Will genes = saving lives?

The concept of using genetic tests that can show a predisposition to a variety of illnesses is no longer new. The completion of the human genome project in 2003 has paved the way for companies to release tests that ultimately lead to early identification of diseases such as breast cancer and cystic fibrosis, potentially improving the management and prognosis of these conditions.

Today, at the symposium ‘Can Psychiatric Disorders Be Predicted and Prevented?’, Professor Wasserman talked about the hope that current genetic studies bring to the early identification of suicide risk. Prof Wasserman is the lead in one of these studies, an EU FP7 (7^th Framework Programme for Research and Technological Development)-funded project called a Genetic Investigation of Suicide Attempt and Suicide (GISS).

Using a database of 660 nuclear families with suicide attempter children and a control-sample of 519 non-suicidal, healthy volunteers, Prof Wasserman studied a variety of genes associated with the hypothalamic–pituitary–adrenal (HPA) axis to see if they tell us anything about the roles of stress and genes in suicide.

Stress, genes and suicide

One of the aims of GISS is to investigate how environmental stress may cause acute or chronic dysregulation of biological stress-responsive systems, and subsequently affect the suicidality of certain subjects (but not others).

“We showed that the different parts of the CRHR1 gene, which is a key regulator of the major stress-responsive system, was associated with suicide attempts through a rather complex pattern of gene-environment interactions (GxEs) in our sample involving a history of physical assaults or cumulative exposure to stressful life events, for example.”

Prof Wasserman added that these findings indicated potential targets for:

• • The development of pharmacological treatments on the HPA axis, glutamate and polyamine systems (CRHR1, GRIN2B, ODC1).
• • Public health interventions by preventing violence and physical assaults, as well as intervening on exposure to physical assaults.
• • Intervening on exposure to Ph among non-GG carriers of OCD1 gene, targets of ~86% of the population, resulting in reduction of suicide attempts (SA) incidence by 5.5%
• • Intervening on exposure to Ph, GG carriers of OCD1 gene, targets ~1.5% of the population, resulting in reduction of SA incidence by 2.6%, due to GxE effect

Working together

But currently genetic studies can’t be used to predict patients at risk of suicide. In the meantime, the community at large needs to play a role in reducing risk factors for suicide, and this includes ensuring social support is in place as well as satisfactory living conditions and income support where necessary.

“We need the full array of suicidal preventative activities in place because whilst we can treat patients, clinicians aren’t in a position to change things such as living conditions,” said Prof Wasserman.

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