Christopher Reist MD, MBA
Spring 2007
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Archived Profiles
Dr. Reist is Associate Director, of the VISN 22 MIRECC and Director
of Research at the VA Long Beach Medical Center. He
was raised in Western Pennsylvania, received his BS
in biology and chemistry at Eastern Mennonite University
and his medical training at Virginia Commonwealth University.
He completed a psychiatric residency at the University
of California, Irvine and earned an MBA at the University
of California, Los Angeles. Prior to becoming the Director
of Research, he served as the Chief of Mental Health
for the Long Beach VA Healthcare System. Dr. Reist is
Associate Professor and Vice Chair of Psychiatry and
Human Behavior at the University of California, Irvine.
Dr. Reist is an "action junkie" spending his free time
playing soccer, ice hockey and snowboarding.
Describe your top interest current research project
I am interested in the broad area of personalized medicine as it applies
to psychiatry. Where this has had most relevance is in the area of drug
metabolism and transport. Learning more about these systems may
lead us to be able to use medications in a more effective and safe
manner. A current project is looking at how drug transporters can
affect how much medication actually reaches the brain. While these
systems serve to protect the brain from environmental toxins at the
blood-brain-barrier, they can also work to "pump" medications such
as risperidone and olanzapine out of the brain. This may explain some
cases of treatment non-response. We are studying approaches to
measure how active the drug transport system is in individuals along
with ways of modifying its activity.
What first interested you in this area?
It has been known for some time that the activity of certain liver
enzymes that metabolize medications can be influenced by genetic
and environmental factors. For example, individuals of Asian descent
are more likely to have genes that produce a less active version of the
CYP2D6 enzyme. This can result in slowed metabolism of certain
drugs such as risperidone, codeine and drugs used for treating high
blood pressure. Regular use of cigarettes can dramatically "rev up"
the CYP1A2 enzyme that metabolizes olanzapine. Consequently
smokers require higher doses of olanzapine to achieve the same blood
level compared to non-smokers. Physicians are becoming more and
more aware of the importance of understanding these variables to
maximize the effectiveness of medications in their patients.
An important factor that is promoting interest in this area is that
drug companies are having a more difficult time developing "blockbuster"
medication. Part of being a "blockbuster" is that the drug
needs to be equally safe and effective in all populations. The development
of many potentially useful drugs has been abandoned because
of differences in metabolism or effectiveness in various subgroups of
the population. Through advances in our understanding of pharmacogenetics,
the study of genetic variation that gives rise to differing
response to drugs, medications can now be developed for use only in
populations that have a particular genetic make up. With an absence
of "blockbuster" drugs on the horizon, these smaller market drugs are
looking more attractive.
What are your future research plans?
Another developing area in the pharmacogenetics is understanding
how genetic variations in drug targets such as receptors can impact
drug effectiveness. Not only can we optimize drug dose through
understanding of an individual's metabolism, the future holds the
promise of selecting drug treatments based on genetics. This is
already occurring in cancer chemotherapy. I hope to contribute to the
development of this approach to bring personalized medicine to psychiatry.
