Optimizing drug outcomes through pharmacogenetics: a case for preemptive genotyping

Routine integration of genotype data into drug decision making could improve patient safety, particularly if many relevant genetic variants can be assayed simultaneously before prescribing the target drug. The frequency of opportunities for pharmacogenetic prescribing and the potential adverse events (AEs) mitigated are unknown. We examined the frequency with which 56 medications with known outcomes influenced by variant alleles were prescribed in a cohort of 52,942 medical home patients at Vanderbilt University Medical Center (VUMC). Within a 5-year window, we estimated that 64.8% (95% confidence interval (CI): 64.4-65.2%) of individuals were exposed to at least one medication with an established pharmacogenetic association. Using previously published results for six medications with severe, well-characterized, genetically linked AEs, we estimated that 383 events (95% CI, 212-552) could have been prevented with an effective preemptive genotyping program. Our results suggest that multiplexed, preemptive genotyping may represent an efficient alternative approach to current single-use ("reactive") methods and may also improve safety.

Operational implementation of prospective genotyping for personalized medicine: the design of the Vanderbilt PREDICT project

The promise of "personalized medicine" guided by an understanding of each individual's genome has been fostered by increasingly powerful and economical methods to acquire clinically relevant information. We describe the operational implementation of prospective genotyping linked to an advanced clinical decision-support system to guide individualized health care in a large academic health center. This approach to personalized medicine entails engagement between patient and health-care provider, identification of relevant genetic variations for implementation, assay reliability, point-of-care decision support, and necessary institutional investments. In one year, approximately 3,000 patients, most of whom were scheduled for cardiac catheterization, were genotyped on a multiplexed platform that included genotyping for CYP2C19 variants that modulate response to the widely used antiplatelet drug clopidogrel. These data are deposited into the electronic medical record (EMR), and point-of-care decision support is deployed when clopidogrel is prescribed for those with variant genotypes. The establishment of programs such as this is a first step toward implementing and evaluating strategies for personalized medicine.

Systemic FasL neutralization increases eosinophilic inflammation in a mouse model of asthma

BACKGROUND

Eosinophils and lymphocytes are pathogenically important in allergic inflammation and sensitive to Fas-mediated apoptosis. Fas ligand (FasL) activity therefore should play a role in regulating the allergic immune response. We aimed to characterize the role of FasL expression in airway eosinophilia in Aspergillus fumigatus (Af)-induced sensitization and to determine whether FasL neutralization alters the inflammatory response.

METHODS

Sensitized Balb/c mice were killed before (day 0) and 1, 7 and 10 days after a single intranasal challenge with Af. Animals received either neutralizing antibody to FasL (clone MFL4) or irrelevant hamster IgG via intraperitoneal injection on days -1 and 5. FasL expression, BAL and tissue inflammatory cell and cytokine profile, and apoptosis were assessed.

RESULTS

Postchallenge FasL gene expression in BAL cells and TUNEL positivity in the airways coincided with the height of inflammatory cell influx on day 1, while soluble FasL protein was released on day 7, preceding resolution of the inflammatory changes. Although eosinophil numbers showed a negative correlation with soluble FasL levels in the airways, MBP(+) eosinophils remained TUNEL negative in the submucosal tissue, throughout the 10-day period after Af challenge. Systemic FasL neutralization significantly enhanced BAL and tissue eosinophil counts. This effect was associated with increased activation of T cells and release of IL-5, IL-9, and GM-CSF in the BAL fluid of mice, indicating an involvement of pro-eosinophilic survival pathways.

CONCLUSIONS

FasL activity may play an active role in resolving eosinophilic inflammation through regulating T cells and pro-eosinophilic cytokine release during the allergic airway response.

A multicentre phase II trial of gemcitabine for the treatment of patients with newly diagnosed, relapsed or chemotherapy resistant mantle cell lymphoma: SAKK 36/03

Mantle cell lymphoma (MCL) has a poor prognosis with often short and incomplete remissions. We aimed to test the efficacy and tolerability of gemcitabine in treating MCL. Gemcitabine was given in doses of 1000 mg/m(2) as a 30 min infusion on days 1 and 8 of each 3 week cycle for a maximum of nine cycles. Eighteen patients with a median age of 70 years were recruited. MCL was newly diagnosed in half of patients and relapsed in the remainder. Fifteen patients had Ann Arbor stage IV. The best-recorded responses were 1 CR (complete remission), 4 PRs (partial responses), 8 SDs (stable diseases) and 4 PDs (diseases progression). The response rate (RR) (CR + PR) was 5 (28%; 95% confidence interval: 7.1, 48.5). The patient achieving a CR had stage IV disease. Most haematological adverse events occurred during the first chemotherapy cycle. Three patients developed non-haematological serious adverse events: dyspnea, glomerular microangiopathy with haemolytic uremic syndrome (HUS) and hyperglycaemia. The median time-to-progression and treatment response duration (TRD) was 8.0 (95% confidence interval: 5.5, 9.3) and 10.6 (95% confidence interval: 5.5, 10.9) months, respectively. We conclude that Gemcitabine is well tolerated, moderately active and can induce disease stabilization in patients with MCL.

Thermochromatography of 241Am and 254Es in chlorinating carrier gases

Gas adsorption chromatography experiments were carried out with Es and Am in a temperature gradient tube using chlorinating carrier gas. From the observed deposition temperatures the adsorption enthalpies of AmCl3 and EsCl3 on the chromatographic surface (quartz glass surface, dynamically modified by the chlorinating carrier gases) were deduced for the first time. In good agreement, both the model of mobile adsorption and the Monte Carlo model resulted in:

Thermochromatographic studies of berkelium chlorides: BkCl3 and BkCl4

The thermochromatographic behavior of berkelium chlorides in various chlorinating gases was studied. Using Cl2 or a mixture of Cl2/SOCl2, two peaks were observed in a thermochromatographic column. The "high temperature" peak corresponds to BkCl3 and the "low temperature" one corresponds most probably to BkCl4. Using both the model of mobile adsorption and the of Monte Carlo method, the adsorption enthalpies were determined. The possible chemical reactions in a chromatographic column are discussed.

Bone responses to body weight and moderate treadmill exercising in growing male obese (fa/fa) and lean Zucker rats

OBJECTIVE

To evaluate if exercise in a young growing model of obesity would be able to reduce adiposity without adversely affecting bone.

METHODS

Obese (fa/fa) and lean (Fa/Fa) male Zucker rats were randomly assigned (n=8-9 rats/group) to no exercise or to a moderate treadmill exercise regimen consisting of a speed of 20 m/min for approximately 1 h, 5 d/wk for 9 wks. Bone morphometry, total bone ash, and bone strength by three-point bending test were determined in the femur and the tibia. Serum alkaline phosphatase was determined using calorimetric enzyme assays. Serum osteocalcin, deoxypyridinoline (DPD), and pyridinoline (PYD) crosslinks were measured using enzyme immunoassays. Various blood chemistry measurements were determined including: serum glucose, insulin, and leptin.

RESULTS

Growing obese (fa/fa) Zucker rats have long bone ash comparable to lean Zucker rats, although bone size is reduced. Moderate treadmill running successfully reduced body weight without increasing muscle mass, but did not attenuate the reduction in bone growth or promote greater bone mass and strength in obese Zucker rats.

CONCLUSIONS

Moderate treadmill running for 9 wks successfully reduced the body weight of obese Zucker rats by 7.5% without negatively affecting bone.

Bacterial community composition in Brazilian Anthrosols and adjacent soils characterized using culturing and molecular identification

Microbial community composition was examined in two soil types, Anthrosols and adjacent soils, sampled from three locations in the Brazilian Amazon. The Anthrosols, also known as Amazonian dark earths, are highly fertile soils that are a legacy of pre-Columbian settlement. Both Anthrosols and adjacent soils are derived from the same parent material and subject to the same environmental conditions, including rainfall and temperature; however, the Anthrosols contain high levels of charcoal-like black carbon from which they derive their dark color. The Anthrosols typically have higher cation exchange capacity, higher pH, and higher phosphorus and calcium contents. We used culture media prepared from soil extracts to isolate bacteria unique to the two soil types and then sequenced their 16S rRNA genes to determine their phylogenetic placement. Higher numbers of culturable bacteria, by over two orders of magnitude at the deepest sampling depths, were counted in the Anthrosols. Sequences of bacteria isolated on soil extract media yielded five possible new bacterial families. Also, a higher number of families in the bacteria were represented by isolates from the deeper soil depths in the Anthrosols. Higher bacterial populations and a greater diversity of isolates were found in all of the Anthrosols, to a depth of up to 1 m, compared to adjacent soils located within 50-500 m of their associated Anthrosols. Compared to standard culture media, soil extract media revealed diverse soil microbial populations adapted to the unique biochemistry and physiological ecology of these Anthrosols.