Genetic and Drug Testing

INSynergy uses Genetic Testing to predict responses to anti-craving medication and risk for addiction and alcoholism.

INSynergy uses Highly Complex CLIA-Certified Laboratories to measure levels of medications, drugs of abuse, and metabolites of alcohol. Results help monitor progress towards sobriety and harm reduction.


Can addiction lie in our genes?

Addiction has been considered historically as a "moral defect" or "lack of will-power". In reality, studies have shown that 40- 60% of the predisposition to addiction can be attributed to genetics. Addiction is very complex and there is no ONE reason a person may get addicted to a drug when another person may not.

At INSynergy, as part of the work-up, genetic testing is offered to predict response to certain treatments. Metabolism of certain drugs, neurotransmitters, and vitamins, can be identified using genetic testing. Some of genetic signals involved in addiction are: OPRM-1, DRD2-A1, MTHFR, GluK1 or GluK2 , SLC6A4, and COMT.

Chasing Dopamine

When we eat, have sex, or experience positive social interactions, dopamine is released and reminds us that these events are good and should be repeated. In other words, dopamine makes things rewarding and re-enforcing. Drugs and alcohol an increase the release of endorphin which then releases dopamine which results in “a high”.

DRDS2-A1 and the Reward Deficiency Syndrome

The gene DRD2-A1 encodes for dopamine function and how it's transported throughout the brain. DRD2-A1 is carried in about 30% of the US population. These carriers have 30-40% less Dopamine receptors. Why is this important? People with lower dopamine receptors tend to share common behaviors that are associated with addiction. These are: risk taking behaviors, ADHD, gambling, conduct disorder, anti-social personality, aggression, generalized anxiety, and aberrant sexual behavior. This low dopamine state leads to impulsivity, inability to feel pleasure, higher cravings. This combination of behaviors increases risk for addiction. This syndrome has been described as the "Reward Deficiency Syndrome".

Opiate Receptor Gene (OPRM-1) Predicts Addiction and Naltrexone Treatment Response

Naltrexone is a medication that reduces the pleasurable feelings associated with using opiates or alcohol. Naltrexone however, doesn't work for everyone. Research has found that persons who had a certain OPRM-1 gene influenced the likelihood that a person taking naltrexone would have a "good clinical outcome".

Also, different versions of the OPRM-1 gene are thought to affect how much morphine one needs to feel a given effect. A study of 139 heroin addicts and 170 non-addicts found that people with at least one G at rs1799971 have almost 2.9 times the odds of being a heroin addict.

Topiramate

The drug topiramate is an anticonvulsant that is often prescribed to treat migraines and seizures. It is also helpful for weight loss. Research at the University of Pennsylvania, found that a mutation in a type of glutamate receptor (GluK1 or GluK2 subunits) may predict response when given to alcoholics. When administered to people with risky drinking habits (defined as drinking more than 24 drinks a week for men and more than 15 drinks a week for women) those patients were able to reduce the number of nights of extreme drinking and also have more days of complete abstinence.

Ondansetron

Another promising pharmacogenetic target for alcohol addiction is the serotonin receptor and its related transporter molecule, which carries serotonin from one neuron to another.

Ondansetron, marketed under the brand name Zofran, is a medication currently approved to treat nausea in cancer patients may help alcoholics reduce their drinking by reducing their craving for alcohol,

A study at the University of Texas Health Science Center at San Antonio of 271 patients identified as early-onset alcoholics found that dosages of ondansetron over an 11-week period resulted in fewer drinks per day and more days of complete abstainace, compared to the control group.

In a study in 2011, a team from the University of Maryland found that drinkers with a specific mutation in a gene SLC6A4, associated with the serotonin transporter had significant reductions of alcohol use and higher abstinence while taking ondansetron.

COMT Gene

Catechol-O-methyltransferase (COMT) is one of several enzymes responsible for metabolizing and inactivating the catecholamine neurotransmitters, including dopamine and norepinephrine and also controls the level of the neurotransmitter dopamine in the cortex.

A study found that a variant of the COMT gene, Val158 allele, resulted in lower dopamine concentrations in the prefrontal cortex and was associated with inefficient frontal lobe function and behavior disinhibition leading to impulsive behavior and addictive behavior.

What is MTHFR?

MTHFR is an enzyme that breaks down folic acid (Vit B-9) to its usable form for the body. The MTHFR gene produces this enzyme that is necessary for properly using vitamin B9. This gene plays a key role with regard to many aspects of emotional and physical health.

The presence of an MTHFR deficiency or mutation can be linked to certain mental health issues like depression, bipolar disorder, schizophrenia, attention-deficit hyperactivity disorder (ADHD). MTHFR mutations also increase the risk of several physical health problems, including but not limited to cardiovascular disease and stroke, recurrent early miscarriage, migraine with aura, osteoporosis, and some cancers. Treatment of MTHFR deficiency with the usable form of folate (L-methy-folate) can improve response to certain medications for depression.


Protective Genes

The Asian flush

Individuals who experience flushing when drinking may be less prone to alcoholism. This is called "The Asian Flush" because this genetic deficiency of Aldehyde Dehydrogenase (ALDH2), is common in some Asians. This reaction is the result of an accumulation of acetaldehyde, a toxic byproduct of metabolizing of alcohol. The resulting irritating flushing reaction takes all the fun out of drinking for some predisposed people.

The Bitterness Gene

Studies have shown that some people are less interested in drinking beer because of the perceived bitterness taste. Researchers already new that some people (about 1/4 of the population) have a version of one taste receptor gene, known as TAS2R38, that makes them more sensitive to the perception of bitter. The perceived bitterness was correlated with unpleasant sensations from beer. Those who tasted bitterer beer also report ethanol, and red wines, as more bitter or irritating.