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Chunk #33 — Discussion

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Multi-ancestry study of the genetics of problematic alcohol use in over 1 million individuals.
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In other fields, there has been progress in translating recent knowledge on genetic mechanisms into more effective therapeutic applications51. A UKB whole-exome sequencing study identified 564 genes associated with health-related traits, include 36 (6.4%) gene targets of drugs approved by the Food and Drug Administration, which is more common than in the remaining genes (1.9% are gene targets of approved drugs)52. Several genes associated with PAU encode proteins that interact with medications approved to treat AUD (for example, GABRA4 with acamprosate and OPRM1 with naltrexone53). Our multivariate analysis provided evidence for several potentially repurposable drugs. Trichostatin-a, a histone deacetylase inhibitor, showed effects on H3 and H4 acetylation and neuropeptide Y expression in the amygdala, and prevented the development of alcohol withdrawal-related anxiety in rats54. Spironolactone, a mineralocorticoid receptor antagonist, reduced alcohol use in both rats and humans in a recent study55. Clomethiazole, a GABA receptor antagonist, also showed an effect in treating alcohol withdrawal syndrome56. We anticipate that the prioritization of genes in this study will lead to follow-up studies that could improve the likelihood of successful drug development. However,