Highlights d Development of a mouse model of pancreatic adenocarcinoma (PDA)-induced cachexia d Model develops progressive wasting associated with advancing pancreas pathology d Induction of cachexia in adult KPP mice models tissue loss in PDA cancer patients d Gene ontology of cachectic muscles from KPP mice resembles that of PDA patients

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Background The 5-hydroxytryptamine 2A receptor, encoded by HTR2A, is a major post-synaptic target for serotonin in the human brain and a therapeutic drug target. Despite hundreds of genetic associations investigating HTR2A polymorphisms in neuropsychiatric disorders and therapies, the role of genetic HTR2A variability in health and disease remains uncertain. Methods To discover and characterize regulatory HTR2A variants, we sequenced whole transcriptomes from ten human brain regions with massively-parallel RNA sequencing and measured allelic expression of multiple HTR2A mRNA transcript variants. Following discovery of functional variants, we further characterized their impact on genetic expression in vitro. Results Three polymorphisms modulate the use of novel alternative exons and untranslated regions (UTRs), changing expression of RNA and protein. The frequent promoter variant rs6311, widely implicated in human neuropsychiatric disorders, decreases usage of an upstream transcription start site encoding a longer 5′UTR with greater translation efficiency. rs76665058, located in an extended 3′UTR and unique to individuals of African descent, modulates allelic HTR2A mRNA expression. The third SNP, unannotated and present in only a single subject, directs alternative splicing of exon 2. Targeted analysis of HTR2A in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study reveals associations between functional variants and depression severity or citalopram response. Conclusions Regulatory polymorphisms modulate HTR2A mRNA expression in an isoform-specific manner, directing the usage of novel untranslated regions and alternative exons. These results provide a foundation for delineating the role of HTR2A and serotonin signaling in CNS disorders.

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