Introduction
Approximately 90% of smokers begin smoking in adolescence. A substantial proportion (∼40–75%) of smoking behaviour is influenced by genetics. CYP2A6 inactivates nicotine, the principle psychoac-tive compound in cigarette smoke, to cotinine. Genetic variation in CYP2A6 that reduces the rate of nico-tine metabolism is associated with lower cigarette consumption, dependence scores, brain response to smoking cues, and greater ces-sation, evenin adolescence. In adolescents, CYP2A6slow nicotine metabolism was also associated with an increasedrisk of tobacco dependence acquisition at young ages, but slower escalation in nicotine dependence and reduced cigarette consumption. In young adults, CYP2A6 slow (vs. normal) metabolizers wereless likely to be smokers. Together these find-ings suggest that while CYP2A6 slow metabolism increases the riskof becoming a smoker in younger adolescence, slow metabolismalso increases cessation, and reduces cigarette consumption independent smokers. However, it is not known whether CYP2A6 slow metabolism increases smoking acquisition in later adolescence, a period during which a substantial amount of smokinguptake occurs.
A small proportion (∼10%) of nicotine’s metabolism to cotin-ine occurs via a second enzyme, CYP2B6. The CYP2B6*6 allele, a prevalent haplotype is associated with lowerCYP2B6 hepatic protein levels andslower CYP2B6-mediated metabolism of bupropion and efavirenz. In adult smokers, CYP2B6*6 wasassociated with lower abstinence rates in the placebo arm of abupropion smoking cessation clinical trial; 15% of individuals withone or two copies of CYP2B6*6 achieved abstinence, compared to 32% of CYP2B6*1/*1 individuals. In a separatestudy, the CYP2B6*6 allele was more frequent in nicotine dependent individuals compared to those that were not dependent. Whether CYP2B6*6 alsoinfluences the risk for acquiring nicotine dependence in adoles-cence is not known.
Here we examined associations for CYP2A6 and CYP2B6 withtobacco dependence acquisition in a larger (n > 400) sample of adolescent smokers assessed four times each year across the entireadolescent period (age 12–18 years). We hypothesized that CYP2A6slow (vs. CYP2A6 normal), and that CYP2B6 slow (i.e., individualswith one or two copies of CYP2B6*6) (vs. CYP2B6 normal) metabolizers would be at increased risk of acquiring dependence. We alsohypothesized that a larger proportion of slow (vs. normal) metab-olizers for each gene would report early smoking experiences, which are associated with the development of nicotine dependence. We also assessed cigarette consumptionat the end of follow-up among dependent smokers, hypothesizingthat CYP2A6 slow (vs. CYP2A6 normal) metabolizers would smokefewer cigarettes; no association was expected between CYP2B6genotype groups. For both CYP2A6 and CYP2B6, we further hypoth-esized that slow (vs. normal) metabolizers would be more likely tobe dependent at end of follow-up. At age 24, we expected CYP2A6 slow (vs. normal) metabolizers to be at lower risk of dependence,as CYP2A6 slow metabolizers are less likely to be dependent smok-ers (vs. non-smokers) as adults. Finally, wehypothesized that CYP2B6 slow (vs. normal) metabolizers would bemore likely to be dependent at age 24, consistent with the higherfrequency of CYP2B6*6 in dependent (vs. non-dependent) adults.
Finally, an adjunct biochemical analysis to assess the validity ofthe self-reported cigarette consumption data was undertaken. Weexamined the construct-related validity of self-reported cigaretteconsumption against salivary cotinine, widely used as an objectivebiomarker of tobacco consumption,and also assessed its relationships with nicotine dependence andwithdrawal scores.