A very important question in the neuroendocrinology of stress-related disorders is why some individuals thrive and others break down under similar adverse conditions. The hypothalamic-pituitary-adrenal (HPA) axis is the central component of the stress system, displaying extensive variability in reactivity among human subjects. Common gene variants have been associated with several changes in HPA axis reactivity. These gene variants are identified in the GABAA receptor, the μ-opioid receptor, the serotonin transporter, catechol O-methyltransferase (COMT), monoamine oxidase (MAOA), the α2-adrenergic receptor, brain-derived neurotrophic factor and the anginotensin-converting enzyme. Most extensively studied are genetic variants of the two central corticosteroid receptors, the high-affinity mineralocorticoid receptor (MR) and the lower-affinity glucocorticoid receptor (GR). In the GR, the TthIIII, NR3C1-1, ER22/23EK, N363S, BclI and the A3669G, and in the MR, the –2 G/C and the I180V all modify HPA axis responsiveness at several levels. As a result of these genetic variants, HPA axis reactivity will be changed exposing not only the brain but the whole body to suboptimal cortisol levels during challenges. We propose that these genetic variants which modulate HPA axis reactivity are part of the genetic makeup that determines individual stress responsivity and coping style, affecting vulnerability to disease.
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