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Rad F, Hamidpour M, Dorgalaleh A, Poopak B. The Effect of Demographic Factors and VKORC1 1639 G>A Genotypes on Estimated Warfarin Maintenance Dose in Iranian Patients Under Warfarin Therapy. Indian J Hematol Blood Transfus 2018; 35:167-171. [PMID: 30828166 DOI: 10.1007/s12288-018-0987-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors including factor (F) II, FVII, FIX and FX. Different factors can change the effect of this anticoagulant in clinic. Therefore we assessed impact of VKORC1 -1639 G>A polymorphism and demographic factors on required maintenance dose in Iranian patients under warfarin therapy. The study population included 95 patients with a mean age of 61.3 ± 12.6 years. Target INR range of 2-3 was considered for these patients. The frequency of VKORC1 -1639 G>A polymorphism was assessed by polymerase chain reaction-restriction length polymorphism (PCR-RFLP). Finally the obtain data were analyzed by SPSS software. Our study revealed that 30.5%, 49.5%, and 20% of the patients had VKORC1 (G/G), (G/A), and (A/A) genotypes, respectively. Carriers of VKORC1 G/G genotype required a higher warfarin dose as compared to A/A carriers (4.48 ± 1.32 and 2.7 ± 1.16 mg/day, respectively; P < 0.01). In addition, patients with higher age required lower warfarin therapeutic dose (r = - 0.3, P < 0.01). It seems that -1639 G>A polymorphism and demographic variables had significant effects on warfarin maintenance dose in Iranian patients under warfarin therapy.
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Affiliation(s)
- Fariba Rad
- 1Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohsen Hamidpour
- 2Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akbar Dorgalaleh
- 3Department of Hematology and Blood Transfusion, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.,Iranian Comprehensive Hemophilia Center, Tehran, Iran
| | - Behzad Poopak
- 5School of Paramedicine, Tehran Medical Branch of Islamic Azad University, P.O. Box 19395-1495, Tehran, Iran
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Zhou Y, Lauschke VM. Comprehensive overview of the pharmacogenetic diversity in Ashkenazi Jews. J Med Genet 2018; 55:617-627. [PMID: 29970487 DOI: 10.1136/jmedgenet-2018-105429] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/28/2018] [Accepted: 06/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adverse drug reactions are a major concern in drug development and clinical therapy. Genetic polymorphisms in genes involved in drug metabolism and transport are major determinants of treatment efficacy and adverse reactions, and constitute important biomarkers for drug dosing, efficacy and safety. Importantly, human populations and subgroups differ substantially in their pharmacogenetic variability profiles, with important consequences for personalised medicine strategies and precision public health approaches. Despite their long migration history, Ashkenazi Jews constitute a rather isolated population with a unique genetic signature that is distinctly different from other populations. OBJECTIVE To provide a comprehensive overview of the pharmacogenetic profile in Ashkenazim. METHODS We analysed next-generation sequencing data from 5076 Ashkenazim individuals and used sequence data from 117 425 non-Jewish individuals as reference. RESULTS We derived frequencies of 164 alleles in 17 clinically relevant pharmacogenes and derived profiles of putative functional consequences, providing the most comprehensive data set of Jewish pharmacogenetic diversity published to date. Furthermore, we detected 127 variants with an aggregated frequency of 20.7% that were specifically found in Ashkenazim, of which 55 variants were putatively deleterious (aggregated frequency of 9.4%). CONCLUSION The revealed pattern of pharmacogenetic variability in Ashkenazi Jews is distinctly different from other populations and is expected to translate into unique functional consequences, especially for the metabolism of CYP2A6, CYP2C9, NAT2 and VKORC1 substrates. We anticipate that the presented data will serve as a powerful resource for the guidance of pharmacogenetic treatment decisions and the optimisation of population-specific genotyping strategies in the Ashkenazi diaspora.
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Affiliation(s)
- Yitian Zhou
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, Stockholm, Sweden
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, Stockholm, Sweden
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Wang Z, Zhang L, Huang P, Gu X, Xie X, Wang Y, Li W, Zeng Q. Weight and the vitamin K expoxide reductase 1 genotype primarily contribute to the warfarin dosing in pediatric patients with Kawasaki disease. Thromb Res 2018; 167:32-36. [PMID: 29778033 DOI: 10.1016/j.thromres.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Warfarin therapy is recommended in children with giant coronary artery aneurysms (GCAAs) after Kawasaki disease (KD). Large individual variability makes it difficult to predict the warfarin dose. Polymorphisms in the vitamin K expoxide reductase 1 (VKORC1) and cytochrome P4502C9 (CYP2C9) genes have been reported to influence the warfarin dose. We investigated the effects of the VKORC1 and CYP2C9 genotypes on the warfarin dose in pediatric patients with giant CAAs after KD. We attempted to create a dosing algorithm. MATERIALS AND METHODS The clinical and genetic data of patients were documented. VKORC1 (rs 9923231) and CYP2C9 *3 (rs 1057910) were genotyped using TaqMan real-time polymerase chain reaction. A linear regression analysis was performed to evaluate the contribution of clinical and genetic factors to the warfarin maintenance dose. RESULTS Forty-seven patients were enrolled. Patients with the CT or CC genotype of VKORC1 had a relatively higher warfarin dose than did those with the TT genotype (p < 0.05). Three patients with CYP2C9*1/*3 had a lower warfarin dose than did those with the wild CYP2C9*1/*1 genotype, but the difference did not reach significance (p > 0.05). Weight and the VKORC1 genotype predominantly contributed to the warfarin dose, with 33.0% and 11.2% of variability, respectively. The observed warfarin dose was correlated with the predicted dose based on the algorithm used in our study (r = 0.45, p < 0.01). CONCLUSIONS Weight and the VKORC1 genotype primarily determined the warfarin dose in Chinese pediatric patients with KD. Further studies are warranted to verify the findings of our study.
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Affiliation(s)
- Zhouping Wang
- Pediatric Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China; Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Li Zhang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Ping Huang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xiaoqiong Gu
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xiaofei Xie
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yanfei Wang
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Wei Li
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Qiyi Zeng
- Pediatric Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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Hasan SS, Kow CS, Curley LE, Baines DL, Babar ZUD. Economic evaluation of prescribing conventional and newer oral anticoagulants in older adults. Expert Rev Pharmacoecon Outcomes Res 2018; 18:371-377. [PMID: 29741099 DOI: 10.1080/14737167.2018.1474101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Anticoagulants refer to a variety of agents that inhibit one or more steps in the coagulation cascade. Generally, clinical conditions that require the prescribing of an oral anticoagulant increase in frequency with age. However, a major challenge of anticoagulation use among older patients is that this group of patients also experience the highest bleeding risk. To date, economic evaluation of prescribing of anticoagulants that includes the novel or newer oral anticoagulants (NOACs) in older adults has not been conducted and is warranted. AREAS COVERED A review of articles that evaluated the cost of prescribing conventional (e.g. vitamin K antagonists) and NOACs (e.g. direct thrombin inhibitors and direct factor Xa inhibitors) in older adults. EXPERT COMMENTARY While the use of NOACs significantly increases the cost of the initial treatment for thromboembolic disorders, they are still considered cost-effective relative to warfarin since they offer reduced risk of intracranial haemorrhagic events. The optimum anticoagulation with warfarin can be achieved by providing specialised care; clinics managed by pharmacists have been shown to be cost-effective relative to usual care. There are suggestions that genotyping the CYP2C9 and VKORC1 genes is useful for determining a more appropriate initial dose and thereby increasing the effectiveness and safety of warfarin.
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Affiliation(s)
- Syed Shahzad Hasan
- a Department of Pharmacy , University of Huddersfield , Huddersfield , United Kingdom.,e School of Biomedical Sciences and Pharmacy, The University of Newcastle , Newcastle , Australia
| | - Chia Siang Kow
- b Department of Pharmacy , Health Clinic Bukit Kuda , Klang , Malaysia
| | - Louise E Curley
- c School of Pharmacy, The University of Auckland , Auckland , New Zealand
| | - Darrin L Baines
- d Department of Accounting , Finance & Economics, Bournemouth University , Bournemouth , United Kingdom
| | - Zaheer-Ud-Din Babar
- a Department of Pharmacy , University of Huddersfield , Huddersfield , United Kingdom.,c School of Pharmacy, The University of Auckland , Auckland , New Zealand
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Bedewy AML, Sheweita SA, Mostafa MH, Kandil LS. The Influence of CYP2C9 and VKORC1 Gene Polymorphisms on the Response to Warfarin in Egyptians. Indian J Hematol Blood Transfus 2018; 34:328-336. [PMID: 29622878 DOI: 10.1007/s12288-016-0725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022] Open
Abstract
Warfarin is the most commonly used drug for chronic prevention of thromboembolic events, it also ranks high among drugs that cause serious adverse events. The variability in dose requirements has been attributed to inter-individual differences in medical, personal, and genetic factor. Cytochrome P-450 2C9 is the principle enzyme that terminates the anticoagulant effect of warfarin by catalyzing the conversion of the pharmacologically more potent S-enantiomer to its inactive metabolites. Warfarin exerts its effect by inhibition of vitamin K epoxide reductase. This protein is encoded by vitamin K epoxide reductase complex subunit 1 gene (VKORC1). The current study aimed to investigate the pharmacogenetic effect of CYP2C9 and VKORC1 gene polymorphisms on the patients response to warfarin. One hundred cases starting warfarin treatment and 20 healthy controls were enrolled. The mean daily dose of warfarin was calculated from patient's medical records. For each patient, less than 10 % variability in warfarin dose and a target international normalized ratio (INR) within the therapeutic target range were required for at least 3 months for one of the following indications (deep vein thrombosis, pulmonary embolism, cerebrovascular stroke and myocardial infarction) prior to inclusion in the study. Tetraprimer amplification refractory mutation system PCR was performed to determine CYP2C9*2, CYP2C9*3, and the VKORC1 1639 G > A genetic polymorphisms. Plasma warfarin determination was performed using rapid fluorometric assay. Plasma warfarin concentration ranged from 2.19 to 10.98 μg/ml with a median 3.52 μg/ml. Supratherpeutic INR was observed in 11 % of the cases. Thromboembolic complications occurred in 7 % of the cases and 8 % of cases experienced major bleeding. High maintenance dose (>7 mg/day) was associated with the combined non VKORC1*2 and homozygous wild type CYP2C9 (CYP2C9*1*1) alleles, while low maintenance dose was associated with the Variant (AG + AA)/Wild (*1/*1). (p value <0.001). CYP2C9 variant was a risk factor for supratherapeutic INR in the multivariate logistic regression model. Thromboembolic complication and incidence of supratherapeutic INR were observed in patients carrying combined VKORC1 Variant (AG + AA) and CYP2C9 Variant (*2/*3). Data from our study suggest that together with clinical factors, VKORC1 and CYP2C9 polymorphisms are important contributors to warfarin dosing and may help predict adverse effects in Egyptian patients.
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Affiliation(s)
- Ahmed M L Bedewy
- 1Hematology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt.,Abraj Al-Shaker, Zaky Ragab Street, Smouha, Alexandria, 21615 Egypt
| | - Salah A Sheweita
- 2Biotechnology Department, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
| | - Mostafa Hasan Mostafa
- 2Biotechnology Department, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
| | - Lamia Saeed Kandil
- 3Biochemistry Department, Pharos University in Alexandria, Alexandria, Egypt
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Al-Saikhan FI, Abd-Elaziz MAE, Ashour RH, Langaee T. Influence of Vitamin K Epoxide Reductase Complex 1 Polymorphism on Warfarin Therapy in a Cohort Study of Saudi Patients. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2018.415.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ajmi M, Omezzine A, Achour S, Amor D, Hamdouni H, Ismaïl FBF, Rejeb NB, Kechrid CL, Boughzela E, Bouslama A. Influence of genetic and non-genetic factors on acenocoumarol maintenance dose requirement in a Tunisian population. Eur J Clin Pharmacol 2018; 74:711-722. [PMID: 29479633 DOI: 10.1007/s00228-018-2423-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/23/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE We aimed to study potential variables involved in interindividual variability to acenocoumarol (AC) response in order to establish a pharmacogenetic algorithm (PA) that includes clinical and genetic factors to predict adequate AC dose to stabilize anticoagulation in a cohort of Tunisian patients. METHODS Genotyping of the CYP2C9, VKORC1, CYP4F2, and CALU polymorphisms was conducted on 246 patients using PCR-RFLP technique. AC normalized maintenance dose (NMD): ((mean maintenance dose/international normalized ratio (INR)) equilibrium) was calculated. The statistical study was carried out with SPSS V20. RESULTS A significant correlation was found between age, BMI, and daily AC dose (r = - 0.397; p < 0.001 and r = 0.215; p = 0.001, respectively). The carriers of mutated alleles CYP2C9*2 or CYP2C9*3 or VKORC1 haplotypes (H1 and H7) were associated with AC hyper-sensibility. After adjustment to potential covariates, these patients presented supra-therapeutic INR during treatment period and needed low AC dose (ORs* = 0.28 [0.06-0.60], p = 0.004; ORs* = 0.12 [0.04-0.05], p < 0.001; ORs* = 0.45 [0.24-0.84], p = 0.01; and ORs* = 0.28 [0.06-0.98], p = 0.049, respectively). However, carriers of VKORC1 haplotypes (H3 and H12) or mutated alleles CYP4F2 (rs2108622) or CALU (rs1043550) tend to resist to treatment, hence long period of therapy initiation, and must be treated with high AC dose (ORs* = 2.67 [81.12-5.91], p = 0.013; ORs* = 8.76 [1.07-76.26], p = 0.019; ORs* = 3.12 [1.01-9.63], p = 0.047; and ORs* = 3.96 [1.41-11.09], p = 0.009, respectively). A final multivariate regression model explained 48.1% of the global interindividual variability in AC dose requirement. CONCLUSION The PA demonstrated that VKORC1 and CYP2C9 polymorphisms contribution was more important than clinical factors. Applying the PA would allow dose adjustment to treat patients in a personalized manner.
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Affiliation(s)
- Marwa Ajmi
- LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia. .,Higher Institute of Biotechnology of Monastir, University of Monastir, Monastir, Tunisia.
| | - Asma Omezzine
- LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Slim Achour
- LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia
| | - Dorra Amor
- LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia
| | - Haithem Hamdouni
- LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | | | - Nabila Ben Rejeb
- LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | | | - Essia Boughzela
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Ali Bouslama
- LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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Mizera L, Geisler T, Mörike K, Gawaz M, Steeg M. Problems in anticoagulation of a patient with antibiotic treatment for endocarditis: interaction of rifampicin and vitamin K antagonists. BMJ Case Rep 2018; 2018:bcr-2016-215155. [PMID: 29440136 DOI: 10.1136/bcr-2016-215155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The cytochrome P450 is a superfamily of isoenzymes that are responsible for the metabolism of many drugs. Significant changes in pharmacokinetics and drug interactions may be due to induction of hepatic cytochrome P450 enzymes. Rifampicin is a common inducer of CYP3A4. We report a case of a 57-year-old woman who was suspected for endocarditis and therefore treated with rifampicin. Due to previous mechanical aortic valve replacement, she also received phenprocoumon for anticoagulation. Although continuing anticoagulant therapy, antibiotic coadministration led to normal international normalised ratio (INR) level. Fifteen days after the treatment with rifampicin ended, INR returned to therapeutic level.
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Affiliation(s)
- Lars Mizera
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Tobias Geisler
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Klaus Mörike
- Department fur Experimentelle und Klinische Pharmakologie und Toxikologie, Eberhard Karls Universitat Tubingen, Tübingen, Germany
| | - Meinrad Gawaz
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Martin Steeg
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
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DMET™ (Drug Metabolism Enzymes and Transporters): a pharmacogenomic platform for precision medicine. Oncotarget 2018; 7:54028-54050. [PMID: 27304055 PMCID: PMC5288240 DOI: 10.18632/oncotarget.9927] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/29/2016] [Indexed: 02/07/2023] Open
Abstract
In the era of personalized medicine, high-throughput technologies have allowed the investigation of genetic variations underlying the inter-individual variability in drug pharmacokinetics/pharmacodynamics. Several studies have recently moved from a candidate gene-based pharmacogenetic approach to genome-wide pharmacogenomic analyses to identify biomarkers for selection of patient-tailored therapies. In this aim, the identification of genetic variants affecting the individual drug metabolism is relevant for the definition of more active and less toxic treatments. This review focuses on the potentiality, reliability and limitations of the DMET™ (Drug Metabolism Enzymes and Transporters) Plus as pharmacogenomic drug metabolism multi-gene panel platform for selecting biomarkers in the final aim to optimize drugs use and characterize the individual genetic background.
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Yan M, Li D, Zhao G, Li J, Niu F, Li B, Chen P, Jin T. Genetic polymorphisms of pharmacogenomic VIP variants in the Yi population from China. Gene 2018; 648:54-62. [PMID: 29337087 DOI: 10.1016/j.gene.2018.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Drug response and target therapeutic dosage are different among individuals. The variability is largely genetically determined. With the development of pharmacogenetics and pharmacogenomics, widespread research have provided us a wealth of information on drug-related genetic polymorphisms, and the very important pharmacogenetic (VIP) variants have been identified for the major populations around the world whereas less is known regarding minorities in China, including the Yi ethnic group. Our research aims to screen the potential genetic variants in Yi population on pharmacogenomics and provide a theoretical basis for future medication guidance. MATERIALS AND METHODS In the present study, 80 VIP variants (selected from the PharmGKB database) were genotyped in 100 unrelated and healthy Yi adults recruited for our research. Through statistical analysis, we made a comparison between the Yi and other 11 populations listed in the HapMap database for significant SNPs detection. Two specific SNPs were subsequently enrolled in an observation on global allele distribution with the frequencies downloaded from ALlele FREquency Database. Moreover, F-statistics (Fst), genetic structure and phylogenetic tree analyses were conducted for determination of genetic similarity between the 12 ethnic groups. RESULTS Using the χ2 tests, rs1128503 (ABCB1), rs7294 (VKORC1), rs9934438 (VKORC1), rs1540339 (VDR) and rs689466 (PTGS2) were identified as the significantly different loci for further analysis. The global allele distribution revealed that the allele "A" of rs1540339 and rs9934438 were more frequent in Yi people, which was consistent with the most populations in East Asia. F-statistics (Fst), genetic structure and phylogenetic tree analyses demonstrated that the Yi and CHD shared a closest relationship on their genetic backgrounds. Additionally, Yi was considered similar to the Han people from Shaanxi province among the domestic ethnic populations in China. CONCLUSIONS Our results demonstrated significant differences on several polymorphic SNPs and supplement the pharmacogenomic information for the Yi population, which could provide new strategies for optimizing clinical medication in accordance with the genetic determinants of drug toxicity and efficacy.
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Affiliation(s)
- Mengdan Yan
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China
| | - Dianzhen Li
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China
| | - Guige Zhao
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China
| | - Jing Li
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China
| | - Fanglin Niu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China
| | - Bin Li
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China
| | - Peng Chen
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China
| | - Tianbo Jin
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi 710069, China; College of Life Science, Northwest University, Xi'an, Shaanxi 710069, China; Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China.
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Vranckx P, Valgimigli M, Heidbuchel H. The Significance of Drug-Drug and Drug-Food Interactions of Oral Anticoagulation. Arrhythm Electrophysiol Rev 2018; 7:55-61. [PMID: 29636974 DOI: 10.15420/aer.2017.50.1] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Vitamin K antagonists (VKAs) such as warfarin are the most commonly prescribed oral anticoagulants worldwide. However, factors affecting the pharmacokinetics of VKAs, such as food and drugs, can cause deviations from their narrow therapeutic window, increasing the bleeding or thrombosis risk and complicating their long-term use. The use of direct oral anticoagulants (DOACs) offers a safer and more convenient alternative to VKAs. However, it is important to be aware that plasma levels of DOACs are affected by drugs that alter the cell efflux transporter P-glycoprotein and/or cytochrome P450. In addition to these pharmacokinetic-based interactions, DOACs have the potential for pharmacodynamic interaction with antiplatelet agents and non-steroidal anti-inflammatory drugs. This is an important consideration in patient groups already at high risk of bleeding, such as patients with renal impairment.
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Affiliation(s)
- Pascal Vranckx
- Hartcentrum Hasselt, Faculty of Medicine and Life Sciences, Hasselt UniversityHasselt, Belgium
| | - Marco Valgimigli
- Swiss Cardiovascular Center Bern, Bern University HospitalBern, Switzerland
| | - Hein Heidbuchel
- Antwerp University and Antwerp University HospitalAntwerp, Belgium
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Berny P, Esther A, Jacob J, Prescott C. Development of Resistance to Anticoagulant Rodenticides in Rodents. EMERGING TOPICS IN ECOTOXICOLOGY 2018. [DOI: 10.1007/978-3-319-64377-9_10] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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63
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Mili FD, Allen T, Wadell PW, Hooper WC, Staercke CD, Bean CJ, Lally C, Austin H, Wenger NK. VKORC1-1639A allele influences warfarin maintenance dosage among Blacks receiving warfarin anticoagulation: a retrospective cohort study. Future Cardiol 2017; 14:15-26. [PMID: 29218998 DOI: 10.2217/fca-2017-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM The study objectives were to investigate the association between selected CYP2C9 and VKORC1 single nucleotide polymorphisms with serious bleeding or thrombotic risk, and to estimate mean daily maintenance dose of warfarin and international normalized ratio measurements among Blacks receiving warfarin anticoagulation. METHODS We conducted a retrospective cohort study among 230 Black adults receiving warfarin for a minimum of three consecutive months with a confirmed date of first dosage. RESULTS A lower mean daily maintenance dosage of warfarin was required to maintain an international normalized ratio measurement within the therapeutic range among Blacks with the VKORC1-1639G>A variant alleles ([G/A vs G/G, p = 0.02], [A/A vs G/A, p = 0.008] and [A/A vs G/G, p = 0.001]). CONCLUSION Data indicated that VKORC1-1639A variant allele influenced warfarin daily maintenance dosage among our small, likely admixed Black patient population.
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Affiliation(s)
- Fatima Donia Mili
- Hemostasis Laboratory Branch, Division of Blood Disorders, Centers for Disease Control & Prevention, Atlanta, GA 30329, USA
| | - Tenecia Allen
- Emory Heart & Vascular Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Paula Weinstein Wadell
- Hemostasis Laboratory Branch, Division of Blood Disorders, Centers for Disease Control & Prevention, Atlanta, GA 30329, USA
| | - W Craig Hooper
- Hemostasis Laboratory Branch, Division of Blood Disorders, Centers for Disease Control & Prevention, Atlanta, GA 30329, USA
| | - Christine De Staercke
- Hemostasis Laboratory Branch, Division of Blood Disorders, Centers for Disease Control & Prevention, Atlanta, GA 30329, USA
| | - Christopher J Bean
- Hemostasis Laboratory Branch, Division of Blood Disorders, Centers for Disease Control & Prevention, Atlanta, GA 30329, USA
| | - Cathy Lally
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Harland Austin
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Nanette K Wenger
- Emory Heart & Vascular Center, Emory University School of Medicine, Atlanta, GA 30322, USA
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Pharmacogenetics-Based Warfarin Dosing in Patients With Cardiac Valve Replacement: The Effects of CYP2C9 and VKORC1 Gene Polymorphisms. Lab Med 2017; 49:25-34. [DOI: 10.1093/labmed/lmx072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nagler M, Angelillo-Scherrer A, Méan M, Limacher A, Abbal C, Righini M, Beer JH, Osterwalder J, Frauchiger B, Aschwanden M, Matter CM, Kucher N, Cornuz J, Banyai M, Husmann M, Staub D, Mazzolai L, Hugli O, Rodondi N, Aujesky D. Long-term outcomes of elderly patients with CYP2C9 and VKORC1 variants treated with vitamin K antagonists. J Thromb Haemost 2017; 15:2165-2175. [PMID: 28834238 DOI: 10.1111/jth.13810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Indexed: 08/31/2023]
Abstract
Essentials The long-term effects of VKORC1 and CYP2C9 variants on clinical outcomes remains unclear. We followed 774 patients ≥65 years with venous thromboembolism for a median duration of 30 months. Patients with CYP2C9 variants are at increased risk of death and non-major bleeding. Patients with genetic variants have a slightly lower anticoagulation quality only. SUMMARY Background The long-term effect of polymorphisms of the vitamin K-epoxide reductase (VKORC1) and the cytochrome P450 enzyme gene (CYP2C9) on clinical outcomes remains unclear. Objectives We examined the association between CYP2C9/VKORC1 variants and long-term clinical outcomes in a prospective cohort study of elderly patients treated with vitamin K antagonists for venous thromboembolism (VTE). Methods We followed 774 consecutive patients aged ≥ 65 years with acute VTE from nine Swiss hospitals for a median duration of 30 months. The median duration of initial anticoagulant treatment was 9.4 months. The primary outcome was the time to any clinical event (i.e. the composite endpoint of overall mortality, major and non-major bleeding, and recurrent VTE. Results Overall, 604 (78%) patients had a CYP2C9 or VKORC1 variant. Three hundred and thirty-four patients (43.2%) had any clinical event, 119 (15.4%) died, 100 (12.9%) had major and 167 (21.6%) non-major bleeding, and 100 had (12.9%) recurrent VTE. After adjustment, CYP2C9 (but not VKORC1) variants were associated with any clinical event (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.08-1.66), death (HR, 1.74; 95% CI, 1.19-2.52) and clinically relevant non-major bleeding (sub-hazard ratio [SHR], 1.39; 95% CI, 1.02-1.89), but not with major bleeding (SHR, 1.03; 95% CI, 0.69-1.55) or recurrent VTE (SHR, 0.95; 95% CI, 0.62-1.44). Patients with genetic variants had a slightly lower anticoagulation quality. Conclusions CYP2C9 was associated with long-term overall mortality and non-major bleeding. Although genetic variants were associated with a slightly lower anticoagulation quality, there was no relationship between genetic variants and major bleeding or VTE recurrence.
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Affiliation(s)
- M Nagler
- Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - A Angelillo-Scherrer
- Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - M Méan
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Limacher
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - C Abbal
- Division of Hematology, Lausanne University Hospital, Lausanne, Switzerland
| | - M Righini
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
| | - J H Beer
- Cantonal Hospital of Baden, Baden, Switzerland
| | - J Osterwalder
- Emergency Department, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - B Frauchiger
- Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland
| | - M Aschwanden
- Division of Angiology, Basel University Hospital, Basel, Switzerland
| | - C M Matter
- Center for Molecular Cardiology, University of Zurich and University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - N Kucher
- Division of Angiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Cornuz
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - M Banyai
- Division of Angiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - M Husmann
- Division of Angiology, Zurich University Hospital and University of Zurich, Zurich, Switzerland
| | - D Staub
- Division of Angiology, Basel University Hospital, Basel, Switzerland
| | - L Mazzolai
- Service of Angiology, Lausanne University Hospital, Lausanne, Switzerland
| | - O Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - N Rodondi
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - D Aujesky
- Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Arunkumar G, Vishnuprabu D, Nupur B, Vidyasagaran T, Murugan AK, Munirajan AK. Genotyping of CYP2C9 and VKORC1 polymorphisms predicts south Indian patients with deep vein thrombosis as fast metabolizers of warfarin/acenocoumarin. Drug Discov Ther 2017; 11:198-205. [PMID: 28867752 DOI: 10.5582/ddt.2017.01031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Deep vein thrombosis (DVT) is a life-threatening disease. Warfarin and acenocoumarol are anticoagulants used to treat DVT and vary among individuals in terms of treatment response/toxicity. Single nucleotide polymorphisms (SNPs) in CYP2C9 and VKORC1 play a role in the pharmacokinetics and dynamics of warfarin and acenocoumarol and they determine the efficacy of treatment by controlling drug clearance in treated individuals. The aim of the current study was to genotype the critical SNPs of CYP2C9 and VKORC1 genes in a south Indian population in order to understand the metabolizer phenotype of patients with DVT. CYP2C9 (rs1799853, rs1057910, rs1057909, rs28371686) and VKORC1 (rs9923231) SNPs were genotyped in 124 cases of DVT. Genomic regions of these SNPs from genomic DNA were amplified with PCR and directly sequenced using Sanger sequencing except for the SNP rs1799853, which was detected using Sau96I restriction endonuclease-based digestion of variant alleles. Among south Indian patients with DVT, 6.5% (8/124) had the rs1799853 SNP of CYP2C9 and 11% (14/124) had the rs1057910 SNP while 16% (20/124) had the rs9923231 SNP of VKORC1 which were associated with the response to warfarin treatment. None of the patients tested positive for poor drug metabolizing genotypes of the CYP2C9 gene and only 1.6% of the south Indian population was sensitive to warfarin treatment. Genotyping results suggest that a relatively greater amount of the therapeutic drug is required to achieve/maintain the international normalized ratio (INR) in south Indian patients with DVT.
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Affiliation(s)
- Ganesan Arunkumar
- Department of Genetics, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras
| | - Durairajpandian Vishnuprabu
- Department of Genetics, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras.,Centre for Cardiovascular Biology and Disease (CCBD), Institute for Stem Cell Biology & Regenerative Medicine (inStem), National Center for Biological Sciences (NCBS), GKVK
| | - Bitt Nupur
- Department of Vascular Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital
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Askari B, Khaleqsefat E, Khalafkhani D, Khalaj-Kondori M, Khademvatan K, Soraya H. Study on a novel polymorphism in the VKORC1 promoter region using bioinformatic tools and warfarin dosing data. Thromb Res 2017; 158:76-78. [PMID: 28846878 DOI: 10.1016/j.thromres.2017.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Behnam Askari
- Department of Cardiovascular Surgery, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Esmat Khaleqsefat
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Davood Khalafkhani
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Khalaj-Kondori
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Kamal Khademvatan
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Soraya
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran; Department of Pharmacology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran.
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Wakamiya T, Hokosaki T, Tsujimoto SI, Kadota K, Nakano Y, Watanabe S, Iwamoto M, Yanagimachi M, Ito S. Effect of VKORC1, CYP2C9, CFP4F2, and GGCX Gene Polymorphisms on Warfarin Dose in Japanese Pediatric Patients. Mol Diagn Ther 2017; 20:393-400. [PMID: 27262824 DOI: 10.1007/s40291-016-0212-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Warfarin dosage requirements show considerable inter-individual variability. There are some reports of warfarin dose regimens correlating with single nucleotide polymorphisms (SNP) for CYP2C9, VKORC1 and other genes in adults. In children, however, reports are scarcer than in adults and the number of genes examined is more limited. We explored the effects of genetic variation on warfarin dose requirement in Japanese pediatric patients. METHODS A total of 45 patients who were prescribed warfarin at the Yokohama City University Hospital were included in this study. The influence of genetic polymorphisms on stable warfarin dosage requirement was investigated by genotyping SNPs of the VKORC1, CYP2C9, CYP4F2, and GGCX genes (rs9923231, rs1057910, rs2108622, and rs699664, respectively) in each patient. RESULTS Patients with the TT genotype in rs9923231 in VKORC1 required significantly lower maintenance dosages than those with the TC genotype (p = 0.001). Multiple regression analysis showed that, while VKORC1 status and patient height account for 78.2 % of the variability in maintenance warfarin dosage, genetic polymorphisms in VKORC1 account for 27 %, although polymorphisms in CYP4F2 and GGCX had no effect on dosage and the effect of CYP2C9 could not be evaluated. CONCLUSIONS Polymorphisms in VKORC1 partially affected daily warfarin dosage requirements. VKORC1 genotype and height are the primary determinants influencing warfarin dosage in Japanese pediatric patients. Further studies with larger sample sizes are needed to confirm our results.
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Affiliation(s)
- Takuya Wakamiya
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tatsunori Hokosaki
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shin-Ichi Tsujimoto
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Keisuke Kadota
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yusuke Nakano
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shigeo Watanabe
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mari Iwamoto
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masakatsu Yanagimachi
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Vandell AG, Walker J, Brown KS, Zhang G, Lin M, Grosso MA, Mercuri MF. Genetics and clinical response to warfarin and edoxaban in patients with venous thromboembolism. Heart 2017; 103:1800-1805. [PMID: 28689179 PMCID: PMC5749368 DOI: 10.1136/heartjnl-2016-310901] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether genetic variants can identify patients with venous thromboembolism (VTE) at an increased risk of bleeding with warfarin. METHODS Hokusai-venous thromboembolism (Hokusai VTE), a randomised, multinational, double-blind, non-inferiority trial, evaluated the safety and efficacy of edoxaban versus warfarin in patients with VTE initially treated with heparin. In this subanalysis of Hokusai VTE, patients genotyped for variants in CYP2C9 and VKORC1 genes were divided into three warfarin sensitivity types (normal, sensitive and highly sensitive) based on their genotypes. An exploratory analysis was also conducted comparing normal responders to pooled sensitive responders (ie, sensitive and highly sensitive responders). RESULTS The analysis included 47.7% (3956/8292) of the patients in Hokusai VTE. Among 1978 patients randomised to warfarin, 63.0% (1247) were normal responders, 34.1% (675) were sensitive responders and 2.8% (56) were highly sensitive responders. Compared with normal responders, sensitive and highly sensitive responders had heparin therapy discontinued earlier (p<0.001), had a decreased final weekly warfarin dose (p<0.001), spent more time overanticoagulated (p<0.001) and had an increased bleeding risk with warfarin (sensitive responders HR 1.38 [95% CI 1.11 to 1.71], p=0.0035; highly sensitive responders 1.79 [1.09 to 2.99]; p=0.0252). CONCLUSION In this study, CYP2C9 and VKORC1 genotypes identified patients with VTE at increased bleeding risk with warfarin. TRIAL REGISTRATION NUMBER NCT00986154.
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Affiliation(s)
- Alexander G Vandell
- Translational Medicine Clinical Pharmacology, Daiichi Sankyo Pharma Development, Edison, New Jersey, USA
| | - Joseph Walker
- Translational Medicine Clinical Pharmacology, Formerly of Daiichi Sankyo Pharma Development, Edison, New Jersey, USA
| | - Karen S Brown
- Translational Medicine Clinical Pharmacology, Formerly of Daiichi Sankyo Pharma Development, Edison, New Jersey, USA
| | - George Zhang
- Biostatistics, Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | - Min Lin
- Biostatistics, Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | - Michael A Grosso
- Cardiovascular and Metabolism Therapeutic Area Development, Daiichi Sankyo Pharma Development, Edison, New Jersey, USA
| | - Michele F Mercuri
- Cardiovascular and Metabolism Therapeutic Area Development, Daiichi Sankyo Pharma Development, Edison, New Jersey, USA
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Abstract
Pharmacogenomics (PGx), a substantial component of "personalized medicine", seeks to understand each individual's genetic composition to optimize drug therapy -- maximizing beneficial drug response, while minimizing adverse drug reactions (ADRs). Drug responses are highly variable because innumerable factors contribute to ultimate phenotypic outcomes. Recent genome-wide PGx studies have provided some insight into genetic basis of variability in drug response. These can be grouped into three categories. [a] Monogenic (Mendelian) traits include early examples mostly of inherited disorders, and some severe (idiosyncratic) ADRs typically influenced by single rare coding variants. [b] Predominantly oligogenic traits represent variation largely influenced by a small number of major pharmacokinetic or pharmacodynamic genes. [c] Complex PGx traits resemble most multifactorial quantitative traits -- influenced by numerous small-effect variants, together with epigenetic effects and environmental factors. Prediction of monogenic drug responses is relatively simple, involving detection of underlying mutations; due to rarity of these events and incomplete penetrance, however, prospective tests based on genotype will have high false-positive rates, plus pharmacoeconomics will require justification. Prediction of predominantly oligogenic traits is slowly improving. Although a substantial fraction of variation can be explained by limited numbers of large-effect genetic variants, uncertainty in successful predictions and overall cost-benefit ratios will make such tests elusive for everyday clinical use. Prediction of complex PGx traits is almost impossible in the foreseeable future. Genome-wide association studies of large cohorts will continue to discover relevant genetic variants; however, these small-effect variants, combined, explain only a small fraction of phenotypic variance -- thus having limited predictive power and clinical utility.
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Affiliation(s)
- Ge Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, United States.
| | - Daniel W Nebert
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, United States; Department of Environmental Health and Center for Environmental Genetics, University of Cincinnati School of Medicine, Cincinnati, OH 45267-0056, United States.
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Membrane Cholesterol Modulates Superwarfarin Toxicity. Biophys J 2017; 110:1777-1788. [PMID: 27119638 DOI: 10.1016/j.bpj.2016.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 12/14/2022] Open
Abstract
Superwarfarins are modified analogs of warfarin with additional lipophilic aromatic rings, up to 100-fold greater potency, and longer biological half-lives. We hypothesized that increased hydrophobicity allowed interactions with amphiphilic membranes and modulation of biological responses. We find that superwarfarins brodifacoum and difenacoum increase lactate production and cell death in neuroblastoma cells. In contrast, neither causes changes in glioma cells that have higher cholesterol content. After choleterol depletion, lactate production was increased and cell viability was reduced. Drug-membrane interactions were examined by surface X-ray scattering using Langmuir monolayers of dipalmitoylphosphatidylcholine and/or cholesterol. Specular X-ray reflectivity data revealed that superwarfarins, but not warfarin, intercalate between dipalmitoylphosphatidylcholine molecules, whereas grazing incidence X-ray diffraction demonstrated changes in lateral crystalline order of the film. Neither agent showed significant interactions with monolayers containing >20% cholesterol. These findings demonstrate an affinity of superwarfarins to biomembranes and suggest that cellular responses to these agents are regulated by cholesterol content.
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Pescetelli I, Genovesi E, Renda G, Di Renzo E, De Caterina R. Intracardiac thrombi during warfarin anticoagulation - A case report and a brief literature review. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Genetic determinants of variability in warfarin response after the dose-titration phase. Pharmacogenet Genomics 2017; 26:510-516. [PMID: 27632229 DOI: 10.1097/fpc.0000000000000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Genetic factors contribute considerably toward variability in warfarin dose requirements and are important in the dose-titration phase; their effects on the stability of anticoagulation later in therapy are not known. METHODS Using deidentified electronic medical records linked to a DNA-biobank, we studied 140 African-Americans and 943 European-Americans after the warfarin dose-titration phase. We genotyped 12 single nucleotide polymorphisms in genes (CYP2C9, VKORC1, CYP4F2, GGCX, EPHX1, CALU) associated with altered warfarin dose requirements and tested their associations with international normalized ratio variability (INRVAR) and percent time in therapeutic range in European-Americans and African-Americans. RESULTS One allele copy of rs2108622 in CYP4F2 was associated with a 15% [95% confidence interval (CI): 1-26, P=0.03] decrease in the median INRVAR in European-Americans. In African-Americans, GGCX variants rs11676382 and rs699664 were associated with 4.16-fold (95% CI: 1.45-11.97, P=0.009) and 1.50-fold (95% CI: 1.07-2.08, P=0.02) changes in the median INRVAR per variant allele copy, respectively; rs11676382 was also significantly associated with a 23.19% (95% CI: 5.89-40.48, P=0.01) decrease in time in therapeutic range. The total variation in INRVAR explained by both clinical factors and rs2108622 was 5.2% for European-Americans. In African-Americans, the inclusion of GGCX variants rs11676382 and rs699664, and the CYP2C9*8 variant rs7900194 explained ∼29% of the variation in INRVAR. CONCLUSION The stability of anticoagulation after the warfarin dose-titration phase is differentially affected by variants in CYP4F2 in European-Americans and GGCX loci in African-Americans.
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Li W, Bu F, Li R, Wang B, Shaikh AS, Zhang Y, Guo R, Zhang R. Bioequivalence Study of Warfarin in Healthy Chinese Volunteers With a Validated High-Performance Liquid Chromatography-Mass Spectrometry Method. Clin Pharmacol Drug Dev 2017; 7:256-262. [PMID: 28371488 DOI: 10.1002/cpdd.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/16/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Wenlong Li
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
| | - Fanlong Bu
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
| | - Rong Li
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
| | - Benjie Wang
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
| | - Abdul Sami Shaikh
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
| | - Yunyun Zhang
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
| | - Ruichen Guo
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
| | - Rui Zhang
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University; Jinan Shandong Province China 250012
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Jia L, Wang Z, Men J, Cai H, Wei M. Polymorphisms of VKORC1 and CYP2C9 are associated with warfarin sensitivity in Chinese population. Ther Clin Risk Manag 2017; 13:421-425. [PMID: 28408837 PMCID: PMC5384741 DOI: 10.2147/tcrm.s130198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective Warfarin is a commonly prescribed anticoagulant for prevention of thromboembolic events. Wide inter-individual dose variation, narrow therapeutic range and risk of serious bleeding result in difficulties in achieving the therapeutic effect. The present study was designed to clarify the real biological significance of the polymorphisms of VKORC1 and cytochrome P450 2C9 (CYP2C9) in warfarin metabolism. Methods A total of 214 patients with warfarin anticoagulant therapy were selected. During follow-up of anticoagulation, warfarin dosage and associated international normalized ratio values were recorded. Genetic polymorphisms of VKORC1 promoter and from exon 1 to exon 3 and CYP2C9 exon 4 sequence were detected by polymerase chain reaction and gene sequencing. Results Five polymorphisms were identified in this research, which were VKORC1 1173C>T (intron 1), 1542G>C (intron 2), 2255C>T (intron 2), 3730C>T (3′-downstream) and CYP2C9 exon 4 −65G>C. VKORC1 1173CT, 1542GC, 2255CT and 3730CT polymorphisms were detected in same patients, but CYP2C9 exon 4 −65GC carriers were different from them. VKORC1 1173CT, 1542GC, 2255CT, 3730CT carriers and CYP2C9 exon 4 −65GC carriers had significantly higher warfarin daily dosage than others (3.2±0.6 vs 3.1±1.1 vs 2.6±0.8 mg/day). Logistic regression analysis revealed VKORC1 1173CT, 1542GC, 2255CT, 3730CT carrier status (odds ratio [OR] =3.233, 95% confidence interval [CI]: 1.259–8.303, P=0.015) and obesity with body mass index >27 kg/m2 (OR =1.223, 95% CI: 1.097–1.363, P<0.001) to have independent and statistically significant contributions to high warfarin dosage. Conclusion In general, in VKORC1 1173CT, 1542GC, 2255CT and 3730CT carriers and in obese patients, warfarin maintenance doses were significantly higher than in the others.
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Affiliation(s)
- LiQun Jia
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin
| | - Zanxin Wang
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin.,Department of Cardiac Surgery, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen
| | | | - Heng Cai
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Minxin Wei
- Department of Cardiac Surgery, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen
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76
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Goulois J, Lambert V, Legros L, Benoit E, Lattard V. Adaptative evolution of the Vkorc1 gene in Mus musculus domesticus is influenced by the selective pressure of anticoagulant rodenticides. Ecol Evol 2017; 7:2767-2776. [PMID: 28428867 PMCID: PMC5395456 DOI: 10.1002/ece3.2829] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/15/2017] [Accepted: 01/28/2017] [Indexed: 11/24/2022] Open
Abstract
Anticoagulant rodenticides are commonly used to control rodent pests worldwide. They specifically inhibit the vitamin K epoxide reductase (VKORC1), which is an enzyme encoded by the Vkorc1 gene, involved in the recycling of vitamin K. Therefore, they prevent blood clotting. Numerous mutations of Vkorc1 gene were reported in rodents, and some are involved in the resistant to rodenticides phenotype. Two hundred and sixty‐six mice tails were received from 65 different locations in France. Coding sequences of Vkorc1 gene were sequenced in order to detect mutations. Consequences of the observed mutations were evaluated by the use of recombinant VKORC1. More than 70% of mice presented Vkorc1 mutations. Among these mice, 80% were homozygous. Contrary to brown rats for which only one predominant Vkorc1 genotype was found in France, nine missense single mutations and four double mutations were observed in house mice. The single mutations lead to resistance to first‐generation antivitamin K (AVKs) only and are certainly associated with the use of these first‐generation molecules by nonprofessionals for the control of mice populations. The double mutations, probably obtained by genetic recombination, lead to in vitro resistance to all AVKs. They must be regarded as an adaptive evolution to the current use of second‐generation AVKs. The intensive use of first‐generation anticoagulants probably allowed the selection of a high diversity of mutations, which makes possible the genetic recombination and consequently provokes the emergence of the more resistant mutated Vkorc1 described to date.
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Affiliation(s)
- Joffrey Goulois
- USC 1233 RS2GPVetAgro Sup, INRA, Univ LyonF‐69280MARCY L’ETOILEFrance
- Liphatech, BonnelPont du CasseFrance
| | - Véronique Lambert
- USC 1233 RS2GPVetAgro Sup, INRA, Univ LyonF‐69280MARCY L’ETOILEFrance
| | | | - Etienne Benoit
- USC 1233 RS2GPVetAgro Sup, INRA, Univ LyonF‐69280MARCY L’ETOILEFrance
| | - Virginie Lattard
- USC 1233 RS2GPVetAgro Sup, INRA, Univ LyonF‐69280MARCY L’ETOILEFrance
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77
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Al-Metwali B, Mulla H. Personalised dosing of medicines for children. J Pharm Pharmacol 2017; 69:514-524. [DOI: 10.1111/jphp.12709] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/12/2017] [Indexed: 12/16/2022]
Abstract
Abstract
Objectives
Doses for most drugs are determined from population-level information, resulting in a standard ?one-size-fits-all’ dose range for all individuals. This review explores how doses can be personalised through the use of the individuals’ pharmacokinetic (PK)-pharmacodynamic (PD) profile, its particular application in children, and therapy areas where such approaches have made inroads.
Key findings
The Bayesian forecasting approach, based on population PK/PD models that account for variability in exposure and response, is a potent method for personalising drug therapy. Its potential utility is even greater in young children where additional sources of variability are observed such as maturation of eliminating enzymes and organs. The benefits of personalised dosing are most easily demonstrated for drugs with narrow therapeutic ranges such as antibiotics and cytotoxics and limited studies have shown improved outcomes. However, for a variety of reasons the approach has struggled to make more widespread impact at the bedside: complex dosing algorithms, high level of technical skills required, lack of randomised controlled clinical trials and the need for regulatory approval.
Summary
Personalised dosing will be a necessary corollary of the new precision medicine initiative. However, it faces a number of challenges that need to be overcome before such an approach to dosing in children becomes the norm.
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Affiliation(s)
- Basma Al-Metwali
- School of Pharmacy, De Montfort University, Leicester, UK
- Department of Pharmacy, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Hussain Mulla
- Department of Pharmacy, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
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78
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Hypermethylation of brain natriuretic peptide gene is associated with the risk of rheumatic heart disease. Biosci Rep 2017; 37:BSR20160408. [PMID: 27920275 PMCID: PMC5240589 DOI: 10.1042/bsr20160408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/15/2016] [Accepted: 12/05/2016] [Indexed: 01/09/2023] Open
Abstract
To investigate the contribution of brain natriuretic peptide (BNP) promoter DNA methylation to the risk of rheumatic heart disease (RHD) and the influence of warfarin anticoagulant therapy on BNP methylation levels for RHD patients after surgery. BNP methylation levels were determined by bisulfite pyrosequencing from plasma samples of RHD patients compared with healthy controls. Several factors influencing the RHD patients were included like age, smoking and cholesterol levels. A fragment of five CG sites (CpG1–5) in the promoter region of BNP gene was measured. BNP gene hypermethylation was found in CpG4 and CpG5 in RHD patients compared with non-RHD controls. A significant difference was also observed between RHD patients with long-term administration of warfarin and RHD patients who had recently undergone an operation. Moreover, single CpG4 and CpG5 analysis revealed a significant increase in methylation levels in men. BNP gene body hypermethylation is associated with the risk of RHD, and also influenced by the warfarin anticoagulant therapy of RHD patients after surgery, which could represent novel and promising targets for therapeutic development.
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DNA sensors to assess the effect of VKORC1 and CYP2C9 gene polymorphisms on warfarin dose requirement in Chinese patients with atrial fibrillation. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:249-258. [PMID: 28083852 DOI: 10.1007/s13246-016-0519-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
The optimal dose of warfarin depends on polymorphisms in the VKORC1 (the vitamin K epoxide reductase complex subunit (1) and CYP2C9 (cytochrome P450 2C9) genes. To minimize the risk of adverse reactions, warfarin dosages should be adjusted according to results from rapid and simple monitoring methods. However, there are few pharmacogenetic-guided warfarin dosing algorithms that are based on large cohorts from the Chinese population, especially patients with atrial fibrillation. This study aimed to validate a pharmacogenetic-guided warfarin dosing algorithm based on results from a new rapid electrochemical detection method used in a multicenter study. Three SNPs (CYP2C9 *2, *3 and VKORC1 c.-1639G > A) were genotyped by electrochemical detection using a sandwich-type format that included a 3' short thiol capture probe and a 5' ferrocene-labeled signal probe. A total of 1285 samples from four clinical hospitals were evaluated. Concordance rates between the results from the electrochemical DNA biosensor and the sequencing test were 99.8%. The results for gene distribution showed that most Chinese patients had higher warfarin susceptibility because mutant-type and heterozygotes were present in the majority of subjects (99.4%) at locus c.-1639G > A. When the International Warfarin Pharmacogenetics Consortium algorithm was used to estimate therapeutic dosages for 362 patients with AF and the values were compared with their actual dosages, the results revealed that 56.9% were similar to actual dosages (within the 20% range). A novel electrochemical detection method of CYP2C9 *2, *3and VKORC1 c.-1639G > A alleles was evaluated. The warfarin dosing algorithm based on data gathered from a large patient cohort can facilitate the reasonable and effective use of warfarin in Chinese patients with AF.
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80
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Liu R, Cao J, Zhang Q, Shi XM, Pan XD, Dong R. Clinical and genetic factors associated with warfarin maintenance dose in northern Chinese patients with mechanical heart valve replacement. Medicine (Baltimore) 2017; 96:e5658. [PMID: 28079798 PMCID: PMC5266160 DOI: 10.1097/md.0000000000005658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The effects of genetic variants on warfarin dosing vary among different ethnic groups, especially in the Chinese population. The objective of this study was to recruit patients through a rigorous experimental design and to perform a comprehensive screen to identify gene polymorphisms that may influence warfarin dosing in northern Han Chinese patients with mechanical heart valve replacement. Consenting patients (n = 183) with a stable warfarin dose were included in this study. Ninety-six single nucleotide polymorphisms (SNPs) in 30 genes involved in warfarin pharmacological pathways were genotyped using the Illumina SNP GoldenGate Assay, and their associations with warfarin dosing were assessed using univariate regression analysis with post hoc comparison using least significant difference analysis. Multiple linear regression was performed by incorporating patients' clinical and genetic data to create a new algorithm for warfarin dosing. From the 96 SNPs analyzed, VKORC1 rs9923231, CYP1A2 rs2069514, CYP3A4 rs28371759, and APOE rs7412 were associated with higher average warfarin maintenance doses, whereas CYP2C9 rs1057910, EPHX1 rs2260863, and CYP4F2 rs2189784 were associated with lower warfarin doses (P < 0.05). Multiple linear regression analysis could estimate 44.4% of warfarin dose variability consisting of, in decreasing order, VKORC1 rs9923231 (14.2%), CYP2C9*3 (9.6%), body surface area (6.7%), CYP1A2 rs2069514 (3.7%), age (2.7%), CYP3A4 rs28371759 (2.5%), CYP4F2 rs2108622 (1.9%), APOE rs7412 (1.7%), and VKORC1 rs2884737 (1.4%). In the dosing algorithm we developed, we confirmed the strongest effects of VKORC1, CYP2C9 on warfarin dosing. In the limited sample set, we also found that novel genetic predictors (CYP1A2, CYP3A4, APOE, EPHX1, CYP4F2, and VKORC1 rs2884737) may be associated with warfarin dosing. Further validation is needed to assess our results in larger independent northern Chinese samples.
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Affiliation(s)
- Rui Liu
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | - Jian Cao
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | - Qian Zhang
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Disease
| | - Xin-Miao Shi
- Department of Pediatrics, Peking University First Hospital, Beijing
| | - Xiao-Dong Pan
- Experimental Center, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing
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81
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Burn J, Sheth H. Personalised Approach to Anticoagulation. J R Coll Physicians Edinb 2016; 46:302. [DOI: 10.4997/jrcpe.2016.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- J Burn
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - H Sheth
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
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82
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Qayyum A, Najmi MH, Mansoor Q, Irfan M, Naveed AK, Hanif A, Kazmi AR, Ismail M. Frequency of Common VKORC1 Polymorphisms and Their Impact on Warfarin Dose Requirement in Pakistani Population. Clin Appl Thromb Hemost 2016; 24:323-329. [PMID: 27879469 DOI: 10.1177/1076029616680478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Polymorphisms in vitamin K epoxide reductase complex subunit 1 (VKORC1) gene lead to interindividual variability in warfarin dose requirement. The characterization of genotype frequency distribution is required in different populations for construction of customized dosing algorithms to enhance the efficacy and reduce the toxicity of warfarin therapy. This study was carried out in Pakistani population to evaluate the contribution of common VKORC1 polymorphisms to warfarin therapy. A total of 550 stable patients taking warfarin were enrolled after medical history, physical examination, and laboratory investigations. Single blood sample was collected after informed consent. Genomic DNA was extracted and genotype analysis for VKORC1 1173C>T and VKORC1-1639G>A polymorphisms was done by polymerase chain reaction-restriction fragment length polymorphism assay. A number of samples were also analyzed by direct DNA sequencing for validation of results. Data were analyzed using SPSS version 20. Genotype frequency distributions of VKORC1 1173C>T and VKORC1-1639G>A were found to be different from other populations. Both of these polymorphisms did not demonstrate significant effect on warfarin dose requirement. Although Cytochrome P450 2C9 (CYP2C9) and VKORC1 polymorphisms together attributed only 3.8% variability in warfarin dose but it was statistically significant ( p value = .004). It is concluded that there is a need to study genotype frequency distribution and their effect on warfarin dose variability among different populations due to diversity in outcome. At the same time, no effect on warfarin dose variation explained by VKORC1 polymorphisms and small variability explained by studied genotypes stresses the need for exploration of more genetic and nongenetic factors in Pakistani population.
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Affiliation(s)
- Aisha Qayyum
- 1 Department of Pharmacology, Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Muzammil Hasan Najmi
- 2 Department of Pharmacology, Foundation University Medical College, Islamabad, Pakistan
| | - Qaisar Mansoor
- 3 Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
| | - Muhammad Irfan
- 4 Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - Abdul Khaliq Naveed
- 5 Department of Biochemistry, Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Andleeb Hanif
- 3 Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
| | - Ali Raza Kazmi
- 3 Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
| | - Muhammad Ismail
- 3 Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
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83
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Collins SL, Carr DF, Pirmohamed M. Advances in the Pharmacogenomics of Adverse Drug Reactions. Drug Saf 2016; 39:15-27. [PMID: 26650062 DOI: 10.1007/s40264-015-0367-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rapid developments in pharmacogenomics have been noticeable in recent years, and much of this knowledge has improved understanding of adverse drug reactions. This improved knowledge has largely been the result of improved sequencing technologies and falling costs in this area, as well as improved statistical techniques to analyse the data derived from studies. While the genetic reasons behind adverse drug reactions are becoming better understood, translation of this knowledge, particularly in terms of biomarkers that might be clinically applicable at the bedside, has been more difficult. Understanding of the technologies and their application is limited among practising clinicians. The cost of some of the technologies available may also be prohibitive in stretched healthcare economies. As education about the potential for applying pharmacogenomics improves and costs fall, understanding of adverse drug reactions and application of this knowledge in a clinical setting should improve.
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Affiliation(s)
- Susannah L Collins
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Daniel F Carr
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.
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84
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Mital S, Musunuru K, Garg V, Russell MW, Lanfear DE, Gupta RM, Hickey KT, Ackerman MJ, Perez MV, Roden DM, Woo D, Fox CS, Ware S. Enhancing Literacy in Cardiovascular Genetics: A Scientific Statement From the American Heart Association. ACTA ACUST UNITED AC 2016; 9:448-467. [PMID: 27672144 DOI: 10.1161/hcg.0000000000000031] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advances in genomics are enhancing our understanding of the genetic basis of cardiovascular diseases, both congenital and acquired, and stroke. These advances include finding genes that cause or increase the risk for childhood and adult-onset diseases, finding genes that influence how patients respond to medications, and the development of genetics-guided therapies for diseases. However, the ability of cardiovascular and stroke clinicians to fully understand and apply this knowledge to the care of their patients has lagged. This statement addresses what the specialist caring for patients with cardiovascular diseases and stroke should know about genetics; how they can gain this knowledge; how they can keep up-to-date with advances in genetics, genomics, and pharmacogenetics; and how they can apply this knowledge to improve the care of patients and families with cardiovascular diseases and stroke.
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85
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G-1639A but Not C1173T VKORC1 Gene Polymorphism Is Related to Ischemic Stroke and Its Various Risk Factors in Ukrainian Population. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1298198. [PMID: 27703968 PMCID: PMC5040782 DOI: 10.1155/2016/1298198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/25/2016] [Accepted: 08/17/2016] [Indexed: 11/18/2022]
Abstract
Vitamin K epoxide reductase complex subunit 1 (VKORC1) is integral 163-amino acid long transmembrane protein which mediates recycling of vitamin K 2,3-epoxide to vitamin K hydroquinone and it is necessary for activation of vitamin K-dependent proteins (VKDPs). Herein, the association between G-1639A (rs9923231) and C1173T (rs9934438) single-nucleotide polymorphisms (SNPs) of the VKORC1 gene and ischemic stroke (IS) was tested in Ukrainian population. Genotyping was performed in 170 IS patients and 124 control subjects (total 294 DNA samples) using PCR-RFLP (polymerase chain reaction with following restriction fragment length polymorphism analysis) method. Our data showed that G-1639A but not C1173T polymorphism was related to IS, regardless of adjustment for age, sex, body mass index, smoking status, and arterial hypertension. The risk for IS in -1639A allele carriers (OR = 2.138, P = 0.015) was higher than in individuals with G/G genotype. Haplotype analysis demonstrated that -1639G/1173T and -1639A/1173C were related to increased risk for IS (OR = 3.813, P = 0.010, and OR = 2.189, P = 0.011, resp.), while -1639G/1173C was a protective factor for IS (OR = 0.548, P < 0.001). Obtained results suggested that -1639A allele can be a possible genetic risk factor for IS in Ukrainian population.
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86
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Jin T, Zhao R, Shi X, He N, He X, Ouyang Y, Wang H, Wang B, Kang L, Yuan D. Genetic polymorphisms study of pharmacogenomic VIP variants in Han ethnic of China's Shaanxi province. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 46:27-35. [PMID: 27414743 DOI: 10.1016/j.etap.2016.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/21/2016] [Accepted: 06/26/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Multiple factors include genetic and non-genetic interactions induce to different drug response among different individuals. Lots of researches proved that different frequencies of genetic variants exists different ethnic groups. The aim of this study was to screen Han volunteers in Shaanxi for VIP gene polymorphisms. MATERIALS AND METHODS We genotyped 80 Very Important Pharmacogenes (VIP) (selected from the PharmGKB database) in 192 unrelated, healthy Han ethnic adults from Shaanxi, the northwest of China, and then analyzed genotyping data wtih Structure and F-statistics (Fst) analysis. RESULTS We compared our data with 15 other populations (Deng, Kyrgyz, Tajik, Uygur and 11 HapMap populations), and found the frequency distribution of Han population in Shaanxi is most similar with CHB. Also, Structure and Fst showed that Shaanxi Han has a closest genetic background with CHB. CONCLUSIONS Our study have supplemented the Han Chinese data related to pharmacogenomics and illustrated differences in genotypic frequencies of selected VIP variants' among the Han population and 15 other populations.
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Affiliation(s)
- Tianbo Jin
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China; Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; National Engineering Research Center for Miniaturized Detection Systems, School of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, China
| | - Ruimin Zhao
- Otorhinolaryngological, Head and Neck Surgery Department, School of Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xugang Shi
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China; Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; National Engineering Research Center for Miniaturized Detection Systems, School of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, China
| | - Na He
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China; Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China
| | - Xue He
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China; Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China
| | - Yongri Ouyang
- National Engineering Research Center for Miniaturized Detection Systems, School of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, China
| | - Hong Wang
- National Engineering Research Center for Miniaturized Detection Systems, School of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, China
| | - Bo Wang
- National Engineering Research Center for Miniaturized Detection Systems, School of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, China
| | - Longli Kang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China; Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China
| | - Dongya Yuan
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China; Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China.
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Danziger J, Young RL, Shea KM, Duprez DA, Jacobs DR, Tracy RP, Ix JH, Jenny NS, Mukamal KJ. Circulating Des-gamma-carboxy prothrombin is not associated with cardiovascular calcification or stiffness: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2016; 252:68-74. [PMID: 27508317 DOI: 10.1016/j.atherosclerosis.2016.07.924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/09/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Vitamin K-dependent protein (VKDP) activity may have a role in preventing cardiovascular calcification, but has not previously been studied in large, generally healthy populations. METHODS Using an elevated ankle-brachial index (ABI) as a measure of medial vascular calcification, we performed a case-cohort analysis within the Multi-Ethnic Study of Atherosclerosis, measuring Des-gamma-carboxy prothrombin (DCP) to estimate VKDP activity. In secondary analyses of the weighted subcohort, we examined the cross-sectional associations between DCP and prevalent vascular calcification of the coronary vessels, aortic and mitral valves, and aortic wall, and with vascular stiffness. RESULTS In adjusted analysis, cases (n = 104) had 0.21 ng/ml (-0.94-0.52) lower DCP concentrations than the subcohort (n = 613). Furthermore, amongst the 717 participants in the weighted cohort, VKDP activity was not associated with coronary artery, mitral valve, aortic valve or aortic wall calcification, nor was it associated with vascular stiffness. CONCLUSIONS Our negative results do not support a role of circulating VKDP activity in cardiovascular calcification in community-dwelling adults.
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Affiliation(s)
- John Danziger
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
| | | | - Kyla M Shea
- Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
| | - Daniel A Duprez
- Division of Cardiology, University of Minnesota, United States
| | - David R Jacobs
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, United States
| | - Russell P Tracy
- College of Medicine, University of Vermont, Burlington, VT, United States
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Nancy S Jenny
- Department of Pathology, University of Vermont, Burlington, VT, United States
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Kalpana SR, Bharath G, Manjunath CN, Christopher R. Influence of VKORC1 and CYP2C9 Polymorphisms on Daily Acenocoumarol Dose Requirement in South Indian Patients With Mechanical Heart Valves. Clin Appl Thromb Hemost 2016; 23:876-882. [DOI: 10.1177/1076029616655617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background and Aim: Chronic rheumatic heart disease (RHD) patients who undergo valve replacement with mechanical valves require lifelong anticoagulation. Acenocoumarol, a vitamin K antagonist has a narrow therapeutic range and wide inter-individual variability. Our aim was to investigate the influence of polymorphisms of VKORC1 and CYP2C9 genes on the mean daily dose requirement of acenocoumarol. Methods: 205 chronic RHD patients, with mechanical heart valves and on acenocoumarol therapy, were recruited. Genotyping for VKORC1 (−1639G>A and 1173C>T) and CYP2C9 (*2 & *3 alleles) polymorphisms was done by PCR-RFLP. There was complete linkage disequilibrium between VKORC1 polymorphisms (r2 = 0.98, D′ = 1.0, LOD = 74.02). VKORC1 genotype distribution for GG/CC, GA/CT, and AA/TT were 57.6%, 36.1%, and 6.3%, respectively. CYP2C9 genotype distribution for *1/*1, *1/*3, *1/*2, *2/*2, and *2/*3 were 78.5%, 14.1%, 6.3%, 0.5%, and 0.5%, respectively. Patients with a wild type of both VKORC1 (−1639GG and 1173CC) and CYP2C9 gene variants required higher acenocoumarol dose compared to those with mutant genotype ( P = 0.023 and P = 0.008 respectively). On combined genotype analysis, patients having a combination of wild type of VKORC1 with wild type of CYP2C9 (44.4%) required higher daily dose compared to patients bearing heterozygous VKORC1 (−1639GA & 1173CT) with wild type of CYP2C9 (30.2%, P = 0.008). Conclusion: Presence of a mutant allele of VKORC1 (−1639A & 1173T) and CYP2C9 genes increased the odds of requiring a lower mean dosage of acenocoumarol. Studying the combination of genotypes in RHD patients could predict acenocoumarol dose requirement more accurately.
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Affiliation(s)
- S. R. Kalpana
- Department of Pathology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - G. Bharath
- Department of Pathology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - C. N. Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
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Qayyum A, Najmi MH, Mansoor Q, Farooqi ZUR, Naveed AK, Hanif A, Kazmi SAR, Ismail M. Frequency of Common CYP2C9 Polymorphisms and Their Impact on Warfarin Dose Requirement in Pakistani Population. Clin Appl Thromb Hemost 2016; 23:800-806. [PMID: 27313202 DOI: 10.1177/1076029616654264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Polymorphisms in cytochrome P450 (CYP) 2C9 (CYP2C9) gene result in interindividual variability in warfarin dose requirement. There is a need for characterization of genotype frequency distribution in different populations for construction of customized dosing algorithms to enhance the efficacy and reduce the toxicity of warfarin therapy. This study was carried out in Pakistani population to evaluate the contribution of common CYP2C9 polymorphisms to warfarin therapy. A total of 550 stable patients taking warfarin were enrolled after medical history, physical examination, and laboratory investigations. Single blood sample was collected after informed consent. Genomic DNA was extracted, and genotype analysis for CYP2C9*2 and CYP2C9*3 polymorphisms was done by polymerase chain reaction-restriction fragment length polymorphism assay. A number of samples were also analyzed by direct DNA sequencing for validation of the results. Data were analyzed using SPSS version 20. Genotype frequency distribution of CYP2C9*2 and CYP2C9*3 was found to be different from other populations. Of these 2 polymorphisms, CYP2C9*2 did not demonstrate significant effect on warfarin dose requirement, whereas CYP2C9*3 did show significant effect ( P value = .012). It is concluded that there is a need to study genotype frequency distribution and their effect on warfarin dose variability among different populations due to diversity in outcome.
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Affiliation(s)
- Aisha Qayyum
- 1 Department of Pharmacology, Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Muzammil Hasan Najmi
- 2 Department of Pharmacology, Foundation University Medical College, Islamabad, Pakistan
| | - Qaisar Mansoor
- 3 Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
| | - Zia-Ur-Rehman Farooqi
- 4 Department of Medical Technology, ShifaTameer-e-Millat University, Islamabad, Pakistan
| | - Abdul Khaliq Naveed
- 5 Department of Biochemistry, Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Andleeb Hanif
- 3 Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
| | | | - Muhammad Ismail
- 3 Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
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90
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Nakamura S, Watanabe N, Yoshimura N, Ozawa S, Hirono K, Ichida F, Taguchi M. A model analysis for dose-response relationship of warfarin in Japanese children: An introduction of the SIZE parameter. Drug Metab Pharmacokinet 2016; 31:234-41. [PMID: 27234489 DOI: 10.1016/j.dmpk.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 11/24/2022]
Abstract
The objective of the present study was to develop an optimal equation for the pediatric dose-response relationship of warfarin using a size parameter with an exponent of body weight (SIZE) which has been proposed for scaling drug clearance. Twenty patients with stable anticoagulation by warfarin were enrolled in the present study. During a mean follow-up period of 7.36 years, 857 data points were obtained. The average patient age and body weight were 8.49 years and 24.5 kg, respectively. The relative response index to warfarin with PT-INR values normalized by daily-dose per SIZE showed fewer systematic changes than those per body weight. The anticoagulant effect of warfarin in patients with the VKORC1 1173CT or 1173CC genotype was 47.3% of that with the 1173TT genotype. Concomitant use of bosentan attenuated the anticoagulant effect of warfarin to 84.1%. In conclusion, the SIZE parameter appeared to be an effective way to describe the pediatric dose-response relationship of warfarin, and consequently, a longitudinal follow-up study design with multiple measurements was useful to detect changes within individual subjects.
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Affiliation(s)
- Saki Nakamura
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Nao Watanabe
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Naoki Yoshimura
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Sayaka Ozawa
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Keiichi Hirono
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Fukiko Ichida
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Masato Taguchi
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan.
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91
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Impact of CYP2C9 and VKORC1 genetic polymorphisms upon warfarin dose requirements in Egyptian patients with acute coronary syndrome. Blood Coagul Fibrinolysis 2016; 26:499-504. [PMID: 25699611 DOI: 10.1097/mbc.0000000000000272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Warfarin is the most widely prescribed anticoagulant drugs. Cytochrome P450-2C9 (CYP2C9) and vitamin K epoxide reductase-oxidaxe complex subunit 1 (VKORC1) contribute significantly to the variability of warfarin dose requirements among patients. We investigated the impact of CYP2C9 and VKORC1 polymorphisms on the variability of warfarin dosage requirements in Egyptian patients with acute coronary syndrome and their association with other nongenetic factors. Eighty participants with acute coronary syndrome were enrolled in this cross-sectional study. Associations between CYP2C9 and VKORC1 gene variants together with daily warfarin dose, demographic data, clinical status of patients and time to target international normalized ratio were assessed. Mean warfarin dose among patients with wild-type CYP2C91/1 genotype was significantly higher than heterozygous CYP2C91/2 and CYP2C91/3 variants (P ≤ 0.001). Patients with wild VKORC1 (G/G) genotype were treated with significantly higher daily warfarin dosages than homozygous (A/A) and heterozygous (G/A) genotypes. Patients carrying VKORC1 (G/G) genotype in combination with the CYP2C91/1 type alleles had the highest daily warfarin dosage, whereas the lowest daily warfarin dosage to achieve the required clinical effect was found among patients having CYP2C91/2 and CYP2C91/3 genotypes combined with VKORC1 (A/A) genotype (P ≤ 0.001). Regression analysis revealed that age, height, CYP2C9 and VKORC1 genotypes were significantly associated with warfarin dose. Genetic polymorphisms in VKORC1, CYP2C9 along with age and height are determinants of warfarin dose requirements in Egyptian population acute coronary syndrome. Higher warfarin loading dose is required for both wild CYP2C9 and VKORC1 gene variants which may contribute to warfarin-resistant cases.
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92
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Liao Z, Feng S, Ling P, Zhang G. Meta-analysis of randomized controlled trials reveals an improved clinical outcome of using genotype plus clinical algorithm for warfarin dosing. J Thromb Thrombolysis 2016; 39:228-34. [PMID: 24962733 DOI: 10.1007/s11239-014-1099-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies have raised interest in using the genotyping of CYP2C9 and VKORC1 to guide warfarin dosing. However, there is lack of solid evidence to prove that genotype plus clinical algorithm provides improved clinical outcomes than the single clinical algorithm. The results of recent reported clinical trials are paradoxical and needs to be systematically evaluated. In this study, we aim to assess whether genotype plus clinical algorithm of warfarin is superior to the single clinical algorithm through a meta-analysis of randomized controlled trials (RCTs). All relevant studies from PubMed and reference lists from Jan 1, 1995 to Jan 13, 2014 were extracted and screened. Eligible studies included randomized trials that compared clinical plus pharmacogenetic algorithms group to single clinical algorithm group using adult (≥ 18 years) patients with disease conditions that require warfarin use. We further used fix-effect models to calculate the mean difference or the risk ratios (RRs) and 95% CIs to analyze the extracted data. The statistical heterogeneity was calculated using I(2). The percentage of time within the therapeutic INR range was considered to be the primary clinical outcome. The initial search strategy identified 50 citations and 7 trials were eligible. These seven trials included 1,910 participants, including 960 patients who received genotype plus clinical algorithm of warfarin dosing and 950 patients who received clinical algorithm only. We discovered that the percentage of time within the therapeutic INR range of the genotype-guided group was improved compared with the standard group in the RCTs when the initial standard dose was fixed (95% CI 0.09-0.40; I(2) = 47.8%). However, for the studies using non-fixed initial doses, the genotype-guided group failed to exhibit statistically significant outcome compared to the standard group. No significant difference was observed in the incidences of adverse events (RR 0.94, 95% CI 0.84-1.04; I(2) = 0%, p = 0.647) and death rates (RR 1.36, 95% CI 0.46-4.05; I(2) = 10.4%, p = 0.328) between the two groups. Allocation to genotype plus clinical algorithm may be associated with a significant improvement of the percentage of time within the therapeutic INR range for patients adopting fixed dose of warfarin. The incidence of total adverse events and death rates did not differ between these two groups. Further experiments need to be conducted to confirm these findings.
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Affiliation(s)
- Zhenqi Liao
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Suzhou University, Suzhou, 215000, Jiangsu, China
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93
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Ding Y, He P, He N, Li Q, Sun J, Yao J, Yi S, Xu H, Wu D, Wang X, Jin T. Genetic polymorphisms of pharmacogenomic VIP variants in Li nationality of southern China. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 42:237-242. [PMID: 26901752 DOI: 10.1016/j.etap.2016.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The present study aimed to screen members of the Li nationality in southern China for genotype frequencies of VIP variants and to determine differences between the Li ethnicity and global human population samples in HapMap. METHODS In this study, we genotyped 77 very important pharmacogenetic (VIP) variants selected from the pharmacogenomics knowledge base (PharmGKB) in members of the Li population and compared our data with other eleven populations from the HapMap data set. RESULTS Our results showed that VDR rs1540339, VKORC1 rs9934438, and MTHFR rs1801133 were most different in Li compared with most of the eleven populations from the HapMap data set. Furthermore, population structure and F-statistics (Fst) analysis also showed differences between the Li and other HapMap populations, and the results suggest that the Li are most genetically similar to the CHD population, and the least similar to the YRI in HapMap. CONCLUSIONS The findings of our study complement the pharmacogenomics database with information on members of the Li ethnicity and provide a stronger scientific basis for safer drug administration, which may help clinicians to predict individual drug responses, thereby avoiding the risk of adverse effects and optimizing efficacy in this population.
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Affiliation(s)
- Yipeng Ding
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China.
| | - Ping He
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Na He
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; National Engineering Research Center for Miniaturized Detection Systems, Xi'an 710069, China
| | - Quanni Li
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Juan Sun
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Jinjian Yao
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Shengyang Yi
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Heping Xu
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Duoyi Wu
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Xiang Wang
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311, China
| | - Tianbo Jin
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi 712082, China; National Engineering Research Center for Miniaturized Detection Systems, Xi'an 710069, China; School of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, China.
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94
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Cavalli M, Pan G, Nord H, Eriksson N, Wadelius C, Wadelius M. Novel regulatory variant detected on the VKORC1 haplotype that is associated with warfarin dose. Pharmacogenomics 2016; 17:1305-14. [PMID: 26847243 DOI: 10.2217/pgs-2015-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM Warfarin dose requirement is associated with VKORC1 rs9923231, and we studied whether it is a functional variant. MATERIALS & METHODS We selected variants in linkage disequilibrium with rs9923231 that bind transcription factors in an allele-specific way. Representative haplotypes were cloned or constructed, nuclear protein binding and transcriptional activity were evaluated. RESULTS rs56314408C>T and rs2032915C>T were detected in a liver enhancer in linkage disequilibrium with rs9923231. The rs56314408-rs2032915 C-C haplotype preferentially bound nuclear proteins and had higher transcriptional activity than T-T and the African-specific T-C. A motif for TFAP2A/C was disrupted by rs56314408T. No difference in transcriptional activity was detected for rs9923231G>A. CONCLUSION Our results supported an activating role for rs56314408C, while rs9923231G>A had no evidence of being functional.
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Affiliation(s)
- Marco Cavalli
- Department of Immunology, Genetics & Pathology, & Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Gang Pan
- Department of Immunology, Genetics & Pathology, & Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Helena Nord
- Department of Immunology, Genetics & Pathology, & Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Niclas Eriksson
- Uppsala Clinical Research Center & Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Claes Wadelius
- Department of Immunology, Genetics & Pathology, & Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Mia Wadelius
- Department of Medical Sciences & Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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95
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Pharmacogenetics-based warfarin dosing algorithm decreases time to stable anticoagulation and the risk of major hemorrhage: an updated meta-analysis of randomized controlled trials. J Cardiovasc Pharmacol 2016; 65:364-70. [PMID: 25551322 DOI: 10.1097/fjc.0000000000000204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Warfarin is yet the most widely used oral anticoagulant for thromboembolic diseases, despite the recently emerged novel anticoagulants. However, difficulty in maintaining stable dose within the therapeutic range and subsequent serious adverse effects markedly limited its use in clinical practice. Pharmacogenetics-based warfarin dosing algorithm is a recently emerged strategy to predict the initial and maintaining dose of warfarin. However, whether this algorithm is superior over conventional clinically guided dosing algorithm remains controversial. We made a comparison of pharmacogenetics-based versus clinically guided dosing algorithm by an updated meta-analysis. We searched OVID MEDLINE, EMBASE, and the Cochrane Library for relevant citations. The primary outcome was the percentage of time in therapeutic range. The secondary outcomes were time to stable therapeutic dose and the risks of adverse events including all-cause mortality, thromboembolic events, total bleedings, and major bleedings. Eleven randomized controlled trials with 2639 participants were included. Our pooled estimates indicated that pharmacogenetics-based dosing algorithm did not improve percentage of time in therapeutic range [weighted mean difference, 4.26; 95% confidence interval (CI), -0.50 to 9.01; P = 0.08], but it significantly shortened the time to stable therapeutic dose (weighted mean difference, -8.67; 95% CI, -11.86 to -5.49; P < 0.00001). Additionally, pharmacogenetics-based algorithm significantly reduced the risk of major bleedings (odds ratio, 0.48; 95% CI, 0.23 to 0.98; P = 0.04), but it did not reduce the risks of all-cause mortality, total bleedings, or thromboembolic events. Our results suggest that pharmacogenetics-based warfarin dosing algorithm significantly improves the efficiency of International Normalized Ratio correction and reduces the risk of major hemorrhage.
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96
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The population genetics of pharmacogenomics VIP variants in the Sherpa population. Drug Metab Pharmacokinet 2016; 31:82-89. [PMID: 26825850 DOI: 10.1016/j.dmpk.2015.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/13/2015] [Accepted: 11/29/2015] [Indexed: 11/20/2022]
Abstract
Polymorphic distributions of pharmacogenes among some ethnicities are under-represented in current pharmacogenetic research. Particularly, there is a paucity of pharmacogenetic information in the Sherpa population in Tibet. We used the Sequenom MassARRAY single nucleotide polymorphism (SNP) genotyping technology to detect 86 very important pharmacogene (VIP) variants in Sherpas and compared the genotypic frequencies of these variants with HapMap populations. Overall, 59 of the 60 previously reported variants in the HapMap populations were found in our study. We found minimal differences between populations of Sherpas and Chinese Han in Beijing (CHB), Chinese in Metropolitan Denver, Colorado (CHD), Japanese in Tokyo, Japan (JPT), and Mexicans in Los Angeles, California (MEX) after a strict Bonferroni correction. Only 8, 4, 5, 4 VIP genotypes, respectively, were different in these groups. Additionally, pairwise FST values and clustering analyses showed that the VIP variants in the Sherpa population exhibited a close genetic affinity with the CHB and JPT populations, but they were most similar to the CHD population. Our results contribute to a better understanding of the molecular basis underlying ethnic differences in drug response, which may potentially benefit the development of personalized medicine for the Sherpa population.
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97
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Bourgeois S, Jorgensen A, Zhang EJ, Hanson A, Gillman MS, Bumpstead S, Toh CH, Williamson P, Daly AK, Kamali F, Deloukas P, Pirmohamed M. A multi-factorial analysis of response to warfarin in a UK prospective cohort. Genome Med 2016; 8:2. [PMID: 26739746 PMCID: PMC4702374 DOI: 10.1186/s13073-015-0255-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/10/2015] [Indexed: 01/13/2023] Open
Abstract
Background Warfarin is the most widely used oral anticoagulant worldwide, but it has a narrow therapeutic index which necessitates constant monitoring of anticoagulation response. Previous genome-wide studies have focused on identifying factors explaining variance in stable dose, but have not explored the initial patient response to warfarin, and a wider range of clinical and biochemical factors affecting both initial and stable dosing with warfarin. Methods A prospective cohort of 711 patients starting warfarin was followed up for 6 months with analyses focusing on both non-genetic and genetic factors. The outcome measures used were mean weekly warfarin dose (MWD), stable mean weekly dose (SMWD) and international normalised ratio (INR) > 4 during the first week. Samples were genotyped on the Illumina Human610-Quad chip. Statistical analyses were performed using Plink and R. Results VKORC1 and CYP2C9 were the major genetic determinants of warfarin MWD and SMWD, with CYP4F2 having a smaller effect. Age, height, weight, cigarette smoking and interacting medications accounted for less than 20 % of the variance. Our multifactorial analysis explained 57.89 % and 56.97 % of the variation for MWD and SMWD, respectively. Genotypes for VKORC1 and CYP2C9*3, age, height and weight, as well as other clinical factors such as alcohol consumption, loading dose and concomitant drugs were important for the initial INR response to warfarin. In a small subset of patients for whom data were available, levels of the coagulation factors VII and IX (highly correlated) also played a role. Conclusion Our multifactorial analysis in a prospectively recruited cohort has shown that multiple factors, genetic and clinical, are important in determining the response to warfarin. VKORC1 and CYP2C9 genetic polymorphisms are the most important determinants of warfarin dosing, and it is highly unlikely that other common variants of clinical importance influencing warfarin dosage will be found. Both VKORC1 and CYP2C9*3 are important determinants of the initial INR response to warfarin. Other novel variants, which did not reach genome-wide significance, were identified for the different outcome measures, but need replication. Electronic supplementary material The online version of this article (doi:10.1186/s13073-015-0255-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephane Bourgeois
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK.
| | | | - Eunice J Zhang
- University of Liverpool, Liverpool, Merseyside, L69 3GE, UK.
| | - Anita Hanson
- University of Liverpool, Liverpool, Merseyside, L69 3GE, UK.
| | - Matthew S Gillman
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK.
| | - Suzannah Bumpstead
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK.
| | - Cheng Hock Toh
- University of Liverpool, Liverpool, Merseyside, L69 3GE, UK.
| | | | - Ann K Daly
- Newcastle University, Newcastle upon Tyne, UK.
| | | | - Panos Deloukas
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK. .,William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Munir Pirmohamed
- University of Liverpool, Liverpool, Merseyside, L69 3GE, UK. .,Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK. .,The Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Block A: Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
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98
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Zhao Y, Liu N, Wang Y, Hickey KT. A rolling-horizon pharmacokinetic pharmacodynamic model for warfarin inpatients in transient clinical states. Per Med 2016; 13:21-32. [DOI: 10.2217/pme.15.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To design a pharmacokinetic pharmacodynamic model to make individualized and adaptive international normalized ratio (INR) predictions for warfarin inpatients in changing clinical status. Methods: We tested a new model on 60 inpatients at Columbia University. The model personalizes four submodels and minimizes the number of parameters to be estimated. Prediction accuracy was assessed by prediction error, absolute prediction error and percentage absolute prediction error. Results: The INRs were accurately predicted 5 days into the future. Median prediction error: 0.01–0.12; median absolute prediction error: 0.17–0.5 and median percentage absolute prediction error: 9.85–26.06%. Conclusion: Patients exhibit interindividual and intertemporal variability. The model captures the variability and provides accurate and personalized INR predictions.
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Affiliation(s)
- Yao Zhao
- Department of Supply Chain Management, Rutgers Business School, Rutgers – the State University of New Jersey, Newark, NJ, USA
| | - Nan Liu
- Department of Health Policy & Management, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yijun Wang
- Department of Supply Chain Management, Rutgers Business School, Rutgers – the State University of New Jersey, Newark, NJ, USA
| | - Kathleen T Hickey
- Columbia University School of Nursing, Columbia University Medical Center, NY, USA
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99
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CYP4F2 (rs2108622) Gene Polymorphism Association with Age-Related Macular Degeneration. Adv Med 2016; 2016:3917916. [PMID: 27652291 PMCID: PMC5019857 DOI: 10.1155/2016/3917916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/23/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
Background. Age-related macular degeneration is the leading cause of blindness in elderly individuals where aetiology and pathophysiology of age-related macular degeneration are not absolutely clear. Purpose. To determine the frequency of the genotype of rs2108622 in patients with early and exudative age-related macular degeneration. Methods. The study enrolled 190 patients with early age-related macular degeneration, 181 patients with exudative age-related macular degeneration (eAMD), and a random sample of 210 subjects from the general population (control group). The genotyping of rs2108622 was carried out using the real-time polymerase chain reaction method. Results. The analysis of rs2108622 gene polymorphism did not reveal any differences in the distribution of C/C, C/T, and T/T genotypes between the early AMD group, the eAMD group, and the control group. The CYP4F2 (1347C>T) T/T genotype was more frequent in males with eAMD compared to females (10.2% versus 0.8%; p = 0.0052); also T/T genotype was less frequently present in eAMD females compared to healthy control females (0.8% versus 6.2%; p = 0.027). Conclusion. Rs2108622 gene polymorphism had no predominant effect on the development of early AMD and eAMD. The T/T genotype was more frequent in males with eAMD compared to females and less frequently present in eAMD females compared to healthy females.
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Pengo V, Zambon CF, Fogar P, Padoan A, Nante G, Pelloso M, Moz S, Frigo AC, Groppa F, Bozzato D, Tiso E, Gnatta E, Denas G, Padayattil Jose S, Padrini R, Basso D, Plebani M. A Randomized Trial of Pharmacogenetic Warfarin Dosing in Naïve Patients with Non-Valvular Atrial Fibrillation. PLoS One 2015; 10:e0145318. [PMID: 26710337 PMCID: PMC4692529 DOI: 10.1371/journal.pone.0145318] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/30/2015] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Genotype-guided warfarin dosing have been proposed to improve patient’s management. This study is aimed to determine whether a CYP2C9- VKORC1- CYP4F2-based pharmacogenetic algorithm is superior to a standard, clinically adopted, pharmacodynamic method. Two-hundred naïve patients with non-valvular atrial fibrillation were randomized to trial arms and 180 completed the study. No significant differences were found in the number of out-of-range INRs (INR<2.0 or >3.0) (p = 0.79) and in the mean percentage of time spent in the therapeutic range (TTR) after 19 days in the pharmacogenetic (51.9%) and in the control arm (53.2%, p = 0.71). The percentage of time spent at INR>4.0 was significantly lower in the pharmacogenetic (0.7%) than in the control arm (1.8%) (p = 0.02). Genotype-guided warfarin dosing is not superior in overall anticoagulation control when compared to accurate clinical standard of care. TRIAL REGISTRATION ClinicalTrials.gov NCT01178034.
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Affiliation(s)
- Vittorio Pengo
- Department of Cardiac, Thoracic, and Vascular Sciences University of Padova, Padova, Italy
| | - Carlo-Federico Zambon
- Department of Medicine-DIMED, University of Padova, Padova, Italy
- Department of Laboratory Medicine, University of Padova, Padova, Italy
- * E-mail:
| | - Paola Fogar
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Medicine-DIMED, University of Padova, Padova, Italy
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Giovanni Nante
- Department of Cardiac, Thoracic, and Vascular Sciences University of Padova, Padova, Italy
| | - Michela Pelloso
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Stefania Moz
- Department of Medicine-DIMED, University of Padova, Padova, Italy
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, and Vascular Sciences University of Padova, Padova, Italy
| | - Francesca Groppa
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Dania Bozzato
- Department of Medicine-DIMED, University of Padova, Padova, Italy
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Enrico Tiso
- Department of Cardiac, Thoracic, and Vascular Sciences University of Padova, Padova, Italy
| | - Elisa Gnatta
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Gentian Denas
- Department of Cardiac, Thoracic, and Vascular Sciences University of Padova, Padova, Italy
| | - Seena Padayattil Jose
- Department of Cardiac, Thoracic, and Vascular Sciences University of Padova, Padova, Italy
| | - Roberto Padrini
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Daniela Basso
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
- Department of Laboratory Medicine, University of Padova, Padova, Italy
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