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Atremorine is a potent dopamine (DA) enhancer with powerful effects on the neuronal dopaminergic system, acting as a neuroprotective agent in Parkinson's disease (PD). Over 97% of PD patients respond to a single dose of Atremorine (5\u2009g, p.o.) 1\u2009h after administration. This response is gender\u2010, time\u2010, dose\u2010, and genotype\u2010dependent, with optimal doses ranging from 5 to 20\u2009g\/day, depending upon disease severity and concomitant medication. Drug\u2010free patients show an increase in DA levels from 12.14\u2009\u00b1\u20090.34\u2009pg\/ml to 6463.21\u2009\u00b1\u20091306.90\u2009pg\/ml; and patients chronically treated with anti\u2010PD drugs show an increase in DA levels from 1321.53\u2009\u00b1\u2009389.94\u2009pg\/ml to 16,028.54\u2009\u00b1\u20094783.98\u2009pg\/ml, indicating that Atremorine potentiates the dopaminergic effects of conventional anti\u2010PD drugs. Atremorine also influences the levels of other neurotransmitters (adrenaline, noradrenaline) and hormones which are regulated by DA (e.g., prolactin, PRL), with no effect on serotonin or histamine. The variability in Atremorine\u2010induced DA response is highly attributable to pharmacogenetic factors. Polymorphic variants in pathogenic (<jats:italic>SNCA, NUCKS1, ITGA8, GPNMB, GCH1, BCKDK, APOE, LRRK2, ACMSD<\/jats:italic>), mechanistic (<jats:italic>DRD2<\/jats:italic>), metabolic (<jats:italic>CYP2D6, CYP2C9, CYP2C19, CYP3A4\/5, NAT2<\/jats:italic>), transporter (<jats:italic>ABCB1, SLC6A2, SLC6A3, SLC6A4<\/jats:italic>) and pleiotropic genes (<jats:italic>APOE<\/jats:italic>) influence the DA response to Atremorine and its psychomotor and brain effects. Atremorine enhances DNA methylation and displays epigenetic activity via modulation of the pharmacoepigenetic network. Atremorine is a novel neuroprotective agent for dopaminergic neurons with potential prophylactic and therapeutic activity in PD.<\/jats:p>","DOI":"10.1002\/med.21838","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T15:35:03Z","timestamp":1623252903000},"page":"2841-2886","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Atremorine in Parkinson's disease: From dopaminergic neuroprotection to pharmacogenomics"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0554-4037","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Cacabelos","sequence":"first","affiliation":[{"name":"Department of Genomic Medicine EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine  Bergondo 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