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Testing association of rare genetic variants with resistance to three common antiseizure medications
Author(s) -
Wolking Stefan,
Moreau Claudia,
Nies Anne T.,
Schaeffeler Elke,
McCormack Mark,
Auce Pauls,
Avbersek Andreja,
Becker Felicitas,
Krenn Martin,
Møller Rikke S.,
Nikanorova Marina,
Weber Yvonne G.,
Weckhuysen Sarah,
Cavalleri Gianpiero L.,
Delanty Norman,
Depondt Chantal,
Johnson Michael R.,
Koeleman Bobby P.C.,
Kunz Wolfram S.,
Marson Anthony G.,
Sander Josemir W.,
Sills Graeme J.,
Striano Pasquale,
Zara Federico,
Zimprich Fritz,
Schwab Matthias,
Krause Roland,
Sisodiya Sanjay M.,
Cossette Patrick,
Girard Simon L.,
Lerche Holger
Publication year - 2020
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16467
Subject(s) - pharmacogenetics , lamotrigine , levetiracetam , medicine , epilepsy , exome sequencing , genetics , pharmacology , drug resistance , gene , exome , genotype , biology , mutation , psychiatry
Objective Drug resistance is a major concern in the treatment of individuals with epilepsy. No genetic markers for resistance to individual antiseizure medication (ASM) have yet been identified. We aimed to identify the role of rare genetic variants in drug resistance for three common ASMs: levetiracetam (LEV), lamotrigine (LTG), and valproic acid (VPA). Methods A cohort of 1622 individuals of European descent with epilepsy was deeply phenotyped and underwent whole exome sequencing (WES), comprising 575 taking LEV, 826 LTG, and 782 VPA. We performed gene‐ and gene set–based collapsing analyses comparing responders and nonresponders to the three drugs to determine the burden of different categories of rare genetic variants. Results We observed a marginally significant enrichment of rare missense, truncating, and splice region variants in individuals who were resistant to VPA compared to VPA responders for genes involved in VPA pharmacokinetics. We also found a borderline significant enrichment of truncating and splice region variants in the synaptic vesicle glycoprotein ( SV2 ) gene family in nonresponders compared to responders to LEV. We did not see any significant enrichment using a gene‐based approach. Significance In our pharmacogenetic study, we identified a slightly increased burden of damaging variants in gene groups related to drug kinetics or targeting in individuals presenting with drug resistance to VPA or LEV. Such variants could thus determine a genetic contribution to drug resistance.