a lysine at amino acid position 92 or a proline at amino acid position 421; angiotensin 2 type 1 receptor having an arginine at amino acid position 45 or a serine at amino acid position 204 or a tryptophan at amino acid position 289; cannabinoid CB1 receptor having a leucine at amino acid position 200; cholecystokinin B receptor having a glutamine at amino acid position 224; gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a proline at amino acid position 452; thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a valine at amino acid position 94 or a glutamic acid at amino acid position 176; or neuropeptide Y1 receptor having a proline at amino acid position 298; and a sequence encoding a portion of the above variant GPCR having at least 10 bases that includes the sequence that encodes the designated amino acid.
Polynucleotides of the invention can be of various lengths. In one embodiment, the polynucleotide is from about 10 to 50 bases in length. Polynucleotides of the invention can also have various amounts of complementarity or homology to the nucleic acid sequence encoding GPCR. In one embodiment, the polynucleotide has 90% or more complementarity or homology to a sequence that encodes the GPCR. In another embodiment, the polynucleotide specifically hybridizes to a GPCR variant nucleic acid sequence selected from any of (SEQ ID NOs:2, 3, 8, 12-15, 22, 23, 28, 32, 33, 38-40, 46-48, 54, 58, 59, 64, 65, 70, 74, 75, 80-82, 88, 92, 96, 97, 102-104, 110).
Polynucleotides of the invention include single and double strand, circular and linear and which specifically hybridize to a double strand sequence; a single strand sense sequence; a single strand antisense sequence; a cDNA sequence, a genomic sequence; or an RNA sequence, the sequence including that portion of the GPCR sequence that contains the nucleotide variant that encodes the variant amino acid residue.
The invention additionally provides detection substrates, which include a two-dimensional array of one or more of the invention compositions. In one embodiment, a detection substrate includes a polynucleotide that specifically hybridizes to nucleic acid sequence encoding a variant GPCR, attached to a substrate at defined positions. In additional embodiments, detection substrates include multiple GPCR variant sequences, or alternatively or in addition to, one or more nucleic acids distinct from a GPCR variant sequence. In various aspect, additional nucleic acids number from about 10 to 100, 100 to 500, 500 to 100, 1000 to 5000, 5000 to 10,000, 10,000 to 100,000, which optionally includes variant GPCRs, wild type GPCRs sequences (e.g., wild type in respect to a GPCR variant) distinct from GPCRs.
The invention moreover provides kits that includes one or more of the compositions of the invention. In one embodiment, a kit includes a polynucleotide that specifically hybridizes to nucleic acid sequence encoding a variant GPCR, and instructions for detecting the presence of the variant GPCR in a subject. In another embodiment, a kit includes a detection substrate with one or more polynucleotides that specifically hybridize to nucleic acid sequence encoding a variant GPCR, attached to a substrate at defined positions and, optionally, instructions for detecting the presence of the variant GPCR in a subject. In particular aspects, instructions for screening a subject for a clinical indication of a GPCR variant are included in the kit. In more particular aspects, the clinical indications are selected from: decreased or increased sensitivity to a beneficial physiological effect of an agonist or antagonist of the corresponding GPCR; identifying a subject requiring a higher or lower clinical dose of an agonist or antagonist of the corresponding GPCR; identifying a subject having decreased or increased sensitivity towards an adverse side effect of an agonist or antagonist of the corresponding GPCR; identifying a subject susceptible to, or at risk of malignant or benign disease progression in a pathophysiological state in which an agonist or antagonist of the corresponding GPCR is therapeutically useful; identifying a subject having lesser susceptibility to, or decreased risk of malignant or benign disease progression in a pathophysiological state in which an agonist or antagonist of the corresponding GPCR is therapeutically useful.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows the functional response of the “Wild Type” human 5HT1A receptor (Filled Squares), and the A50V 5HT1A receptor polymorphic variant (Filled Diamonds) to the 5HT1A receptor agonist 8-OH-DPAT as determined by the R-SAT assay. There is an approximately twenty-fold decrease in functional potency observed for this particular GPCR variant.
FIG. 2 shows that a S78L mutation in the beta 3 receptor protein renders the receptor unresponsive to the reference and clinical agonists tested.
FIG. 3 shows that a T37R mutation in the dopamine D1 receptor protein renders the receptor unresponsive to the reference and clinical agonists tested.
FIG. 4 shows that a V50L mutation in the dopamine D3 receptor protein renders the receptor unresponsive to the reference and clinical agonists tested.
FIG. 5 shows that a K175N mutation in the histamine H2 receptor protein significantly diminishes constitutive receptor activity.
FIG. 6 shows that a T221N mutation in the serotonin 1B receptor protein renders the receptor protein non-functional.
FIG. 7 shows that a T92K mutation in the serotonin 7 receptor protein significantly diminishes constitutive receptor activity.
FIG. 8 shows that a G45W mutation in the angiotensin II Type 1 receptor protein renders the receptor protein non-functional.
FIG. 9 shows that a F200L mutation in the cannabinoid 1 receptor decreases the basal biological activity of the receptor protein.
FIG. 10 shows that a L542P mutation in the GABA-BR1 receptor protein renders the receptor protein significantly less responsive.



DETAILED DESCRIPTION
The functional consequences of genetic variation in 19 G-protein coupled receptor genes are disclosed. For each receptor a number of reference agonists, and clinically useful therapeutic agents, were assayed for functional potency at the variants under study using the in-vitro, cell based, receptor selection and amplification technology (R-SAT) system (Example 1). The majority of polymorphic variants studied did not affect receptor function. However, 37 GPCR polymorphisms were found to have functional consequences. In particular, polymorphic variation altered the functional potencies observed for the various clinically used agents. Two phenotypes were observed: 1) Loss of function phenotypes were characterized by a statistically significant (two tailed student T-Test with p<0.05) decrease in functional potencies for the ligands tested, or a decrease in agonist independent, basal, constitutive receptor activity; and 2) Gain of function phenotypes were characterized by a statistically significant (two tailed student T-Test with p<0.05) increase in functional potencies for the ligands tested, or an increase in agonist independent, basal, constitutive receptor activity.
The altered function of 37 variants of G-protein coupled receptor genes include: two variants of the alpha 1A/C adrenergic receptor gene, a variant of the beta 3 adrenergic receptor gene, four variants in the dopamine D1 receptor gene, two variants of the dopamine D2 receptor, a variant of the dopamine D3 receptor, two variants of the H1 histamine receptor, three variants of the H2 histamine receptor, three variants of the serotonin 1A receptor, one variant of the serotonin 1B receptor, two variants of the serotonin 1D receptor, two variants of the serotonin 1E receptor, one variant of the serotonin 2B receptor, two variants of the serotonin 7 receptor, three variants of the angiotensin II, type 1 receptor, one variant of the CB1 cannabinoid receptor, one variant of the cholecystokinin B receptor, two variants of the gamma-amino-butyric acid type B receptor, and three variants of the TP prostanoid receptor, and one variant of the neuropeptide Y1 receptor.
The identification of the functional consequences of theses polymorphic variations enables predictions of the clinical consequences of drugs that target these proteins. For example, genotyping individuals for these variants allows an assessment of: 1) sensitivity towards, or resistance to, therapeutic or adverse side effects of a given drug whose actions are mediated in full, or in part, by GPCR activation or inactivation, and 2) susceptibility or predisposition towards, and/or benign or malignant progression of, a disease whose cause or clinical course is determined or modified GPCR activation or inactivation.
The genotyping of individuals for the presence of these genetic variants, or any genetic haplotype associated with these variants, can guide decisions regarding which patients to treat with a given drug, and which doses of a given drug will achieve a therapeutic response. In addition, such genotyping will guide decisions concerning disease diagnosis, disease predisposition, and decisions regarding aggressive or passive disease treatment options.
As used herein, the terms “variant” and “polymorphism” and grammatical variations thereof, are used interchangeably to refer to one or more nucleotide changes in a gene sequence that is different than that which is most commonly found at that nucleotide position in the population, e.g., different from a wild-type sequence. The nucleotide changes of the GPCR variants disclosed herein result in changes of single amino acid residues (point mutations) in the expressed GPCR protein, which in turn alters the functional potency of the variant GPCR relative to wild type GPCR.
As used herein, the term “functional potency,” when used in reference to a receptor (e.g., a GPCR), means the response of the receptor to a ligand, such as a drug. A “shift” in functional potency means that the receptors' response to the given drug or class of drugs is different relative to a reference receptors' response. The shift may reflect an increased or decreased response of the receptor to a ligand relative to a reference receptors' response. For example, an isoleucine to serine transition at amino acid position 200 (I200S) of the alpha 1A/C receptor protein induces a 2 to 4 fold shift in functional potency for several drugs tested, which indicates that 2 to 4 fold more or less drug is required to activate the alpha 1A/C receptor protein when serine is substituted for isoleucine at position 200. In this example, the shift results in a decrease of biological function.
As used herein, the term “haplotype linked with,” when used in reference to a polymorphic variant, means that there is a polymorphism elsewhere in the gene or the genomic sequence (e.g., introns, 5′ or 3′ upstream regions, etc.), which is associated with the presence of a particular variant. Thus, where the presence of a haplotype is linked with the presence of a particular polymorphic variant, detecting the presence of the haplotype that is associated with the variant allows one to detect the presence of the polymorphic variant.
As used herein, the term “EC50” means the concentration of drug required to produce 50% of the maximal biological or pharmacological response observed in an assay. Thus, in the case of GPCR's, the EC50 is the amount of ligand that provides 50% maximal activity as determined using an assay (see, e.g., Example 1, which describes an R-SAT assay for determining the amount of a given ligand needed for 50% maximal activity). The EC50 values displayed in the Tables are inverse log values such that a higher value denotes a lower concentration of agonist required to activate the receptor. Thus, a variant GPCR having a number greater than the wild type GPCR indicates that the variant exhibits a gain of function (requires less agonist to exhibit the same activity), whereas a variant GPCR having a number less than wild type GPCR indicates that the variant GPCR exhibits a loss of function (requires more agonist to exhibit the same activity).
As used herein, the terms “sensitivity” or “insensitivity” refers to the response of a receptor to a ligand (e.g., a drug) relative to a reference receptor. Thus, when the term is used with a modifier, such as “increase,” “enhance,” “stimulate” “promote,” and the like, the receptor exhibits greater sensitivity or greater insensitivity to a ligand, such as a drug, relative to a reference receptor. When the term is used with a modifier, such as “decrease,” “abrogate,” “inhibit” “prevent,” “block” and the like, the receptor exhibits lesser sensitivity or lesser insensitivity to a ligand, such as a drug, relative to a reference receptor.
As used herein, the term “susceptibility” refers to a relative likelihood of the phenomenon referred to occurring. Thus, when the term is used with a modifier, such as “increase,” “enhance,” “stimulate” “promote,” and the like, there is a greater likelihood of the phenomenon occurring (e.g., clinical indication). When the term is used with a modifier, such as “decrease,” “abrogate,” “inhibit” “prevent,” and the like, there is a greater likelihood of the phenomenon (e.g., clinical indication) occurring.
The following abbreviations are used for convenience:













NR
no response


“n”
defines the number of experimental replicates


AVE
average


STD DEV
standard deviation


8-0H-DPAT
(+/−)-2-DIPROPYLAMINO-8-HYDROXY-1,2,3,4-



TETRAHYDRONAPHTHALENE HYDROBROMIDE


5HT
5-hydroxytryptamine


5CT
5-carboxytryptamine


DHE
dihydroergotamine


mCPP
1-(3-CHLOROPHENYL)PIPERAZINE



DIHYDROCHLORIDE


CCK
cholecystokinin


AMPA
3-AminopropylMethylPhosphonic Acid


PYY
PEPTIDE YY (HUMAN)


BRL4443
3-(1-Methylpiperidin-4-yl)-1H-indole-5-ol maleate


CGP12177A
4-[3-[(1,1-Dimethylethyl)amino]-2-hydroxypropoxy]-



1,3-dihydro-2H-benzimidazol-2-one hydrochloride


SKF 38393
(+/−)-1-Phenyl-2,3,4,5-tetrahydro-(1H)-3-benzazapine-7,8-



diol hydrochloride


SKF 82957
R(+)-6-Chloro-7,8-dihydroxy-3-methyl-1-phenyl-2,3,4,5-



tetrahydro-1H-3-benzazapine hydrobromide


SKF 81297
R(+)-6-Chloro-7,8-dihydroxy-1-phenyl-2,3,4,5-tetrahydro-



1H-3-benzazepine hydrobromide


ANG II
Angiotensin 2


HU210
(6AR)-TRANS-3-(1,1-DIMETHYLHEPTYL)-



6A,7,10,10A-TETRAHYDRO-1-HYDROXY-6,6-



DIMETHYL-6H-DIBENZO[B,D]PYRAN-9-METHANOL


SR141716
N-(PIPERIDIN-1-YL)-5-(4-CHLOROPHENYL)-4-



METHYL-1H-PYRAZOLE-3-CARBOXAMIDE









Alpha Adrenergic 1A/C Receptors (ADRA1A, Genbank #NM—000680)

A functional effect of polymorphic variation at amino acid position 43 was observed:










TABLE 1









Glycine 43
Cysteine 43















Ave


Ave





G43C
−Log
STD

−Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD





Phenylephrine
6.97
0.10
7
7.57
0.09
7
−4.0


Cirazoline
7.37
0.08
5
7.84
0.13
5
−3.0


Oxymetazoline
8.00
0.33
6
8.72
0.28
6
−5.2









A glycine to cysteine transition at amino acid position 43 (G43C) in the alpha 1A/C receptor protein was found to induce 3 to 5 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a gain of biological function, and individuals that possess this variant will be particularly sensitive to the physiological effects of a therapeutic drug that activates the Alpha 1A/C receptor.
A functional effect of polymorphic variation at amino acid position 200 was observed:










TABLE 2









Isoleucine 200
Serine 200















Ave


Ave





I200S
−Log
STD

−Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD





Phenylephrine
7.05
0.10
7
6.61
0.14
7
2.8


Dobutamine
6.26
0.24
7
5.67
0.19
7
3.9


Cirazoline
7.81
0.17
7
7.32
0.27
7
3.1


Oxymetazoline
8.10
0.50
7
7.66
0.43
7
2.8









A isoleucine to serine transition at amino acid position 200 (I200S) in the alpha 1A/C receptor protein was found to induce 2 to 4 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, and individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the Alpha 1A/C receptor.
Alpha 1A/C receptors mediate some of the varied physiological effects of the endogenous catecholamines epinephrine and norepinephrine. Therapeutic drugs with alpha 1A/C receptor agonist activity are used clinically to treat hypotension, orthostatic hypotension, hypotension associated with shock and sepsis, vascular headache (migraine), nasal congestion, cardiac arrhythmias including paroxysmal supraventricular tachycardia, cardiopulmonary arrest, broncospasm, allergic reactions, deep venous thrombosis prophylaxis, and the behavioral aspects of chronic neurodegenerative diseases such as Alzheimer's disease. Therapeutic drugs with alpha 1A/C receptor antagonist activity are used clinically to treat hypertension, hypertensive crises, the hypertension associated with pheochromocytomas, congestive heart failure, cocaine overdoses, erectile dysfunction, and urinary retention often associated with benign prostatic hypertrophy.
GPCR Variants #1 and #2: Alpha 1A/C Receptor G43C and I200S Polymorphisms
The presence in an individual of the genetic variant in the alpha 1A/C receptor gene that introduces a cysteine residue at amino acid position 43 or a serine residue at amino acid position 200 will predispose that individual to one or more of the following clinical indications:
1) Particular sensitivity or insensitivity (variant #2) to the beneficial physiological effects of alpha 1A/C receptor agonists, including, yet not limited to; dobutamine hydrochloride, ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine, epinephrine bitartrate, epinephrine hydrochloride, mephentermine sulfate, metaraminol bitartrate, methoxamine hydrochloride, midodrine hydrochloride, norepinephrine bitartrate, phenylephrine hydrochloride, psuedoephedrine hydrochloride, psuedoephedrine sulfate, dihydroergotamine mesylate, ergotamine tartrate. Genotyping individuals for polymorphic variants, cysteine residue at amino acid position 43 or a serine residue at amino acid position 200 (variant #2), can identify those patients requiring lower or higher (variant #2), respectively, clinical doses of these agents.
2) Particular sensitivity or insensitivity (variant #2), respectively, to the adverse cardiovascular (including, yet not limited to; hypertension, hypotension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, heart valvulopathies, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, parasthesias, blurred vision, miosis, drowsiness, fatigue, and stroke), and urologic (including, yet not limited to; urinary retention, priapism) side effects of alpha 1A/C receptor agonists including, dobutamine hydrochloride, ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine, epinephrine bitartrate, epinephrine hydrochloride, mephentermine sulfate, metaraminol bitartrate, methoxamine hydrochloride, midodrine hydrochloride, norepinephrine bitartrate, phenylephrine hydrochloride, psuedoephedrine hydrochloride, psuedoephedrine sulfate, dihydroergotamine mesylate, ergotamine tartrate. Genotyping individuals for polymorphic variants, cysteine residue at amino acid position 43 or a serine residue at amino acid position 200 (variant #2), can identify those patients that will exhibit increased sensitivity or insensitivity (variant #2), respectively, towards these side effects.
3) Particular resistance or susceptibility (variant #2) to, or benign disease progression in, pathophysiological states in which alpha 1A/C receptor agonist activity is a therapeutically useful intervention including, yet not limited to: hypotension orthostatic hypotension, hypotension associated with shock and sepsis, vascular (migraine) headache, cardiac arrhythmias including paroxysmal supraventricular tachycardia, broncospasm, allergic reactions, deep venous thrombosis, and the behavioral aspects of chronic neurodegenerative diseases such as Alzheimer's disease. Genotyping individuals for the polymorphic variants, cysteine residue at amino acid position 43 or a serine residue at amino acid position 200(variant #2), can identify those patients that will exhibit a lesser or greater (variant #2), respectively, susceptibility to, or benign progression of, these disease states.
4) Particular insensitivity or sensitivity (variant #2) to the beneficial physiological effects of alpha 1A/C receptor antagonists including, yet not limited to: doxazosin mesylate, ergoloid mesylates, phenoxybenzamine hydrochloride, phentolamine mesylate, labetalol hydrochloride, prazosin hydrochloride, terazosin hydrochloride, tolazoline hydrochloride, a variety of clinically useful antipsychotics including chlorpromazine and risperidone, and a variety of clinically useful antidepressants including amitriptyline and desipramine. Genotyping individuals for the polymorphic-variants, cysteine residue at amino acid position 43 or a serine residue at amino acid position 200 (variant #2), can identify those patients requiring higher or lower (variant #2), respectively, clinical doses of these agents.
Particular insensitivity or sensitivity (variant #2) to the adverse cardiovascular (including, yet not limited to; hypertension, hypotension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, parasthesias, blurred vision, miosis, drowsiness, fatigue, and stroke), urologic (including, yet not limited to; urinary retention), and other (including, yet not limited to; muscle and joint pain, and rash) side effects of alpha 1A/C receptor antagonists including, yet not limited to: doxazosin mesylate, ergoloid mesylates, phenoxybenzamine hydrochloride, phentolamine mesylate, labetalol hydrochloride, prazosin hydrochloride, terazosin hydrochloride, tolazoline hydrochloride, a variety of clinically useful antipsychotics including chlorpromazine and risperidone, and a variety of clinically useful antidepressants including amitriptyline and desipramine. Genotyping individuals for the polymorphic variants, cysteine residue at amino acid position 43 or a serine residue at amino acid position 200 (variant #2), can identify those patients that will exhibit a lesser or greater (variant #2) propensity, respectively, towards these side effects.
6) Particular susceptibility or resistance (variant #2) to, or malignant disease progression, in pathophysiological states in which alpha 1A/C receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: hypertension, congestive heart failure, cocaine addiction and overdose, erectile dysfunction, and benign prostatic hypertrophy. Genotyping individuals for the polymorphic variants, cysteine residue at amino acid position 43 or a serine residue at amino acid position 200 (variant #2), can identify those patients that will exhibit a greater or lesser (variant #2), respectively, susceptibility to, or malignant progression of, these disease states.
Beta 3 Adrenergic Receptors (ADRB3, Genbank # X72861)
A functional effect of polymorphic variation at amino acid position 78 was observed:
A serine to leucine transition at amino acid position 78 (S78L) in the beta 3 receptor protein was found render the receptor unresponsive to the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the beta 3 receptor. Beta 3 receptors mediate some of the varied physiological effects of the endogenous catecholamines epinephrine and norepinephrine. Therapeutic drugs with beta 3 receptor agonist activity are used clinically to treat; hypertension, chronic obstructive airway disease, asthma, acute bronchospasm, as tocolytics, the hypotension associated with shock and sepsis, arrhythmias including paroxysmal supraventricular tachycardia, cardiopulmonary arrest, migraines, and as metabolism increasing agents for the control of obesity and body weight. Therapeutic drugs with beta 3 receptor antagonist activity are in development to treat anorexia nervosa, and to treat various neuropsychiatric diseases.
GPCR Variant #3: Beta 3 Receptor S78L Polymorphism
The presence in an individual of the genetic variant in the beta 3 receptor gene that introduces a leucine residue at amino acid position 78 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of beta 3 receptor agonists, including, yet not limited to; albuterol, carvedilol, dihydro-ergotamine mesylate, ergotamine tartrate, epinephrine, epinephrine bitartrate, epinephrine hydrochloride, esmolol hydrochloride, isoproterenol hydrochloride, metoprolol succinate, metoprolol tartrate, norepinephrine bitartrate, phenylephrine hydrochloride, pindolol, and propranolol hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse cardiovascular (including, yet not limited to; hypertension, hypotension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, heart valvulopathies, peripheral ischemia, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, parasthesias, blurred vision, miosis, drowsiness, fatigue, insomnia, hallucinations, and stroke), pulmonary, (including, yet not limited to; dyspnea, broncho-constriction, and wheezing), metabolic (including, yet not limited to; hyperglycemia, and transaminitis), and urologic (including, yet not limited to; urinary retention, priapism) side effects of beta 3 receptor agonists including, albuterol, carvedilol, dihydro-ergotamine mesylate, ergotamine tartrate, epinephrine, epinephrine bitartrate, epinephrine hydrochloride, esmolol hydrochloride, isoproterenol hydrochloride, metoprolol succinate, metoprolol tartrate, norepinephrine bitartrate, phenylephrine hydrochloride, pindolol, and propranolol hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which beta 3 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: hypertension, chronic obstructive airway disease, asthma, acute bronchospasm, premature labor, the hypotension associated with shock and sepsis, arrhythmias including paroxysmal supraventricular tachycardia, cardiopulmonary arrest, migraines, and obesity. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of beta 3 receptor antagonists including, yet not limited to: L-748,328, L-742,791, and L-748,337. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse effects of beta 3 receptor antagonists. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which beta 3 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to anorexia nervosa, and various neuropsychiatric diseases. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Dopamine D1 Receptors (DRD1, Genbank # S58541)
A functional effect of polymorphic variation at amino acid position 37 was observed:










TABLE 3









Threonine 37
Proline 37















Ave


Ave





T37P
−Log
STD

−Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















SKF38393
7.46
0.21
7
5.24
0.44
7
166


SKF82957
7.04
0.12
6
6.02
0.15
5
11


SKF81297
7.87
0.21
7
5.95
0.36
7
83


Pergolide
8.02
0.33
6
5.78
0.45
6
173









A threonine to proline transition at amino acid position 37 (T37P) in the dopamine D1 receptor protein was found to induce 11-173 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the dopamine D1 receptor.
A functional effect of polymorphic variation at amino acid position 37 was observed:
A threonine to arginine transition at amino acid position 37 (T37R) in the dopamine D1 receptor protein was found to render the receptor unresponsive to the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the dopamine D1 receptor.
A functional effect of polymorphic variation at amino acid position 79 was observed:










TABLE 4









Proline 79
Serine 79















Ave


Ave





P79S
−Log
STD

−Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















SKF38393
7.67
0.17
6
6.61
0.07
6
12


SKF82957
7.46
0.14
6
5.34
0.28
6
132


SKF81297
8.02
0.28
6
6.79
0.08
6
17


Pergolide
8.45
0.37
5
7.05
0.25
6
25









A proline to serine transition at amino acid position 79 (P79S) in the dopamine D1 receptor protein was found to induce 12-178 fold decreases in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the dopamine D1 receptor.
A functional effect of polymorphic variation at amino acid position 199 was observed:











TABLE 5









Serine 199
Alanine 199















S199A
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















SKF38393
7.60
0.17
10
6.46
0.22
8
14


SKF82957
7.04
0.13
8
6.02
0.09
7
11


SKF81297
7.89
0.16
10
6.72
0.12
7
15


Pergolide
8.18
0.29
8
7.01
0.16
6
15









A serine to alanine transition at amino acid position 199 (S199A) in the dopamine D1 receptor protein was found to induce 11-15 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the dopamine D1 receptor.
Dopamine D1 receptors mediate some of the varied physiological effects of the endogenous catecholamine dopamine. Therapeutic drugs with D1 receptor agonist activity are used clinically to treat shock, cardiopulmonary arrest, hepato-renal syndrome, and renal failure. Therapeutic drugs with dopamine D1 receptor antagonist activity are currently in clinical trials for the treatment of neuropsychiatric disease, including addiction and dependence behaviors.
GPCR Variants #4, #5, #6, and #7: Dopamine D1 Receptor T37P, T37R, P79S, and S199A Polymorphisms
The presence in an individual of the genetic variant in the dopamine D1 receptor gene that introduces a proline residue at amino acid position 37, an arginine at amino acid position 37, a serine at amino acid position 79, or an alanine at amino acid position 199 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of dopamine D1 receptor agonists including, yet not limited to; dopamine hydrochloride, fenoldopam, dopexamine, and pergolide. Genotyping individuals for these polymorphic variants can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse cardiovascular (including, yet not limited to; tachycardia, angina, palpitations, orthostatic hypotension, dyspnea, arrhythmias, and vasoconstriction), neuropsychiatric (including, yet not limited to; anxiety, confusion, hallucinations, and headache), renal (including, yet not limited to; azotemia), metabolic (including, yet not limited to; hyperglycemia), and other (including, yet not limited to; pleural pulmonary and retroperitoneal fibrosis) side effects of dopamine D1 receptor agonists including, yet not limited to; dopamine hydrochloride, fenoldopam, dopexamine, and pergolide. Genotyping individuals for these polymorphic variants can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which dopamine D1 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: shock, cardiopulmonary arrest, hepato-renal syndrome, and renal failure. Genotyping individuals for these polymorphic variants can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of the dopamine D1 receptor antagonists including, yet not limited to; bromocriptine, and SCH23390. Genotyping individuals for these polymorphic variants can identify those patients requiring lower clinical doses of these agents.
Particular sensitivity to the adverse cardiovascular (including, yet not limited to; hypotension, and arrhythmias) and neuropsychiatric (including, yet not limited to; confusion, and hallucinations) side effects of the dopamine D1 receptor antagonists including, yet not limited to; bromocriptine and SCH23390. Genotyping individuals for these polymorphic variants can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which dopamine D1 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases, including addiction and dependence behaviors. Genotyping individuals for these polymorphic variants can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Dopamine D2 Receptors (DRD2, Genbank # S69899)
A functional effect of polymorphic variation at amino acid position 40 was observed:











TABLE 6









Leucine 40
Arginine 40















L40R
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















Pergolide
9.87
0.26
7
7.65
0.12
7
166


Lisuride
10.68
0.18
4
8.89
0.20
4
62


Bromocriptine
9.35
0.53
4
7.32
0.45
4
107 


Dihydroergota-
10.29
0.30
4
7.61
0.39
3
479 


mine


Trazodone
6.39
0.10
4
NR


NR


8-OH-DPAT
6.73
0.19
4
4.89
0.12
2
69


Mesulergine
8.45
0.14
5
NR


NR









A lysine to arginine transition at amino acid position 40 (L40R) in the dopamine D2 receptor protein was found to induce 62-479 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the dopamine D2 receptor.
A functional effect of polymorphic variation at amino acid position 208 was observed:











TABLE 7









Valine 208
Leucine 208















V208L
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















Pergolide
9.28
0.13
11
9.65
0.14
11
−2.3


Lisuride
10.69
0.11
5
11.14
0.18
4
−2.8


Bromocriptine
8.78
0.14
3
9.53
0.54
3
−5.6


Dihydroergota-
9.57
0.12
5
10.29
0.15
4
−5.2


mine


Trazodone
6.20
0.10
5
6.28
0.08
5
−1.2


8-OH-DPAT
6.35
0.20
5
7.25
0.15
5
−7.9


Mesulergine
8.16
0.22
5
8.67
0.32
5
−3.2









A valine to lysine transition at amino acid position 208 (V208L) in the dopamine receptor protein was found to induce 2-6 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a gain of biological function, such that individuals that possess this variant will be particularly sensitive to the physiological effects of a therapeutic drug that activates the dopamine D2 receptor.
Dopamine D2 receptors mediate some of the varied physiological effects of the endogenous catecholamine dopamine. Therapeutic drugs with D2 receptor agonist activity are used clinically to Parkinson's disease, hyper-prolactinemia, acromegaly, neuroleptic malignant syndrome, as oxytoxics to induce uterine contractions in post-partum hemorrhage and uterine atony, hepato-renal syndrome, renal failure, and hypotension. Therapeutic drugs with dopamine D2 receptor antagonist activity are used to treat the psychosis associated with Schizophrenia, Schizo-affective disorder, and related psychoses, depression, the behavioral disturbances observed with neurodegenerative disorders such as Alzheimer's disease, as anti-emetics, to control symptoms of motion sickness, and as anti-diarrhea agents.
GPCR Variants # 8 and #9: Dopamine D2 Receptor L40R and V208L Polymorphisms
The presence in an individual of the genetic variant in the dopamine D2 receptor gene that introduces a arginine residue at amino acid position 40 or a leucine residue at amino acid position 208 will predispose that individual to one or more of the following clinical indications:
1) Particular insensitivity or sensitivity (variant #9), to the beneficial physiological effects of dopamine D2 receptor agonists including, yet not limited to; dopamine hydrochloride, bromocriptine mesylate, ergonovine maleate, methylergonovine maleate, metoprolol succinate, metoprolol tartrate, trihexyphenidyl hydrochloride, pramipexole, pergolide, and ropinirole. Genotyping individuals for the polymorphic variants, an arginine residue at amino acid position 40 or a leucine residue at amino acid position 208 (variant #9), can identify those patients requiring higher or lower (variant #9), respectively, clinical doses of these agents.
2) Particular insensitivity or sensitivity (variant #9), to the adverse cardiovascular (including, yet not limited to; tachycardia, angina, palpitations, orthostatic hypotension, syncope, shock, arrhythmias, and peripheral vasoconstriction), neuropsychiatric (including, yet not limited to; anxiety, confusion, hallucinations, psychosis, headache, dizziness, drowsiness, seizure, and stroke), renal (including, yet not limited to; azotemia), metabolic (including, yet not limited to; nausea, vomiting, epigastric pain, and hyperglycemia), and other (including, yet not limited to; erythromyalgia, pleural pulmonary and retroperitoneal fibrosis) side effects of dopamine D2 receptor agonists including, yet not limited to; dopamine hydrochloride, bromocriptine mesylate, ergonovine maleate, methylergonovine maleate, metoprolol succinate, metoprolol tartrate, trihexyphenidyl hydrochloride, pramipexole, pergolide, and ropinirole. Genotyping individuals for the polymorphic variants, an arginine residue at amino acid position 40 or a leucine residue at amino acid position 208 (variant #9), can identify those patients that will exhibit a lesser or greater (variant #9), respectively, propensity towards these side effects.
3) Particular susceptibility or resistance (variant #9) to, or malignant disease progression in, pathophysiological states in which dopamine D2 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: Parkinson's disease, hyper-prolactinemia, acromegaly, neuroleptic malignant syndrome, post-partum hemorrhage and uterine atony, hepato-renal syndrome, renal failure, and hypotension. Genotyping individuals for the polymorphic variants, an arginine residue at amino acid position 40 or a leucine residue at amino acid position 208 (variant #9), can identify those patients that will exhibit a greater or lesser (variant #9), respectively, susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity or insensitivity (variant #9) to the beneficial physiological effects of the dopamine D2 receptor antagonists including, yet not limited to; all antipsychotics as a class exemplified by haloperidol, chlorpromazine, thiothixene, clozapine, respiridone, olanzapine, and quetiapine, anti-depressants including amoxapine, buspirone, and amitriptyline, nortriptyline, and imipramine, and anti-emetics including prochlorperazine edisylate, prochlorperazine maleate, meclizine hydrochloride, thiethylperazine malate, thiethylperazine maleate, and loperamide hydrochloride. Genotyping individuals for the polymorphic variants, an arginine residue at amino acid position 40 or a leucine residue at amino acid position 208 (variant #9), can identify those patients requiring lower or higher (variant #9), respectively, clinical doses of these agents.
5) Particular sensitivity or insensitivity (variant #9) to the adverse cardiovascular (including, yet not limited to; hypotension, and arrhythmias) and neuropsychiatric (including, yet not limited to; confusion, bradykinesia, tremors, tardive dyskinesias, cognitive impairment, and akithesias), endocrine (including, yet not limited to; prolactinemia) and other (including, yet not limited to; neuroleptics malignant syndrome, breast hypertrophy and hyperthermia) side effects of the dopamine D2 receptor antagonists including, yet not limited to; all antipsychotics as a class exemplified by haloperidol, chlorpromazine, thiothixene, clozapine, respiridone, olanzapine, and quetia pine, anti-depressants including amoxapine, buspirone, and amitriptyline, nortriptyline, and imipramine, and anti-emetics including prochlorperazine edisylate, prochlorperazine maleate, meclizine hydrochloride, thiethylperazine malate, thiethylperazine maleate, and loperamide hydrochloride. Genotyping individuals for the polymorphic variants, an arginine residue at amino acid position 40 or a leucine residue at amino acid position 208 (variant #9), can identify those patients that will exhibit a heightened sensitivity or lesser propensity (variant #9), respectively, towards these side effects.
6) Particular resistance or sensitivity (variant #9) to, or benign disease progression in, pathophysiological states in which dopamine D2 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: Schizophrenia, Schizo-affective disorder, and related psychoses, depression, as well as the behavioral disturbances observed with neurodegenerative disorders such as Alzheimer's disease, emesis, motion sickness, and diarrhea. Genotyping individuals for the polymorphic variants, an arginine residue at amino acid position 40 or a leucine residue at amino acid position 208 (variant #9), can identify those patients that will exhibit a lesser or greater (variant #9), respectively, susceptibility to, or benign progression of, these disease states.
Dopamine D3 Receptor (DRD3, Genbank # U32499)
A functional effect of polymorphic variation at amino acid position 50 was observed:
A valine to leucine transition at amino acid position 50 (V50L) in the dopamine D3 receptor protein was found to render the receptor unresponsive to the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the dopamine D3 receptor. Dopamine D3 receptors mediate some of the varied physiological effects of the endogenous catecholamine dopamine. Therapeutic drugs with D3 receptor agonist activity are used clinically to Parkinson's disease, hyper-prolactinemia, acromegaly, neuroleptic malignant syndrome, as oxytoxics to induce uterine contractions in post-partum hemorrhage and uterine atony, hepato-renal syndrome, renal failure, and hypotension. Therapeutic drugs with dopamine D3 receptor antagonist activity are used to treat the psychosis associated with Schizophrenia, Schizo-affective disorder, and related psychoses, depression, the behavioral disturbances observed with neurodegenerative disorders such as Alzheimer's disease, as anti-emetics, to control symptoms of motion sickness, and as anti-diarrhea agents.
GPCR Variant # 10: Dopamine D3 Receptor V50L Polymorphism
The presence in an individual of the genetic variant in the dopamine D3 receptor gene that introduces a leucine residue at amino acid position 50 will predispose that individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of dopamine D3 receptor agonists including, yet not limited to; dopamine hydrochloride, bromocriptine mesylate, ergonovine maleate, methylergonovine maleate, metoprolol succinate, metoprolol tartrate, trihexyphenidyl hydrochloride, pramipexole, pergolide, and ropinirole. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse cardiovascular (including, yet not limited to; tachycardia, angina, palpitations, orthostatic hypotension, syncope, shock, arrhythmias, and peripheral vasoconstriction), neuropsychiatric (including, yet not limited to; anxiety, confusion, hallucinations, psychosis, headache, dizziness, drowsiness, seizure, and stroke), renal (including, yet not limited to; azotemia), metabolic (including, yet not limited to; nausea, vomiting, epigastric pain, and hyperglycemia), and other (including, yet not limited to; erythromyalgia, pleural pulmonary and retroperitoneal fibrosis) side effects of dopamine D3 receptor agonists including, yet not limited to; dopamine hydrochloride, bromocriptine mesylate, ergonovine maleate, methylergonovine maleate, metoprolol succinate, metoprolol tartrate, trihexyphenidyl hydrochloride, pramipexole, pergolide, and ropinirole. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which dopamine D3 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: Parkinson's disease, hyper-prolactinemia, acromegaly, neuroleptic malignant syndrome, post-partum hemorrhage and uterine atony, hepato-renal syndrome, renal failure, and hypotension. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of the dopamine D3 receptor antagonists including, yet not limited to; most antipsychotics as a class exemplified by haloperidol, chlorpromazine, thiothixene, clozapine, respiridone, olanzapine, and quetiapine, anti-depressants including amoxapine, buspirone, and amitriptyline, nortriptyline, and imipramine, and anti-emetics including prochlorperazine edisylate, prochlorperazine maleate, meclizine hydrochloride, thiethylperazine malate, thiethylperazine maleate, and loperamide hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse cardiovascular (including, yet not limited to; hypotension, and arrhythmias) and neuropsychiatric (including, yet not limited to; confusion, bradykinesia, tremors, tardive dyskinesias, cognitive impairment, and akithesias), endocrine (including, yet not limited to; prolactinemia) and other (including, yet not limited to; neuroleptics malignant syndrome, breast hypertrophy and hyperthermia, and agranulocystosis) side effects of the dopamine D3 receptor antagonists including, yet not limited to; most antipsychotics as a class exemplified by haloperidol, chlorpromazine, thiothixene, clozapine, respiridone, olanzapine, and quetiapine, anti-depressants including amoxapine, buspirone, and amitriptyline, nortriptyline, and imipramine, and anti-emetics including prochlorperazine edisylate, prochlorperazine maleate, meclizine hydrochloride, thiethylperazine malate, thiethylperazine maleate, and loperamide hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which dopamine D3 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: Schizophrenia, Schizo-affective affective disorder, and related psychoses, depression, as well as the behavioral disturbances observed with neurodegenerative disorders such as Alzheimer's disease, emesis, motion sickness, and diarrhea. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Histamine H1 Receptors (HRH1, Genbank # D14436)
A functional effect of polymorphic variation at amino acid 216 was observed:











TABLE 8









Alanine 216
Glycine 216















A216G
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















Agonists









HISTAMINE
7.86
0.13
11
7.52
0.13
16
2.2


LISURIDE
8.70
0.15
11
8.18
0.11
14
3.3


TERGURIDE
7.07
0.14
8
6.43
0.09
11
4.4









An alanine to glycine transition at amino acid position 216 (A216G) in the histamine H1 receptor protein was found to induce 2-5 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the histamine H1 receptor.
A functional effect of polymorphic variation at amino acid 226 was observed:











TABLE 9









Leucine 226
Proline 226















L226P
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD





Agonists









HISTAMINE
7.40
0.11
4
6.63
0.05
4
5.9


LISURIDE
8.03
0.07
4
7.49
0.13
4
3.5


TERGURIDE
6.46
0.09
3
5.87
0.17
4
3.9









A leucine to proline transition at amino acid position 226 (L226P) in the histamine H1 receptor protein was found to induce 4-6 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the histamine H1 receptor.
Histamine H1 receptors mediate some of the varied physiological effects of the endogenous catecholamine histamine. Drugs with histamine H1 receptor agonist activity are currently in clinical use as anti-Parkinson agents. Therapeutic drugs with histamine H1 receptor antagonist activity are used clinically to induce sedation, to control acute dystonic reactions, as anti-emetics, and to manage the symptoms associated with allergic reactions.
GPCR Variants # 11 and # 12: Histamine H1 Receptor A216G and L226P Polymorphisms
The presence in an individual of the genetic variant in the histamine H1 receptor gene that introduces an glycine residue at amino acid position 216, or a proline at amino acid residue 226, will predispose that individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of histamine H1 receptor agonists including, yet not limited to: histamine, and lisuride. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse physiological effects including cardiovascular (including, yet not limited to; hypotension and edema), pulmonary (including, yet not limited to; bronchodilation), exocrine (including, yet not limited to; diffuse sweating, and salivation) and metabolic (including, yet not limited to; hyperglycemia) of histamine H1 receptor agonists including, yet not limited to; histamine and lisuride. Genotyping individuals for this polymorphic variant can identify those individuals that exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression, in pathophysiological states in which histamine H1 receptor agonist activity is a potentially therapeutically useful intervention including, yet not limited to: neuropsychiatric, cardiovascular, gastrointestinal, and oncogenic disorders. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of histamine H1 receptor antagonists including, yet not limited to; acrivastine, azatadine maleate, brompheniramine maleate, dexbrompheniramine maleate, carbinoxamine maleate, cetrizine hydrochloride, chlorpheniramine maleate, clemastine fumarate, cyproheptadine hydrochloride, diphenhydramine hydrochloride, doxylamine succinate, fexofenadine hydrochloride, loratadine, promethazine hydrochloride, tripelennamine hydrochloride, triprolidine hydrochloride, azelastine hydrochloride, emedastine hydrochloride, ketotifen fumarate, levoclabastine hydrochloride, and olopatadine hydrochloride, dimenhydrinate, and trimethobenzamide hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse neuropsychiatric (including, yet not limited to; sedation, sleepiness, fatigue, headache, dizziness, confusion, agitation, psychosis, depression, anxiety, hallucinations, fever, restlessness, insomnia, tremor, bradykinesia, tardive dyskinesia, and delirium), gastrointestinal (including, yet not limited to; nausea, vomiting, diarrhea, cholestasis, and pancreatitis), dermatological (including, yet not limited to; rash and Steven's Johnson Syndrome), cardiovascular (including, yet not limited to; cardiac arrhythmias and hypotension), hepatic (including, yet not limited to; liver enzyme elevations), and other (including, yet not limited to; gynecomastia, arthralgias, leukopenia, thrombocytopenia, and myalgias) side effects of the histamine H1 receptor antagonists including, yet not limited to; acrivastine, azatadine maleate, brompheniramine maleate, dexbrompheniramine maleate, carbinoxamine maleate, cetrizine hydrochloride, chlorpheniramine maleate, clemastine fumarate, cyproheptadine hydrochloride, diphenhydramine hydrochloride, doxylamine succinate, fexofenadine hydrochloride, loratadine, promethazine hydrochloride, tripelennamine hydrochloride, triprolidine hydrochloride, azelastine hydrochloride, emedastine hydrochloride, ketotifen fumarate, levoclabastine hydrochloride, and olopatadine hydrochloride, dimenhydrinate, and trimethobenzamide hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which histamine H1 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: narcolepsy and related disorders of sleep, Parkinson's disease and related movement disorders, and atopy. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Histamine H2 Receptors (HRH2, Genbank # D49783)
A functional effect of polymorphic variation at amino acid position 175 was observed:
A lysine to asparagine transition at amino acid position 175 (K175N) in the histamine H2 receptor protein was found to significantly diminish constitutive receptor activity. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the histamine H1. In addition, individuals that possess this variant will display a greater physiological response to therapeutic drugs that activate the histamine H2 receptor, as well as a diminished response to drugs that inactivate the histamine H2 receptor.
A functional effect of polymorphic variation at amino acid position 215 was observed:











TABLE 10









Arginine 215
Glycine 215















R215G
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















Agonist









HISTAMINE
7.54
0.09
6
6.58
0.28
6
9.1


DIMAPRIT
6.63
0.25
3
NR


NR


ROLIPRAM
6.36
0.11
3
NR


NR


ANTHAMINE
7.81
0.18
3
7.11
0.52
3
5.0


Inverse


Agonist


CIMETIDINE
6.21
0.16
6
6.92
0.82
5
−5.1


RANITIDINE
6.80
0.11
6
6.85
0.69
4
−1.1









An arginine to glycine transition at amino acid position 215 (R215G) in the histamine H2 receptor protein was found to induce 5-10 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the histamine H2 receptor, and particularly sensitive to therapeutic drugs that inactivate the histamine H2 receptor.
A functional effect of polymorphic variation at amino acid position 231 was observed:











TABLE 11









Lysine 231
Arginine 231















K231R
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















Agonist









HISTAMINE
7.54
0.09
6
6.74
0.11
6
6.3


DIMAPRIT
6.63
0.25
3
NR


NR


ROLIPRAM
6.36
0.11
3
6.16
0.56
2
1.6


ANTHAMINE
7.82
0.13
4
7.29
0.13
3
3.4


Inverse


Agonist


CIMETIDINE
6.21
0.16
6
6.54
0.21
6
−2.1


RANITIDINE
6.80
0.11
6
6.98
0.47
5
−1.5









A lysine to arginine transition at amino acid position 231 (K231R) in the histamine H2 receptor protein was found to induce 3-6 fold shifts in functional potency for the reference and clinical compounds tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the histamine H2 receptor, as well as particular sensitivity to therapeutic drugs that inactivate the histamine H2 receptor.
Histamine H2 receptors mediate some of the varied physiological effects of the endogenous catecholamine histamine. No therapeutic drugs with histamine H2 receptor agonist activity are currently in clinical use. Therapeutic drugs with histamine H2 receptor antagonist activity are used clinically to reduce gastric acid secretion associated with gastritis, duodenal and gastric ulcer disease, gastro-esophageal reflux, prophylaxis of upper gastro-intestinal bleeding, Zollinger-Ellison Syndrome, multiple endocrine neoplasias, and systemic mastocytosis.
GPCR Variants # 13, # 14 and # 15: Histamine H2 Receptor K175N, R215G, and K231R Polymorphisms
The presence in an individual of the genetic variant in the histamine H2 receptor gene that introduces an asparagine residue at amino acid position 175, a glycine residue at amino acid position 215, or an arginine residue at amino acid position 231 will predispose that individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of histamine H2 receptor agonists including, yet not limited to: histamine. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse physiological effects including cardiovascular (including, yet not limited to; hypotension and edema), pulmonary (including, yet not limited to; bronchodilation), exocrine (including, yet not limited to; diffuse sweating, and salivation) and metabolic (including, yet not limited to; hyperglycemia) of histamine H2 receptor agonists including, yet not limited to; histamine hydrochloride. Genotyping individuals for this polymorphic variant can identify those individuals that exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression, in pathophysiological states in which histamine H2 receptor agonist activity is a potentially therapeutically useful intervention including, yet not limited to: neuropsychiatric, cardiovascular, gastrointestinal, and oncogenic disorders. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of histamine H2 receptor antagonists including, yet not limited to; cimetidine hydrochloride, famotidine, nizatidine, and ranitidine hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse neuropsychiatric (including, yet not limited to; headache, dizziness, confusion, agitation, psychosis, depression, anxiety, hallucinations, fever, and delirium), gastrointestinal (including, yet not limited to; diarrhea and pancreatitis), dermatological (including, yet not limited to; rash and Steven's Johnson Syndrome), cardiovascular (including, yet not limited to; cardiac arrhythmias and hypotension), hematological (including, yet not limited to; neutropenia), renal (including, yet not limited to; interstitial nephritis), hepatic (including, yet not limited to; liver enzyme elevations), and other (including, yet not limited to; gynecomastia, arthralgias and myalgias) side effects of the histamine H2 receptor antagonists including, yet not limited to; cimetidine hydrochloride, famotidine, nizatidine, and ranitidine hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which histamine H2 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: gastritis, duodenal and gastric ulcer disease, gastro-esophageal refux, Zollinger-Ellison Syndrome, multiple endocrine neoplasias, and systemic mastocytosis. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Serotonin 1A Receptors (HTR1A, Genbank #M83181)
A functional effect of polymorphic variation at amino acid position 50 was observed:












TABLE 12








Alanine 50
Valine 50




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold





















8-OH-DPAT
6.87 +/− 0.1
5.6 +/− 0.1
19



Lisuride
7.95 +/− 0.1
7.3 +/− 0.1
5



Buspirone
6.06 +/− 0.1
5.2 +/− 0.2
7










An alanine to valine transition at amino acid position 50 (A50V) in the serotonin 1A receptor protein was found to induce 5-19 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the serotonin 1A receptor.
A functional effect of polymorphic variation at amino acid position 381 was observed:












TABLE 13








Leucine 381
Phenylalanine 381




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold









8-OH-DPAT
6.8 +/− 0.1
6.4 +/− 0.1
2



Lisuride
8.0 +/− 0.1
7.6 +/− 0.2
3



Buspirone
6.1 +/− 0.3
5.6 +/− 0.5
3










A leucine to phenylalanine transition at amino acid position 381 (L381F), in the serotonin 1A receptor protein was found to significantly reduce the maximal response for the reference and clinical agonists tested. This variant was found to induce 2-3 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the serotonin 1A receptor.
A functional effect of polymorphic variation at amino acid position 172 was observed:












TABLE 14








Methionine 172
Isoleucine 172




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold









8-OH-DPAT
6.7 +/− 0.1
7.2 +/− 0.1
−3.2



Lisuride
8.0 +/− 0.1
8.5 +/− 0.1
−3.2



Buspirone
5.8 +/− 0.3
6.7 +/− 0.1
−7.9










A methionine to isoleucine transition at amino acid position 172 (M172I), in the serotonin 1A receptor protein was found to induce 3-8 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a gain of biological function, such that individuals that possess this variant will be particularly sensitive to the physiological effects of a therapeutic drug that activates the serotonin 1A receptor.
Serotonin 1A receptors mediate some of the physiological effects of the endogenous hormone-neurotransmitter serotonin, including platelet, cardiovascular, and gastrointestinal functions. The most prominent physiological effects of serotonin occur in the central nervous system, where this neurotransmitter mediates such diverse processes as mood, cognition, memory, temperature regulation, feeding, sleep and wakefulness, and the production of cerebral spinal fluid. Serotonin 1A receptor agonists are used to treat anxiety, depression, headache, and psychosis, while serotonin 1A antagonists are in clinical development for various neuropsychiatric indications.
GPCR Variants # 16, # 17 and #18: Serotonin 1A Receptor A50V, L381F and M172I Polymorphisms
The presence in an individual of the genetic variant in the serotonin 1A receptor gene that introduces a valine residue at amino acid position 50, or a phenylalanine at amino acid position 381 or an isoleucine residue at amino acid position 172 will predispose that individual to one or more of the following clinical indications:
1) Particular insensitivity or sensitivity (variant #18) to the beneficial physiological effects of serotonin 1A receptor agonists including, yet not limited to; buspirone hydrochloride, gepirone, ipsaperone, and sumatriptan succinate. Genotyping individuals for the polymorphic variants, a valine residue at amino acid position 50, or a phenylalanine at amino acid position 381 or an isoleucine residue at amino acid position 172, can identify those patients requiring higher or lower (variant #18) clinical doses of these agents.
2) Particular insensitivity or sensitivity (variant #18) to the adverse neuropsychiatric (including, yet not limited to; dizziness, headache, drowsiness, dream disturbances, akathisias, tremors, dystonia, involuntary movements, agitation, blurred vision, and sedation), gastrointestinal (including, yet not limited to; nausea, vomiting, diarrhea, constipation, and dry mouth), cardiovascular (including, yet not limited to; tachycardia, palpitations, syncope, hypotension, myocardial infarction, and congestive heart failure), dermatologic (including, yet not limited to; rash, edema, pruritis, flushing, and blisters), gynecological (including, yet not limited to; menstrual abnormalities), genitourinary (including, yet not limited to; urinary hesitancy, dysuria, and urinary frequency) and other (including, yet not limited to; cramps, arthralgias, dyspnea, and liver enzyme elevations) side effects of serotonin 1A receptor agonists including, yet not limited to; buspirone hydrochloride, gepirone, ipsaperone, and sumatriptan succinate. Genotyping individuals for the polymorphic variants, a valine residue at amino acid position 50, or a phenylalanine at amino acid position 381 or an isoleucine residue at amino acid position 172 (variant #18), can identify those patients that will exhibit a lesser or greater (variant #18) propensity towards these side effects.
3) Particular susceptibility or resistance (variant #18) to, or malignant disease progression in, pathophysiological states in which serotonin 1A receptor agonist activity is a therapeutically useful intervention including, yet not limited to: anxiety, depression, headache, and psychosis. Genotyping individuals for the polymorphic variants, a valine residue at amino acid position 50, or a phenylalanine at amino acid position 381 or an isoleucine residue at amino acid position 172 (variant #18), can identify those patients that will exhibit a greater or lesser (variant #18) susceptibility or to, or malignant progression of, these disease states.
4) Particular sensitivity or insensitivity (variant #18) to the beneficial effects of serotonin 1A receptor antagonists. Genotyping individuals for the polymorphic variants, a valine residue at amino acid position 50, or a phenylalanine at amino acid position 381 or an isoleucine residue at amino acid position 172, can identify those patients requiring lower or higher (variant #18) clinical doses of these agents.
5) Particular sensitivity or insensitivity (variant #18) to the adverse side effects of serotonin 1A receptor antagonists. Genotyping individuals for the polymorphic variants, a valine residue at amino acid position 50, or a phenylalanine at amino acid position 381 or an isoleucine residue at amino acid position 172, can identify those patients that will exhibit a heightened sensitivity or lesser propensity (variant #18) towards these side effects.
6) Particular resistance or susceptibility (variant #18) to, or benign disease progression in, pathophysiological states in which serotonin 1A receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases. Genotyping individuals for the polymorphic variants, a valine residue at amino acid position 50, or a phenylalanine at amino acid position 381 or an isoleucine residue at amino acid position 172, can identify those patients that will exhibit a lesser or greater (variant #18) susceptibility to, or benign progression of, these disease states.
Serotonin 1B Receptor (HTR1B, Genbank # M89478)
A threonine to asparagine transition at amino acid position 221 (T221N) in the serotonin 1B receptor protein was found to render the receptor protein non-functional. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the serotonin 1B receptor. Serotonin 1B receptors mediate some of the varied physiological effects of the endogenous monoamine serotonin. Therapeutic drugs with serotonin 1B receptor agonist activity are used clinically to treat; migraines, vascular headaches, cluster headaches, hypertension, Parkinson's disease, and affective disorders including depression, and psychoses including Schizophrenia. Therapeutic drugs with serotonin 1B receptor antagonist activity are used clinically to treat; neuropsychiatric diseases including affective disorders, and Schizophrenia.
GPCR Variant # 19: Serotonin 1B Receptor T221N Polymorphism
The presence in an individual of the genetic variant in the serotonin 1B receptor gene that introduces a asparagine residue at amino acid position 221 will predispose that individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of serotonin 1B receptor agonists, including, yet not limited to; serotonin, lisuride, oxymetazoline hydrochloride, pindolol, sumatriptan succinate, rizatriptan benzoate, naratriptan hydrochloride, zolmitriptan, and eletriptan, and a variety of clinically useful antipsychotics including perlapine. Genotyping individuals for this polymorphic variant can identify those patients who fail to respond to, or require higher clinical doses, of these agents.
2) Particular insensitivity to the adverse cardiovascular (including, yet not limited to; hypertension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, heart valvulopathies, flushing, chest pain, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, mouth and jaw discomfort, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, vertigo, parasthesias, blurred vision, miosis, drowsiness, malaise, fatigue, and stroke), musculoskeletal (neck pain and stiffness), dermatological (erythema, pruritis), renal (dysuria), and hepatic (elevated liver enzymes), side effects of serotonin 1B receptor agonists including, yet not limited to; serotonin, lisuride, oxymetazoline hydrochloride, pindolol, sumatriptan succinate, rizatriptan benzoate, naratriptan hydrochloride, zolmitriptan, and eletriptan, and a variety of clinically useful antipsychotics including perlapine. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which serotonin 1B agonist activity is a therapeutically useful intervention including, yet not limited to: migraines, vascular headaches, cluster headaches, hypertension, Parkinson's disease, affective disorders including depression, and Schizophrenia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of serotonin 1B receptor antagonists including, yet not limited to: a variety of clinically useful antidepressants including fluoxetine hydrochloride, and a variety of clinically useful antipsychotics including cis-flupenthixol, ocaperidone, tefludazine, and triflouperazine hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse cardiovascular (including, yet not limited to; hypertension, hypotension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, parasthesias, blurred vision, miosis, drowsiness, fatigue, and stroke), and other (including, yet not limited to; muscle and joint pain, and rash) side effects of serotonin 1B receptor antagonists including, yet not limited to: a variety of clinically useful antidepressants including fluoxetine hydrochloride, and a variety of clinically useful antipsychotics including cis-flupenthixol, ocaperidone, tefludazine, and triflouperazine hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which serotonin 1B receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases including affective disorders and Schizophrenia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Serotonin 1D Receptor (HTR1D, Genbank # M89955)
A functional effect of polymorphic variation at amino acid position 53 was observed:











TABLE 15









Valine 53
Leucine 53















V53L
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















5HT
6.78
0.15
7
6.37
0.18
5
2.6


5CT
8.70
0.24
6
7.85
0.52
4
7.1


Lisuride
10.37
0.06
2
NR


NR


8-OH-DPAT
6.93
0.10
4
6.06
0.27
4
7.4


Sumatriptan
7.71
0.10
9
7.26
0.10
8
2.8









A valine to leucine transition at amino acid position 53 (V53L) in the serotonin 1D receptor protein was found to induce 3-8 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the serotonin 1D receptor.
A functional effect of polymorphic variation at amino acid position 366 was observed:











TABLE 16









Alanine 366
Glycine 366















A366G
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















5HT
6.79
0.13
8
6.29
0.10
8
3.2


5CT
8.56
0.26
8
7.29
0.28
8
18.6


Sumatriptan
7.73
0.12
12
6.95
0.13
12
6.0


Buspirone
5.26
0.18
7
4.54
0.17
7
5.2


Trazodone
6.03
0.24
4
5.02
0.16
4
10.2









An alanine to glycine transition at amino acid position 366 (A366G) in the serotonin 1D receptor protein was found to induce 3 to 19 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activate the serotonin 1D receptor.
Serotonin 1D receptors mediate some of the varied physiological effects of the endogenous monoamine serotonin. Therapeutic drugs with serotonin 1D receptor agonist activity are used clinically to treat; migraines, vascular headaches, cluster headaches, hypertension, Parkinson's disease, and affective disorders including depression and psychosis including Schizophrenia. Therapeutic drugs with serotonin 1D receptor antagonist activity are used clinically to treat; neuropsychiatric diseases including affective disorders, and Schizophrenia.
GPCR Variants # 20 and # 21: Serotonin 1D Receptor V53L and A366G Polymorphisms
The presence in an individual of the genetic variant in the serotonin 1D receptor gene that introduces a leucine residue at amino acid position 53, or a glycine at amino acid position 366 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of serotonin 1D receptor agonists, including, yet not limited to; serotonin, lisuride, oxymetazoline hydrochloride, pindolol, timolol maleate, bromocriptine mesylate, methysergide maleate, sumatriptan succinate, rizatriptan benzoate, naratriptan hydrochloride, zolmitriptan, and eletriptan, a variety of clinically useful antipsychotics including perlapine, and a variety of clinically useful antidepressants including trazodone hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients who may fail to respond to, or require higher clinical doses of, these agents.
2) Particular insensitivity to the adverse cardiovascular (including, yet not limited to; hypertension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, heart valvulopathies, flushing, chest pain, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, mouth and jaw discomfort, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, vertigo, parasthesias, blurred vision, miosis, drowsiness, malaise, fatigue, and stroke), musculoskeletal (neck pain and stiffness), dermatological (erythema, pruritis), renal (dysuria), and hepatic (elevated liver enzymes), side effects of serotonin 1D receptor agonists including; yet not limited to; serotonin, lisuride, oxymetazoline hydrochloride, pindolol, timolol maleate, bromocriptine mesylate, methysergide maleate, sumatriptan succinate, rizatriptan benzoate, naratriptan hydrochloride, zolmitriptan, and eletriptan, a variety of clinically useful antipsychotics including perlapine, and a variety of clinically useful antidepressants including trazodone hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which serotonin 1D agonist activity is a therapeutically useful intervention including, yet not limited to: migraines, vascular headaches, cluster headaches, hypertension, Parkinson's disease, affective disorders including depression, and Schizophrenia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
Particular sensitivity to the beneficial physiological effects of serotonin 1D receptor antagonists including, yet not limited to: a variety of clinically useful antipsychotics including rispiridone, and ocaperidone. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse cardiovascular (including, yet not limited to; hypertension, hypotension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, parasthesias, blurred vision, miosis, drowsiness, fatigue, and stroke), and other (including, yet not limited to; muscle and joint pain, and rash) side effects of serotonin 1D receptor antagonists including, yet not limited to: a variety of clinically useful antipsychotics including respiridone, and ocaperidone. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which serotonin 1D receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases including affective disorders and Schizophrenia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Serotonin 1E Receptor (HTR1E, Genbank # M91467)
A functional effect of polymorphic variation at amino acid position 44 was observed:











TABLE 17









Isoleucine 44
Threonine 44















144T
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















BRL54443
7.53
0.12
5
5.83
0.05
6
50


Lisuride
7.75
0.07
2
5.59
0.04
2
145









An isoleucine to threonine transition at amino acid position 44 (I44T) in the serotonin 1E receptor protein was found to induce 50-145 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the serotonin 1E receptor.
A functional effect of polymorphic variation at amino acid position 262 was observed:











TABLE 18









Serine 262
Phenylalanine 262















S262F
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















BRL54443
7.53
0.12
5
6.76
0.14
6
5.9


Lisuride
7.75
0.07
2
6.50
0.98
2
17.8









A serine to phenylalanine transition at amino acid position 262 (S262F) in the serotonin 1E receptor protein was found to induce 6 to 18 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the serotonin 1E receptor.
Serotonin 1E receptors mediate some of the physiological effects of the endogenous hormone-neurotransmitter serotonin. The most prominent physiological effects of serotonin occur in the central nervous system, where this neurotransmitter mediates such diverse processes as mood, cognition, memory, temperature regulation, feeding, sleep and wakefulness, and the production of cerebral spinal fluid. No specific serotonin 1E receptor agonists or antagonists have been developed, yet known drugs with significant serotonin 1E receptor agonist activity are used to treat anxiety, depression, migraine, and psychosis, while serotonin 1E antagonists are in development for various neuropsychiatric indications.
GPCR Variants #22 and # 23: Serotonin 1E Receptor 144T and S262F Polymorphisms
The presence in an individual of the genetic variant in the serotonin 1E receptor, gene that introduces a threonine residue at amino acid position 44, or a phenylalanine at amino acid position 262 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of serotonin 1E receptor agonists including, yet not limited to; buspirone hydrochloride, amitriptyline hydrochloride, desipramine hydrochloride, nortriptyline hydrochloride, fluoxetine hydrochloride, fluvoxamine maleate, mirtazepine, clozapine, olanzapine, loxapine hydrochloride, loxapine succinate, mesioridazine besylate, and sumatriptan succinate. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse neuropsychiatric (including, yet not limited to; dizziness, headache, drowsiness, dream disturbances, akathisias, tremors, dystonia, involuntary movements, agitation, blurred vision, seizures, decreased libido, and sedation), gastrointestinal (including, yet not limited to; nausea, vomiting, diarrhea, constipation, and dry mouth), cardiovascular (including, yet not limited to; tachycardia, palpitations, syncope, hypotension, myocardial infarction, and congestive heart failure), dermatologic (including, yet not limited to; rash, edema, pruritis, flushing, and blisters), gynecological (including, yet not limited to; menstrual abnormalities), genitourinary (including, yet not limited to; urinary hesitancy, dysuria, erection and ejaculatory disturbances, and urinary frequency) and other (including, yet not limited to; cramps, arthralgias, dyspnea, and liver enzyme elevations) side effects of serotonin 1E receptor agonists including, yet not limited to; buspirone hydrochloride, amitriptyline hydrochloride, desipramine hydrochloride, nortriptyline hydrochloride, fluoxetine hydrochloride, fluvoxamine maleate, mirtazepine, clozapine, olanzapine, loxapine hydrochloride, loxapine succinate, mesioridazine besylate, and sumatriptan succinate. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which serotonin 1E receptor agonist activity is a therapeutically useful intervention including, yet not limited to: anxiety, depression, migraine, and psychosis. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial effects of serotonin 1E receptor antagonists, including, yet not limited to: pindolol. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse neuropsychiatric (including, yet not limited to; dizziness, headache, drowsiness, dream disturbances, akathisias, tremors, dystonia, involuntary movements, agitation, blurred vision, seizures, parasthesias, weakness, catatonia, disorientation, decreased libido, fatigue, insomnia, and sedation) side effects of serotonin 1E receptor antagonists including, yet not limited to: pindolol. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which serotonin 1E receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Serotonin 2B Receptor (HTR2B, Genbank #X77307)
A functional effect of polymorphic variation at amino acid position 388 was observed:











TABLE 19









Arginine 388
Tryptophan 388















R388W
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















Serotonin
6.79
0.13
14
6.27
0.29
3
.3


DHE
10.03
0.29
8
8.93

1
2.5


mCPP
7.84
0.13
10
7.46
0.16
3
.4


Methysergide
9.26
0.39
4
ND


Nortryptiline
7.40
0.12
5
ND









An arginine to tryptophan transition at amino acid position 388 (R388W) in the serotonin 2B receptor protein was found to induce 3 to 13 fold shifts in functional potency for the reference and clinical agonists and inverse agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the serotonin 2B receptor, and particularly sensitivity to therapeutic drugs that inactivate the serotonin 2B receptor. Serotonin 2B receptors mediate some of the varied physiological effects of the endogenous hormone/neurotransmitter serotonin. Although no therapeutic drugs have yet been developed that specifically target the serotonin 2B receptor, many current therapeutic drugs possess potent serotonin 2B receptor agonist or inverse agonist activity. Therapeutic drugs with serotonin 2B receptor agonist activity are used to treat migraine, depression, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, eating disorders, attention deficit disorder, narcolepsy, Parkinson's disease, and irritable bowel syndrome. Therapeutic drugs with serotonin 2B receptor antagonist/inverse agonist activity are used to treat schizophrenia and psychosis.
GPCR Polymorphism # 24: Serotonin 2B Receptor R388W Polymorphism
The presence in an individual of the genetic variation in the serotonin 2B receptor gene that introduces an tryptophan residue at amino acid position 388 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of serotonin 2B receptor agonists including, yet not limited to; serotonin hydrochloride, pergolide, bromocriptine mesylate, lisuride, dihydroergotamine methanosulfate, dihydroergotamine mesylate, methysergide maleate, modafinil, and a variety of anti-depressants including nortriptyline hydrochloride, protryptiline hydrochloride, amoxapine, buspirone, and trazodone hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse cardiovascular (including, yet not limited to; hypertension, hypotension, syncope, tachycardia, bradycardia, angina, palpitations, myocardial infarction, severe vasospasm, heart valvulopathies, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, vomiting, anorexia, abdominal pain, hepatotoxicity, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, confusion, hallucinations, delusions, headache, confusion, dizziness, blurred vision, insomnia, drowsiness, fatigue, ataxia, seizures, and stroke), and urologic (including, yet not limited to; urinary retention, priapism) and other (including, yet not limited to: retroperitoneal fibrosis, pleuropulmonary fibrosis, a constellation of symptoms referred to as serotonin syndrome, telangiectasias, prolactinemia, dry mouth, ileus, thrombocytopenia, and leg cramps) side effects of the serotonin 2B receptor agonists including, yet not limited to; serotonin hydrochloride, pergolide, bromocriptine mesylate, lisuride, dihydroergotamine methanosulfate, dihydroergotamine mesylate, methysergide maleate, modafinil, and a variety of anti-depressants including nortriptyline hydrochloride, protryptiline hydrochloride, amoxapine, buspirone, and trazodone hydrochloride. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which serotonin 2B receptor agonist activity is a therapeutically useful intervention including, yet not limited to: migraine, depression, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, eating disorders, attention deficit disorder, narcolepsy, Parkinson's disease, and irritable bowel syndrome. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial effects of the serotonin 2B receptor antagonists/inverse agonists including, yet not limited to; a number of antipsychotics including clozapine, olanzapine, respiridone, loxapine, fluphenazine, fluspirilene and ziprasidone. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse cardiovascular (including, yet not limited to; hypotension, and arrhythmias) and neuropsychiatric (including, yet not limited to; confusion, bradykinesia, tremors, tardive dyskinesias, cognitive impairment, and akithesias), endocrine (including, yet not limited to; prolactinemia) and other (including, yet not limited to; neuroleptics malignant syndrome, breast hypertrophy and hyperthermia, and agranulocystosis) side effects of serotonin 2b receptor antagonists/inverse agonists including, yet not limited to: a number of antipsychotics including clozapine, olanzapine, respiridone, loxapine, fluphenazine, fluspirilene and ziprasidone. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
Particular resistance to, or benign disease progression in, pathophysiological states in which serotonin 2B receptor antagonist/inverse agonist activity is a therapeutically useful intervention including, yet not limited to: schizophrenia and psychosis. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Serotonin 7 Receptor (HTR7, Genbank #U68488)
A functional effect of polymorphic variation at amino acid position 92 was observed.
A threonine to lysine transition at amino acid position 92 (T92K) in the serotonin 7 receptor protein was found to significantly diminish constitutive receptor activity. This variant displays a loss of biological function, such that individuals that possess this variant will display a greater physiological response to therapeutic drugs that activate the serotonin 7 receptor, as well as a diminished response to drugs that inactivate the serotonin 7 receptor.
A functional effect of polymorphic variation at amino acid position 421 was observed:











TABLE 20









Leucine 421
Proline 421















L421P
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















Clozapine
8.21
0.15
10
7.43
0.14
4
6.0


Fluphenazine
8.17
0.19
10
7.41
0.13
4
5.8


Cis-
8.05
0.28
9
7.61
0.28
3
2.8


flupenthixol


Sertindole
7.64
0.14
13
6.86
0.39
7
6.0


Thiothixene
8.16
0.18
8
7.66
0.15
2
3.2


Tefludazine
9.38
10.38
8
7.95
0.87
4
27.0









A leucine to proline transition at amino acid position 421 (L421P) in the serotonin 7 receptor protein was found to induce 3 to 27 fold shifts in functional potency for the reference and clinical inverse agonists tested. This variant displays a gain of biological function, such that individuals that possess this variant will be particularly sensitive to the physiological effects of a therapeutic drug that activates the serotonin 7 receptor, and particularly insensitivity to therapeutic drugs that inactivate the serotonin 7 receptor.
Serotonin 7 receptors mediate some of the varied physiological effects of the endogenous hormone/neurotransmitter serotonin. Although no therapeutic drugs have yet been developed that specifically target the serotonin 7 receptor, many current therapeutic drugs possess potent serotonin 7 receptor agonist or inverse agonist activity. Drugs with serotonin 7 receptor agonist activity are used to treat migraine, and Parkinson's disease. Drugs with serotonin 7 receptor antagonist/inverse agonist activity are used to treat depression, schizophrenia, and psychosis.
GPCR Polymorphisms # 25 and # 26: Serotonin 7 Receptor T92K and L421P Polymorphisms
The presence in an individual of the genetic variation in the serotonin 7 receptor gene that introduces an lysine residue at amino acid position 92, or a proline at amino acid position 421 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of serotonin 7 receptor agonists including, yet not limited to; serotonin hydrochloride, pergolide, bromocriptine mesylate, dihydroergotamine methanosulfate, and sumatriptan succinate. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse side effects of the serotonin 7 receptor agonists including, yet not limited to; serotonin hydrochloride, pergolide, bromocriptine mesylate, dihydroergotamine methanosulfate and sumatriptan succinate. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
Particular susceptibility to, or malignant disease progression in, pathophysiological states in which serotonin 7 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial effects of the serotonin 7 receptor antagonists including, yet not limited to; clozapine, chlorpromazine hydrochloride, risperidone, amitriptyline hydrochloride and amoxapine. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse side effects of the serotonin 7 receptor antagonists including, yet not limited to; clozapine, chlorpromazine hydrochloride, risperidone, amitriptyline hydrochloride and amoxapine. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which serotonin 7 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases. Genotyping individuals this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Angiotensin II Type 1 Receptors (AGTR1, Genbank #XM—051470)
A functional effect of polymorphic variation at amino acid position 45 was observed:
A glycine to arginine transition at amino acid position 45 (G45W) in the angiotensin II Type 1 receptor protein was found to render the protein non-functional. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the angiotensin II Type 1 receptor.
A functional effect of polymorphic variation at amino acid position 204:












TABLE 21








Phenylalanine 204
Serine 204




Compound
EC50 (−pKi)
EC50 (−pKi)
FOLD









Angiotensin 2
6.9 +/− 0.1
5.1 +/− 0.3
63










A phenylalanine to serine transition at amino acid position 204 (F204S) in the angiotensin II Type 1 receptor protein was found to induce 63 fold shifts in functional potency for the reference agonist tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the angiotensin II Type 1 receptor.
A functional effect of polymorphic variation at amino acid position 289 was observed:












TABLE 22








Cysteine 289
Tryptophan 289




Compound
EC50 (−pKi)
EC50 (−pKi)
FOLD









Angiotensin 2
6.9 +/− 0.1
5.8 +/− 0.1
13










A cysteine to tryptophan transition at amino acid position 289 (C289W) in the angiotensin II Type 1 receptor protein was found to induce 13 fold shifts in functional potency for the reference agonist tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the angiotensin IT Type 1 receptor.
Angiotensin II Type 1 receptor mediate some of the varied physiological effects of the endogenous hormone/neurotransmitter angiotensin II. No therapeutic drugs have yet been developed that are angiotensin II Type 1 receptor agonists. Many angiotensin II Type 1 receptor antagonists are used to treat hypertension, myocardial hypertrophy, congestive heart failure, hyperlipidemia, as renoprotective agents in diabetic nephropathy, and primary and secondary aldosteronism.
GPCR Polymorphisms # 27, # 28 and # 29: Angiotensin II Type 1 Receptor G45R, F204S and C289W Polymorphisms
The presence in an individual of the genetic variation in the angiotensin II Type 1 receptor gene that introduces an arginine residue at amino acid position 45, or a serine at amino acid position 204, or a tryptophan at amino acid position 289 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of angiotensin II Type 1 receptor agonists including, yet not limited to; angiotensin II. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the adverse side effects of angiotensin II Type 1 receptor agonists including, yet not limited to; angiotensin II. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser sensitivity towards these side effects.
3) Particular, susceptibility to, or malignant disease progression in, pathophysiological states in which angiotensin II Type 1 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: hypotension, and aldosterone deficiency. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial effects of angiotensin II Type 1 receptor antagonists including, yet not limited to; valsartan, irbesartan, candesartan, eprosartan, zolasartan, telmisartan, olmesartan, fonsartan, embusartan, saprisartan, and losartan potassium. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to adverse cardiovascular (including, yet not limited to; hypotension, and arrhythmias) neuropsychiatric (including, yet not limited to; headache and lightheadedness), gastrointestinal (including, yet not limited to; diarrhea and constipation), and other (including, yet not limited to; neonatal morbidity and mortality) side effects of the angiotensin II Type 1 receptor antagonists including, yet not limited to; valsartan, candesartan, eprosartan, zolasartan, tasosartan, telmisartan, olmesartan, fonsartan, embusartan, saprisartan, and losartan potassium. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which angiotensin II Type 1 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: hypertension, myocardial hypertrophy, congestive heart failure, hyperlipidemia, diabetic nephropathy, and primary and secondary aldosteronism hypertension. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Cannabinoid 1 Receptor (CNR1, Genbank # X54937)
A functional effect of polymorphic variation at amino acid position 200 was observed:
A phenylalanine to leucine transition at amino acid position 200 (F200L) in the cannabinoid 1 receptor was found to decrease the basal biological activity of the receptor protein. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the cannabinoid 1 receptor. Cannabinoid 1 receptors mediate some of the varied physiological effects of the endogenous autocoid anandamide. Therapeutic drugs with cannabinoid 1 receptor agonist activity are used clinically to treat; nausea, anorexia, and pain, and novel cannabinoid 1 receptor agonists are in development to treat neuropsychiatric diseases including affective disorders. No current therapeutic drugs possess cannabinoid 1 receptor antagonist activity, however cannabinoid 1 receptor antagonists are in development for neuropsychiatric diseases including affective disorders, and psychoses including schizophrenia.
GPCR Variant # 30: Cannabinoid 1 Receptor F200L Polymorphism
The presence in an individual of the genetic variant in the cannabinoid 1 receptor gene that introduces a leucine residue at amino acid position 200 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of cannabinoid 1 receptor agonists, including, yet not limited to; dronabinol, and nabilone. Genotyping individuals for this polymorphic variant can identify those patients who require higher clinical doses of these agents.
2) Particular insensitivity to the adverse cardiovascular (including, yet not limited to; hypertension, syncope, tachycardia, bradycardia, angina, myocardial infarction, severe vasospasm, heart valvulopathies, flushing, chest pain, and arrhythmias), gastrointestinal (including, yet not limited to; nausea, abdominal pain, hepatotoxicity, and diarrhea), neuropsychiatric (including, yet not limited to; anxiety, depression, irritability, headache, confusion, dizziness, vertigo, parasthesias, blurred vision, miosis, drowsiness, malaise, fatigue, delusions and frank psychosis), and hepatic (elevated liver enzymes), side effects of cannabinoid 1 receptor agonists including; yet not limited to; dronabinol and nabinole. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which cannabinoid 1 receptor activity is a therapeutically useful intervention including, yet not limited to: anorexia, chronic pain, and neuropsychiatric diseases including affective disorders and Schizophrenia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of cannabinoid 1 receptor antagonists. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the adverse side effects of cannabinoid 1 receptor antagonists. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which cannabinoid 1 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: neuropsychiatric diseases including affective disorders and Schizophrenia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Cholecystokinin B Receptor (CCKRB Genbank # S70057)
A functional effect of polymorphic variation at amino acid position 224 was observed:











TABLE 23









Leucine 224
Glutamine 224















L224Q
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD

















CCK-4
7.10
0.29
3
8.18
0.23
3
−12.0


CCK-8-
8.07
0.15
3
8.55
0.13
3
−3.0


Sulfated


CCK-8-
7.11
0.35
3
8.05
0.53
3
−8.7


desulfated


Gastrin
8.71
0.01
3
9.78
0.04
3
−11.7









A leucine to glutamine transition at amino acid position 224 (L224Q) in the cholecystokinin B receptor protein was found to induce 3 to 12 fold shifts in functional potency for the reference and clinical agonists tested. This variant displays a gain of biological function, such that individuals that possess this variant will be particularly sensitive to the physiological effects of a therapeutic drug that activates the cholecystokinin B receptor.
Cholecystokinin B receptors mediate some of the varied physiological effects of the endogenous hormones cholecystokinin and gastrin. Therapeutic drugs with cholecystokinin B receptor agonist activity are used clinically to treat disorders of bile secretion including cholecystitis, primary sclerosing cholangitis, and malabsorption syndromes including non-tropical sprue, and are in development for use as antiobesity agents, and to treat autism and chronic and acute pain. Therapeutic drugs with cholecystokinin B receptor antagonist activity are in development to treat anorexia nervosa and acute and chronic pain.
GPCR Variant # 31: Cholecystokinin B Receptor L224Q Polymorphism
The presence in an individual of the genetic variant in the cholecystokinin B receptor gene that introduces a glutamine residue at amino acid position 224 will predispose that individual to one or more of the following clinical indications:
1) Particular sensitivity to the beneficial physiological effects of cholecystokinin B receptor agonists, including, yet not limited to; Sincalide, CCK-4, CCK-8, and gastrin. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
2) Particular sensitivity to the adverse gastrointestinal (including, yet not limited to; nausea, vomiting, abdominal pain, hepatotoxicity, and diarrhea), and neuropsychiatric (including, yet not limited to; dizziness and flushing) side effects of cholecystokinin B receptor agonists, including, yet not limited to; sincalide, CCK-4, CCK-8, and gastrin. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a heightened sensitivity towards these side effects.
3) Particular resistance to, or benign disease progression in, pathophysiological states in which cholecystokinin B receptor agonist activity is a therapeutically useful intervention including, yet not limited to: cholecystitis, primary sclerosing cholangitis, and malabsorption syndromes including non-tropical sprue, obesity, autism and chronic and acute pain. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
4) Particular insensitivity to the beneficial physiological effects of cholecystokinin B receptor antagonists, including, yet not limited to; C1988, and L265260. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular insensitivity to the adverse side effects of cholecystokinin B receptor antagonists including, yet not limited to: C1988, and L265260. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these side effects.
6) Particular susceptibility to, or malignant disease progression, in pathophysiological states in which cholecystokinin B receptor antagonists antagonist activity is a therapeutically useful intervention including, yet not limited to: anorexia nervosa and acute and chronic pain. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
Gamma-Amino Butyric Acid Type B Receptors (GABBR1, Genbank #AJ012288)
A functional effect of polymorphic variation at amino acid position 93 was observed:












TABLE 24








Proline 93
Leucine 93




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold





















R(+) Baclofen
6.7
7.0
−2.0



AMPA
7.2
7.6
−2.5



GABA
6.3
7.6
−20










A proline to leucine transition at amino acid position 93 (P93L) in the GABA-BR1 receptor protein was found to induced 2-20 fold shifts in potency to the reference and clinical agonists tested. This variant displays a gain of biological function, such that individuals that possess this variant will be particularly sensitive to the physiological effects of a therapeutic drug that activates the GABA-BR1 receptor, and particularly insensitivity to therapeutic drugs that inactivate the GABA-BR1 receptor.
A functional effect of polymorphic variation at amino acid position 542 was observed:












TABLE 25








Leucine 542
Proline 542




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold









R(+) Baclofen
6.7
5.3
25



AMPA
7.2
5.7
32



GABA
6.3
4.7
40










A leucine to proline transition at amino acid position 542 (L542P) in the GABA-BR1 receptor protein was found to render the receptor protein significantly less responsive, and induced 25-40 fold shifts in potency to the reference and clinical agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the GABA-BR1 receptor, and particularly sensitivity to therapeutic drugs that inactivate the GABA-BR1 receptor.
GABA-BR1 receptors mediate some of the varied physiological effects of the endogenous hormone/neurotransmitter gamma-amino butyric acid. Therapeutic drugs with GABA-BR1 receptor agonist activity are used as skeletal muscle relaxants to treat spasticity, chorea, and trigeminal neuralgia. Therapeutic drugs with GABA-BR1 receptor antagonist activity are in development for treating neuropsychiatric disease.
GPCR Variants # 32 and #33: GABA-BR1 Receptor P93L and L542P Polymorphisms
The presence in an individual of the genetic variation in the GABA-BR1 receptor gene that introduces a leucine residue at amino acid position 93 or a proline residue at amino acid position 542 will predispose the individual to one or more of the following clinical indications:
1) Particular sensitivity or insensitivity (variant #33) to the beneficial physiological effects of GABA-BR1 receptor agonists including, yet not limited to; baclofen. Genotyping individuals for the polymorphic variants, a leucine residue at amino acid position 93 or a proline residue at amino acid position 542 (variant #33), can identify those patients requiring lower or higher (variant #33), respectively, clinical doses of these agents.
2) Particular sensitivity or resistance (variant #33) to the adverse cardiovascular (including, yet not limited to; bradycardia, dyspnea, palpitations, orthostatic hypotension), neuropsychiatric (including, yet not limited to; anxiety, depression, confusion, hallucinations, euphoria, psychosis, headache, weakness, hypotonia, dizziness, vertigo, fatigue, drowsiness, tremor, rigidity, and seizure), renal (including, yet not limited to; urinary frequency, dysuria, hematuria), metabolic (including, yet not limited to; nausea, vomiting, diarrhea, dry mouth), and other (including, yet not limited to; deep vein thrombosis, rash, weight gain, and transaminitis) side effects of GABA-BR1 receptor agonists including, yet not limited to; baclofen. Genotyping individuals for the polymorphic variants, a leucine residue at amino acid position 93 or a proline residue at amino acid position 542 (variant #33), can identify those patients that will exhibit a heightened sensitivity or lesser propensity (variant #33), respectively, towards these side effects.
3) Particular resistance or susceptibility (variant #33) to, or benign disease progression in, pathophysiological states in which GABA-BR1 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: spasticity of any origin, and headache. Genotyping individuals for the polymorphic variants, a leucine residue at amino acid position 93 or a proline residue at amino acid position 542(variant #33), can identify those patients that will exhibit a lesser or greater susceptibility (variant #33), respectively, to, or benign progression of, these disease states.
4) Particular insensitivity or sensitivity (variant #33) to the beneficial physiological effects of the GABA-BR1 receptor antagonists. Genotyping individuals for the polymorphic variants, a leucine residue at amino acid position 93 or a proline residue at amino acid position 542 (variant #33), can identify those patients requiring higher or lower (variant #33), respectively, clinical doses of these agents.
5) Particular insensitivity or sensitivity (variant #33) to the adverse side effects of the GABA-BR1 receptor antagonists. Genotyping individuals for the polymorphic variants, a leucine residue at amino acid position 93 or a proline residue at amino acid position 542 (variant #33), can identify those patients that will exhibit a lesser propensity or heightened sensitivity (variant #33), respectively, towards these side effects.
6) Particular susceptibility or resistance (variant #33) to, or malignant disease progression in, pathophysiological states in which GABA-BR1 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: Schizophrenia, Schizo-affective disorder, and related psychoses, depression, as well as the behavioral disturbances observed with neurodegenerative disorders such as Alzheimer's disease. Genotyping individuals for the polymorphic variants, a leucine residue at amino acid position 93 or a proline residue at amino acid position 542 (variant #33), can identify those patients that will exhibit a greater or lesser (variant #33), respectively, susceptibility to, or malignant progression of, these disease states.
Thromboxane 2 Prostanoid Receptors (TBXA2R, Genbank #E03829)
A functional effect of polymorphic variation at amino acid position 80 was observed:












TABLE 26








Valine 80
Glutamic Acid 80




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold









U46619
8.04 +/− 0.2
6.24 +/− 0.4
63



Thromboxane A2
6.41 +/− 0.2
5.39 +/− 0.1
11



I-BOP
9.49 +/− 0.3
7.52 +/− 0.1
93










A valine to glutamic acid transition at amino acid position 80 (V80E) in the thromboxane receptor protein was found to induce 11-93 fold shifts in functional potency for the reference agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the thromboxane receptor.
A functional effect of polymorphic variation at amino acid position 94 was observed:












TABLE 27








Glutamine 94
Valine 94




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold









U46619
8.34 +/− 0.2
7.56 +/− 0.1
6.0



Thromboxane A2
6.12 +/− 0.2
6.48 +/− 0.2
2.3



I-BOP
9.50 +/− 0.2
8.95 +/− 0.1
3.5










A glutamine to valine transition at amino acid position 94 (E94V) in the thromboxane receptor protein was found to induce 3-6 fold shifts in functional potency for the reference agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the thromboxane receptor.
A functional effect of polymorphic variation at amino acid position 176 was observed:

















Valine 176
Glutamic Acid 176




Compound
EC50 (−pKi)
EC50 (−pKi)
Fold





















U46619
8.04 +/− 0.2
7.33 +/− 0.3
5



Thromboxane A2
6.41 +/− 0.2
5.58 +/− 0.3
7



I-BOP
9.49 +/− 0.3
8.39 +/− 0.1
13










A valine to glutamic acid transition at amino acid position 176 (V176E) in the thromboxane receptor protein was found to induce 5-13 fold shifts in functional potency for the reference agonists tested. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the thromboxane receptor.
Thromboxane receptors mediate some of the varied physiological effects of the endogenous autocoid thromboxane A2. This receptor is an important mediator of platelet aggregation, vasoconstriction, leukocyte maturation, and has been shown to modulate atherosclerotic processes. No therapeutic drugs with thromboxane receptor agonist activity have yet been developed. Therapeutic drugs with thromboxane receptor antagonist activity are being developed to inhibit platelet aggregation, block vasoconstriction, and to treat nephrotic syndrome.
GPCR Polymorphisms # 34, # 35 and # 36: Thromboxane Receptor V80E, E94V and V176E Polymorphisms
The presence in an individual of the genetic variation in the thromboxane receptor gene that introduces an glutamine residue at amino acid position 80, or a valine at amino acid position 94, or a glutamic acid at amino acid position 176 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of thromboxane receptor agonists including, yet not limited to; thromboxane A2. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the potential adverse side effects of thromboxane receptor agonists including, yet not limited to; thromboxane A2. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which thromboxane receptor agonist activity is a therapeutically useful intervention including, yet not limited to: hemorrhage, hypotension, and renal disorders including nephritic syndromes. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of thromboxane receptor antagonists including, yet not limited to; sulotroban, and vapiprost. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the potential adverse side effects of thromboxane receptor antagonists including, yet not limited to; sulotroban, and vapiprost. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater propensity towards these effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which thromboxane receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: thrombosis, hypertension, systemic vascular resistance syndromes, asthma, renal disorders including nephrotic syndrome, and atherosclerosis and its consequences including stroke, myocardial infarction, and peripheral vascular disease. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Neuropeptide Y1 Receptor (NPYR1, Genbank # A26481)
A functional effect of polymorphic variation at amino acid position 298 was observed:











TABLE 28









Histidine 298
Proline 298















H298P
Ave −Log
STD

Ave −Log
STD




Compound
EC50
DEV
“n”
EC50
DEV
“n”
FOLD





NPY
6.36
0.09
4
NR


NR


PYY
9.94
0.80
3
6.91
0.2
3
1072


Leu/Pro NPY
7.50
0.11
4
NR


NR









A histidine to proline transition at amino acid position 298 (H298P) in the neuropeptide Y1 receptor protein was found to render the protein non-functional. This variant displays a loss of biological function, such that individuals that possess this variant will be particularly insensitive to the physiological effects of a therapeutic drug that activates the neuropeptide Y1 receptor.
Neuropeptide Y1 receptors mediate some the varied physiological effects of the endogenous hormone neuropeptide Y. No therapeutic drugs with neuropeptide Y1 receptor antagonist activity are currently in clinical use. Neuropeptide Y regulates a host physiological functions including vasomotor activity, fluid balance, hormonal release, and feeding and drinking behaviors.
GPCR Polymorphism # 37: Neuropeptide Y1 Receptor Polymorphism
The presence in an individual of the genetic variation in the neuropeptide Y1 receptor gene that introduces an arginine residue at amino acid position 298 will predispose the individual to one or more of the following clinical indications:
1) Particular insensitivity to the beneficial physiological effects of neuropeptide Y1 receptor agonists including, yet not limited to; NPY and PYY. Genotyping individuals for this polymorphic variant can identify those patients requiring higher clinical doses of these agents.
2) Particular insensitivity to the potential adverse side effects of neuropeptide Y1 receptor agonists including, yet not limited to; NPY and PYY. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser propensity towards these effects.
3) Particular susceptibility to, or malignant disease progression in, pathophysiological states in which neuropeptide Y1 receptor agonist activity is a therapeutically useful intervention including, yet not limited to: hemorrhage, hypotension, neuropsychiatric disease, obesity and anorexia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater susceptibility to, or malignant progression of, these disease states.
4) Particular sensitivity to the beneficial physiological effects of neuropeptide Y1 receptor antagonists. Genotyping individuals for this polymorphic variant can identify those patients requiring lower clinical doses of these agents.
5) Particular sensitivity to the potential adverse side effects of neuropeptide Y1 receptor antagonists. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a greater propensity towards these effects.
6) Particular resistance to, or benign disease progression in, pathophysiological states in which neuropeptide Y1 receptor antagonist activity is a therapeutically useful intervention including, yet not limited to: hemorrhage, hypotension, neuropsychiatric disease, obesity and anorexia. Genotyping individuals for this polymorphic variant can identify those patients that will exhibit a lesser susceptibility to, or benign progression of, these disease states.
Thus, in accordance with the invention, there are provided methods of screening a subject for the presence of GPCR variants, said variants providing clinical indications as set forth herein. In various embodiments, a method includes detecting the presence of one or more variants of alpha 1 adrenergic receptor, beta 3 adrenergic receptor, dopamine D1 receptor, dopamine D2 receptor, dopamine D3 receptor, histamine H1 receptor, histamine H2 receptor, serotonin 1A receptor, serotonin 1B receptor, serotonin 1D receptor, serotonin 1E receptor, serotonin 2B receptor, serotonin 7 receptor, angiotensin II type 1 receptor, CB1 cannabinoid receptor, cholecystokinin B receptor, gamma-amino-butyric acid Type B receptor, thromboxane A2 receptor, and neuropeptide Y1 receptor. In various aspects, a method includes screening a biological sample from a subject for one or more variants of: alpha 1 adrenergic receptor, beta 3 adrenergic receptor, dopamine D1 receptor, dopamine D2 receptor, dopamine D3 receptor, histamine H1 receptor, histamine H2 receptor, serotonin 1A receptor, serotonin 1B receptor, serotonin 1D receptor, serotonin 1E receptor, serotonin 2B receptor, serotonin 7 receptor, angiotensin II type 1 receptor, CB1 cannabinoid receptor, cholecystokinin B receptor, gamma-amino-butyric acid Type B receptor, thromboxane A2 receptor, and neuropeptide Y1 receptor.
In various aspects, the variants are selected from one or more of: alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 43 or a haplotype linked with a cysteine residue at amino acid position 43, or a serine residue at amino acid position 200 or a haplotype linked with a serine residue at amino acid position 200; beta 3 adrenergic receptor having a leucine residue at amino acid position 78 or a haplotype linked with a leucine residue at amino acid position 78; dopamine D1 receptor having a proline at amino acid position 37 or a haplotype linked with a proline at amino acid position 37, or an arginine at amino acid position 37 or a haplotype linked with an arginine at amino acid position 37, or a serine at amino acid position 79 or a haplotype linked with a serine at amino acid position 79, or an alanine at amino acid position 199 or a haplotype linked with an alanine at amino acid position 199; dopamine D2 receptor having an arginine at amino acid position 40 or a haplotype linked with an arginine at amino acid position 40, or a leucine at amino acid position 208 or a haplotype linked to a leucine at amino acid position 208; dopamine D3 receptor having a leucine at amino acid position 50 or a haplotype linked with a leucine at amino acid position 50; histamine H1 receptor having a glycine at amino acid position 216 or a haplotype linked to a glycine at amino acid position 216, or a proline at amino acid position 226 or a haplotype linked to a proline at amino acid position 226; histamine H2 receptor having an asparagine at amino acid 175 or a haplotype linked to an asparagine at amino acid 175, or a glycine at amino acid position 215 or a haplotype linked to a glycine at amino acid position 215, or an arginine at amino acid position 231 or a haplotype linked to an aspartic acid at amino acid 231; serotonin 1A receptor having a valine at amino acid position 50 or a haplotype linked to a valine at amino acid position 50, or an isoleucine at amino acid position 172 or a haplotype linked to an isoleucine at amino acid position 172, or a phenylalanine at amino acid position 381 or a haplotype linked to a phenylalanine at amino acid position 381; serotonin 1B receptor having an asparagine at amino acid position 221 or a haplotype linked to an asparagine at amino acid position 221; serotonin 1D receptor having a leucine at amino acid position 53 or a haplotype linked to a leucine at amino acid position 53, or a glycine at amino acid position 366 or a haplotype linked to a glycine at amino acid position 366; serotonin 1E receptor having a threonine at amino acid position 44 or a haplotype linked to a threonine at amino acid position 44, or a phenylalanine at amino acid position 262 or a haplotype linked to a phenylalanine at amino acid position 262; serotonin 2B receptor having a tryptophan at amino acid position 388 or a haplotype linked to a tryptophan at amino acid position 388; serotonin 7 receptor having a lysine at amino acid position 92 or a haplotype linked to a lysine at amino acid position 92, or a proline at amino acid position 421 or a haplotype linked to a proline at amino acid position 421; angiotensin II type 1 receptor having an arginine at amino acid position 45 or a haplotype linked to an arginine at amino acid position 45, or a serine at amino acid position 204 or a haplotype linked to a serine at amino acid position 204, or a tryptophan at amino acid position 289 or a haplotype linked to a tryptophan at amino acid position 289; CB1 cannabinoid receptor having a leucine at amino acid position 200 or a haplotype linked to a leucine at amino acid position 200; cholecystokinin B receptor having a glutamine at amino acid position 224 or a haplotype linked to a glutamine at amino acid position 224; gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a haplotype linked to a leucine at amino acid position 93, or a proline at amino acid position 452 or a haplotype linked to a proline at amino acid position 452; thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a haplotype linked to a glutamic acid at amino acid position 80, a valine at amino acid position 94 or a haplotype linked to a valine at amino acid position 94, or a glutamic acid at amino acid position 176 or a haplotype linked to a glutamic acid at amino acid position 176; or a neuropeptide Y1 receptor having a proline at amino acid position 298, or a haplotype linked to a proline at amino acid position 298.
The presence of the variant receptor or haplotype linked to the variant identifies the subject as having the corresponding receptor variant. Thus, further in accordance with the invention, there are provided methods for identifying individuals having increased or decreased sensitivity or insensitivity to beneficial physiological effects of GPCR agonists and antagonists; having increased or decreased sensitivity or insensitivity to adverse side effects produced by agonists or antagonists of GPCRs; having increased or decreased resistance or susceptibility to, or benign disease progression in, pathophysiological states in which GPCR agonist or antagonist activity is a therapeutically useful intervention.
In additional embodiments of the methods of the invention, the presence of the GPCR variants set forth herein may be detected by hybridization with polynucleotides that specifically hybridize to the variant sequence, i.e., the sequence that contains the nucleotide(s) polymorphism. Alternatively, direct nucleotide sequencing of the GPCR gene of interest will reveal whether the polymorphism is present. Thus, the invention methods may be practiced by hybridizing a polynucleotide to nucleic acid obtained from a subject, and the presence of the variant to which the polynucleotide specifically hybridizes detected using methods known in the art such as Northern or Southern blots or other methods, such as nucleotide sequencing.
The invention therefore also provides methods of screening for the presence of a GPCR variant employing polynucleotides that specifically hybridize to at least a portion of the GPCR sequence that encodes a variant amino acid residue of a GPCR variant disclosed herein. In one embodiment, a method includes contacting a sample that contains nucleic acid with a polynucleotide capable of specific hybridization to one or more GPCR sequences that encodes a variant sequence. Detecting a hybridization signal thereby detects the presence of a nucleic acid that encodes the variant. In various aspects, the hybridization signal is compared to a control polynucleotide that specifically hybridizes to a GPCR that does not contain the variant, e.g., a sequence that is wild type in respect to the particular polymorphism being detected. The hybridization signals of the polynucleotide that hybridizes to the GPCR variant sequence and the polynucleotide that hybridizes to a GPCR that does not contain the variant can be compared in order to confirm the presence or absence of the variant GPCR. In various aspects, the sample is from a subject, such as a mammal (human).
The methods of the invention directed to detecting one or more variant GPCRs, e.g. in a subject, generally require nucleic acid. Nucleic acid can be isolated from a biological sample such as cells, tissue or organ (e.g. biopsy) from a subject according to any well known method. The sample may be of any biological tissue or fluid. Samples include, but are not limited to, sputum, blood, blood cells (e.g., white cells), tissue or biopsy samples, stool, urine, peritoneal fluid, pleural fluid, spinal or cranial fluid or cells there from. Biological samples may also include sections of tissues such as frozen sections taken for histological purposes. Thus, essentially any sample that contains nucleic acid can be used for detecting variant GPCR.
The term “subject” refers to animals, typically mammalian animals, such as a non-human primate (gorillas, chimpanzees, orangutans, macaques, gibbons), a domestic animal (dogs and cats), a farm animal (horses, cows, goats, sheep, pigs), experimental animal (mouse, rat, rabbit, guinea pig) and humans that have or may have a GPCR variant. Human subjects include adults, and children, for example, newborns and older children, for example, between the ages of 1 and 5, 5 and 10 and 10 and 18. Subjects include disease model animals (e.g., such as mice and non-human primates) for studying the effect of a therapy on these animals having a GPCR variant sequences as disclosed herein.
Subjects that may be screened for the presence of a GPCR variant in accordance with the invention include, for example, any subject that is being treated or that is a candidate for treatment, for example, with any agent disclosed herein, or with any agent that exhibits activity on one or more of the GPCRs disclosed herein. For example, a subject being treated or a candidate for treatment with any alpha 1A/C adrenergic receptor agonist or antagonist, such as dobutamine, is a candidate subject to be screened in a method of the invention for the presence of a cysteine residue at amino acid position 43 or a serine residue at amino acid position 200 of alpha 1A/C adrenergic receptor. Likewise, a subject being treated or a candidate for treatment with any Beta 3 adrenergic receptor agonist or antagonist, such as albuterol, is a candidate subject to be screened in a method of the invention for the presence of a leucine residue at amino acid position 78 of Beta 3 adrenergic receptor. Thus, subjects that may be screened include subjects where GPCR variant screening may increase the likelihood of successful treatment with a drug that acts at least in part through the GPCR, diagnosis or identification of those with increased or decreased sensitivity or resistance to pathophysiological states in which GPCR agonists or antagonists are useful in treating, for tailoring the types and doses of particular drugs to that subject, and for identifying subjects having increased or decreased risk of an adverse side effect of the treatment.
The invention further provides compositions including, for example, polynucleotides that specifically hybridize to GPCR variant nucleic acids and antibodies that specifically bind to the variant GPCR polypeptides. In one embodiment, a polynucleotide of the invention specifically binds to a nucleic acid that includes a sequence (sense, antisense or RNA transcript) that codes for that portion of the GPCR sequence that contains the variant amino acid residue, or a haplotype linked with the variant amino acid residue. In particular aspects, the sequence codes for at least a portion of a polypeptide that includes a sequence selected, for example, from:
1) Alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 43 or a serine at amino acid position 200;
2) Beta 3 adrenergic receptor having a leucine residue at amino acid position 78;
3) D1 dopamine receptor having a proline at amino acid position 37 or an arginine at amino acid position 37 or a serine at amino acid position 79 or an alanine at amino acid position 199;
4) D2 dopamine receptor having an arginine at amino acid position 40 or a leucine at amino acid position 208;
5) D3 dopamine receptor having a leucine at amino acid position 50;
6) H1 Histamine receptor having a glycine at amino acid position 216 or a proline at amino acid 226;
7) H2 histamine receptor having an asparagine at amino acid position 175 or a glycine at amino acid position 215 or an arginine at amino acid position 231;
8) 1A serotonin receptor having a valine at amino acid position 50 or an isoleucine at amino acid position 172 or a phenylalanine at amino acid position 381;
9) 1B serotonin receptor having an asparagine at amino acid position 221;
10) 1D serotonin receptor having a leucine at amino acid position 53 or a glycine at amino acid position 366;
11) 1E serotonin receptor having a threonine at amino acid position 44 or a phenylalanine at amino acid position 262;
12) 2B serotonin receptor having a tryptophan at amino acid position 388;
13) serotonin 7 receptor having a lysine at amino acid position 92 or a proline at amino acid position 421;
14) angiotensin 2 type 1 receptor having an arginine at amino acid position 45 or a serine at amino acid position 204 or a tryptophan at amino acid position 289;
15) cannabinoid CB1 receptor having a leucine at amino acid position 200;
16) cholecystokinin B receptor having a glutamine at amino acid position 224;
17) gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a proline at amino acid position 452;
18) thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a valine at amino acid position 94 or a glutamic acid at amino acid position 176; and
19) neuropeptide Y1 receptor having a proline at amino acid position 298.
In more particular aspects, polynucleotides of the invention specifically hybridize to one or more nucleic acid sequences that encode the variant GPCR selected, or a portion of the sequence that contains the polymorphism, for example, from:
1) Alpha 1A/C adrenergic receptor having a thymine at position 564 or a guanine at position 1035 or a haplotype linked with thymine at position 564 or a guanine at position 1035;
2) Beta 3 adrenergic receptor having a thymine at nucleotide position 870, or a haplotype linked with a thymine at nucleotide position 870;
3) D1 dopamine receptor having a cytidine at nucleotide position 382 or a guanine at nucleotide position 383 or a thymine at nucleotide position 508 or a guanine at nucleotide position 868, or a haplotype linked with a cytidine at nucleotide position 382 or a guanine at nucleotide position 383 or a thymine at nucleotide position 508 or a guanine at nucleotide position 868;
4) D2 dopamine receptor having a guanine at nucleotide position 218 or a cytidine at nucleotide position 721, or a haplotype linked with a guanine at nucleotide position 218 or a cytidine at nucleotide position 721;
5) D3 dopamine receptor having a cytidine at nucleotide position 148, or a haplotype linked with a cytidine at nucleotide position 148;
6) H1 histamine receptor having a guanine at nucleotide position 2811 or a cytidine at nucleotide position 2841, or a haplotype linked to a guanine at nucleotide position 2811 or a cytidine at nucleotide position 2841;
7) H2 histamine receptor having a thymine at nucleotide position 2298 or a guanine at nucleotide position 2416 or a guanine at nucleotide position 2465;
8) 1A serotonin receptor having a thymine at nucleotide position 540 or a cytidine at nucleotide position 907 or a cytidine at nucleotide position 1534;
9) 1B serotonin receptor having an alanine at nucleotide position 1033;
10) 1D serotonin receptor having a cytidine at nucleotide position 427 or a guanine at nucleotide position 1367;
11) 1E serotonin receptor having a cytidine at nucleotide position 697 or a thymine at nucleotide position 1351;
12) 2B serotonin receptor having a thymine at nucleotide position 1217;
13) serotonin 7 receptor having a guanine at nucleotide position 302 or a cytidine at amino acid position 1289;
14) angiotensin II type 1 receptor having an alanine at nucleotide position 339 or a cytidine at nucleotide position 817 or a guanine at nucleotide position 1073;
15) cannabinoid CB1 receptor having a cytidine at nucleotide position 746;
16) cholecystokinin B receptor having a alanine at nucleotide position 856;
17) Gamma-amino-butyric acid B receptor having a thymine at nucleotide position 321 or a cytidine at nucleotide position 1698;
18) Thromboxane A2 receptor having an alanine at nucleotide position 1230 or a thymine at nucleotide position 1272 or an alanine at nucleotide position 1518; and
19) Neuropeptide Y1 receptor having a cytosine at nucleotide position 1068.
Of course, the methods of the invention may be performed using multiple polynucleotides capable of specifically hybridizing to multiple GPCR variants. For example, both alpha 1A/C adrenergic receptor variants can be simultaneously detected by using polynucleotides that specifically hybridize to sense or antisense nucleic acid coding for cysteine at amino acid position 43 and serine at position 200. If the variants are located closely enough to each other, a single polynucleotide that specifically hybridizes to GPCR sequences that include nucleotides that encode the variants can be used to detect two or more variants simultaneously. In this way, the presence of more than one GPCR variants may be detected affording economies of scale and additional clinical indication information for tailoring clinical treatment to the individual. Therefore, the invention also provides mixtures of polynucleotides (two or more polynucleotides, or a plurality) that specifically hybridize to GPCR variant nucleic acids and mixtures of antibodies (two or more antibodies, or a plurality) that specifically bind to the variant GPCR polypeptides. The term “polynucleotide,” “oligonucleotide,” “nucleic acid,” “gene” and the like include linear oligomers of natural or modified monomers or linkages, including deoxyribonucleotides, ribonucleotides, α-anomeric forms thereof capable of specifically binding to a target sequence by way of a regular pattern of monomer-to-monomer interactions, such as Watson-Crick type of base pairing, base stacking, Hoogsteen or reverse Hoogsteen types of base pairing. Monomers are typically linked by phosphodiester bonds or analogs thereof to form the polynucleotides. Whenever a polynucleotide is represented by a sequence of letters, such as “ATGCCTG,” it is understood that the nucleotides are in a 5′→3′ orientation from left to right.
Polynucleotides can be a synthetic oligomer, a sense or antisense, single or double strand full-length cDNA encoding a variant GPCR, or a less-than full length cDNA that includes at least that portion of the sequence that contains the variant nucleotide(s), or a genomic sequence or subsequence which contains, for example, non-coding 5′ and 3′ regions and introns. Polynucleotides therefore include sequences that specifically hybridize to the portion of the GPCR variant that contains a sequence that codes for the variant amino acid residue. Thus, the polynucleotide need only hybridize to a region of the variant GPCR sequence that includes the polymorphism.
Polynucleotides also include for example, RNA, such as mRNA. Thus, polynucleotides include, but are not limited to, mRNA transcripts of the GPCR variant gene or genomic sequence, cDNA reverse transcribed from the mRNA, cRNA transcribed from the cDNA, DNA amplified from the GPCR genes or genomic sequences, RNA transcribed from amplified DNA, etc.
Polynucleotides of the invention include sequences suitable for hybridization or for attachment to a detection substrate. Typically polynucleotides for hybridization comprise the four natural nucleotides; however, they may also comprise non-natural nucleotide analogs, derivatized forms or mimetics. Analogs of phosphodiester linkages include phosphorothioate, phosphorodithioate, phosphoranilidate, phosphoramidate, for example. A particular example of a mimetic is protein nucleic acid (see, e.g., Egholm et al., Nature 365:566 (1993); see also U.S. Pat. No. 5,539,083.
Polynucleotides suitable for such applications are typically between 8 and 50 bases in length. Polynucleotides of the invention therefore can be of any length, but are more likely between about 8 and 50, for example, 8 to 12, 8 to 15, 12 to 15, 12 to 20, 15 to 20, 12 to 25, 15 to 25, 15 to 30, 15 to 35, 12 to 30, 18 to 25, 18 to 30, 12 to 35, 15 to 40, 20 to 30, 20 to 35, 20 to 40, 25 to 40, 30 to 40, 30 to 45, 30 to 50, 35 to 50, or any number between 8 and 50 nucleotides.
Polynucleotides of the invention will specifically hybridize to a sequence including a sequence encoding the variant GPCR, whether the sequence to which the polynucleotide hybridizes is the sense or antisense strand (genomic sequence or a cDNA sequence) or an RNA transcript transcribed from the variant GPCR. Therefore, polynucleotides of the invention include double or single strand, linear or circular, sequences that specifically hybridize to sense or antisense strands of regions of GPCRs that include the variant sequence, as well as polynucleotides that specifically hybridize to an RNA transcript that encodes a variant GPCR.
The term “hybridization” refers to the binding between complementary nucleic acids. The term “specific hybridization” or grammatical variations thereof, when used in reference to a polynucleotide capable of forming a non-covalent bond with another sequence, means that the hybridization is selective between 1) the polynucleotide and 2) a sequence that includes the variant nucleotide(s) that encodes at least a portion of the GPCR polypeptide that contains the variant amino acid residue. In other words, the polynucleotide will preferentially hybridize to the variant sequence over the wild type sequence, or other sequences (e.g., other variants) to the extent that one skilled in the art will be able to determine that the target GPCR variant is present. Suitable polynucleotide controls, for example, a polynucleotide that specifically hybridizes to GPCR encoding a wild-type amino acid residue instead of variant residue can be used for comparison in order to determine whether the GPCR variant is present or not.
For two nucleic acid sequences to bind, the temperature of a hybridization reaction must be less than the calculated TM for the sequences. As is understood by those skilled in the art, the TM (melting temperature) refers to the temperature at which binding between complementary sequences is no longer stable. The TM is influenced by the amount of sequence complementarity, length, composition (% GC), type of nucleic acid (RNA vs. DNA), and the amount of salt, detergent and other components in the reaction (e.g., formamide). For example, longer hybridizing sequences are stable at higher temperatures. Duplex stability between RNAs or DNAs is generally in the order of RNA:RNA>RNA:DNA>DNA:DNA. All of these factors are considered in establishing appropriate hybridization conditions (see, e.g., the hybridization techniques and formula for calculating TM described in Sambrook et al., 1989, supra). Generally, stringent conditions are selected to be about 5° C. lower than the melting point (Tm) for the specific sequence at a defined ionic strength and pH.
Typically, wash conditions are adjusted so as to attain the desired degree of hybridization stringency. Thus, hybridization stringency can be determined empirically, for example, by washing under particular conditions, e.g., at low stringency conditions or high stringency conditions. For example, a polynucleotide that specifically binds to a variant GPCR can be compared for hybridization to the variant GPCR sequence and the wild type GPCR sequence under the same hybridization conditions. A hybridization signal of at least two-fold greater for the variant than the wild type identifies appropriate hybridization conditions for differentiating between the variant and wild type GPCR sequence and, therefore, appropriate hybridization conditions for use in the methods of the invention. However, if the conditions are insufficient to detect differences in hybridization signal, stringency of the conditions can be increased.
Exemplary hybridization conditions include, for example, moderately stringent hybridization, 2×SSC/0.1% SDS at about 37° C. or 42° C. (hybridization); 0.5×SSC/0.1% SDS at about room temperature (low stringency wash); 0.5×SSC/0.1% SDS at about 42° C. (moderate stringency wash); moderately-high stringency hybridization: 2×SSC/0.1% SDS at about 37° C. or 42° C. (hybridization); 0.5×SSC/0.1% SDS at about room temperature (low stringency wash); 0.5×SSC/0.1% SDS at about 42° C. (moderate stringency wash); and 0.1×SSC/0.1% SDS at about 52° C. (moderately-high stringency wash); high stringency hybridization: 2×SSC/0.1% SDS at about 37° C. or 42° C. (hybridization); 0.5×SSC/0.1% SDS at about room temperature (low stringency wash); 0.5×SSC/0.1% SDS at about 42° C. (moderate stringency wash); and 0.1×SSC/0.1% SDS at about 65° C. (high stringency wash). Nucleic acid hybridization conditions using gene chips is described, for example, in U.S. Pat. No. 6,040,138.
Invention polynucleotide sequences will typically be highly homologous to the GPCR nucleotide sequence that encodes the variant. Examples of high homology depend on the length of the polynucleotide used for hybridization. For example, a 10 base polynucleotide may require 100% homology with the sequence it binds, i.e., the variant GPCR, because a single base mismatch may also allow it to bind to wild type GPCR sequence to the extent that they may not be distinguishable (i.e., less than a two-fold difference in hybridization signal between the variant and wild type GPCRs). However, longer sequences are able to tolerate mismatches; the longer the sequence, the greater the number of mismatches that may be tolerated without affecting specific hybridization. For example, a 12 to 15 base polynucleotide is likely to tolerate 1-2 mismatches; a 15 to 20 base polynucleotide is likely to tolerate 1-3 mismatches; a 20 to 25 base polynucleotide is likely to tolerate 1-4 mismatches; a 25 to 30 base polynucleotide is likely to tolerate 1-5 mismatches, and so forth. Thus, polynucleotides of the invention that specifically hybridize to variant GPCRs therefore are complementary to a portion of the variant GPCR nucleotide sequences disclosed herein that includes the sequence that codes for the variant amino acid residue to the extent that they are capable of distinguishing between the variant sequence and a GPCR sequence wild type in respect to the variant. Accordingly, invention polynucleotides need not be 100% homologous or 100% complementary to sequences that encode GPCR variant polypeptide sequence disclosed herein, or to the specific nucleic acid sequences disclosed herein that can encode the particular 37 GPCR variants.
Invention polynucleotides having less than 100% homology or complementarity to a GPCR variant nucleic acid sequence may be identified using routine assays. For example, a series of polynucleotides with less than 100% homology or complementarity to the variant GPCR sequence can be produced having various lengths. The polynucleotides can then be individually hybridized to the variant GPCR sequence; sequences that hybridize can then be compared for their ability to differentiate between the variant and the wild type GPCR sequence, for example, by comparing the hybridization signal when the polynucleotide hybridizes to the variant GPCR and vs. the wild type GPCR. Detecting a difference in hybridization signal, generally at least a two-fold or greater difference in the signal for the variant sequence than the wild type sequence identifies polynucleotides of the invention that specifically hybridize to the variant GPCR sequence.
The polynucleotides for hybridization may be labeled before, during, or after hybridization to a GPCR, although typically polynucleotides are labeled before hybridization. The labels may be incorporated by any of a number of means well known to those of skill in the art. For example, polymerase chain reaction (PCR) with labeled primers or labeled nucleotides will produce a labeled amplification product. Labels that may be employed include radioisotope labeled nucleotides (e.g., dCTP), fluorescein-labeled nucleotides (UTP or CTP). A label may be attached directly to the nucleic acid sample (e.g., mRNA, polyA mRNA, cDNA, etc.) or to the amplification product after the amplification is completed using methods well known to those of skill in the art including, for example nick translation or end-labeling (e.g. with a labeled RNA).
“Direct labels” are directly attached to or incorporated into the polynucleotides prior to hybridization. Indirect labels are attached to the hybrid duplex after hybridization. For example, an indirect label, such as biotin, can be attached to the polynucleotide prior to the hybridization. Following hybridization, an aviden-conjugated fluorophore will bind the biotin bearing hybrid duplexes to facilitate detection.
Labels therefore include any composition that can be attached to or incorporated into nucleic acid that is detectable by spectroscopic, photochemical, biochemical, immunochemical, electrical, optical or chemical means. Useful labels include biotin for staining with labeled streptavidin conjugate, magnetic beads (e.g., DynabeadsTM), fluorescent dyes (e.g., 6-FAM, HEX, TET, TAMRA, ROX, JOE, 5-FAM, R110, fluorescein, texas red, rhodamine, lissamine, phycoerythrin (Perkin Elmer Cetus), Cy2, Cy3, Cy3.5, Cy5, Cy5.5, Cy7, FluorX (Amersham), radiolabels, enzymes (e.g., horse radish peroxidase, alkaline phosphatase and others used in ELISA), and colorimetric labels such as colloidal gold or colored glass or plastic beads (e.g., polystyrene, polypropylene, latex, etc.), fluorophore, a radioisotope or a chemiluminescent moiety.
Compositions further include detection substrates that include a two-dimensional array of polynucleotide sequences and a substrate; the polynucleotide sequences are typically attached to the surface of the substrate (e.g., via a covalent bond) at defined positions (addresses). In one aspect, the polynucleotides attached to the surface of the substrate encode at least a portion of a polypeptide that includes a sequence selected, for example, from: Alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 43 or a serine at amino acid position 200; Beta 3 adrenergic receptor having a leucine residue at amino acid position 78; D1 dopamine receptor having a proline at amino acid position 37 or an arginine at amino acid position 37 or a serine at amino acid position 79 or an alanine at amino acid position 199; D2 dopamine receptor having an arginine at amino acid position 40 or a leucine at amino acid position 208; D3 dopamine receptor having a leucine at amino acid position 50; H1 histamine receptor having a glycine at amino acid position 216 or a proline at amino acid 226; H2 histamine receptor having an asparagine at amino acid position 175 or a glycine at amino acid position 215 or an arginine at amino acid position 231; 1A serotonin receptor having a valine at amino acid position 50 or an isoleucine at amino acid position 172 or a phenylalanine at amino acid position 381; 1B serotonin receptor having an asparagine at amino acid position 221; 1D serotonin receptor having a leucine at amino acid position 53 or a glycine at amino acid position 366; 1E serotonin receptor having a threonine at amino acid position 44 or a phenylalanine at amino acid position 262; 2B serotonin receptor having a tryptophan at amino acid position 388; serotonin 7 receptor having a lysine at amino acid position 92 or a proline at amino acid position 421; angiotensin 2 type 1 receptor having an arginine at amino acid position 45 or a serine at amino acid position 204 or a tryptophan at amino acid position 289; cannabinoid CB1 receptor having a leucine at amino acid position 200; cholecystokinin B receptor having a glutamine at amino acid position 224; gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a proline at amino acid position 452; thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a valine at amino acid position 94 or a glutamic acid at amino acid position 176; and neuropeptide Y1 receptor having a proline at amino acid position 298.
In various aspects, the substrate includes a number of nucleic acid sequences greater than about 100, greater than about 1000, greater than about 10,000, greater than about 100,000, greater than about 1,000,000, or more. In additional aspects, the substrate includes a polynucleotide that codes for at least a portion of a polypeptide that includes a sequence selected, for example, from: Alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 43 or a serine at amino acid position 200; Beta 3 adrenergic receptor having a leucine residue at amino acid position 78; D1 dopamine receptor having a proline at amino acid position 37 or an arginine at amino acid position 37 or a serine at amino acid position 79 or an alanine at amino acid position 199; D2 dopamine receptor having an arginine at amino acid position 40 or a leucine at amino acid position 208; D3 dopamine receptor having a leucine at amino acid position 50; H1 histamine receptor having a glycine at amino acid position 216 or a proline at amino acid 226; H2 histamine receptor having an asparagine at amino acid position 175 or a glycine at amino acid position 215 or an arginine at amino acid position 231; 1A serotonin receptor having a valine at amino acid position 50 or an isoleucine at amino acid position 172 or a phenylalanine at amino acid position 381; 1B serotonin receptor having an asparagine at amino acid position 221; 1D serotonin receptor having a leucine at amino acid position 53 or a glycine at amino acid position 366; 1E serotonin receptor having a threonine at amino acid position 44 or a phenylalanine at amino acid position 262; 2B serotonin receptor having a tryptophan at amino acid position 388; serotonin 7 receptor having a lysine at amino acid position 92 or a proline at amino acid position 421; angiotensin 2 type 1 receptor having an arginine at amino acid position 45 or a serine at amino acid position 204 or a tryptophan at amino acid position 289; cannabinoid CB1 receptor having a leucine at amino acid position 200; cholecystokinin B receptor having a glutamine at amino acid position 224; gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a proline at amino acid position 452; thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a valine at amino acid position 94 or a glutamic acid at amino acid position 176; neuropeptide Y1 receptor having a proline at amino acid position 298; or subsequences thereof (e.g., from about 10-20, 20-30, 30-50, 50-100 or more nucleotides in length) that contain the variant. In yet additional aspects, the nucleic acid sequences include one or more GPCR sequences, e.g. one or more sequences that are wild type in respect to the variant GPCR nucleotide sequences.
Detection substrates that include a two-dimensional array of polynucleotide sequences of the invention, also referred to herein as “gene chips” or “arrays,” and that are useful in the methods of the invention, are comprised of polynucleotide chains (e.g., DNA or RNA or combinations thereof) likely single stranded, or at least single stranded prior to hybridization. Arrays can comprise as few as about 25, 50, 100, 250, 500 or 1000 polynucleotides that are different in one or more nucleotides or 2500, 5000, 10,000, 20,000, 30,000, 40,000, 50,000, 75,000, 100,000, 250,000, 500,000, 1,000,000 or more polynucleotides. The greater the number of polynucleotides on the array representing different gene sequences, the more powerful the assay system. Thus, polynucleotides that hybridize to all or almost all GPCR variants are ideal for screening. However, such comprehensiveness is not required in order to practice the invention. Accordingly, polynucleotide arrays in which all or a subset of the polynucleotides represent or several GPCR variants may be used.
Arrays can have any polynucleotide density; the greater the density the greater the number of genes that can be screened on a given chip size. Density can be as few as 1-10 (e.g., 1, 2, 4, 5, 6, 8, 10) polynucleotides per cm2. Density can be as many as 10-100 (e.g., 10-15, 15-20, 20-30, 30-40, 40-50, 50-60, 60-70, 70-80, 90-100) polynucleotides per cm2 or more. Greater density arrays afford economies of scale.
Purified or isolated variant GPCR polypeptides and fragments thereof that contain the variant amino acid sequence are also provided. Such variant polypeptides are useful for producing antibodies that specifically bind to the polypeptides. Such antibodies are useful for detecting the presence of variant GPCR in a sample. Thus, antibodies that specifically bind to variant GPCRs disclosed herein are further provided.
The term “antibody” refers to a protein that binds to other molecules (antigens) via heavy and light chain variable domains, VH and VL, respectively. Antibodies include IgG, IgD, IgA, IgM and IgE. The antibodies may be intact immunoglobulin molecules, two full length heavy chains linked by disulfide bonds to two full length light chains, as well as subsequences (i.e. fragments) of immunoglobulin molecules, with our without constant region, that bind to an epitope of an antigen, or subsequences thereof (i.e. fragments) of immunoglobulin molecules, with or without constant region, that bind to an epitope of an antigen. Antibodies may comprise full length heavy and light chain variable domains, VH and VL, individually or in any combination.
Polypeptide sequences can be produced by recombinant expression from a cell that produces the protein or alternatively, using a chemical synthesizer (see, e.g., Applied Biosystems, Foster City, Calif.). Antibodies and subsequences thereof can be expressed from recombinantly produced antibody-encoding nucleic acid, such as a polynucleotide isolated from hybridoma cells (see, e.g., Harlow and Lane, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, 1989; Harlow and Lane, Using Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, 1999; Fitzgerald et al., J.A.C.S. 117:11075 (1995); Gram et al., Proc. Natl. Acad. Sci. USA 89:3576-80 (1992)). For antibody subsequences, pepsin or papain digestion of whole antibodies can be used to generate antibody fragments.
As used herein, the term “isolated,” when used as a modifier of invention compositions (e.g., polynucleotides, polypeptides, antibodies, etc.), means that the compositions are separated from their naturally occurring in vivo environment. Generally, compositions so separated are substantially free of one or more materials with which they normally associate with in nature, for example, one or more protein, nucleic acid, lipid, carbohydrate, and cell membrane. An “isolated” polypeptide can also be “substantially pure” when free of most or all of the materials with which it normally associate with in nature. Thus, an isolated polypeptide that also is substantially pure does not include polypeptides or polynucleotides present among millions of other sequences, such as antibodies of an antibody library or nucleic acids in a genomic or cDNA library, for example. Purity can be at least about 60% or more by mass. The purity can also be about 70% or 80% or more, and can be greater, for example, 90% or more. Purity can be determined by any appropriate method, including, for example, UV spectroscopy, chromatography (e.g., HPLC, gas phase), gel electrophoresis (e.g., silver or coomassie staining) and sequence analysis (nucleic acid and peptide).
In another embodiment, a detection substrate includes a two-dimensional array of polypeptide sequences and a substrate; the polypeptide sequences are attached to the substrate at defined positions. In one aspect, the polypeptide sequences attached to the surface of the substrate include one or more polypeptide sequences selected, for example, from: Alpha 1A/C adrenergic receptor having a cysteine residue at amino acid position 43 or a serine at amino acid position 200; Beta 3 adrenergic receptor having a leucine residue at amino acid position 78; D1 dopamine receptor having a proline at amino acid position 37 or an arginine at amino acid position 37 or a serine at amino acid position 79 or an alanine at amino acid position 199; D2 dopamine receptor having an arginine at amino acid position 40 or a leucine at amino acid position 208; D3 dopamine receptor having a leucine at amino acid position 50; H1 histamine receptor having a glycine at amino acid position 216 or a proline at amino acid 226; H2 histamine receptor having an asparagine at amino acid position 175 or a glycine at amino acid position 215 or an arginine at amino acid position 231; 1A serotonin receptor having a valine at amino acid position 50 or an isoleucine at amino acid position 172 or a phenylalanine at amino acid position 381; 1B serotonin receptor having an asparagine at amino acid position 221; 1D serotonin receptor having a leucine at amino acid position 53 or a glycine at amino acid position 366; 1E serotonin receptor having a threonine at amino acid position 44 or a phenylalanine at amino acid position 262; 2B serotonin receptor having a tryptophan at amino acid position 388; serotonin 7 receptor having a lysine at amino acid position 92 or a proline at amino acid position 421; angiotensin 2 type 1 receptor having an arginine at amino acid position 45 or a serine at amino acid position 204 or a tryptophan at amino acid position 289; cannabinoid CB1 receptor having a leucine at amino acid position 200; cholecystokinin B receptor having a glutamine at amino acid position 224; gamma-amino-butyric acid B receptor having a leucine at amino acid position 93 or a proline at amino acid position 452; thromboxane A2 receptor having a glutamic acid at amino acid position 80 or a valine at amino acid position 94 or a glutamic acid at amino acid position 176; and neuropeptide Y1 receptor having a proline at amino acid position 298. The polypeptides attached to the substrate are useful for detecting molecules that bind to the variant GPCR proteins, such as agonists or antagonists of variant or wild type GPCRs.
The substrates to which the polynucleotides or polypeptides are attached include any impermeable or semi-permeable, rigid or semi-rigid, substance substantially inert so as not to interfere with the use of the array in hybridization reactions. The substrate may be a contiguous two-dimensional surface or may be perforated, for example. Exemplary substrates compatible with hybridization reactions include glass, plastic, polypropylene, polystyrene, nylon, polyacrylamide and nitrocellulose.
Arrays can include one or more polynucleotides for mismatch control or for expression level control. For example, each polynucleotide of the array that represents a known gene, that is, it specifically hybridizes to a GPCR gene transcript or nucleic acid produced from a transcript, can have a mismatch control oligonucleotide. The term “mismatch control” means a sequence that is not perfectly complementary to a particular oligonucleotide. The mismatch may comprise one or more mismatched bases. The mismatch(s) may be located at or near the center of the probe such that the mismatch is most likely to destabilize the duplex with the target sequence under hybridization conditions, but may be located anywhere, for example, a terminal mismatch. The mismatch control typically has a corresponding test probe that is perfectly complementary to the same particular target sequence. Mismatches are selected such that under appropriate hybridization conditions the test or control polynucleotide hybridizes with its target sequence, but the mismatch oligonucleotide does not. Mismatch polynucleotides therefore indicate whether hybridization is specific or not. For example, if the target variant GPCR is present the perfect match polynucleotide should provide a consistently stronger signal than the mismatch oligonucleotide.
Expression levels controls are polynucleotides that hybridize to constitutively expressed genes and may be included. Expression level controls are typically designed to control for cell health. Covariance of an expression level control with the expression of a target gene indicates whether measured changes in expression level of a gene is due to changes in transcription rate of that gene or to general variations in health of the cell. For example, when a cell is in poor health or lacking a critical metabolite the expression levels of both an active target gene and a constitutively expressed gene are expected to decrease. Thus, where the expression levels of an expression level control and the target gene appear to both decrease or to both increase, the change may be attributed to changes in the metabolic activity of the cell, not to differential expression of the target gene. Virtually any constitutively expressed gene is a suitable target for expression level controls. Typically expression level control genes are “housekeeping genes” including, but not limited to -actin gene, transferrin receptor and GAPDH.
Normalization controls are typically unnecessary for detection of GPCR variants as disclosed herein where polynucleotides that specifically hybridize to the target GPCR sequences has already been identified. Thus, the hybridization signal produced by the polynucleotide provides an accurate measure of the concentration of hybridized nucleic acid. Relative differences in gene expression can be detected without the use of such control polynucleotides. Therefore, the inclusion of control polynucleotides is optional.
Polynucleotides can be synthesized directly on the array by sequentially adding nucleotides to a particular position on the substrate until the desired sequence or length is achieved. For example, arrays containing thousands of polynucleotides complementary to particular sequences, at defined locations on a substrate are known (see, e.g., PCT Publication No. WO 90/15070.) and can be made by a variety of techniques known in the art including photolithography (see, Fodor et al., Science 251:767 (1991); Pease et al., Proc. Natl. Acad. Sci. USA 91:5022 (1994); Lockhart et al., Nature Biotech 14:1675 (1996); and U.S. Pat. Nos. 5,578,832; 5,556,752; and 5,510,270). Additional methods for rapid synthesis and deposition of defined oligonucleotides are described in Blanchard et al., Biosensors & Bioelectronics 11:687 (1996). Light-directed chemical coupling, and mechanically directed coupling, as described, for example, in U.S. Pat. No. 5,143,854 and PCT Publication Nos. WO 92/10092 and WO 93/09668 which disclose methods of forming vast arrays of oligonucleotides, peptides and other biomolecules. These procedures for biomolecule array synthesis are now referred to as VLSIPS.TM. procedures (see, also U.S. Pat. No. 6,040,138). U.S. Pat. No. 5,677,195 describes forming polynucleotides or peptides having diverse sequences on a single substrate by delivering various monomers or other reactants to multiple reaction sites on a single substrate where they are reacted in parallel. A series of channels, grooves, or spots are formed on or adjacent and reagents are selectively flowed through or deposited in the channels, grooves, or spots, forming the array on the substrate.
Alternatively, the polynucleotides can first be synthesized and then attached at defined positions on the substrate. Arrays made by first synthesizing the oligonucleotide and then attaching it to the surface of the substrate e.g., using N-phosphonate or phosphoramidite chemistries are described, for example, in Froehler et al., Nucleic Acid Res 14:5399 (1986); and McBride et al., Tetrahedron Lett. 24:245 (1983). In either case, the sequence and position (i.e., address) of all or a subset of the polynucleotides comprising the array will typically be known. The array produced may be redundant with respect to polynucleotide molecules that specifically hybridize to a single GPCR variant.
Any type of array, for example, dot blots on a nylon hybridization membrane (see Sambrook et al., Molecular Cloning—A Laboratory Manual (2nd Ed.), Vol. 1-3, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y., 1989), could be used, although, microarrays allow the use of less hybridization reagents and can contain many more oligonucleotides.
Fluorescence emission of sequences hybridized to polynucleotides of an array can be detected by scanning confocal laser microscopy. Using the excitation line appropriate for the fluorophore, or for two fluorophores if used, will produce an emission signal whose intensity correlates with the amount of hybridized sequence. Alternatively, a laser that allows simultaneous specimen illumination at wavelengths specific to the two fluorophores and emissions from the two fluorophores can be used for simultaneously analyzing both (see Schena et al., Genome Research 6:639 (1996)).
In any case, hybridized arrays can be scanned with a laser fluorescent scanner with a computer controlled X-Y stage and a microscope objective. Sequential excitation of the two fluorophores is achieved with a multi-line, mixed gas laser and the emitted light is split by wavelength and detected with two photomultiplier tubes. Alternatively, the fiber-optic bundle described by Ferguson et al. (Nature Biotech. 14:1681 (1996)) may be used to monitor mRNA levels simultaneously. For any particular hybridization site on the array, a ratio of the emission of the two fluorophores may be calculated. The ratio is independent of the absolute expression level of the gene.
The invention provides kits including the polynucleotides that specifically hybridize to a GPCR variant sequence, antibodies that specifically bind to variant GPCR polypeptides and substrates containing the polynucleotides and antibodies, packaged into suitable packaging material. A kit typically includes a label or packaging insert including a description of the components or instructions for use (e.g., detecting the presence of a GPCR variant) in vitro, in vivo, or ex vivo, of the components therein. A kit can contain additional components, e.g., control polynucleotides that specifically hybridize to a GPCR sequence that is wild type in respect to a variant GPCR.
The term “packaging material” refers to a physical structure housing the components of the kit. The packaging material can maintain the components sterilely, and can be made of material commonly used for such purposes (e.g., paper, corrugated fiber, glass, plastic, foil, ampules, etc.). The label or packaging insert can include appropriate written instructions, for example, practicing a method of the invention.
Kits of the invention therefore can additionally include labels or instructions for using the kit components in a method of the invention. Instructions can include instructions for practicing any of the methods of the invention described herein. Thus, for example, a kit can include one or more polynucleotides that specifically hybridize to a GPCR variant sequence(s) together with instructions for screening a subject for the presence of one or more of the GPCR variant sequences, and providing one or more clinical indications for the subject based upon which of the GPCR variant(s) are present in the subject.
The instructions may be on “printed matter,” e.g., on paper of cardboard within the kit, or on a label affixed to the kit or packaging material, or attached to a vial or tube containing a component of the kit. Instructions may additionally be included on a computer readable medium, such as a disk (floppy diskette or hard disk), optical CD such as CD- or DVD-ROM/RAM, magnetic tape, electrical storage media such as RAM and ROM and hybrids of these such as magnetic/optical storage media.
Invention kits can include each component of the kit enclosed within an individual container and all of the various containers can be within a single package. Invention kits can be designed for cold storage.
Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable methods and materials are described herein.
All publications, patents and other references cited herein are incorporated by reference in their entirety. In case of conflict, the present specification, including definitions, will control.
As used herein, the singular forms “a”, “and,” and “the” include plural referents unless the context clearly indicates otherwise. Thus, for example, reference to “a variant GPCR” includes a plurality of such variant GPCRs and reference to “a polynucleotide that specifically hybridizes to a GPCR variant sequence” includes reference to one or more such polynucleotides, and so forth.
A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, the following examples are intended to illustrate but not limit the scope of invention described in the claims.
EXAMPLES
Example 1
This example describes assaying the variant GPCR receptor activities.
R-SAT assays were performed with minor modifications from that previously described. In brief, NIH-3T3 cells were grown in 96 well tissue culture plates to 70-80% confluence in Delbecco's Modified Essential Media (DMEM) supplemented with 10% calf serum and 1% penicillin/streptomycin/glutamine (PSG). Cells were transfected for 12-16 hours with plasmid DNAs using Superfect Reagent (Qiagen) as per manufacturer's protocol. R-SAT's were generally performed with 1-50 ng/well of receptor and 20 ng/well of β galactosidase plasmid DNA. After overnight transfection, media was replaced with serum free DMEM containing 2% cyto-sf3 (Kemp Biotechnologies), and 1% PSG and varying concentrations of drug. Cells were then grown in a humidified atmosphere with 5% ambient CO2 for four to six days. Media was then removed from the plates and β-galactosidase activity was measured by the addition of o-nitrophenyl β-d-galactopyranoside (in phosphate buffered saline with 5% NP-40 detergent). The resulting colorimetric reaction was measured in a spectrophotometric plate reader (Titertek) at 420 nM. All data were analyzed using the computer programs Excel Fit and Graph Pad Prism software.
Example 2
This example lists wild type GPCR nucleotide (SEQ ID NOs: 1, 7, 11, 21, 27, 31, 37, 45, 53, 57, 63, 69, 73, 79, 87, 91, 95, 101, 109) and amino acid sequences (SEQ ID NOs:4, 9, 16, 24, 29, 34, 41, 49, 55, 60, 66, 71, 76, 83, 89, 93, 98, 105, 111) and the nucleotide (SEQ ID NOs:2, 3, 8, 12-15, 22, 23, 28, 32, 33, 38-40, 46-48, 54, 58, 59, 64, 65, 70, 74, 75, 80-82, 88, 92, 96, 97, 102-104, 110) and amino acid sequences (SEQ ID NOs:5, 6, 10, 17-20, 25, 26, 30, 35, 36, 42-44, 50-52, 56, 61, 62, 67, 68, 72, 77, 78, 84-86, 90, 94, 99, 100, 106-108, 112) of the 37 variant GPCRs which have biologically functional consequences.

## Claims

1. A method for selecting an appropriate course of treatment for a human who is being treated with or is a candidate for treatment with an agonist of the 1A/C adrenergic receptor, comprising:
a) providing a sample comprising nucleic acids or proteins from a human who is being treated with or is a candidate for treatment with an agonist of the 1A/C adrenergic receptor;
b) determining whether the sample from the human comprises a variant alpha 1A/C adrenergic receptor having serine residue at amino acid position 200; and
c) selecting an appropriate course of treatment using an agonist of the 1A/C adrenergic receptor for said human based on whether said sample comprises said variant alpha 1A/C adrenergic receptor;
wherein said agonist of the 1A/C adrenergic receptor is selected from the group consisting of phenylephrine, dobutamine, cirazoline and oxymetazoline; and
wherein said determining step comprises directly determining the nucleotide present at position 1035 of the gene encoding the alpha 1A/C adrenergic receptor or directly determining the amino acid present at position 200 of the alpha 1A/C adrenergic receptor.

2. The method of claim 1, wherein said appropriate course of treatment comprises a treatment selected from the group consisting of:
administering said agonist of the alpha 1A/C adrenergic receptor if said human does not comprise said variant alpha 1A/C adrenergic receptor;
selecting a treatment which does not involve administering said agonist of the alpha 1A/C adrenergic receptor if said human does comprise said variant alpha 1A/C adrenergic receptor; and
selecting and administering a higher dose of said agonist of the alpha 1A/C adrenergic receptor if said human does comprise said variant alpha 1A/C adrenergic receptor.

3. The method of claim 2, wherein said variant alpha 1A/C adrenergic receptor confers in said human a decreased sensitivity to a beneficial physiological effect of said agonist of the alpha 1A/C adrenergic receptor.

4. The method of claim 1, wherein said determining step is selected from the group consisting of determining the nucleotide present at nucleotide position 1035 of the gene encoding ADRA1A by sequencing said gene and determining the nucleotide present at nucleotide position 1035 of the gene encoding ADRA1A by hybridizing a probe to said gene.