@phdthesis{Schartner2018,
  author    = {Schartner, Christoph},
  title     = {The regulation of corticotropin releasing hormone receptor 1 gene expression and its role in panic disorder},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-150586},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2018},
  abstract  = {Panic Disorder (PD) is characterized by unexpected, recurrent panic attacks, which are not restricted to certain situations, medication or stimuli. Like other anxiety disorders, PD is a multifactorial disorder and develops through the interaction of genetic and environmental risk factors. Despite an estimated heritability of up to 48\%, no distinct genetic mechanism could be revealed yet. A dysregulation of the stress response has been shown in patients with PD and several studies could find an association of components of the corticotropin-releasing factor (CRF) system with PD. The corticotropin releasing hormone receptor 1 (CRHR1) is the main receptor of CRF in the brain and thus a crucial regulator of cerebral CRF signaling. Recent genetic studies found an association of certain CRHR1 single nucleotide polymorphisms (SNPs) with PD and other anxiety disorders. Among the associated CRHR1 SNPs, rs17689918 showed further evidence in a multilevel study regulating CRHR1 gene expression in panic-relevant brain regions and affecting brain activation in fMRI experiments, as well as flight behavior in a behavioral avoidance task (Weber et al, 2015). Here, we aimed to investigate the underlying neurogenetic and neurobiological mechanisms, by which the rs17689918 risk allele affects CRHR1 gene expression and receptor function, and its putative function in the pathophysiology of PD. Due to its intronic position and the predicted change of splicing regulatory elements by the risk allele of rs17689918, the expression of alternative spliced CRHR1 isoforms was investigated using quantitative real-time PCR (qPCR) in a human post-mortem brain tissue sample. Of eight known CRHR1 isoforms, expression of three CRHR1 isoforms and the CRHR1-IT1-CRHR1 readthrough transcript variant 5 - all expressing the seven transmembrane domains needed for functional receptors - was analyzed. Subsequently, electrophysiological assays were developed to measure the receptor activity of differentially expressed CRHR1 isoforms via co-expressed Kir2.3 potassium channels in vitro. In a second approach, possible epigenetic regulation of CRHR1 expression by rs17689918 was investigated by analyses of DNA methylation patterns of a CpG Island within the CRHR1 promoter region, firstly in a case-control sample for PD and secondly in a healthy control sample, separated in high and low anxious individuals. To investigate a possible gene × epigene × environment interaction, the impact of early life stress by means of childhood trauma was evaluated via the childhood trauma questionnaire (CTQ). Finally, consequences of differential DNA methylation of the CRHR1 promoter region on gene expression were investigated by luciferase-based reporter gene assays in vitro. The expression of CRHR1β was significantly decreased in amygdalae and midbrains of risk allele carriers. The expression of CRHR1-IT1-CRHR1 readthrough transcript variant 5 was significantly increased in forebrains and midbrains of risk allele carriers. All other analyzed isoforms showed no differences in expression between non-risk and risk allele carriers of rs17689918. The electrophysiological recordings of membrane potential showed an activation of Kir2.3 channels by CRHR1β in contrast to an inconsistent mix of activation and inhibition of Kir2.3 by the main isoform CRHR1α. DNA methylation of the CRHR1 promoter region was significantly reduced in panic disorder patients, as well as in high anxious individuals of an independent healthy control sample, but no direct relation to the rs17689918 risk allele could be discerned. However, the combination of carrying the risk allele, low DNA methylation and high CTQ scores lead to increased sum scores in the Beck Anxiety Inventory (BAI) in healthy individuals. Functional analyses revealed an activation of gene expression by decreased DNA methylation of the promoter region in vitro. Our results revealed that rs17689918 regulates CRHR1 function by increasing the expression of alternative transcript variants with altered function. Our analyses of DNA methylation revealed decreased methylation as a new risk factor for panic disorder and high anxious behavior, which in combination with other risk factors like childhood trauma and the rs17689918 risk allele might further increase cognitive and somatic anxiety symptoms. This supports the role of CRHR1 as a plasticity gene of anxiety behavior, i.e. a gene that is highly regulated by epigenetic or post-transcriptional mechanisms in response to environmental stressors. By its role in CRF signaling, the dysregulation of CRHR1 might extensively affect the stress response and contribute to the pathophysiology of stress-related disorders like PD. The understanding of the underlying mechanisms, especially the genetic and epigenetic regulation, would however enhance CRHR1 as a target of improved future therapeutics for PD and other anxiety disorders.},
  subject      = {Corticoliberin},
  language  = {en}
}