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The Genetic Determinants of Smoking*

Vikas Batra; Ashwin A. Patkar; Wade H. Berrettini; Stephen P. Weinstein; Frank T. Leone
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*From the Department of Medicine (Drs. Batra and Leone), Division of Critical Care, Pulmonary, Allergic and Immunologic Diseases, Thomas Jefferson University, Philadelphia; Department of Psychiatry (Drs. Patkar and Weinstein), Division of Substance Abuse Programs, Thomas Jefferson University, Philadelphia; and Center for Neurobiology and Behavior (Dr. Berrettini), University of Pennsylvania, Philadelphia, PA.

Correspondence to: Ashwin A. Patkar, MD, Associate Professor of Psychiatry, and Associate Director, Comprehensive Center for Tobacco Research and Treatment, 833 East Chestnut St, Suite 210E, Philadelphia, PA 19107; e-mail: Ashwin.Patkar@mail.tju.edu



Chest. 2003;123(5):1730-1739. doi:10.1378/chest.123.5.1730
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Dependence on tobacco, like many other drug dependencies, is a complex behavior with both genetic and environmental factors contributing to the variance. The heritability estimates for smoking in twin studies have ranged from 46 to 84%, indicating a substantial genetic component to smoking. Candidate gene studies have detected functional polymorphisms in genes coding for the cytochrome P450 enzymes, and variations in these genes that lead to more rapid nicotine metabolism have been implicated in smoking. Similarly, smoking has been associated with polymorphisms in dopaminergic genes that may influence the dopamine receptor number and/or function. Animal experiments have localized specific subunits of the nicotinic receptors that may mediate the reinforcing properties of nicotine and have investigated their role in nicotine dependence. However, environmental factors have also been found to contribute to the risk of initiation and persistence of smoking. We review the scientific evidence that supports a role for genetic influences on smoking, discuss the specific genetic and neurobiological mechanisms that may mediate susceptibility to nicotine dependence, identify possible gene/environmental interactions that may be important in understanding smoking behavior, and suggest directions for future research. Insights into the genetic contributions to smoking can potentially lead to more effective strategies to reduce smoking.

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