Abstract
To elucidate the genetic underpinnings of the antidepressant efficacy of S-ketamine (esketamine) nasal spray in major depressive disorder (MDD), we performed a genome-wide association study (GWAS) in cohorts of European ancestry (n = 527). This analysis was followed by a polygenic risk score approach to test for associations between genetic loading for psychiatric conditions, symptom profiles and esketamine efficacy. We identified a genome-wide significant locus in IRAK3 (p = 3.57 × 10–8, rs11465988, β = − 51.6, SE = 9.2) and a genome-wide significant gene-level association in NME7 (p = 1.73 × 10–6) for esketamine efficacy (i.e. percentage change in symptom severity score compared to baseline). Additionally, the strongest association with esketamine efficacy identified in the polygenic score analysis was from the genetic loading for depressive symptoms (p = 0.001, standardized coefficient β = − 3.1, SE = 0.9), which did not reach study-wide significance. Pathways relevant to neuronal and synaptic function, immune signaling, and glucocorticoid receptor/stress response showed enrichment among the suggestive GWAS signals.
Highlights
To elucidate the genetic underpinnings of the antidepressant efficacy of S-ketamine nasal spray in major depressive disorder (MDD), we performed a genome-wide association study (GWAS) in cohorts of European ancestry (n = 527)
In a small clinical study assessing the antidepressant efficacy of ketamine, a racemate consisting of two enantiomers, R- and S-ketamine, it was recently reported that body mass index (BMI) was associated with the remission rate, with greater BMI being associated with greater remission r ate10
Esketamine treatment response outcome was assessed at the 4 week study endpoint using one continuous variable (percent change from baseline in the Montgomery–Asberg Depression Rating Scale (MADRS) score ) and two dichotomized variables
Summary
To elucidate the genetic underpinnings of the antidepressant efficacy of S-ketamine (esketamine) nasal spray in major depressive disorder (MDD), we performed a genome-wide association study (GWAS) in cohorts of European ancestry (n = 527). This analysis was followed by a polygenic risk score approach to test for associations between genetic loading for psychiatric conditions, symptom profiles and esketamine efficacy. We assessed the genetic contributions to esketamine treatment response from patients with TRD who participated in two Phase III trials testing the efficacy and safety of esketamine, using both a genome-wide association analysis and a polygenic risk score (PRS) approach
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