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Pharmacoepigenetics of Vertigo and Related Vestibular Syndromes

J. Guerra,R. Cacabelos

Published 2019 in Pharmacoepigenetics

ABSTRACT

Abstract Vertigo is a complex and heterogeneous entity that can be categorized as vestibular or central. Alterations in the vestibular system cause an illusory sensation of tilting, floating, or spinning. Most cases have a genetic background, so deep phenotyping might be necessary to complete an accurate diagnosis. Epigenetic mechanisms are involved in hair cell regeneration, and alterations may cause vertigo-associated disorders. There are reports of genetic mutations and epigenetic changes in Meniere disease, neurofibromatosis, different types of ataxia, and other syndromes. Treatment of vertigo varies depending on its type, characteristics, and sequels. Pharmacological treatments include corticosteroids, anticonvulsants, anticholinergics, calcium channel blockers, antihistamines, diuretics, benzodiazepines, and other drugs. Most of the drugs involved in vertigo metabolize through CYP group enzymes that can be present in central structures and can be affected by epigenetic factors that also affect interindividual variability in drug response. There are different receptor genes involved in vestibular functioning that may be useful for the development of new treatments. These receptors may also be modified epigenetically, and their epigenetic status can affect patient response to therapy. Multiple lines of pharmacological and nonpharmacological treatments may induce epigenetic changes, diminishing or increasing gene expression. Drugs can induce epigenetic modifications, and there are several reports showing effectiveness when using epigenetic treatments, such as in vestibular schwannoma, Friedreich ataxia, or inner ear disorders.

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