The serotonin transporter (HTT) is a candidate gene for obsessive-compulsive disorder (OCD) that has been associated with anxiety-related traits. The long (1) and short (s) variants of theThe serotonin transporter (HTT = SLC6A4) is a plausible candidate gene for obsessive-compulsive disorder (OCD) and several other psychiatric disorders (Altemus et al. 1996;Lesch et al. 1995;Ogilvie et al. 1996). It has been associated with anxiety-related traits in two predominantly male samples (Gelernter et al. 1995;Ramamoorthy et al. 1993). A complementary deoxyribose nucleic acid (cDNA) encoding the 5-HTT in the human midbrain raphe complex has been isolated, and its identity with the human platelet serotonin (5-HT) transporter site has been demonstrated (Lesch et al. 1993a,b).HTT gene transcription is regulated by a deletion/ insertion polymorphism in the promoter (Heils et al. 1995). The long (I) and short (s) variants of this polymorphic region have different transcriptional efficiencies in transfection assays and lymphoblastoid cell lines Lesch et al. 1996). The short allele reduces the transcriptional efficiency of the HTT gene promoter, resulting in decreased 5-HTT binding and 5-HT uptake in lymphoblasts . Studies of HIT gene expression in lymphoblast cell lines from 10 subjects with different genotypes suggested that the polymorphism has more of a dominant-recessive than a codominant-additive effect, with the short variant ap-0893-133X/98/$19.00 PII S0893-133X(97)00097-3 NEUROPSYCHOPHARMACOLOGY 1998-VOL. 18, NO. 2 pearing dominant to the long variant. However, the dominant mode of action of the short allele has been questioned (Goldman 1996).Because of the small sample size in that study and the importance of the HTT, we examined the relationship between the HTT promoter variant and whole blood 5-HT concentration in 70 individuals from 20 families ascertained through children and adolescents between 10 and 17 years of age with a DSM-III-R diagnosis of OCD. Sampling through early-onset cases can be a useful strategy in identifying a more clearly genetic or homogeneous form of a disorder (Lander and Schork 1994). Family studies have demonstrated that OCD is often familial and that the morbid risk of the disorder is higher among the relatives of early-onset probands than among the relatives of late-onset probands (Bellodi et al. 1992;Pauls et al. 1995).The selective response of OCD to potent 5-HT transporter inhibitors (serotonin reuptake inhibitors, SRis) has suggested that a serotonergic abnormality may be involved in OCD (Goodman et al. 1990;Leonard et al. 1989). The 5-HTT is an initial site of action for those drugs and is crucial to the termination of serotonergic neurotransmission (Amara and Kuhar 1993). Two treatment studies of childhood OCD using clomipramine, a potent 5-HT transporter inhibitor, have demonstrated a significant correlation between clinical improvement and a marked reduction in either platelet 5-HT or whole blood 5-HT content, reflecting the effect of the drug on the platelet uptake site (F...