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Association study of promoter polymorphisms at the dopamine transporter gene in Attention Deficit Hyperactivity Disorder
© Xu et al; licensee BioMed Central Ltd. 2009
Received: 25 September 2008
Accepted: 05 February 2009
Published: 05 February 2009
Attention deficit hyperactivity disorder (ADHD) is a complex neurobehavioral disorder. The dopamine transporter gene (DAT1/SLC6A3) has been considered a good candidate for ADHD. Most association studies with ADHD have investigated the 40-base-pair variable number of tandem repeat (VNTR) polymorphism in the 3'-untranslated region of DAT1. Only few studies have reported association between promoter polymorphisms of the gene and ADHD.
To investigate the association between the polymorphisms -67A/T (rs2975226) and -839C/T (rs2652511) in promoter region of DAT1 in ADHD, two samples of ADHD patients from the UK (n = 197) and Taiwan (n = 212) were genotyped, and analysed using within-family transmission disequilibrium test (TDT).
A significant association was found between the T allele of promoter polymorphism -67A/T and ADHD in the Taiwanese population (P = 0.001). There was also evidence of preferential transmission of the T allele of -67A/T polymorphism in combined samples from the UK and Taiwan (P = 0.003). No association was detected between the -839C/T polymorphism and ADHD in either of the two populations.
The finding suggests that genetic variation in the promoter region of DAT1 may be a risk factor in the development of ADHD.
Attention deficit hyperactivity disorder (ADHD) is a common and highly heritable neurodevelopmental disorder that affects 3–10% of children and 2–4% of adults [1, 2]. ADHD is characterized by inattention, hyperactivity and impulsivity. Data from twin, adoption and family studies show that ADHD is highly heritable, and that genetic variation is likely to play a substantial role in the etiology of the disorder . Molecular genetic and pharmacological studies suggest the involvement of the dopaminergic, serotonergic and noradrenergic neurotransmitter systems in the pathogenesis of ADHD. Polymorphic variants in several genes involved in regulation of the dopamine, and related neurotransmitter pathways have been reported to be associated with ADHD [3–6].
The dopamine transporter (DAT) plays a key role in the regulation of dopaminergic neurotransmission by mediating the active reuptake of synaptic dopamine. Several lines of evidence implicate altered function of DAT in the aetiology of ADHD. In particular, the DAT is a major target for various pharmacologically active stimulants, including methylphenidate, which is one of the most commonly prescribed treatments for ADHD.
Functional variants in the DAT1 gene have been widely studied in aetiological studies of ADHD. Most association studies between DAT1 and ADHD have concentrated on a variable number of tandem repeat (VNTR) polymorphism in the 3'-untranslated region of the gene. Cook et al.  first reported an association between the 10-reapeat allele of this polymorphism and ADHD, and several groups subsequently replicated this finding [8–13], although such replications are not ubiquitous and several studies have failed to detect any association [14–21]. More recent studies have examined additional markers across the DAT1 gene, finding stronger evidence for an association with multi-marker haplotypes containing the 10-repeat VNTR allele [18, 22]. The 10-repeat allele has been associated with quantitative ADHD-trait scores in general population samples [23, 24], suggesting it may act as a quantitative trait locus (QTL) influencing hyperactivity in the normal range above and beyond its role as a risk for clinical ADHD. The mechanism behind the reported associations is not yet understood, although several lines of evidence implicate variation in gene expression [25, 26].
Linkage disequilibrium does not extend across the entire DAT1 gene, and recent evidence suggests the presence of independent risk variants at the 5' end of the gene. Rubie et al.  found four polymorphisms (-67A/T, -839C/T, -1169C/G, -1476T/G), all in tight LD in the DAT1 promoter region that are related to potential transcriptional recognition sites. It is plausible that these polymorphisms may be functional and thus potential candidates for a role in ADHD. Recently, three studies have investigated several of these promoter polymorphisms in clinical ADHD samples [20, 28, 29]. In a large study of 51 candidate genes, Brookes et al  found nominal significance with one or more SNPs in 18 genes, including -839C/T polymorphism of DAT1, with the C allele being significantly over-transmitted to affected ADHD probands (χ2 = 5.58, P = 0.018). Genro et al.  also investigated this SNP in a sample of 243 Brazilian ADHD children and adolescents, and also found a significant association for biased transmission of the C allele to ADHD children (P = 0.03). Another study examined the association between the DAT1 promoters -67A/T polymorphism and ADHD in a case/control study, finding a significant association with the T allele .
In this study we aimed to provide further clarification of reported associations by genotyping two polymorphisms in the DAT1 promoter region for association with ADHD in two independent family-based clinical samples from the UK and from Taiwan.
For the UK sample DNA was collected using buccal swabs from 197 ADHD combined subtype probands, from both parents in 133 families, and from only the mother in 64 families. One hundred and seventeen of the ADHD probands had at least one sibling who was also genotyped. Cases were referred for assessment if they were thought by experienced clinicians to have a diagnosis of the combined subtype of ADHD under DSM-IV criteria, with no significant Axis I co-morbidity apart from oppositional defiant disorder (ODD) and conduct disorder (CD) and IQ greater than 70. The age range was 5–15 years at the time of assessment (mean 10.41, SD 2.34). Parents were interviewed with a modified version of the Child and Adolescent Psychiatric Assessment (CAPA) . Information on ADHD symptoms at school was obtained using the long form of the Conner's questionnaire . The subjects gave their written informed consent, and this study was approved by the Ethical Committee of King's College London (Reference number: G9814668).
The Taiwanese sample consisted of 212 children with ADHD diagnosed between the ages of 5–15 years (mean 8.96, SD 2.60). Both parents were available for 114 families, only the mother for 59 families and only the father for 39 families. ADHD cases were ascertained from the Child Psychiatric Clinics in the Chang Gung Memorial Hospital in Taipei area, Taiwan. A diagnosis of ADHD was made according to DSM-IV criteria following completion of a standard maternal interview , and completion of parent and teacher Conner's revised rating scales . Autism cases were excluded from the study. No other neurological or behavioural disorders were identified. Subjects gave their written informed consent, and were approved by the Institutional Review Board, Chang Gung Memorial Hospital, Taiwan (Reference number: 94-471 and 96-0058B).
The -67A/T (rs2975226) and -839C/T (rs2652511) polymorphisms were genotyped using PCR and enzyme digestion. For the -67A/T SNP the genomic DNA was amplified using forward primers 5'CCAGCCATCTGCGTCC-3' (spanning nucleotide position -151 to -135) and reverse primers 5'-GATGCCGAGAGCGACG-3' (spanning nucleotide position +98 to +113). For the -839C/T SNP the PCR was performed using forward primers 5'GCTCACGGGAGCATCGAG-3' (spanning nucleotide position -973 to -956) and reverse primers 5'-GCACTCGCCTAAGAAAACCA-3' (spanning nucleotide position -689 to -708). After amplification of genomic DNA the PCR product were digested with restriction enzyme Tth111I (for -67A/T SNP) and MspI (for -839C/T SNP) (New England Biolabs). The detail protocols were described in previous study .
Family genotype data were analysed using the transmission disequilibrium test (TDT) implemented in UNPHASED program (TDTPHASE) , http://www.mrc-bsu.cam.ac.uk/personal/frank/software/unphased/. Linkage disequilibrium (LD) was estimated by calculating D' and r2 statistics. The Bonferroni correction was applied for multiple comparisons and P < 0.0125 was considered to show a statistically significant difference.
Population frequencies for the two markers were estimated from parental genotypes. For the UK and the Taiwanese sample the A-allele frequency of the -67A/T polymorphism is 61% and 68%, respectively, and the C-allele frequency of the -839C/T polymorphism is 52% and 53%, respectively. Allele frequencies of both markers did not show any significant deviation from those expected according to Hardy -Weinberg equilibrium in either population. Significant LD was observed between the two markers (D' = 1, r2 = 0.91 in UK samples; D' = 0.70, r2 = 0.59 in Taiwanese samples).
TDT Analysis of the DAT1 Promoter -67A/T Polymorphism
UK samples Allele
Taiwanese samples Allele
Combined samples Allele
χ2, df (P-value)
0.45, 1 df (0.502)
10.43, 1 df (0.001)
8.56, 1 df (0.003)
TDT Analysis of the DAT1 Promoter -839C/T Polymorphism
UK samples Allele
Taiwanese samples Allele
Combined samples Allele
χ2, df (P-value)
0.01, 1 df (0.919)
2.38, 1 df (0.123)
1.01, 1 df (0.315)
Results of the TDT Analysis of the Haplotypes for -67A/T and -839C/T Polymorphisms
In this study, we set out to investigate previously reported findings of association between the two promoter polymorphisms of the DAT1gene in two independent samples of ADHD probands from UK and Taiwan. We found a significant over-transmission of the -67T allele to ADHD combined subtype cases in Taiwanese population and the two combined samples from UK and Taiwan. Our study replicates a finding conducted by Ohadi et al. , who found that the T allele of -67A/T polymorphism was over-represented (around 1.6 fold excess) in the ADHD probands compared to controls (χ2 = 14.50, P < 0.001) in an Iranian sample. We did not observe any association with the -839C/T polymorphism and ADHD in either of our samples, and were thus unable to replicate the findings by Brookes et al  and Genro et al. . In this study there were no effects at all on the two markers in the UK samples. However, haplotype analysis demonstrated significant preferential transmission of the -67T/-839T haplotype in the Taiwanese ADHD sample and the combined UK and Taiwanese samples. In addition, haplotypes -67A/-839T were under-transmitted to Taiwanese ADHD probands and combined samples.
In conclusion, in this study we used family-based ADHD data in the UK and Taiwanese population to test for an association between two SNP variants in the promoter region of DAT1 and susceptibility to the disorder. Our findings support the notion that genetic variation in the promoter region of DAT1 might be a risk factor in the development of ADHD, particularly in the Taiwanese sample studied. Whilst further studies are needed to confirm these findings, our data suggest that association studies of DAT1 in ADHD should not be limited to variation at the 3' end of the gene, which has been the traditional focus for aetiological studies.
The research was found by research grants for the Wellcome Trust and UK Medical Research council. The Department of Psychiatry of Chang Gung Memorial Hospital in Taiwan also supported the study. We would like to thank the families for their participation in this research.
- Burd L, Klug MG, Coumbe MJ, Kerbeshian J: Children and adolescents with attention deficit-hyperactivity disorder: 1. Prevalence and cost of care. J Child Neurol. 2003, 18: 555-561. 10.1177/08830738030180080101.View ArticlePubMedGoogle Scholar
- Kessler RC, Adler L, Ames M, Barkley RA, Birnbaum H, Greenberg P, Johnston JA, Spencer T, Ustün TB: The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. J Occup Environ Med. 2005, 47: 565-572. 10.1097/01.jom.0000166863.33541.39.View ArticlePubMedGoogle Scholar
- Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P: Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005, 57: 1313-1323. 10.1016/j.biopsych.2004.11.024.View ArticlePubMedGoogle Scholar
- Asherson P, the IMAGE Consortium: Attention-deficit hyperactivity disorder in the post-genomic era. Eur Child Adolesc Psychiatry. 2004, 13: 50-70. 10.1007/s00787-004-1006-6.View ArticleGoogle Scholar
- Faraone SV, Khan SA: Candidate gene studies of attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2006, 67 (Suppl 8): 13-20.PubMedGoogle Scholar
- Thapar A, Langley K, Owen MJ, O'donovan MC: Avances in genetic findings on attention deficit hyperactivity disorder. Psychol Med. 2007, 37: 1681-1692. 10.1017/S0033291707000773.View ArticlePubMedGoogle Scholar
- Cook EH, Stein MA, Krasowski MD, Cox NJ, Olkon DM, Kieffer JE, Leventhal BL: Association of attention-deficit disorder and the dopamine transporter gene. Am J Hum Genet. 1995, 56: 993-998.PubMedPubMed CentralGoogle Scholar
- Gill M, Daly G, Heron S, Hawi Z, Fitzgerald M: Confirmation of association between attention deficit hyperactivity disorder and a dopamine transporter polymorphism. Mol Psychiatry. 1997, 2: 311-313. 10.1038/sj.mp.4000290.View ArticlePubMedGoogle Scholar
- Daly G, Hawi Z, Fitzgerald M, Gill M: Mapping susceptibility loci in attention deficit hyperactivity disorder: preferential transmission of parental alleles at DAT1, DBH and DRD5 to affected children. Mol Psychiatry. 1999, 4: 192-196. 10.1038/sj.mp.4000510.View ArticlePubMedGoogle Scholar
- Curran S, Mill J, Tahir E, Kent L, Richards S, Gould A, Huckett L, Sharp J, Batten C, Fernando S, Ozbay F, Yazgan Y, Simonoff E, Thompson M, Taylor E, Asherson P: Association study of a dopamine transporter polymorphism and attention deficit hyperactivity disorder in UK and Turkish samples. Mol Psychiatry. 2001, 6: 425-428. 10.1038/sj.mp.4000914.View ArticlePubMedGoogle Scholar
- Chen CK, Chen SL, Mill J, Huang YS, Lin SK, Curran S, Purcell S, Sham P, Asherson P: The dopamine transporter gene is associated with attention deficit hyperactivity disorder in a Taiwanese sample. Mol Psychiatry. 2003, 8: 393-396. 10.1038/sj.mp.4001238.View ArticlePubMedGoogle Scholar
- Galili-Weisstub E, Levy S, Frisch A, Gross-Tsur V, Michaelovsky E, Kosov A, Meltzer A, Goltser T, Serretti A, Cusin C, Darvasi A, Inbar E, Weizman A, Segman RH: Dopamine transporter haplotype and attention-deficit hyperactivity disorder. Mol Psychiatry. 2005, 10: 617-618. 10.1038/sj.mp.4001655.View ArticlePubMedGoogle Scholar
- Yang B, Chan RC, Jing J, Li T, Sham P, Chen RY: A meta-analysis of association studies between the 10-repeat allele of a VNTR polymorphism in the 3'-UTR of dopamine transporter gene and attention deficit hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet. 2007, 144B (4): 541-550. 10.1002/ajmg.b.30453.View ArticlePubMedGoogle Scholar
- Palmer CG, Bailey JN, Ramsey C, Cantwell D, Sinsheimer JS, Del'Homme M, McGough J, Woodward JA, Asarnow R, Asarnow J, Nelson S, Smalley SL: No evidence of linkage or linkage disequilibrium between DAT1 and attention deficit hyperactivity disorder in a large sample. Psychiatr Genet. 1999, 9: 157-160. 10.1097/00041444-199909000-00009.View ArticlePubMedGoogle Scholar
- Vandenbergh DJ, Thompson MD, Cook EH, Bendahhou E, Nguyen T, Krasowski MD, Zarrabian Comings D, Sellers EM, Tyndale RF, George SR, O'Dowd BF, Uhl GR: Human dopamine transporter gene: coding region conservation among normal, Tourette's disorder, alcohol dependence and attention-deficit hyperactivity disorder populations. Mol Psychiatry. 2000, 5: 283-292. 10.1038/sj.mp.4000701.View ArticlePubMedGoogle Scholar
- Roman T, Schmitz M, Polanczyk G, Eizirik M, Rohde LA, Hutz MH: Attention-deficit hyperactivity disorder: a study of association with both the dopamine transporter gene and the dopamine D4 receptor gene. Am J Med Genet. 2001, 105: 471-478. 10.1002/ajmg.1408.View ArticlePubMedGoogle Scholar
- Langley K, Turic D, Peirce TR, Mills S, Bree Van Den MB, Owen MJ, O'Donovan MC, Thapar A: No support for association between the dopamine transporter (DAT1) gene and ADHD. Am J Med Genet B Neuropsychiatr Genet. 2005, 139B (1): 7-10. 10.1002/ajmg.b.30206.View ArticlePubMedGoogle Scholar
- Feng Y, Wigg KG, Makkar R, Ickowicz A, Pathare T, Tannock R, Roberts W, Malone M, Kennedy JL, Schachar R, Barr CL: Sequence variation in the 3'-untranslated region of the dopamine transporter gene and attention-deficit hyperactivity disorder (ADHD). Am J Med Genet B Neuropsychiatr Genet. 2005, 139B (1): 1-6. 10.1002/ajmg.b.30190.View ArticlePubMedGoogle Scholar
- Hebebrand J, Dempfle A, Saar K, Thiele H, Herpertz-Dahlmann B, Linder M, Kiefl H, Remschmidt H, Hemminger U, Warnke A, Knölker U, Heiser P, Friedel S, Hinney A, Schäfer H, Nürnberg P, Konrad K: A genome-wide scan for attention-deficit/hyperactivity disorder in 155 German sib-pairs. Mol Psychiatry. 2006, 11: 196-205. 10.1038/sj.mp.4001761.View ArticlePubMedGoogle Scholar
- Genro JP, Zeni C, Polanczyk GV, Roman T, Rohde LA, Hutz MH: A promoter polymorphism (-839 C > T) at the dopamine transporter gene is associated with attention deficit/hyperactivity disorder in Brazilian children. Am J Med Genet B Neuropsychiatr Genet. 2007, 144B (2): 215-219. 10.1002/ajmg.b.30428.View ArticlePubMedGoogle Scholar
- Banoei MM, Majidizadeh T, Shirazi E, Moghimi N, Ghadiri M, Najmabadi H, Ohadi M: No association between the DAT1 10-repeat allele and ADHD in the Iranian population. Am J Med Genet B Neuropsychiatr Genet. 2007, 147B (1): 110-111.View ArticleGoogle Scholar
- Brookes KJ, Mill J, Guindalini C, Curran S, Xu X, Knight J, Chen CK, Huang YS, Sethna V, Taylor E, Chen W, Breen G, Asherson P: A common haplotype of the dopamine transporter gene associated with attention-deficit/hyperactivity disorder and interacting with maternal use of alcohol during pregnancy. Arch Gen Psychiatry. 2006, 63: 74-81. 10.1001/archpsyc.63.1.74.View ArticlePubMedGoogle Scholar
- Cornish KM, Manly T, Savage R, Swanson J, Morisano D, Butler N, Grant C, Cross G, Bentley L, Hollis CP: Association of the dopamine transporter (DAT1) 10/10-repeat genotype with ADHD symptoms and response inhibition in a general population sample. Mol Psychiatry. 2005, 10: 686-698. 10.1038/sj.mp.4001641.View ArticlePubMedGoogle Scholar
- Mill J, Xu X, Ronald A, Curran S, Price T, Knight J, Craig I, Sham P, Plomin R, Asherson P: Quantitative trait locus analysis of candidate gene alleles associated with attention deficit hyperactivity disorder (ADHD) in five genes: DRD4, DAT1, DRD5, SNAP-25, and 5HT1B. Am J Med Genet B Neuropsychiatr Genet. 2005, 133B (1): 68-73. 10.1002/ajmg.b.30107.View ArticlePubMedGoogle Scholar
- Mill J, Asherson P, Browes C, D'Souza U, Craig I: Expression of the dopamine transporter gene is regulated by the 3' UTR VNTR: Evidence from brain and lymphocytes using quantitative RT-PCR. Am J Med Genet. 2002, 114: 975-979. 10.1002/ajmg.b.10948.View ArticlePubMedGoogle Scholar
- VanNess SH, Owens MJ, Kilts CD: The variable number of tandem repeats element in DAT1 regulates in vitro dopamine transporter density. BMC Genet. 2005, 6: 55-10.1186/1471-2156-6-55.View ArticlePubMedPubMed CentralGoogle Scholar
- Rubie C, Schmidt F, Knapp M, Sprandel J, Wiegand C, Meyer J, Jungkunz G, Riederer P, Stöber G: The human dopamine transporter gene: the 5'-flanking region reveals five diallelic polymorphic sites in a Caucasian population sample. Neurosci Lett. 2001, 297: 125-128. 10.1016/S0304-3940(00)01685-2.View ArticlePubMedGoogle Scholar
- Brookes K, Xu X, Chen W, Zhou K, Neale B, Lowe N, Anney R, Franke B, Gill M, Ebstein R, Buitelaar J, Sham P, Campbell D, Knight J, Andreou P, Altink M, Arnold R, Boer F, Buschgens C, Butler L, Christiansen H, Feldman L, Fleischman K, Fliers E, Howe-Forbes R, Goldfarb A, Heise A, Gabriëls I, Korn-Lubetzki I, Johansson L, Marco R, Medad S, Minderaa R, Mulas F, Müller U, Mulligan A, Rabin K, Rommelse N, Sethna V, Sorohan J, Uebel H, Psychogiou L, Weeks A, Barrett R, Craig I, Banaschewski T, Sonuga-Barke E, Eisenberg J, Kuntsi J, Manor I, McGuffin P, Miranda A, Oades RD, Plomin R, Roeyers H, Rothenberger A, Sergeant J, Steinhausen HC, Taylor E, Thompson M, Faraone SV, Asherson P: The analysis of 51 genes in DSM-IV combined type attention deficit hyperactivity disorder: association signals in DRD4, DAT1 and 16 genes. Molecular Psychiatry. 2006, 11: 934-953. 10.1038/sj.mp.4001869.View ArticlePubMedGoogle Scholar
- Ohadi M, Shirazi E, Tehranidoosti M, Moghimi N, Keikhaee MR, Ehssani S, Aghajani A, Najmabadi H: Attention-deficit/hyperactivity disorder (ADHD) association with the DAT1 core promoter -67 T allele. Brain Res. 2006, 1101: 1-4. 10.1016/j.brainres.2006.05.024.View ArticlePubMedGoogle Scholar
- Angold A, Prendergast M, Cox A, Harrington R, Simonoff E, Rutter M: The Child and Adolescent Psychiatric Assessment (CAPA). Psychol Med. 1995, 25: 739-753.View ArticlePubMedGoogle Scholar
- Conners CK: The Conners Rating Scales: Instruments for Assessments of Childhood Psychopathology. 1995, Duke University: Durham, USAGoogle Scholar
- Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moneci P, Williamson D, Ryan N: Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997, 36: 980-988. 10.1097/00004583-199707000-00021.View ArticlePubMedGoogle Scholar
- Dudbridge F: Pedigree disequilibrium tests for multilocus haplotypes. Genet Epidemiol. 2003, 25: 115-121. 10.1002/gepi.10252.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/9/3/prepub
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