GENETIC INDICATORS OF TOBACCO CONSUMPTION

Abstract: There are disclosed genetic screens for predicting the likely extent of tobacco consumption in human subjects based on screening for the presence or absence of genetic variants shown to be associated with tobacco consumption in smokers.

Description: Genetic Indicators of Tobacco Consumption The present invention is concerned with novel associations between known polymorphisms in the dopamine β-hydroxylase and monoamine oxidase A genes and tobacco consumption in smokers. Smoking is one of the most important public health issues facing health professionals and governments. In the United Kingdom alone there are 120,000 deaths attributed to tobacco use each year (Callum, 1998). Effective therapy is available for tobacco dependence but cessation rates of about 20% are the best that can currently be achieved (ICRF, 1993; Schneider, 1995) . Deeper understanding of the molecular basis for tobacco addiction could lead to more effective strategies for prevention and for helping people to stop smoking. Twin studies show a major genetic component to tobacco addiction (Heath, 1995). Recent mathematical models of data from 3997 twin pairs show that starting to smoke and continuing with the habit both have a substantial genetic component (True, 1997). In this study, genetic factors accounted for 50% of the variance in risk of smoking initiation and 70% of the risk of persistent smoking. Taking up smoking and continuing with the habit are likely to come under separate genetic influences (Heath, 1993) . There is substantial evidence to suggest that dopaminergic neurones arising in the ventral tegmental area of the thalamus and projecting to the nucleus accumbens are the final common pathway for addiction to a wide variety of substances (Clarke, 1998; Wickelgreen, 1998). Enzymes involved in dopamine metabolism may therefore be important in determining susceptibility to substance abuse. Monoamine oxidase is involved in the oxidative deamination of dopamine and noradrenaline . Levels of this enzyme are lower in platelets of patients with substance abuse (Faraj, 1994) and smokers have lower monoamine oxidase activity in the brain than non-smokers (Fowler, 1998). It has been suggested that the inhibitors of monoamine oxidase present in tobacco smoke contribute to the development of addiction (Fowler, 1998). Similarly, lower levels of dopamine β-hydroxylase are related to drug dependence (Gabel, 1995) , although no link has as yet been established with smoking. Patients with high activities of catechol O-methyl transferase are more susceptible to developing polysubstance abuse (Vandenbergh, 1997), but again there is no known association with smoking. Relatively few studies have examined the effects of genetic variation (i.e. polymorphisms) on the amount of tobacco consumed by smokers . However in a study of the dopamine Dl receptor Dde I restriction fragment length polymorphism in 238 smokers, those with the 11 genotype were more likely to smoke more than 40 cigarettes a day than those with 1,2 or 22 genotypes (Comings, 1997). In one study on the dopamine D2 receptor Taq IA polymorphism there was no significant difference in numbers of cigarettes smoked between those homozygous or heterozygous for the Al allele, but another study suggested that the Al allele was commoner in those who smoked more heavily (Comings, 1996) . A study on 72 African Americans found a trend for people with the longer alleles of the dopamine D4 receptor variable number tandem repeat polymorphism to smoke fewer cigarettes a day. The mean(SD) was 18(9) cigarettes in those with more than 6 repeat sequences and 13(6) in those with 7 or more repeats. In this small study the effects were not significant and the association was not reproduced in a larger group of Caucasians (n=403). Associations have also been shown between cytochrome P450 enzymes and tobacco consumption. A study on 263 Caucasians showed that people with one CYP1A1 Msp 1 variant allele smoked 23(22) pack years whilst controls smoked 33 (29) pack years (Garcia-Closas, 1997) . The CYP1A1 gene contributes to aryl hydrocarbon hydroxylase activity. This enzyme activates carcinogenic polyaromatic hydrocarbons and has been studied in smokers because of its relationship to the development of lung cancer. The mechanism by which it may exert an effect on tobacco consumption is unknown. Studies on the cytochrome P450 enzyme CYP2D6, which may be important in nicotine metabolism (Cholerton, 1994), have shown no difference in tobacco consumption between extensive and poor metabolisers (Boustead, 1997) . However a study on CYP2A6 showed that people with one or more variant alleles smoked a mean(SD) 18.4 (6.0) cigarettes a day compared to 22.7 (13.6) in those homozygous for the common allele (n=161) (Pianezza, 1998). The present inventors have investigated the relationship between common polymorphisms in enzymes involved in dopamine metabolism and age at initiation of smoking and current cigarette consumption and concluded that individuals with one or more dopamine β-hydroxylase 1368 A alleles smoked more cigarettes than those with the GG genotype (adjusted mean difference 3.3, p=0.009), whilst individuals with a monoamine oxidase A 1460 C allele smoked fewer cigarettes than those homozygous for T (-3.2, p=0.007). Thus, dopamine β-hydroxylase 1368 and monoamine oxidase A 1460 genotypes predict whether a person is a heavy smoker and how many cigarettes they consume. The results of this investigation support the view that these enzymes determine a smoker's requirement for nicotine and may explain why certain people are predisposed to develop tobacco addiction and why some find it very difficult to stop smoking. This finding has important implications for smoking prevention and offers potential for developing patient-specific therapy for smoking cessation. In a first aspect, the invention provides a method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of the monoamine oxidase A 1460 C allele and/or the monoamine oxidase A 1460 T allele, wherein the presence of at least one monoamine oxidase A 1460 C allele indicates that the subject is less likely to be a heavy smoker than subjects who are homozygous for the monoamine oxidase A 1460 T allele. The invention further provides a method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of the dopamine β-hydroxylase 1368 A allele and/or the dopamine β-hydroxylase 1368 G allele, wherein the presence of at least one dopamine β- hydroxylase 1368 A allele indicates that the subject is more likely to be a heavy smoker than subjects who are homozygous for the dopamine β-hydroxylase 1368 G allele . The present inventors were the first to provide evidence linking genetic variation in dopamine metabolic enzymes to tobacco consumption. It seems likely that the enzymes in question exert their effects on smoking behaviour by altering dopamine breakdown, however it is also possible that they have more wide ranging effects since they form key parts of the metabolic pathways of other monoamines. The human monoamine oxidase A gene may also be denoted herein by the abbreviation λ MAO A' ; the human dopamine β-hydroxylase gene may also be denoted herein by the abbreviation Λ DBH' . The novel associations described herein are consistent with the suggestion that dopaminergic reward pathways are important in determining tobacco consumption. Polymorphisms that reduce dopamine activity may contribute to a 'reward deficiency syndrome' where self administration of nicotine restores dopaminergic transmission to 'normal' levels (Blum, 1995). If this is so one would expect to find that the polymorphisms included in the study described herein were either themselves responsible for increased dopamine breakdown and impaired dopaminergic transmission or in linkage disequilibrium with genetic variants which have this effect. In a second aspect, the invention provides a method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of the monoamine oxidase A 1460 C allele and/or the monoamine oxidase A 1460 T allele. In this aspect, the invention further provides a method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of the dopamine β-hydroxylase 1368 A allele and/or the dopamine β-hydroxylase 1368 G allele. In essence, the methods of this second aspect of the invention provide rapid diagnostic genomic tests for smokers which could be used to help in identifying which smoking cessation aid/treatment is most likely to be effective in that individual. A deeper understanding of why people smoke may be the key to developing more effective ways of helping them to stop. The genetic component to smoking behaviour is likely to be multifactorial with different molecular mechanisms contributing to the habit in different people. In general terms, identification of the mechanisms involved in causing disease may allow specific treatments to be used. By way of an example, one person with heart failure may have hypertensive cardiomyopathy, another mitral incompetence - both may benefit from diuretics but specific treatments aimed at modifying the underlying pathophysiology may be more appropriate. At present in the United Kingdom nicotine replacement therapy is suggested for all people wishing to give up smoking. Other effective treatments are likely to become available soon (Hurt, 1997; Jorenby, 1999). It may be that different patients will respond to different treatments. For example, people who metabolise nicotine quickly may respond best to a nicotine patch. Those who metabolise nicotine very rapidly may need a higher replacement dose than slower metabolisers . People with polymorphisms in the dopamine transporter may respond particularly well (or badly) to dopamine re- uptake inhibitors for smoking cessation. Using genotyping to target the most appropriate treatment to the individual smoker could make treatments for tobacco addiction more effective. The presence of a monoamine oxidase A 1460 C allele in the genome of an individual might indicate reduced monoamine oxidase activity, leading to impaired dopaminergic transmission. Smoking would be a means of restoring dopaminergic function to normal. Such individuals might experience reduced desire to smoke if their dopamine levels were increased by using a dopamine reuptake inhibitor such as buproprion, whereas individuals with Λ normal' dopamine function might respond best to behavioural therapy. Accordingly, genetic screens for the presence or absence of at least one MAO A 1460 C allele could possibly be used to target treatment with dopamine reuptake inhibitors to those who are most likely to benefit from such treatment. The polymorphisms in the dopamine β-hydroxylase gene that were included in the study described herein have not previously been linked to smoking phenotype or to human disease. The 910 polymorphism causes an amino acid substitution in the protein (ala 304 ser) but the 1368 variant is 'silent'. Associations have been found however between serum dopamine β-hydroxylase levels and two polymorphisms in linkage disequilibrium with each other and close to the 910 and 1368 loci, namely DBH*444 g/a and DBH STR (Cubells, 1998) . It seems highly likely therefore that the DBH gene is a major determinant of dopamine β-hydroxylase activity and it may be that the polymorphisms studied by the present inventors are in linkage disequilibrium with an allele that controls this activity. Accordingly, the invention also provides a method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the dopamine β-hydroxylase 1368 A allele and a method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the dopamine β-hydroxylase 1368 A allele. In both methods, the said allele is preferably selected from the group consisting of DBH*444 g, DBH*444 a and an allele of the DBH STR polymorphism (Cubells, 1998). Both polymorphisms in the monoamine oxidase A gene included in the study described herein (positions 941 and 1460) are conservative substitutions and are unlikely to be themselves responsible for variations in phenotype. Again it seems likely that these alleles are in linkage disequilibrium with alleles that cause functional changes in monoamine oxidase activity. The invention thus provides a method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the monoamine oxidase A 1460 C allele and a method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the monoamine oxidase A 1460 C allele . In both of the above methods, the allele in close physical proximity to the MAO A C allele is preferably a variable number tandem repeat in the promoter region of the gene (Sabol, 1998), most preferable MAO A uVNTR allele 1 or MAO A uVNTR allele 4. This variable number tandem repeat polymorphism is in linkage disequilibrium with a number of genetic markers in the monoamine oxidase A and monoamine oxidase B genes. Alleles with 3.5 or four copies of the repeat sequence are transcribed between two and 10 times more efficiently than those with three or five copies of the repeat. It is very likely that this increased transcription results in increased enzyme activity. As would be readily apparent to persons skilled in the art of human genetics, "linkage disequilibrium" occurs between a marker polymorphism (e.g. a DNA polymorphism which is λ silent' ) and a functional polymorphism (i.e. genetic variation which affects phenotype or which contributes to a genetically determined trait) if the marker is situated in close proximity to the functional polymorphism. Due to the close physical proximity, many generations may be required for alleles of the marker polymorphism and the functional polymorphism to be separated by recombination. As a result they will be present together on the same haplotype at higher frequency than expected, even in very distantly related people. As used herein the term "close physical proximity" means that the two markers/alleles in question are close enough for linkage disequilibrium to be likely to arise. As mentioned previously, the genetic component to smoking behaviour is likely to be multifactorial with different molecular mechanisms contributing to the habit in different people. The dopamine metabolic genes analysed in this study are likely to form only part of the genetic component of nicotine addiction (Rossing, 1998) . Polymorphisms in dopamine receptors Dl (Comings, 1997) and D2 (Comings, 1996; Noble, 1994) are likely to contribute, although not all studies confirm these associations (Lerman, 1999; Sabol, 1999) . The gene for the D4 receptor has a variable number tandem repeat polymorphism in which the 7 repeat allele reduces the affinity of the receptor for dopamine. This polymorphism seems to predispose to smoking only in African Americans in whom it is more frequent (40%) than in Caucasians (22%) (Shields, 1998) . Another important protein is the dopamine transporter (DAT 1) which is responsible for removing dopamine from the synaptic cleft and thereby terminating its action. A variable number tandem repeat occurs in the 3' untranslated region of this gene. The 9 repeat allele, of uncertain functional significance, is associated with a reduced likelihood of being a smoker (Lerman, 1999) . Smokers who have this allele start smoking later and have longer periods of abstinence than those with fewer repeat sequences. The effects of the dopamine receptor and transporter polymorphisms on smoking may be mediated by an association with a novelty seeking personality (Lerman, 1999) . In view of the foregoing, it is within the scope of the invention to performs screens for the presence or absence in the genome of the human subject of at least one allele selected from the group consisting of: dopamine β-hydroxylase 1368 A, dopamine β- hydroxylase 1368 G, monoamine oxidase A 1460 C and monoamine oxidase 1460 T in conjunction with screens (in the same human subject) for other polymorphisms associated with smoking behaviour, for example as part of a panel of screens. In a preferred embodiment, the panel of screens would include up to 10 different polymorphisms . The individual screens to be included in the panel may be selected from the group consisting of: screens for DBH 1368 A and/or one or more alleles in close physical proximity to or in linkage disequilibrium with DBH 1368 A, screens for MAO A 1460 C and/or one or more alleles in close physical proximity to or in linkage disequilibrium with MAO A 1460 C, screens for one or more alleles of the dopamine Dl receptor Ddel RFLP (Comings, 1997) or one or more alleles in linkage disequilibrium therewith, screens for one or more alleles of the dopamine D2 receptor Taql RFLP (Comings, 1996; Noble, 1994) or one or more alleles in linkage disequilibrium therewith, screens for one or more alleles of the dopamine D4 receptor VNTR polymorphism (Shields, 1998) or one or more alleles in linkage disequilibrium therewith, screens for one or more alleles of the VNTR in the 3' UTR of the DAT 1 gene (Caporaso, 1997; Lerman, 1999) or one or more alleles in linkage disequilibrium therewith, screens for one or more alleles of the CYP1A1 Mspl RFLP or one or more alleles in linkage disequilibrium therewith and screens for one or more variant alleles of CYP2A6, CYP2D6, the tyrosine hydroxylase gene (TH) or the 5-hydroxytryptamine transporter gene (5-HTT). The step of screening for the presence or absence of specific polymorphic alleles, also referred to herein as genotyping' , can be carried out using any of the methodologies known in the art. In a preferred embodiment, genotyping of single nucleotide polymorphisms (SNPs) is carried out by performing PCR using allele specific primers, a technique known in the art as PCR-SSP (Bunce, 1995) . Further techniques are known in the art for the scoring of SNPs (see review by Schafer, A. J. and Hawkins, J. R. in Nature Biotechnology, Vol 16, pp33- 39 (1998), including mass spectrometry, particularly matrix-assisted laser desorption/ionization time-of- flight mass spectrometry (MALDI-TOF-MS, see Roskey, M. T. et al., 1996, PNAS USA, 93: 4724-4729), single nucleotide primer extension (Shumaker, J. M. et al., 1996, Hum. Mutat., 7: 346-354; Pastinen, T. et al., 1997, Genome Res., 7: 606-614) and DNA microchips/microarrays (Underhill, P. A. et al., 1996, PNAS USA, 93: 196-200) . The known techniques for scoring polymorphisms are of general applicability and it would therefore be readily apparent to persons skilled in the art that the known techniques could be adapted for the scoring of single nucleotide polymorphisms in the monoamine oxidase A gene and the dopamine β-hydroxylase gene. Variable number tandem repeat polymorphisms, such as the MAO A uVNTR, can be scored by performing non- allele-specific PCR using primers corresponding to sequences on either side of the variable number repeat region. Different alleles will give rise to PCR products of slightly different sizes which may be resolved by gel electrophoresis or other techniques known in the art. Restriction fragment length polymorphisms are typically scored by digesting genomic DNA with the appropriate enzyme then performing a Southern blot using a labelled probe corresponding to the polymorphic region (see Molecular Cloning: A Laboratory Manual, Sambrook, Fritsch and Maniatis, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY) . In a still further aspect, the invention provides a kit for use screening for the presence or absence of at least one allele of the dopamine β-hydroxylase 1368 A/G polymorphism and at least one allele of the monoamine oxidase 1460 C/T polymorphism, the kit comprising at least an oligonucleotide comprising 10 or more contiguous nucleotides from the dopamine β- hydroxylase gene, including the polymorphic locus at position 1368 and an oligonucleotide comprising 10 or more contiguous nucleotides from the monoamine oxidase A gene, including the polymorphic locus at position 1460. The oligonucleotide molecules for inclusion into the kit are preferably from 10 to 50 nucleotides in length, even more preferably from 20-30 nucleotides in length, and may be DNA, RNA or a synthetic nucleic acid, and may be chemically or biochemically modified or may contain non-natural or derivatized nucleotide bases, as will be readily appreciated by those skilled in the art. Possible modifications include, for example, the addition of isotopic or non-isotopic labels, substitution of one or more of the naturally occurring nucleotide bases with an analog, internucleotide modifications such as uncharged linkages (e.g. methyl phosphonates , phosphoamidates, carbamates, etc.) or charged linkages (e.g. phosphorothioates, phosphorodithioates, etc.). Also included are synthetic molecules that mimic polynucleotides in their ability to bind to a designated sequence to form a stable hybrid. Such molecules are known in the art and include, for example, so-called peptide nucleic acids (PNAs) in which peptide linkages substitute for phosphate linkages in the backbone of the molecule. An oligonucleotide molecule according to the invention may be produced according to techniques well known in the art, such as by chemical synthesis or recombinant means . The oligonucleotide molecules for inclusion into the kit are preferably single stranded and may correspond to the sense strand or the antisense strand of the relevant gene and to either allelic variant. In a preferred embodiment, the kit comprises at least on oligonucleotide selected from : 5'-GGAAGGTGACCGAGAAAGAC-3' (SEQ ID NO : 4 ) and 5'-GGAAGGTGACCGAGAAAGAT-3' (SEQ ID NO: 5) and at least one oligonucleotide selected from: 5'-CCAGCTCCCGGTCTTCC-3' (SEQ ID NO: 17) and 5'-CCAGCTCCCGGTCTTCT-3' (SEQ ID NO: 18) and may additionally comprise oligonucleotides having the following sequences: 5'-TGGCCCAATGACACAGCCT-3' (SEQ ID NO: 6) and 5' -AGAAGGTCGTGTCGGTCCAT-3' (SEQ ID NO: 16) The above-listed set of six oligonucleotides are suitable for performing PCR-SSP genotyping of the MAO 1460 C/T and the DBH 1368 A/G polymorphisms, as exemplified below. The association which the present inventors have found between genetic variation in the dopamine β- hydroxylase gene and tobacco consumption identifies the dopamine β-hydroxylase enzyme as a novel target for pharmaceutical intervention in the development of treatments/therapies to assist in smoking cessation. In particular, inhibitors of dopamine β-hydroxylase are likely to ameliorate the withdrawal effects of nicotine. Accordingly, in a further aspect the invention also provides a method of ameliorating the symptoms associated with nicotine withdrawal in a human subject, which method comprises administering to a human subject in need thereof a therapeutically effective amount of a medicament comprising an inhibitor of dopamine β-hydroxylase . Consistent with this aspect of the invention, there is also provided use of an inhibitor of dopamine β-hydroxylase as an aid to smoking cessation or to ameliorate the symptoms associated with nicotine withdrawal. The invention further provides use of an inhibitor of dopamine β-hydroxylase for the manufacture of a medicament for use as an aid to smoking cessation or to ameliorate the symptoms associated with nicotine withdrawal. It is well documented that the cessation of cigarette smoking often results in the development of a nicotine withdrawal syndrome, as described by Benowitz, NL (1988) Pharmacologic aspects of cigarette smoking and nicotine addiction. N. Engl . J. Med . , 319, 1318-30. Compounds which are inhibitors of dopamine β- hydroxylase activity could be identified using an in vi tro assay of dopamine β-hydroxylase enzyme activity. The compound to be tested in such an assay may be of any chemical formula and may be one of known biological or pharmacological activity, a known compound without such activity or a novel molecule such as might be present in a combinatorial library of compounds . The present invention will be further understood with reference to the following non-limiting Examples: Example 1-Identification of genetic variants associated with tobacco consumption. Participants Patients were selected from a cohort of people who responded to an invitation to see their general practitioner for a health check (ICRF, 1994; ICRF, 1995). From a total of 11,090 patients 8,109 attended for the check, 7,692 agreed to giving a blood sample and of these 1773 smoked cigarettes at the time of the interview. From these a sample of 234 smokers was picked using computer-generated random numbers. Blood was collected in EDTA and buffy coat lymphocytes were separated and stored at -80°C. Genotvping Polymorphisms were selected in monoamine oxidase A, monoamine oxidase B, catechol O-methyl transferase and dopamine β-hydroxylase on the basis that they could be typed using the polymerase chain reaction with sequence specific primers, using methods previously described for human leukocyte antigens (HLA) (Bunce, 1995) . Reactions were developed to detect both the common allele and the variant allele. Each reaction mixture included control primers to detect a conserved sequence to eliminate the possibility of false negative results. Genomic DNA was isolated from samples and genotyped using the primers shown below: Monoamine oxidase A, Xpll.3, exon 8 G941T (M68850) sense primer 5'-CGTAATTAATGCGATCCCTCC-3' (SEQ ID NO: 1) antisense 5'-GACAGCTCCCATTGGAAGC-3' (SEQ ID NO: 2) 5'-GACAGCTCCCATTGGAAGA-3' (SEQ ID NO: 3) Monoamine oxidase A, Xpll.3, exon 14 T1460C (M68856) sense primers 5'-GGAAGGTGACCGAGAAAGAC-3' (SEQ ID NO: 4) 5'-GGAAGGTGACCGAGAAAGAT-3' (SEQ ID NO: 5) antisense 5'-TGGCCCAATGACACAGCCT-3' (SEQ ID NO: 6) Monoamine oxidase B, Xpll.3, intron 13, G644A (Z29071) sense primer 5'-CTGACAGTTCCTCTGATGTC-3' (SEQ ID NO: 7) antisense 5'-CACACTGGCAAATAGCAAAAGC-3' (SEQ ID NO: 8) 5'-CACACTGGCAAATAGCAAAAGT-3' (SEQ ID NO: 9) Catechol O-methyl transferase, 22qll.2, exon 3, G11947A (Z26491) , Vall08Met sense primers 5'-ATGGTGGATTTCGCTGGCG-3' (SEQ ID NO: 10) 5'-ATGGTGGATTTCGCTGGCA-3' (SEQ ID NO: 11) antisense 5'-GATGTCCTGGACGCTCC-3' (SEQ ID NO: 12) Dopamine β-hydroxylase, 9q34, exon 4, G910T (X13260) , Ala304Ser sense primer 5'-CCTGGGCCCTGGGTGCCA-3' (SEQ ID NO: 13) antisense primers 5'-CCTGGACCCCCGAAGGC-3' (SEQ ID NO: 14) 5'-CCTGGACCCCCGAAGGA-3' (SEQ ID NO: 15) Dopamine β-hydroxylase, 9q34, exon 8, G1368A (X13264) sense primer 5'-AGAAGGTCGTGTCGGTCCAT-3' (SEQ ID NO: 16) antisense primers 5'-CCAGCTCCCGGTCTTCC-3' (SEQ ID NO: 17) 5'-CCAGCTCCCGGTCTTCT-3' (SEQ ID NO: 18) Concentrations of the primers in the reaction mixture were adjusted so that all reactions were optimised for the same conditions. Buffers, PCR and gel electrophoresis conditions were as previously described (Bunce, 1995) . Sample size and statistical analysis A previous study on smokers in the OXCHECK cohort showed a mean (SD) of 14.9 (7.4) cigarettes smoked a day (Haldar et al submitted for publication) . Assuming a standard deviation of 8.0 in each of two equal groups (with and without variant alleles) a study with 226 patients will have 80% power to detect a difference of three cigarettes a day (a=0.05). Pearson's coefficient was used to measure correlations between variables in the regression model. Stepwise linear regression was used to adjust differences in mean number of cigarettes smoked for potential confounders. In the analysis those having one or more variant alleles were grouped together and compared to those who were homozygous for the common allele. Differences in proportions with variant alleles across quartiles of cigarette consumption were compared using the χ 2 test for linear trend. Result s Clinical characteristics of the study group are shown in Table 1. DNA of sufficiently high quality for genotyping was extracted from 225 of the 234 samples taken from the randomly selected smokers. The numbers of cigarettes smoked for the alleles at each locus are shown in Table 2. The two monoamine oxidase A polymorphisms were strongly correlated (r=0.97, p<0.0001) in the study group. Alleles at the monoamine oxidase 941 locus were therefore omitted from regression analysis. The dopamine β-hydroxylase 910 and 1368 alleles were also significantly correlated although less strongly related (r=-0.183, p=0.003). These alleles were therefore analysed independently. Linear regression was used to adjust for the effects of age, sex, social class and marital status on age at initiation of smoking. Women began smoking 2.4 (95%CI 0.07, 4.1) years earlier than men (p=0.006), however there was no effect of genetic polymorphisms on the age when participants started to smoke . The effects that possession of variant alleles had on reported cigarette consumption were also examined. Smokers with one or more A alleles at the dopamine β-hydroxylase 1368 locus smoked significantly more cigarettes than those homozygous for the more common G allele. The mean (95%CI) difference after adjustment for age, sex and alcohol consumption was 3.3 (0.7, 5.7) cigarettes a day (p=0.009). In contrast, smokers with variant alleles (genotype CT or CC) at the monoamine oxidase 1460 locus smoked significantly fewer cigarettes. The adjusted mean difference was -3.2 (-5.4, -0.9) cigarettes a day (p=0.007). The proportion of patients with one or more variant alleles by quartile of cigarette consumption is shown in Table 3. There was a significant trend for those who smoked more heavily to have one or more variant alleles at the dopamine β-hydroxylase 1368 locus. The relative risk for those smoking more than 20 a day compared to those smoking less than 10 a day was 2.32 (95% CI 1.1-5.0). A significant reversed trend was seen at the monoamine oxidase A 1460 locus with those smoking more than 20 a day being less likely to have variant alleles (genotype CT or CC) , relative risk 0.31 (0.13-0.74). The results of this study are likely to be generalisable because it was carried out on a cohort of smokers who responded to an invitation from their general practitioner to attend a health check. The response rate to the invitation was high implying that study participants are likely to be representative of the population who attend health centres in the United Kingdom. This is an advance on previous studies where recruitment often depended on response to a media advertisement (Lerman, 1997). Such studies may be biased by including substantial numbers of people whose tobacco dependence behaviour is atypical. Table 1 Characteristics of the study population Characteristic Study group Age. (Years) mean (SD) 50.1 (8.3) median (range) 49.0 (36 to 67) Sex male N (%) 100 (44%) female N (%) 125 (56%) Number of cigarettes smoked each day mean (SD) 16.7 (8.8) median (range) 15.0 (1 to 50) Age at initiation of smoking (years) mean (SD) 19.8 (6.5) median (range) 18.0 (5 to 53) Alcohol consumed, (units a day ) mean (SD) 11.5 (20.3) median (range) 3.5 (0 to 145) Socio-economic class N (%) Professional (I) 6 (3%) Managerial (II) 30 (13%) Clerical (IIIN) 44 (19%) Skilled manual (IIIM) 54 (24%) Semi skilled manual (IV) 32 (14%) Unskilled (V) 8 (4%) Housewife 25 (11%) Unclassified 4 (2%) No response 22 (10%) Marital status Married/living as married 172 Widowed 14 Divorced/separated 23 Single, never married 13 Unknown 3 Table 2 Mean number of cigarettes smoked each day by genotype for dopamine metabolic enzymes Locus Genotype N (%) Mean number of cigarettes smoked a day (95% CI) Dopamine β-hydroxylase 910 GG 188(84%) 17.2(16.0,18.5) GT 37(16%) 14.2(11.3,17.1) Dopamine β-hydroxylase 1368 GG 62 (28%) 14.6(12.5,16.7) GAorAA 163 (72%) 17.5(16.1, 18.9) Monoamine oxidase A 941 TT 13861%) 17.6(16.0,19.1) GT 87 (39%) 15.3(13.7,17.0) Monoamine oxidase A 1460 TT 13560%) 17.9(16.3,19.5) CT or CC 90 (40%) 15.1 (13.4, 16.6) Monoamine oxidase B intron 13 GG 98 (44%) 17.1 (15.3,18.9) AGorAA 127 (56%) 16.4(14.9,17.9) Catechol O-methyl transferase 1947 AA 48(21%) 16.0(13.6,18.4) AG or GG 17779%) 16.1(15.6,18.3) Table 3 Proportion of patients with one or more variant allele by quartile of cigarette consumption Locus Genotype Frequency of genotype by quartile of reported daily cigarette consumption Significance N (% ) a 0-9 cigarettes 10-14 cigarettes 15-19 cigarettes 20+ cigarettes Dopamine β- hydroxylase 910 GT 15 (21%) 9 (17%) 8 (13%) 5 (13%) 0.140 Dopamine β- hydroxylase 1368 AG or AA 44 (63%) 40 (77%) 45 (71%) 34 (85%) 0.028 Monoamine oxidase A 1460 CT or CC 34 (49%) 19 (37%) 28 (44%) 9 (23%) 0.033 Monoamine oxidase B intron 13 AG or AA 42 (60%) 30 (58%) 33 (52%) 22 (55%) 0.447 Catechol O-methyl transferase AG or GG 56 (80%) 39 (75%) 49 (78%) 33 (83%) 0.815 ' Total Number of smokers in each category: 0-9 cigarettes a day, 70; 10-14 cigarettes a day, 52; 15-19 cigarettes a day, 63; 20+ cigarettes a day, 40. Chi square for linear trend Example 2-PATCH II trial Study design The PATCH II trial was carried out on a group of individuals receiving 'treatment' for smoking cessation in the form of a nicotine patch in order to evaluate the extent to which genetic variation influences smoking cessation m these individuals. Methods Genotypmg of the monoamine oxidase A 1460 T/C and dopamine β-hydroxylase 1368 G/A polymorphisms was carried out as described in Example 1 above. Results-Dopamine β-hydroxylase Table 4 Smoking status m 1999: Table 5 Risk estimate: P=0.147 The results of this study indicate that the dopamine β-hydroxylase A allele is more common in people who continue to smoke, whilst the G allele seems to be associated with successful cessation. About 60% of people with one or more A alleles continued to smoke, whereas only 40% of those with the GG genotype did so. This is consistent with the results from the OXCHECK patient cohort (Example 1) which supported an association between presence of one or more A alleles and high tobacco consumption. Example 3-Further results from PATCH II study The following tables 6 and 7 show the numbers of patients given a nicotine patch who stopped smoking at one week on nicotine or placebo, broken down by genotype (results were similar at 12 weeks). The results indicate that nicotine replacement therapy is more effective in individuals carrying alleles known to be linked to smoking, i.e. the dopamine β- hydroxylase A allele and the DRD2 T allele. Table 6 DBH: all with GA/AA Patch Placebo Quit at one week 104(38.8) 59(23.1) patch rate/placebo rate = 1.68 Did not quit 164 196 patch rate/placebo rate = 15.71 DBH: all with GG Patch Placebo Quit at one week 37(37.4) 34(32.4) patch rate/placebo rate = 1.15 Did not quit 62 71 patch rate/placebo rate = 5.0% Table 7 DRD2: All with CT/TT Patch Placebo Quit at one week 68(44.7) 32(22.1) patch rate/placebo rate = 2.03 Did not quit 84 113 patch rate/placebo rate = 22.7? DRD2: All with CC Patch Placebo Quit at one week 73(34.3) 60(28.0) patch rate/placebo rate = 1.22 Did not quit 140 154 patch rate/placebo rate = 6.2% References 1. Callum C. The smoking epidemic, London, Health Education Authority, 1998. 2. ICRF. General Practice Research Group Effectiveness of a nicotine patch in helping people stop smoking: results of a randomised trial in general practice BMJ 1993/306(6888) : 1304-8. 3. Schneider NG, Olmstead R, Mody FV, et al. 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Fowler JS, Volkow ND, Wang GJ, et al Neuropharmacological actions of cigarette smoke: brain monoamine oxidase B (MAO B) inhibition. J Addict Dis 1998 ; 17 (1) : 23-34. 11. Gabel S, Stadler J, Bjorn J, Shindledecker R, Homovanillic acid and dopamine-beta-hydroxylase in male youth; relationships with paternal substance abuse and antisocial behaviour. Am J Drug Alcohol Abuse 1995;21 (3) : 363-78. 12. Vandenberg DJ, Rodriguez LA Miller IT, Uhl GR, Lachman HM, High-activity catechol-O- methyltransferase allele is more prevalent in polysubstance abusers . Am J Med Genet 1997;74(4) :439-42. 13. ICRF. OXCHECK Study Group. Effectiveness of health checks conducted by nurses in primary care results of the OXCHECK study after one year. BMJ 1994;308(6924) :308-12. 14. ICRF. OXCHECK Study Group. Effectiveness of health checks conducted by nurses in primary care: final results of the OXCHECK study. BMJ 1995;310(6987) .1099-104. 15. Bunce M, O'Neill CM, Barnardo MC, et al Phototyping: comprehensive DNA typing for HLA-A, B, C, DRB1, DRB3, DRB4, DRB5 & DQB1 by PCR with 144 primer mixes utilizing sequence-specific primers (PCR-SSP) Tissue Antigens 1995; 46 (5) : 355- 67. 16. Lerman C, Shields PG, Main D, et al. Lack of association of tyrosine hydroxylase genetic polymorphism with cigarette smoking Pharma cogenetics 1997,-7(6) : 521-4. 17. Bunce M, Young NT, Welsh KI . Molecular HLA typing the brave new world, Transplanta tion 1997;64(11) :1505-13. 18. Bell J. The new genetics in clinical practice BMJ 1998;316(14 February) : 618-620. 19. Rossing MA. Genetic influences on smoking: candidate genes. Environ Heal th Perspect 1998;106(5) :231-8 20. Comings DE, Gade R, Wu S, et al. Studies of the potential role of the dopamine Dl receptor gene in addictive behaviours. Mol Psychia try 1997 ; 2 ( 1 ) : 44 - 56 . 21. Comings DE, Ferry L, Bradshaw-Robinson S, Burchette R, Chiu C. Muhleman D. The dopamine D2 receptor (DRD2) gene: a genetic risk factor in smoking. Pharmacogenetics 1996; 6 ( 1) : 73-9 22. Noble EP, St. Jeor ST, Ritchie T, et al . D2 dopamine receptor gene and cigarette smoking: a reward gene? Med Hypotheses 1994 ; 2 (4 ): 257-60. 23. Lerman C, Caporaso NE, Audrian J. et al . Evidence suggesting the role of specific genetic factors in cigarette smoking. Health Psychol 1999;18(1) :14-20. 24. Sabol SZ, Nelson ML, Fisher C, et al . A genetic association for cigarette smoking behaviour. Heal th Psychol 1999; 18 (1) : 7-13. 25. Shields PG, Lerman C. Audrain J. et al. Dopamine D4 receptors and the risk of cigarette smoking in African-Americans and Caucasians. Cancer Epidemiol Biomarkers Prev 1998 ; 7 ( 6) : 453-8. 26. Garcia-Closas M, Caporaso N, Kelsey K, Christiani D, Association between CYP1A1 polymorphism and smoking in a control population: implications for the study of genetic factors on cancer risk. Proceedings of the American Associa tion for Cancer Research 1997 ; 38 (March 1997) :211. 27. Cholerton S, Arpanahi A, McCracken N, et al. Poor metabolisers of nicotine and CYP2D6 polymorphism Lancet 199 ; 343 ( 8888 ): 62-3. 28. Boustead C, Taber H, Idle JR, Cholerton S. CYP2D6 genotype and smoking behaviour in cigarette smokers. Pharmacogenetics 1997; 7 (5) : 411- . 29. Cubells JF, van Kammen DP, Kelley ME, et al. Dopamine beta-hydroxylase : two polymorphisms in linkage disequilibrium at the structural gene DBH associate with biochemical phenotypic variation Hum Genet 1998 ; 102 (5) : 533-40. 30. Sabol SZ, Hu S, Hamer D. A functional polymorphism in the monoamine oxidase A gene promoter. Hum Genet 1998 ; 103 ( 3) : 273-9. 31. Blum K, Sheridan PJ, Wood RC . Braverman ER. Chen TJ, Comings DE . Dopamine D2 receptor gene variants: association and linkage studies in impulsive-addictive-compulsive behaviour . Pharmacogenetics 1995;543 -41. 32. Hurt RD, Sachs DP, Gover ED, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997;337(17) .1195-202. 33. Jorenby DE, Leischow SJ, Nides MA, et al . A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340 ( 9) : 685-91. 34. van der Sande MA, Bailey R, Faal H, et al. Nationwide prevalence study of hypertension and related non-communicable diseases in The Gambia, Trop Med Int Heal th 1997; 2 (11) : 1039-48. 35. Mackay J, Crofton J. Tobacco and the developing world. Br Med Bull 1996; 52 ( 1) : 206-21. 36. Pianezza ML, Sellers EM, Tyndale RF. Nicotine metabolism defect reduces smoking. Na ture 1998;393:750. 37. Sellers EM. Pharmacogenetics and ethnoracial differences in smoking. JAMA 1998 ; 280 (2) : 179-80. 38. Caporaso NE, Lerman C, Main D, Audrain J, Boyd NR, Bowman E, Shields P. The genetics of smoking: the dopamine receptor transporter (DAT) polymrophisms in a smoking cessation study (absract) . Proc . Am . Assoc . Cancer Res . 1997;38:168-169. Abbreviations MAO A Human monoamine oxidase A gene DBH Human dopamine β-hydroxylase gene DAT 1 Human dopamine transporter gene CYP2A6 Human coumarin 7-hydroxylase gene 5-HTT Human 5-hydroxytryptamine (serotonin) transporter gene TH Human tyrosine hydroxylase gene CYP2D6 Human debrisoquine-4-hydroxylase gene RFLP Restriction fragment length polymorphism VNTR Variable number tandem repeat SNP Single nucleotide polymorphism

Claims: Claims : 1. A method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of the monoamine oxidase A 1460 C allele and/or the monoamine oxidase A 1460 T allele, wherein the presence of at least one monoamine oxidase A 1460 C allele indicates that the subject is less likely to be a heavy smoker than subjects who are homozygous for the monoamine oxidase A 1460 T allele. 2. A method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the monoamine oxidase A 1460 C allele. 3. A method as claimed in claim 2 wherein at least one of the one or more alleles in close physical proximity to or in linkage disequilibrium with the monoamine oxidase A 1460 C allele is selected from the group consisting of monoamine oxidase A 941 G, MAO A uVNTR allele 1 and MAO A uVNTR allele 4. 4. A method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of the dopamine β- hydroxylase 1368 A allele and/or the dopamine β- hydroxylase 1368 G allele, wherein the presence of at least one dopamine β-hydroxylase 1368 A allele indicates that the subject is more likely to be a heavy smoker than subjects who are homozygous for the dopamine β-hydroxylase 1368 G allele. 5. A method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the dopamine β-hydroxylase 1368 A allele . 6. A method as claimed in claim 5 wherein at least one of the one or more alleles in close physical proximity to or in linkage disequilibrium with the dopamine β-hydroxylase 1368 A allele is selected from the group consisting of DBH 910 T, DBH*444 g, DBH*444 a and an allele of the DBH STR polymorphism. 7. A method for predicting the likely extent of tobacco consumption in a human subject, which method comprises screening for the presence or absence in the genome of the human subject of at least one allele selected from the group consisting of: dopamine β- hydroxylase 1368 A, dopamine β-hydroxylase 1368 G, monoamine oxidase A 1460 C and monoamine oxidase 1460 T and screening for the presence or absence of at least one further allele associated with smoking behaviour. 8. A method as claimed in claim 7 wherein the further allele (s) associated with smoking behaviour is/are selected from the group consisting of: alleles in close physical proximity to or in linkage disequilibrium with DBH 1368 A, alleles in close physical proximity to or in linkage disequilibrium with MAO A 1460 C, alleles of the dopamine Dl receptor Dde I RFLP or alleles in linkage disequilibrium therewith, alleles of the dopamine D2 receptor Taq I RFLP or alleles in linkage disequilibrium therewith, alleles of the dopamine D4 receptor VNTR polymorphism or alleles in linkage disequilibrium therewith, alleles of the VNTR in the 3' UTR of the human DAT 1 gene or alleles in linkage disequilibrium therewith, alleles of the CYPIAI Msp I RFLP or alleles in linkage disequilibrium therewith and variant alleles of CYP2A6, CYP2D6, TH or 5-HTT. 9. A method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of the monoamine oxidase A 1460 C allele and/or the monoamine oxidase A 1460 T allele. 10. A method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the monoamine oxidase A 1460 C allele. 11. A method as claimed in claim 10 wherein at least one of the one or more alleles in close physical proximity to or in linkage disequilibrium with the monoamine oxidase A 1460 C allele is selected from the group consisting of monoamine oxidase A 941 G, MAO A uVNTR allele 1 and MAO A uVNTR allele 4. 12. A method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of the dopamine β-hydroxylase 1368 A allele and/or the dopamine β-hydroxylase 1368 G allele. 13. A method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of one or more alleles in close physical proximity to or in linkage disequilibrium with the dopamine β-hydroxylase 1368 A allele. 14. A method as claimed in claim 13 wherein at least one of the one or more alleles in close physical proximity to or in linkage disequilibrium with the dopamine β-hydroxylase 1368 A allele is selected from the group consisting of DBH 910 T, DBH*444 g, DBH*444 a and an allele of the DBH STR polymorphism. 15. A method for predicting the response of a human subject to a treatment designed to assist smoking cessation, which method comprises screening for the presence or absence in the genome of the human subject of at least one allele selected from the group consisting of: dopamine β-hydroxylase 1368 A, dopamine β-hydroxylase 1368 G, monoamine oxidase A 1460 C and monoamine oxidase 1460 T and screening for the presence or absence of at least one further allele associated with smoking behaviour and screening for the presence or absence of at least one further allele associated with smoking behaviour. 16. A method as claimed in claim 15 wherein the further allele (s) associated with smoking behaviour is/are selected from the group consisting of: alleles in close physical proximity to or in linkage disequilibrium with DBH 1368 A, alleles in close physical proximity to or in linkage disequilibrium with MAO A 1460 C, alleles of the dopamine Dl receptor Dde I RFLP or alleles in linkage disequilibrium therewith, alleles of the dopamine D2 receptor Taq I RFLP or alleles in linkage disequilibrium therewith, alleles of the dopamine D4 receptor VNTR polymorphism or alleles in linkage disequilibrium therewith, alleles of the VNTR in the 3' UTR of the human DAT 1 gene or alleles in linkage disequilibrium therewith, alleles of the CYPIAI Msp I RFLP or alleles in linkage disequilibrium therewith and variant alleles of CYP2A6, CYP2D6, TH or 5-HTT. 17. A method of ameliorating the symptoms associated with nicotine withdrawal in a human subject, which method comprises administering to a human subject in need thereof a therapeutically effective amount of a medicament comprising an inhibitor of dopamine β-hydroxylase. 18. Use of an inhibitor of dopamine β- hydroxylase as an aid to smoking cessation or to ameliorate the symptoms associated with nicotine withdrawal . 19. Use of an inhibitor of dopamine β- hydroxylase for the manufacture of a medicament for use as an aid to smoking cessation or to ameliorate the symptoms associated with nicotine withdrawal. 20. A kit for use screening for the presence or absence of at least one allele of the dopamine β- hydroxylase 1368 A/G polymorphism and at least one allele of the monoamine oxidase 1460 C/T polymorphism, the kit comprising at least an oligonucleotide comprising 10 or more contiguous nucleotides from the dopamine β-hydroxylase gene, including the polymorphic locus at position 1368 and an oligonucleotide comprising 10 or more contiguous nucleotides from the monoamine oxidase A gene, including the polymorphic locus at position 1460. 21. A kit as claimed in claim 21 comprising at least one oligonucleotide selected from : 5'-GGAAGGTGACCGAGAAAGAC-3' (SEQ ID NO: 4) and 5'-GGAAGGTGACCGAGAAAGAT-3' (SEQID NO: 5) and at least one oligonucleotide selected from: 5'-CCAGCTCCCGGTCTTCC-3' (SEQ ID NO: 17) and 5'-CCAGCTCCCGGTCTTCT-3' (SEQ ID NO: 18) 22. A kit as claimed in claim 21 which further comprises oligonucleotides having the following sequences : 5'-TGGCCCAATGACACAGCCT-3' (SEQ ID NO: 6) and 5'-AGAAGGTCGTGTCGGTCCAT-3' (SEQ ID NO: 16)

Inventors: MARSHALL SARA, MCKINNEY EOIN, MURPHY MICHAEL, WALTON ROBERT, WELSH KENNETH, MARSHALL, SARA, MCKINNEY, EOIN, MURPHY, MICHAEL, WALTON, ROBERT, WELSH, KENNETH
Applicants: ISIS INNOVATION, MARSHALL SARA, MCKINNEY EOIN, MURPHY MICHAEL, WALTON ROBERT, WELSH KENNETH, ISIS INNOVATION LIMITED, MARSHALL, SARA, MCKINNEY, EOIN, MURPHY, MICHAEL, WALTON, ROBERT, WELSH, KENNETH
Application year: 2000
Main classification: C12Q1
IPC codes: A61K45, A61P25, C12Q1