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Mugosa S, Todorovic Z, Cukic J, Sahman-Zaimovic M, Djordjevic N. ABCB1 polymorphism in clopidogrel-treated Montenegrin patients. Open Life Sci 2021; 16:142-149. [PMID: 33817306 PMCID: PMC7968540 DOI: 10.1515/biol-2021-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/21/2022] Open
Abstract
Clopidogrel is an antiplatelet drug that displays significant interindividual variability in treatment response. Its bioavailability depends on the function of P-glycoprotein (P-gp), which is coded by a highly polymorphic ABCB1 gene. Thus, the aim of this study was to investigate the effect of ABCB1 genetic polymorphism on clopidogrel efficacy and safety and to determine the frequency distribution of its most common single nucleotide polymorphisms (SNPs) in 106 Montenegrin cardiology patients. Clopidogrel efficacy and safety were followed up during 1 year after hospitalization, with the lack of efficacy and adverse drug reactions observed in 11 (10.4%) and 8 patients (7.5%), respectively. Genotyping for ABCB1 SNPs rs1128503 (1236C > T), rs2032582 (2677G > A/T), and rs1045642 (3435C > T) was performed by the real-time PCR method, and the variant alleles were detected with the frequencies of 42.9, 44.8, and 52.8%, respectively. No significant association was observed between any of the examined genotypes and clopidogrel efficacy (p = 0.253) or safety (p = 0.424). Due to small sample size, co-treatment with other drugs, and other genetic factors not taken into account, we believe the absence of correlation between ABCB1 genotypes and indicators of clopidogrel efficacy and safety in this study should be apprehended conditionally, and that larger and better-controlled studies are warranted.
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Affiliation(s)
- Snezana Mugosa
- Faculty of Medicine, Department of Pharmacology, University of Montenegro, 81104 Podgorica, Montenegro.,Institute for Medicines and Medical Devices of Montenegro, 81104 Podgorica, Montenegro
| | - Zoran Todorovic
- Department of Pharmacology, Clinical Pharmacology Toxicology, Faculty of Medicine, University of Belgrade, University Medical Center "Bežanijska kosa", 11000 Belgrade, Serbia
| | - Jelena Cukic
- Department for Immunology and Virology, Public Health Institute, 34000 Kragujevac, Serbia
| | - Majda Sahman-Zaimovic
- Faculty of Medicine, Department of Pharmacology, University of Montenegro, 81104 Podgorica, Montenegro.,Institute for Medicines and Medical Devices of Montenegro, 81104 Podgorica, Montenegro
| | - Natasa Djordjevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
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2
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Shuleta-Qehaja S, Kapedanovska Nestorovska A, Naumovska Z, Stefanovski P, Dimovski A, Sterjev Z, Shuturkova L. CYP2D6 polymorphisms and the therapeutic outcome with Tamoxifen therapy in breast cancer patients from Kosovo. MAKEDONSKO FARMACEVTSKI BILTEN 2019. [DOI: 10.33320/maced.pharm.bull.2018.64.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tamoxifen is a selective estrogen receptor modulator (SERM) used for the prevention of breast cancer and for the treatment of metastatic and early stage receptor positive breast cancer. It has been shown than tamoxifen is metabolized by the cytochrome P450 2D6 (CYP2D6) enzymes, especially with the CYP26 isoform. The aim of this study was to examine the prevalence of CYP2D6*4, CYP2D6*9 and CYP2D6*10 variants in patients with breast cancer in Kosovo as well as the association between CYP2D6 polymorphisms and the therapeutic outcome in tamoxifen treated patients. The study included 111 patients who were at the age of 25 to 70 years (45.75 ± 9.50). The overall variant allele frequency of CYP2D6*4 was 0.16. The genotypic frequencies of the CYP2D6*4 polymorphism in all patients were 0.02 for *4/*4, 0.28 for *1/*4 and 0.70 for the *1/*1 genotype. The overall CYP2D6*10 variant allele frequency was 0.30 and the frequency of *10/*10, *1/*10 and *1/*1 genotypes was 0.11, 0.37 and 0.52, respectively. In our study, a population of the CYP2D6∗9 variant allele was not detected. In addition, we did not find any correlation between the evaluated genotypes for CYP2D6 polymorphisms and the therapeutic outcome with tamoxifen therapy. Although our study is a rather small- scale compared to large multicentre studies, we believe that it will contribute to determining the impact of CYP2D6 polymorphisms on the success of tamoxifen therapy in patients with a diagnosed breast cancer. Our results are pointing to the direction of the growing number of claims that there is still no strong evidence of any therapeutic connection between the polymorphisms examined and the outcome of the therapy.
Keywords: Tamoxifen, breast cancer, CY2D6*4, CYP2D6*9, CYP2D6*10
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Affiliation(s)
| | | | - Zorica Naumovska
- Ss Cyril and Methodius University, Faculty of Pharmacy, Majka Tereza 47, Skopje, Republic of Macedonia
| | - Petar Stefanovski
- Clinical Hospital Dr. Trifun Panovski, Department of Oncology, ASNOM n.n., Bitola, Republic of Macedonia
| | - Aleksandar Dimovski
- Ss Cyril and Methodius University, Faculty of Pharmacy, Majka Tereza 47, Skopje, Republic of Macedonia
| | - Zoran Sterjev
- Ss Cyril and Methodius University, Faculty of Pharmacy, Majka Tereza 47, Skopje, Republic of Macedonia
| | - Ljubica Shuturkova
- Ss Cyril and Methodius University, Faculty of Pharmacy, Majka Tereza 47, Skopje, Republic of Macedonia
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3
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Kiss ÁF, Tóth K, Juhász C, Temesvári M, Paulik J, Hirka G, Monostory K. Is CYP2D6 phenotype predictable from CYP2D6 genotype? Microchem J 2018. [DOI: 10.1016/j.microc.2016.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Kiss ÁF, Vaskó D, Déri MT, Tóth K, Monostory K. Combination of CYP2C19 genotype with non-genetic factors evoking phenoconversion improves phenotype prediction. Pharmacol Rep 2017; 70:525-532. [PMID: 29665549 DOI: 10.1016/j.pharep.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND CYP2C19 is an important drug-metabolizing enzyme, responsible for metabolism of approximately 10% of the drugs on the market. Large inter-individual differences exist in metabolic activities, which are primarily attributed to genetic polymorphism of CYP2C19 gene. Conflicting results have been published about the role of CYP2C19 polymorphisms in metabolism of CYP2C19 substrates and clinical outcomes; thus, we aimed to investigate CYP2C19 genotype-phenotype associations, and we sought to elicit potential causes of discrepancies in the genotype-based prediction by incorporating the liver donors' demographic data, drug administration events and pathological conditions. METHODS (S)-Mephenytoin was used to assess CYP2C19 activities in human liver microsomes derived from 114 Hungarian organ donors. CYP2C19 genotype was determined by SNP genotyping for CYP2C19*2, CYP2C19*3, CYP2C19*4 and CYP2C19*17 variants, and CYP2C19 mRNA levels were measured by qPCR method. Clinical data of the donors were considered in the genotype-based phenotype prediction. RESULTS CYP2C19 phenotype of 40% of the donors was well-predicted from the genotype data, whereas the phenotype of 13% was underestimated displaying higher activity, and of 47% was overestimated displaying lower activity than predicted from CYP2C19 genotype. Among the donors with overestimated phenotype, one was treated with CYP2C19 substrate/inhibitor, 9 were on amoxicillin-clavulanic acid therapy, 7 were chronic alcohol consumers and 9 had disease with inflammatory processes. CONCLUSIONS CYP2C19 genotype only partially determines the CYP2C19 phenotypic appearance; co-medication, diseases with inflammatory processes and aspecific factors, such as chronic alcohol consumption and amoxicillin-clavulanic acid therapy (or any drug therapy resulting in liver injury) seem to be potential phenotype-modifying factors.
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Affiliation(s)
- Ádám Ferenc Kiss
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Dorottya Vaskó
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Máté Tamás Déri
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Katalin Tóth
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Katalin Monostory
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary.
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5
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Yu CY, Ang GY, Subramaniam V, Johari James R, Ahmad A, Abdul Rahman T, Mohd Nor F, Shaari SA, Teh LK, Salleh MZ. Inference of the Genetic Polymorphisms of CYP2D6 in Six Subtribes of the Malaysian Orang Asli from Whole-Genome Sequencing Data. Genet Test Mol Biomarkers 2017; 21:409-415. [PMID: 28525288 DOI: 10.1089/gtmb.2016.0235] [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: 11/13/2022] Open
Abstract
AIMS CYP2D6 is one of the major enzymes in the cytochrome P450 monooxygenase system. It metabolizes ∼25% of prescribed drugs and hence, the genetic diversity of a CYP2D6 gene has continued to be of great interest to the medical and pharmaceutical industries. This study was designed to perform a systematic analysis of the CYP2D6 gene in six subtribes of the Malaysian Orang Asli. METHODS Genomic DNAs were extracted from the blood samples followed by whole-genome sequencing. The reads were aligned to the reference human genome hg19 and variants in the CYP2D6 gene were analyzed. CYP2D6*5 and duplication of CYP2D6 were analyzed using previously established methods. RESULTS A total of 72 single nucleotide polymorphisms were identified. CYP2D6*1, *2, *4, *5, *10,*41, and duplication of the gene were found in the Orang Asli, whereby CYP2D6*2 and *41 alleles are reported for the first time in the Malaysian population. CONCLUSION The findings in this study provide insights into the genetic polymorphisms of CYP2D6 in the Orang Asli of Peninsular Malaysia.
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Affiliation(s)
- Choo Yee Yu
- 1 Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA (UiTM) , Puncak Alam, Malaysia
| | - Geik Yong Ang
- 1 Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA (UiTM) , Puncak Alam, Malaysia
| | - Vinothini Subramaniam
- 1 Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA (UiTM) , Puncak Alam, Malaysia
| | - Richard Johari James
- 1 Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA (UiTM) , Puncak Alam, Malaysia .,2 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Malaysia
| | - Aminuddin Ahmad
- 3 Faculty of Medicine, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Malaysia
| | | | - Fadzilah Mohd Nor
- 3 Faculty of Medicine, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Malaysia
| | - Syahrul Azlin Shaari
- 3 Faculty of Medicine, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Malaysia
| | - Lay Kek Teh
- 1 Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA (UiTM) , Puncak Alam, Malaysia .,2 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Malaysia
| | - Mohd Zaki Salleh
- 1 Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA (UiTM) , Puncak Alam, Malaysia .,2 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Malaysia
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6
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Mugoša S, Djordjević N, Bukumirić Z, Djukanović N, Cukić J, Radosavljević I, Baskić D, Protić D, Zdravković M, Todorović Z. PREDICT score and CYP2C19 polymorphism independently predict lack of efficacy of clopidogrel in cardiology patients. Clin Exp Pharmacol Physiol 2016; 43:379-81. [PMID: 26699839 DOI: 10.1111/1440-1681.12531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Snežana Mugoša
- Faculty of Pharmacy, University of Montenegro, Podgorica, Montenegro
| | - Nataša Djordjević
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zoran Bukumirić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Ivan Radosavljević
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dejan Baskić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dragana Protić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Medical Center "Bežanijska kosa", Belgrade, Serbia
| | - Zoran Todorović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Medical Center "Bežanijska kosa", Belgrade, Serbia
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7
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Naranjo MEG, de Andrés F, Delgado A, Cobaleda J, Peñas-Lledó EM, LLerena A. High frequency of CYP2D6 ultrarapid metabolizers in Spain: controversy about their misclassification in worldwide population studies. THE PHARMACOGENOMICS JOURNAL 2016; 16:485-90. [PMID: 27272044 DOI: 10.1038/tpj.2016.47] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/14/2016] [Accepted: 05/02/2016] [Indexed: 02/06/2023]
Abstract
A high frequency (7-10%) of CYP2D6 ultrarapid metabolizers estimated from the genotype (gUMs) has been claimed to exist among Spaniards and Southern Europeans. However, methodological aspects such as the inclusion of individuals carrying non-active multiplied alleles as gUMs may have led to an overestimation. Thus, this study aimed to analyze the gUM frequency (considering only those carrying more than two active genes) in 805 Spanish healthy volunteers studied for CYP2D6*2, *3, *4, *5, *6, *10, *17, *35, *41, and multiplications. Second, all worldwide studies reporting gUM frequencies were reviewed in order to evaluate potential misclassifications. The gUM frequency in this Spanish population was 5.34%, but increased to 8.3% if all individuals with CYP2D6 multiplications were classified as gUMs without considering the activity of the multiplied alleles. Moreover, among all reviewed worldwide studies only 55.6% precisely determined whether the multiplied alleles were active. Present results suggest that the evaluation of CYP2D6 ultrarapid metabolism should be standarized, and that the frequency of gUMs should be reconsidered in Spaniards and globally.
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Affiliation(s)
- M E G Naranjo
- CICAB Clinical Research Center, Extremadura University and Medical School, Badajoz, Spain
| | - F de Andrés
- CICAB Clinical Research Center, Extremadura University and Medical School, Badajoz, Spain
| | - A Delgado
- CICAB Clinical Research Center, Extremadura University and Medical School, Badajoz, Spain
| | - J Cobaleda
- CICAB Clinical Research Center, Extremadura University and Medical School, Badajoz, Spain.,Primary Health Care Center 'Ciudad Jardín', Badajoz, Spain
| | - E M Peñas-Lledó
- CICAB Clinical Research Center, Extremadura University and Medical School, Badajoz, Spain
| | - A LLerena
- CICAB Clinical Research Center, Extremadura University and Medical School, Badajoz, Spain.,CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
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8
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Borba MA, Melo-Neto RP, Leitão GM, Castelletti CH, Lima-Filho JL, Martins DB. Evaluating the impact of missenses mutations in CYP2D6*7 and CYP2D6*14A: does it compromise tamoxifen metabolism? Pharmacogenomics 2016; 17:573-82. [PMID: 27043475 DOI: 10.2217/pgs-2015-0003] [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] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED CYP2D6 is a high polymorphic enzyme from P450, responsible for metabolizing almost 25% of drugs. The distribution of different mutations among CYP2D6 alleles has been associated with poor, intermediate, extensive and ultra-metabolizers. AIM To evaluate how missenses mutations in CYP2D6*7 and CYP2D6*14A poor metabolizer alleles affect CYP2D6 stability and function. MATERIALS & METHODS CYPalleles database was used to collect polymorphisms data present in 105 alleles. We selected only poor metabolizers alleles that presented exclusively missenses mutations. They were analyzed through seven algorithms to predict the impact on CYP2D6 structure and function. RESULTS H324P, the unique mutation in CYP2D6*7, has high impact in enzyme function due to its occurrence between two alpha-helixes involved in active site dynamics. G169R, a mutation that occurs only in CYP2D6*14A, leads to the gain of solvent accessibility and severe protein destabilization. CONCLUSION Our in silico analysis showed that missenses mutations in CYP2D6*7 and CYP2D6*14A cause CYP2D6 dysfunction.
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Affiliation(s)
- Maria Acsm Borba
- Molecular Prospection and Bioinformatics Group (ProspecMol) - Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil
| | - Renato P Melo-Neto
- Molecular Prospection and Bioinformatics Group (ProspecMol) - Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil
| | - Glauber M Leitão
- Molecular Prospection and Bioinformatics Group (ProspecMol) - Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil.,Clinical Hospital - Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil
| | - Carlos Hm Castelletti
- Molecular Prospection and Bioinformatics Group (ProspecMol) - Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil.,Agronomic Institute of Pernambuco (IPA), Av. General San Martin 1371, 50761-000, Bongi, Recife, PE, Brazil
| | - José L Lima-Filho
- Biochemistry Department, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil
| | - Danyelly Bg Martins
- Molecular Prospection and Bioinformatics Group (ProspecMol) - Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil.,Biochemistry Department, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235, 50670-901, Cidade Universitária, Recife, PE, Brazil
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9
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Interethnic variation of CYP2C19 alleles, 'predicted' phenotypes and 'measured' metabolic phenotypes across world populations. THE PHARMACOGENOMICS JOURNAL 2015; 16:113-23. [PMID: 26503820 DOI: 10.1038/tpj.2015.70] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/15/2015] [Accepted: 08/19/2015] [Indexed: 02/08/2023]
Abstract
The present study evaluates the worldwide frequency distribution of CYP2C19 alleles and CYP2C19 metabolic phenotypes ('predicted' from genotypes and 'measured' with a probe drug) among healthy volunteers from different ethnic groups and geographic regions, as well as the relationship between the 'predicted' and 'measured' CYP2C19 metabolic phenotypes. A total of 52 181 healthy volunteers were studied within 138 selected original research papers. CYP2C19*17 was 42- and 24-fold more frequent in Mediterranean-South Europeans and Middle Easterns than in East Asians (P<0.001, in both cases). Contrarily, CYP2C19*2 and CYP2C19*3 alleles were more frequent in East Asians (30.26% and 6.89%, respectively), and even a twofold higher frequency of these alleles was found in Native populations from Oceania (61.30% and 14.42%, respectively; P<0.001, in all cases), which may be a consequence of genetic drift process in the Pacific Islands. Regarding CYP2C19 metabolic phenotype, poor metabolizers (PMs) were more frequent among Asians than in Europeans, contrarily to the phenomenon reported for CYP2D6. A correlation has been found between the frequencies of CYP2C19 poor metabolism 'predicted' from CYP2C19 genotypes (gPMs) and the poor metabolic phenotype 'measured' with a probe drug (mPMs) when subjects are either classified by ethnicity (r=0.94, P<0.001) or geographic region (r=0.99, P=0.002). Nevertheless, further research is needed in African and Asian populations, which are under-represented, and additional CYP2C19 variants and the 'measured' phenotype should be studied.
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10
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Boyle KL, Rosenbaum CD. Oxycodone overdose in the pediatric population: case files of the University of Massachusetts Medical Toxicology Fellowship. J Med Toxicol 2015; 10:280-5. [PMID: 24610706 DOI: 10.1007/s13181-014-0394-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Katherine L Boyle
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, USA,
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11
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LLerena A, Naranjo MEG, Rodrigues-Soares F, Penas-LLedó EM, Fariñas H, Tarazona-Santos E. Interethnic variability ofCYP2D6alleles and of predicted and measured metabolic phenotypes across world populations. Expert Opin Drug Metab Toxicol 2014; 10:1569-83. [DOI: 10.1517/17425255.2014.964204] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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12
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Whittaker MR. Opioid use and the risk of respiratory depression and death in the pediatric population. J Pediatr Pharmacol Ther 2014; 18:269-76. [PMID: 24719587 DOI: 10.5863/1551-6776-18.4.269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64-6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients.
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Affiliation(s)
- Marianne R Whittaker
- New Hampshire's Hospital for Children at Elliot Health System, Manchester, New Hampshire
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13
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ABCB1 C3435T polymorphism is associated with susceptibility to major depression, but not with a clinical response to citalopram in a Turkish population. Pharmacol Rep 2014; 66:235-8. [PMID: 24911075 DOI: 10.1016/j.pharep.2013.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 09/04/2013] [Accepted: 09/12/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND The ATP-binding cassette sub-family B member 1 (ABCB1) gene, which encodes the p-glycoprotein at the blood-brain barrier, is investigated for patients' susceptibility to major depressive disorder (MDD) and their therapeutic response to antidepressants. However, there is an inconsistency between the studies of different ethnic groups. The current study aimed to determine the potential correlations of the ABCB1 gene C3435T polymorphism with the susceptibility to MDD and the therapeutic response to citalopram in a Turkish population. METHODS Fifty-four patients with MDD who received citalopram and 70 controls from the Turkish population were genotyped for ABCB1 C3435T polymorphism. To assess the therapeutic response to citalopram, all patients were rated baseline, first, second, fourth and sixth weeks according to the 17-item Hamilton Rating Scale for Depression (HAMD-17). RESULTS There was a significant correlation between the patient and control groups for ABCB1 C3435T polymorphism. Distribution of CC genotype and C allele frequency were higher in the patients than in the control group (p = 0.006, p = 0.020, respectively). However, no correlation between ABCB1 C3435T polymorphism and a therapeutic response to citalopram was observed. CONCLUSION Our results suggested that C3435T polymorphism in the ABCB1 gene may be an indicator of the susceptibility to major depression, without a likely treatment response to citalopram in a Turkish population. These findings should be replicated in studies on larger patient groups with different ethnicities.
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Albuquerque J, Ribeiro C, Naranjo MEG, Llerena A, Grazina M. Characterization of CYP2D6 genotypes and metabolic profiles in the Portuguese population: pharmacogenetic implications. Per Med 2013; 10:709-718. [DOI: 10.2217/pme.13.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim:CYP2D6 codes for a protein that is vastly involved in the metabolism of various substances. This gene is highly polymorphic, which influences the enzymatic activity and contributes to the huge variability in the enzyme hydroxylation capacity. Different metabolic profiles determine the processing of xenobiotics and endobiotics, thereby influencing disease risk, therapeutic efficacy and side effects, or toxicity of xenobiotics. The aim of this work was to characterize CYP2D6 polymorphisms and predict metabolic profiles in the Portuguese population. Subjects & methods: The study comprised 300 Portuguese unrelated healthy adult volunteers. Genetic analysis included allelic discrimination and copy number determination with TaqMan® probes by real-time PCR and allele duplications of CYP2D6*1, CYP2D6*2, CYP2D6*4 and CYP2D6*10 were confirmed by long PCR and PCR-RFLP. Results: The percentages of poor and ultrarapid metabolizers found in this Portuguese population were 6.3 and 4.7%, respectively. Discussion & conclusion: Compared with other studies, such as in Spaniards, the allelic frequencies observed were similar, with some exceptions, such as for CYP2D6*10, which is higher in the Portuguese population, and for CYP2D6*6 and duplication of *1 and *2, appearing in lower frequencies in the present study. These results allow the determination of the frequency of the most relevant CYP2D6 polymorphisms and the prediction of the enzyme metabolic activity, being of much importance for the CYP2D6 pharmacogenetics approach in the Portuguese population. The data presented here are significant for the study of genetic variability influencing CYP2D6 activity, to improve the effectiveness and safety of xenobiotics exposure, also can be used as a tool in clinical practice for the development of individualized pharmacotherapy.
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Affiliation(s)
| | - Carolina Ribeiro
- CNC – Center for Neuroscience & Cell Biology, University of Coimbra, Portugal
| | - Maria Eugenia G Naranjo
- CICAB Clinical Research Centre, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - Adrián Llerena
- CICAB Clinical Research Centre, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - Manuela Grazina
- CNC – Center for Neuroscience & Cell Biology, University of Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Portugal
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Sipeky C, Weber A, Szabo M, Melegh BI, Janicsek I, Tarlos G, Szabo I, Sumegi K, Melegh B. High prevalence of CYP2C19*2 allele in Roma samples: study on Roma and Hungarian population samples with review of the literature. Mol Biol Rep 2013; 40:4727-35. [PMID: 23645039 DOI: 10.1007/s11033-013-2569-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 04/29/2013] [Indexed: 12/22/2022]
Abstract
The purpose of our study was to characterise the CYP2C19*2 and CYP2C19*3 alleles in healthy Roma and Hungarian populations. DNA of 500 Roma and 370 Hungarian subjects were genotyped for CYP2C19*2 (G681A, rs4244285) and CYP2C19*3 (G636A, rs4986893) by PCR-RFLP assay and direct sequencing. Significant differences were found comparing the Roma and Hungarian populations in CYP2C19 681 GG (63.6 vs. 75.9%), GA (31.8 vs. 23.0%), AA (4.6 vs. 1.1%), GA+AA (36.4 vs. 24.1%) and A allele frequencies (0.205 vs. 0.125) (p<0.004). Striking differences were found between Roma and Hungarian samples in CYP2C19*1 (79.5 vs. 87.4%) and CYP2C19*2 (20.5 vs. 12.6%) alleles, respectively (p<0.001). None of the subjects was found to carry the CYP2C19*3 allele. Frequencies of the intermedier metabolizer phenotype defined by the *1/*2 genotype (0.318 vs. 0.230, p<0.005) and poor metabolizer predicted by the *2/*2 genotype (0.046 vs. 0.011, p<0.005) was significantly higher in Roma than in Hungarians, respectively. Genotype distribution of the Roma population was similar to those of the population of North India, however, a major difference was found in the frequency of the CYP2C19*2 allele, which is likely a result of admixture with European lineages. In conclusion, the frequencies of the CYP2C19 alleles, genotypes and corresponding extensive, intermediate and poor metabolizer phenotypes studied here in the Hungarian population are similar to those of other European Caucasian populations, but display clear differences when compared to the Roma population.
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Affiliation(s)
- Csilla Sipeky
- Department of Medical Genetics, University of Pecs, Szigeti 12, Pecs, 7624, Hungary.
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Zafra-Ceres M, de Haro T, Farez-Vidal E, Blancas I, Bandres F, de Dueñas EM, Ochoa-Aranda E, Gomez-Capilla JA, Gomez-Llorente C. Influence of CYP2D6 polymorphisms on serum levels of tamoxifen metabolites in Spanish women with breast cancer. Int J Med Sci 2013; 10:932-7. [PMID: 23781139 PMCID: PMC3675507 DOI: 10.7150/ijms.5708] [Citation(s) in RCA: 25] [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: 12/14/2012] [Accepted: 05/08/2013] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Estrogen receptor-positive breast cancer tumors depend on estrogen signaling for their growth and replication and can be treated by anti-estrogen therapy with tamoxifen. Polymorphisms of the CYP2D6 and CYP2C19 genes are associated with an impaired response to tamoxifen. The study objective was to investigate the impact of genetic polymorphisms in CYP2D6 and CYP2C19 on the pharmacokinetics of tamoxifen and its metabolites in Spanish women with estrogen receptor-positive breast cancer who were candidates for tamoxifen therapy. METHODS We studied 90 women with estrogen receptor-positive breast cancer, using the AmpliChip CYP450 test to determine CYP2D6 and CYP2C19 gene variants. Plasma levels of tamoxifen and its metabolites were quantified by high-performance liquid chromatography. RESULTS The CYP2D6 phenotype was extensive metabolizer in 80%, intermediate metabolizer in 12.2%, ultra-rapid metabolizer in 2.2%, and poor metabolizer in 5.6% of patients, and the allele frequency was 35.0% for allele (*)1, 21.0% for *2, and 18.9% for *4. All poor metabolizers in this series were *4/*4, and their endoxifen and 4-hydroxy tamoxifen levels were 25% lower than those of extensive metabolizers. CYP2C19*2 allele, which has been related to breast cancer outcomes, was detected in 15.6% of the studied alleles. CONCLUSION CYP2D6*4/*4 genotype was inversely associated with 4-hydroxy tamoxifen and endoxifen levels. According to these results, CYP2D6 and CYP2C19 genotyping appears advisable before the prescription of tamoxifen therapy.
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Affiliation(s)
- Mercedes Zafra-Ceres
- Clinical Biochemistry Services, San Cecilio University Hospital. Avd/ Doctor Olóriz s/n 18012, Granada, Spain
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