Post-traumatic Stress Symptoms and Serotonin Transporter (5-HTTLPR) Polymorphism in Breast Cancer Patients

Luigi Zerbinati; Martino Belvederi Murri; Rosangela Caruso; Maria Giulia Nanni; Wendy Lam; Silvia De Padova; Silvana Sabato; Tatiana Bertelli; Giulia Schillani; Tullio Giraldi; Richard Fielding; Luigi Grassi

doi:10.3389/fpsyt.2021.632596

Post-traumatic Stress Symptoms and Serotonin Transporter (5-HTTLPR) Polymorphism in Breast Cancer Patients

Front Psychiatry. 2021 Apr 21:12:632596. doi: 10.3389/fpsyt.2021.632596. eCollection 2021.

Authors

Luigi Zerbinati¹, Martino Belvederi Murri^{1

2}, Rosangela Caruso^{1

2}, Maria Giulia Nanni^{1

2}, Wendy Lam³, Silvia De Padova⁴, Silvana Sabato¹, Tatiana Bertelli⁴, Giulia Schillani⁵, Tullio Giraldi⁶, Richard Fielding^{2

3}, Luigi Grassi^{1

2}

Affiliations

¹ Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.
² University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
³ Centre for Psycho-Oncological Research and Training, School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong.
⁴ Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola, Italy.
⁵ Child Onco-Hematology Unit, Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Burlo Garofolo, Trieste, Italy.
⁶ Section of Pharmacology, Department of Life Sciences, University of Trieste, Trieste, Italy.

Abstract

Introduction: Post-traumatic Symptoms (PTSS) and Post-traumatic Stress Disorder (PTSD) have been reported to affect a quite significant proportion of cancer patients. No study has examined the relationship between serotonin transporter gene-linked polymorphic region (5-HTTLPR) and cancer, including Gene-Environment interactions between this polymorphism and specific causes of distress, such as cancer related problems (CRP) or life stressful events (SLE). Methods: One hundred and forty five breast cancer outpatients participated in the study and were assessed using the Impact of Event Scale (IES), the Problem List (PL) developed by the National Comprehensive Cancer Network (NCCN) Distress Management Guidelines and the Paykel's Life Events Interview to evaluate the exposure to SLE during the year before the cancer diagnosis. Each patient was genotyped for 5-HTTLPR polymorphism by analyzing genomic DNA obtained from whole blood cells. Gene-Environment interactions were tested through moderation analysis. Results: Twenty-six patients (17.7%) were classified as PTSS cases using the IES. Genotype and phenotype distributions did not differ across individuals with/without PTSS (genotype: χ² = 1.5; df = 2; p = 0.3; phenotype χ² = 0.9; df = 1; p = 0.2). For both the genotype and phenotype model, using CRP as a predictor showed significant gene-environment interactions with IES total score (p = 0.020 and p = 0.004, respectively), with individuals carrying the l/l allele showing a greater probability of experiencing PTSS. No interaction was found in relationship to SLE (p = 0.750). Conclusion: This study showed a significant GEI between CRP and PTSS in breast cancer patients, with carriers of the l/l allele showing indicators consistent with greater sensitivity to stress.

Keywords: 5-HTTLPR polymorphism; breast cancer; post-traumatic stress disorder; post-traumatic stress symptoms; serotonine transporter.