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Sandritter T, Chevalier R, Abt R, Shakhnovich V. Pharmacogenetic Testing for the Pediatric Gastroenterologist: Actionable Drug-Gene Pairs to Know. Pharmaceuticals (Basel) 2023; 16:889. [PMID: 37375836 DOI: 10.3390/ph16060889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Gastroenterologists represent some of the earlier adopters of precision medicine through pharmacogenetic testing by embracing upfront genotyping for thiopurine S-methyltransferase nucleotide diphosphatase (TPMT) before prescribing 6-mercaptopurine or azathioprine for the treatment of inflammatory bowel disease. Over the last two decades, pharmacogenetic testing has become more readily available for other genes relevant to drug dose individualization. Common medications prescribed by gastroenterologists for conditions other than inflammatory bowel disease now have actionable guidelines, which can improve medication efficacy and safety; however, a clear understanding of how to interpret the results remains a challenge for many clinicians, precluding wide implementation of genotype-guided dosing for drugs other than 6-mercaptopurine and azathioprine. Our goal is to provide a practical tutorial on the currently available pharmacogenetic testing options and a results interpretation for drug-gene pairs important to medications commonly used in pediatric gastroenterology. We focus on evidence-based clinical guidelines published by the Clinical Pharmacogenetics Implementation Consortium (CPIC®) to highlight relevant drug-gene pairs, including proton pump inhibitors and selective serotonin reuptake inhibitors and cytochrome P450 (CYP) 2C19, ondansetron and CYP2D6, 6-mercaptopurine and TMPT and Nudix hydrolase 15 (NUDT15), and budesonide and tacrolimus and CYP3A5.
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Affiliation(s)
- Tracy Sandritter
- Division of Clinical Pharmacology/Medical Toxicology and Therapeutic Innovation, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
- Department of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Rachel Chevalier
- Division of Gastroenterology, Children's Mercy Hospital, 2401 Gillham Rd., Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Rebecca Abt
- ProPharma Group, Overland Park, KS 66210, USA
| | - Valentina Shakhnovich
- Division of Clinical Pharmacology/Medical Toxicology and Therapeutic Innovation, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Grzegorzewski J, Brandhorst J, König M. Physiologically based pharmacokinetic (PBPK) modeling of the role of CYP2D6 polymorphism for metabolic phenotyping with dextromethorphan. Front Pharmacol 2022; 13:1029073. [PMID: 36353484 PMCID: PMC9637881 DOI: 10.3389/fphar.2022.1029073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
The cytochrome P450 2D6 (CYP2D6) is a key xenobiotic-metabolizing enzyme involved in the clearance of many drugs. Genetic polymorphisms in CYP2D6 contribute to the large inter-individual variability in drug metabolism and could affect metabolic phenotyping of CYP2D6 probe substances such as dextromethorphan (DXM). To study this question, we (i) established an extensive pharmacokinetics dataset for DXM; and (ii) developed and validated a physiologically based pharmacokinetic (PBPK) model of DXM and its metabolites dextrorphan (DXO) and dextrorphan O-glucuronide (DXO-Glu) based on the data. Drug-gene interactions (DGI) were introduced by accounting for changes in CYP2D6 enzyme kinetics depending on activity score (AS), which in combination with AS for individual polymorphisms allowed us to model CYP2D6 gene variants. Variability in CYP3A4 and CYP2D6 activity was modeled based on in vitro data from human liver microsomes. Model predictions are in very good agreement with pharmacokinetics data for CYP2D6 polymorphisms, CYP2D6 activity as described by the AS system, and CYP2D6 metabolic phenotypes (UM, EM, IM, PM). The model was applied to investigate the genotype-phenotype association and the role of CYP2D6 polymorphisms for metabolic phenotyping using the urinary cumulative metabolic ratio (UCMR), DXM/(DXO + DXO-Glu). The effect of parameters on UCMR was studied via sensitivity analysis. Model predictions indicate very good robustness against the intervention protocol (i.e. application form, dosing amount, dissolution rate, and sampling time) and good robustness against physiological variation. The model is capable of estimating the UCMR dispersion within and across populations depending on activity scores. Moreover, the distribution of UCMR and the risk of genotype-phenotype mismatch could be estimated for populations with known CYP2D6 genotype frequencies. The model can be applied for individual prediction of UCMR and metabolic phenotype based on CYP2D6 genotype. Both, model and database are freely available for reuse.
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Peñas-Lledó EM, Guillaume S, de Andrés F, Cortés-Martínez A, Dubois J, Kahn JP, Leboyer M, Olié E, LLerena A, Courtet P. A one-year follow-up study of treatment-compliant suicide attempt survivors: relationship of CYP2D6-CYP2C19 and polypharmacy with suicide reattempts. Transl Psychiatry 2022; 12:451. [PMID: 36257936 PMCID: PMC9579135 DOI: 10.1038/s41398-022-02140-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
This study of a cohort of 1-year treatment-compliant survivors of a suicide attempt examined for the first time whether a high CYP2D6-CYP2C19 metabolic capacity (pharmacogenes related to psychopathology, suicide, and attempt severity) and/or polypharmacy treatments predicted repeat suicide attempts, adjusting for sociodemographic and clinical factors as confounders. Of the 461 (63% women) consecutively hospitalized patients who attempted suicide and were evaluated and treated after an index attempt, 191 (67.5% women) attended their 6- and 12-month follow-up sessions. Clinicians were blinded to the activity scores (AS) of their genotypes, which were calculated as the sum of the values assigned to each allele (CYP2C19 *2, *17; CYP2D6 *3, *4, *4xN, *5, *6, *10, wtxN). No differences were found in polypharmacy prescription patterns and the variability of CYP2D6 and CYP2C19 genotypes between adherents and dropouts, but the formers were older, with a higher frequency of anxiety and bipolar disorders and fewer alcohol and substance use disorders. The risk of reattempts was higher for CYP2D6 ultrarapid (AS > 2) metabolizers (β = 0.561, p = 0.005) and violent suicide survivors (β = -0.219, p = 0.042) if the attempt occurred during the first 6-month period, individuals with an increased number of MINI DSM-IV Axis I mental disorders (β = 0.092, p = 0.032) during the second 6-month period and individuals with a combined high CYP2D6-CYP2C19 metabolic capacity (AS > 4) (β = 0.345, p = 0.024) and an increased use of drugs other than antidepressants, anxiolytics-depressants and antipsychotics-lithium (β = 0.088, p = 0.005) in multiple repeaters during both periods. CYP2D6 and CYP2C19 rapid metabolism and polypharmacy treatment for somatic comorbidities must be considered to prevent the severe side effects of short-term multiple suicide reattempts after a previous attempt.
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Affiliation(s)
- Eva M. Peñas-Lledó
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain ,grid.8393.10000000119412521University of Extremadura Medical School, Badajoz, Spain
| | - Sebastien Guillaume
- grid.121334.60000 0001 2097 0141IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France ,grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France
| | - Fernando de Andrés
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain
| | - Ana Cortés-Martínez
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain
| | - Jonathan Dubois
- grid.121334.60000 0001 2097 0141IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France ,grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France
| | - Jean Pierre Kahn
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, Nancy, France, Clinique Soins-Etudes de Vitry le François, Fondation Sant´e des Etudiants de France (FSEF), Paris, France
| | - Marion Leboyer
- FondaMental Foundation, Créteil, France ,grid.462410.50000 0004 0386 3258Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil, France ,grid.511339.cAP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Emilie Olié
- grid.121334.60000 0001 2097 0141IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France ,grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France
| | - Adrián LLerena
- grid.8393.10000000119412521INUBE Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain ,grid.8393.10000000119412521University of Extremadura Medical School, Badajoz, Spain ,grid.413448.e0000 0000 9314 1427CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Philippe Courtet
- IGF, CNRS, INSERM, Univ. Montpellier, Montpellier, France. .,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, 34090, Montpellier, France.
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Kutuk MO, Tufan AE, Topal Z, Acikbas U, Guler G, Karakas B, Basaga H, Kilicaslan F, Altintas E, Aka Y, Kutuk O. CYP450 2D6 and 2C19 genotypes in ADHD: not related with treatment resistance but with over-representation of 2C19 ultra-metabolizers. Drug Metab Pers Ther 2022; 37:261-269. [PMID: 35218180 DOI: 10.1515/dmpt-2021-0163] [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: 07/18/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cytochrome P450 (CYP450) is a major enzyme system involved in drug metabolism as well as regulation of brain function. Although individual variability in CYP enzymes have been studied in terms of personality traits and treatment effects, no study up to now evaluated CYP polymorphisms in children with attention deficit/hyperactivity disorder (ADHD). We aimed to define the genetic profiles of CYP2D6 and CYP2C19 relevant alleles in children with ADHD according to treatment status and compare the frequencies according to past results. METHODS Three hundred and seventeen patients with ADHD-Combined Presentation were enrolled; symptom severity was evaluated by parents and clinicians while adverse effects of previous treatments were evaluated with parent and child reports. Reverse blotting on strip assays was used for genotyping and descriptive and bivariate analyses were conducted. A p-value was set at 0.05 (two-tailed). RESULTS Children were divided into treatment-naïve (n=194, 61.2%) and treatment-resistant (n=123, 38.8%) groups. Within the whole sample PM, EM and UM status according to 2D6 were 3.8% (n=12), 94.3% (n=299) and 21.9% (n=6); respectively. PM, IM, EM and UM status according to 2C19 were 2.5% (n=8), 19.8% (n=63), 48.6% (n=154) and 29.0% (n=92), respectively. No relationship with treatment resistance, comorbidity or gender could be found. Importantly, CYP2C19 UMs were significantly more frequent in ADHD patients compared to previous studies in the general population. CONCLUSIONS CYPs may be a rewarding avenue of research to elucidate the etiology and treatment of patients with ADHD.
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Affiliation(s)
- Meryem Ozlem Kutuk
- Department of Child and Adolescent Psychiatry, Baskent University School of Medicine, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University, School of Medicine, Bolu, Turkey
| | - Zehra Topal
- Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | | | - Gulen Guler
- Department of Child and Adolescent Psychiatry, Mersin University School of Medicine, Mersin, Turkey
| | - Bahriye Karakas
- Molecular Biology, Genetics and Bioengineering Program, Sabanci University, Istanbul, Turkey
| | - Huveyda Basaga
- Molecular Biology, Genetics and Bioengineering Program, Sabanci University, Istanbul, Turkey
| | - Fethiye Kilicaslan
- Department of Child and Adolescent Psychiatry, Harran University, Sanliurfa, Turkey
| | - Ebru Altintas
- Department of Psychiatry, Baskent University, Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Yeliz Aka
- Department of Immunology, Baskent University School of Medicine, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Ozgur Kutuk
- Department of Immunology, Baskent University School of Medicine, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
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In Vitro and In Vivo Effect of Xylopic Acid on Cytochrome P450 Enzymes. Adv Pharmacol Pharm Sci 2022; 2022:4524877. [PMID: 35098133 PMCID: PMC8799360 DOI: 10.1155/2022/4524877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Xylopic acid (XA), the major constituent of the fruit of Xylopia aethiopica, has shown several pharmacological properties. Traditionally, the plant is used to treat several diseases and is being used in the preparation of several local foods despite the lack of information about its safety, food-drug interaction, and other pharmacokinetic properties. This study, therefore, investigated the effect of XA on rat liver cytochrome P450 (CYP) enzymes in vivo and in vitro. Methods Inhibition or induction of some isoforms of CYP450 enzymes: CYP 1A1/1A2, 1A2, 2B1/2B2, 3A4, 2D6, and 2C9 were investigated using microsomal fractions of the liver obtained from rats pretreated with a low dose of xylopic acid (LDT) 30 mg/kg, high dose of xylopic acid (HDT) 100 mg/kg, phenobarbitone (PC) 80 mg/kg, and ketoconazole (NC) 100 mg/kg, and a no-treatment group received distilled water, with (n = 5) animals in each group. The in vitro inhibition of CYP 3A4 was assessed by treating rat liver microsomes with XA. Results Xylopic acid induced CYP 1A1/1A2, 1A2, 2D6, and 2C9, inhibited CYP 3A4, and had no effect on 2B1/2B2. Conclusion The findings would help mitigate toxicity and therapeutic failure especially in cases of coadministration of medications with food containing XA, with metabolism altered by the latter.
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Meta-analysis of probability estimates of worldwide variation of CYP2D6 and CYP2C19. Transl Psychiatry 2021; 11:141. [PMID: 33627619 PMCID: PMC7904867 DOI: 10.1038/s41398-020-01129-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 01/31/2023] Open
Abstract
Extensive migration has led to the necessity of knowledge regarding the treatment of migrants with different ethnical backgrounds. This is especially relevant for pharmacological treatment, because of the significant variation between migrant groups in their capacity to metabolize drugs. For psychiatric medications, CYP2D6 and CYP2C19 enzymes are clinically relevant. The aim of this meta-analysis was to analyze studies reporting clinically useful information regarding CYP2D6 and CYP2C19 genotype frequencies, across populations and ethnic groups worldwide. To that end, we conducted a comprehensive meta-analysis using Embase, PubMed, Web of Science, and PsycINFO (>336,000 subjects, 318 reports). A non-normal metabolizer (non-NM) probability estimate was introduced as the equivalent of the sum-prevalence of predicted poor, intermediate, and ultrarapid metabolizer CYP2D6 and CYP2C19 phenotypes. The probability of having a CYP2D6 non-NM predicted phenotype was highest in Algeria (61%) and lowest in Gambia (2.7%) while the probability for CYP2C19 was highest in India (80%) and lowest in countries in the Americas, particularly Mexico (32%). The mean total probability estimates of having a non-NM predicted phenotype worldwide were 36.4% and 61.9% for CYP2D6 and CYP2C19, respectively. We provide detailed tables and world maps summarizing clinically relevant data regarding the prevalence of CYP2D6 and CYP2C19 predicted phenotypes and demonstrating large inter-ethnic differences. Based on the documented probability estimates, pre-emptive pharmacogenetic testing is encouraged for every patient who will undergo therapy with a drug(s) that is metabolized by CYP2D6 and/or CYP2C19 pathways and should be considered in case of treatment resistance or serious side effects.
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David A, Fernandez A, Menard ML, Dor E, Leali G, Maria F, Cruzel C, Askenazy F, Verstuyft C, Thümmler S. [Pharmacoresistance to psychotropic drugs in children and adolescents: Pharmacogenetic anomalies of cytochrome P450 2D6]. Encephale 2021; 47:227-234. [PMID: 33551122 DOI: 10.1016/j.encep.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Some patients in child and adolescent psychiatry present resistance to psychotropic drugs, often resulting in polytherapy, an increased risk of adverse events, and more frequent and longer hospitalisation. Psychotropic drugs are mainly metabolised in the liver, in particular by the CYP2D6 subunit of cytochrome P450. Anomalies such as a duplication of the CYP2D6 gene related to an ultra-rapid metaboliser phenotype has been described to be linked to clinical efficacy. However, little research has been done in child and adolescent psychiatry. METHODS A multi-centric cross-sectional study in the southeast of France explored the relation between pharmaco-resistance to psychotropic drugs and the prevalence of duplications or polymorphisms of CYP2D6 associated with an ultra-rapid phenotype in children and adolescents with severe mental health disease. RESULTS Twenty-two patients have been included. The presence of an ultra-rapid phenotype concerns one patient in our study. A second patient presents a slow metaboliser phenotype. CONCLUSIONS This study allows a clinical characterisation of the population of pediatric drug-resistant patients whose severity and the impact of their pathology are major and require long-term care associated with repeated hospitalisations, multiple drug prescriptions and numerous side effects. However, a link between drug resistance to psychotropic drugs and CYP2D6 UFM abnormalities could not be confirmed. An additional pharmacogenetic analysis by a panel of genes applied in the metabolism, transport and action of psychotropic drugs should be considered to answer questions about the resistance and independent effects of CYP2D6.
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Affiliation(s)
- A David
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - A Fernandez
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - M-L Menard
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - E Dor
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - G Leali
- Service de psychiatrie de l'enfant, hôpitaux pédiatriques de Nice, CHU-Lenval, 06200 Nice, France
| | - F Maria
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - C Cruzel
- Délégation à la recherche clinique et à l'innovation, CHU de Nice, 06000 Nice, France
| | - F Askenazy
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - C Verstuyft
- Service de génétique moléculaire, pharmacogénétique et hormonologie, centre de ressource biologie Paris-Sud, hôpital Bicêtre, groupe hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France; Université Paris-Sud, CESP/UMR-S1178, Équipe "dépression et antidépresseurs", Faculté de médecine, Université Paris-Sud, Inserm, 78, rue Général-Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - S Thümmler
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France.
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Tafazoli A, Wawrusiewicz-Kurylonek N, Posmyk R, Miltyk W. Pharmacogenomics, How to Deal with Different Types of Variants in Next Generation Sequencing Data in the Personalized Medicine Area. J Clin Med 2020; 10:jcm10010034. [PMID: 33374421 PMCID: PMC7796098 DOI: 10.3390/jcm10010034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Pharmacogenomics (PGx) is the knowledge of diverse drug responses and effects in people, based on their genomic profiles. Such information is considered as one of the main directions to reach personalized medicine in future clinical practices. Since the start of applying next generation sequencing (NGS) methods in drug related clinical investigations, many common medicines found their genetic data for the related metabolizing/shipping proteins in the human body. Yet, the employing of technology is accompanied by big obtained data, which most of them have no clear guidelines for consideration in routine treatment decisions for patients. This review article talks about different types of NGS derived PGx variants in clinical studies and try to display the current and newly developed approaches to deal with pharmacogenetic data with/without clear guidelines for considering in clinical settings.
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Affiliation(s)
- Alireza Tafazoli
- Department of Analysis and Bioanalysis of Medicines, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Białystok, 15-089 Białystok, Poland;
- Clinical Research Centre, Medical University of Białystok, 15-276 Bialystok, Poland
| | | | - Renata Posmyk
- Department of Clinical Genetics, Medical University of Białystok, 15-089 Białystok, Poland; (N.W.-K.); (R.P.)
| | - Wojciech Miltyk
- Department of Analysis and Bioanalysis of Medicines, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Białystok, 15-089 Białystok, Poland;
- Correspondence: ; Tel.: +48-857485845
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Babayeva M, Loewy Z. Repurposing Drugs for COVID-19: Pharmacokinetics and Pharmacogenomics of Chloroquine and Hydroxychloroquine. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2020; 13:531-542. [PMID: 33122936 PMCID: PMC7591012 DOI: 10.2147/pgpm.s275964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
Background A new coronavirus SARS-CoV-2 has been identified as the etiological agent of the severe acute respiratory syndrome, COVID-19, the source and cause of the 2019–20 coronavirus pandemic. Hydroxychloroquine and chloroquine have gathered extraordinary attention as therapeutic candidates against SARS-CoV-2 infections. While there is growing scientific data on the therapeutic effect, there is also concern for toxicity of the medications. The therapy of COVID-19 by hydroxychloroquine and chloroquine is off-label. Studies to analyze the personalized effect and safety are lacking. Methods A review of the literature was performed using Medline/PubMed/Embase database. A variety of keywords were employed in keyword/title/abstract searches. The electronic search was followed by extensive hand searching using reference lists from the identified articles. Results A total of 126 results were obtained after screening all sources. Mechanisms underlying variability in drug concentrations and therapeutic response with chloroquine and hydroxychloroquine in mediating beneficial and adverse effects of chloroquine and hydroxychloroquine were reviewed and analyzed. Pharmacogenomic studies from various disease states were evaluated to elucidate the role of genetic variation in drug response and toxicity. Conclusion Knowledge of the pharmacokinetics and pharmacogenomics of chloroquine and hydroxychloroquine is necessary for effective and safe dosing and to avoid treatment failure and severe complications.
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Affiliation(s)
| | - Zvi Loewy
- Touro College of Pharmacy, New York, NY, USA.,New York Medical College, Valhalla, NY, USA
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David A, Fernandez A, Menard ML, Dor E, Dugand N, Verstuyft C, Askenazy F, Thümmler S. Pédopsychiatrie et pharmacogénétique : pharmacorésistance aux psychotropes et duplication du cytochrome P450 2D6, à propos de trois cas cliniques. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.neurenf.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Marazziti D, Avella MT, Basile L, Mucci F, Dell'Osso L. Pharmacokinetics of serotonergic drugs: focus on OCD. Expert Opin Drug Metab Toxicol 2019; 15:261-273. [PMID: 30793987 DOI: 10.1080/17425255.2019.1584611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Although the treatment of obsessive-compulsive disorder (OCD), a common, chronic, and disabling psychiatric condition, has significantly improved in the last decades, with the demonstration of the specific effectiveness of serotonin reuptake inhibitors (SRIs), a large proportion of patients still show high relapse rates. In addition, pharmacological treatments should be maintained for years, so that the clinicians should take into account the pharmacokinetic changes in the long-term, which may be responsible for dangerous side effects or interactions. Areas covered: The aim of this paper was to review the literature on the pharmacokinetics of SSRIs and clomipramine, and on their pharmacokinetic parameters in OCD patients. Expert opinion: Although the literature on the pharmacokinetics of both clomipramine and SSRIs is consistent, data on pharmacokinetic parameters in OCD patients are very few. Given the impact of OCD, its chronicity requiring long-term treatments, together with the need to increase the clinical response rate, more studies in this field are urgently required.
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Affiliation(s)
- Donatella Marazziti
- a Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Maria Teresa Avella
- a Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Lucia Basile
- a Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Federico Mucci
- a Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Liliana Dell'Osso
- a Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry , University of Pisa , Pisa , Italy
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12
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Pharmacorésistance aux psychotropes et anomalies pharmacogénétiques du cytochrome P450 2D6 : vers une médecine personnalisée en pédopsychiatrie, présentation d’un protocole de recherche. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.neurenf.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Lam YWF. Principles of Pharmacogenomics. Pharmacogenomics 2019. [DOI: 10.1016/b978-0-12-812626-4.00001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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14
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Pharmacogenomics in Psychiatric Disorders. Pharmacogenomics 2019. [DOI: 10.1016/b978-0-12-812626-4.00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Jarvis JP, Peter AP, Shaman JA. Consequences of CYP2D6 Copy-Number Variation for Pharmacogenomics in Psychiatry. Front Psychiatry 2019; 10:432. [PMID: 31281270 PMCID: PMC6595891 DOI: 10.3389/fpsyt.2019.00432] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022] Open
Abstract
Pharmacogenomics represents a potentially powerful enhancement to the current standard of care for psychiatric patients. However, a variety of biological and technical challenges must be addressed in order to provide adequate clinical decision support for personalized prescribing and dosing based on genomic data. This is particularly true in the case of CYP2D6, a key drug-metabolizing gene, which not only harbors multiple genetic variants known to affect enzyme function but also shows a broad range of copy-number and hybrid alleles in various patient populations. Here, we describe several challenges in the accurate measurement and interpretation of data from the CYP2D6 locus including the clinical consequences of increased copy number. We discuss best practices for overcoming these challenges and then explore various current and future applications of pharmacogenomic analysis of CYP2D6 in psychiatry.
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16
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Naranjo MEG, Rodrigues-Soares F, Peñas-Lledó EM, Tarazona-Santos E, Fariñas H, Rodeiro I, Terán E, Grazina M, Moya GE, López-López M, Sarmiento AP, Calzadilla LR, Ramírez-Roa R, Ortiz-López R, Estévez-Carrizo FE, Sosa-Macías M, Barrantes R, LLerena A. Interethnic Variability in CYP2D6, CYP2C9, and CYP2C19 Genes and Predicted Drug Metabolism Phenotypes Among 6060 Ibero- and Native Americans: RIBEF-CEIBA Consortium Report on Population Pharmacogenomics. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2018; 22:575-588. [PMID: 30183544 DOI: 10.1089/omi.2018.0114] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pharmacogenetic variation in Latin Americans is understudied, which sets a barrier for the goal of global precision medicine. The RIBEF-CEIBA Network Consortium was established to characterize interindividual and between population variations in CYP2D6, CYP2C9, and CYP2C19 drug metabolizing enzyme genotypes, which were subsequently utilized to catalog their "predicted drug metabolism phenotypes" across Native American and Ibero American populations. Importantly, we report in this study, a total of 6060 healthy individuals from Ibero-America who were classified according to their self-reported ancestry: 1395 Native Americans, 2571 Admixed Latin Americans, 96 Afro-Latin Americans, 287 white Latin Americans (from Cuba), 1537 Iberians, and 174 Argentinean Ashkenazi Jews. Moreover, Native Americans were grouped into North-, Central-, and South Amerindians (from Mexico, Costa Rica, and Peru, respectively). All subjects were studied for the most common and functional CYP2D6, CYP2C9, and CYP2C19 allelic variants, and grouped as genotype-predicted poor or ultrarapid metabolizer phenotypes (gPMs and gUMs, respectively). Native Americans showed differences from each ethnic group in at least two alleles of CYP2D6, CYP2C9, and CYP2C19. Native Americans had higher frequencies of wild-type alleles for all genes, and lower frequency of CYP2D6*41, CYP2C9*2, and CYP2C19*17 (p < 0.05). Native Americans also showed less CYP2C19 gUMs than the rest of the population sample. In addition, differences within Native Americans (mostly North vs. South) were also found. The interethnic differences described supports the need for population-specific personalized and precision medicine programs for Native Americans. To the best of our knowledge, this is the largest study carried out in Native Americans and other Ibero-American populations analyzing CYP2D6, CYP2C9, and CYP2C19 genetic polymorphisms. Population pharmacogenomics is a nascent field of global health and warrants further research and education.
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Affiliation(s)
- María-Eugenia G Naranjo
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
| | - Fernanda Rodrigues-Soares
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,3 Universidade Federal de Minas Gerais , Belo Horizonte, Brazil .,4 Faculdade Uninassau , Manaus, Brazil
| | - Eva M Peñas-Lledó
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
| | - Eduardo Tarazona-Santos
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,3 Universidade Federal de Minas Gerais , Belo Horizonte, Brazil .,5 PRISMA , Lima, Peru
| | - Humberto Fariñas
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
| | - Idania Rodeiro
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,6 Instituto de Ciencias del Mar , La Habana, Cuba
| | - Enrique Terán
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,7 Universidad San Francisco de Quito , Quito, Ecuador
| | - Manuela Grazina
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,8 UC, CNC-Center for Neuroscience and Cell Biology, FMUC-Faculty of Medicine, University of Coimbra , Coimbra, Portugal
| | - Graciela E Moya
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,9 Universidad Católica de Argentina , Buenos Aires, Argentina
| | - Marisol López-López
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,10 Universidad Autónoma Metropolitana , Ciudad de México, Mexico
| | - Alba P Sarmiento
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,11 Pontifica Universidad Javeriana , Bogotá, Colombia
| | - Luis R Calzadilla
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,12 Centro Comunitario de SaludMental de la Habana Vieja, La Habana, Cuba
| | - Ronald Ramírez-Roa
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,13 Universidad Nacional Autónoma de Nicaragua , León, Nicaragua
| | - Rocío Ortiz-López
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,14 Tecnológico de Monterrey , Monterrey, Mexico
| | - Francisco E Estévez-Carrizo
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,15 Universidad de Montevideo , Montevideo, Uruguay
| | - Martha Sosa-Macías
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,16 Instituto Politécnico Nacional , Durango, Mexico
| | - Ramiro Barrantes
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,17 Universidad de Costa Rica , San José, Costa Rica
| | - Adrián LLerena
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
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17
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Genetic Factors Associated with Postoperative Nausea and Vomiting: a Systematic Review. J Gastrointest Surg 2018; 22:1645-1651. [PMID: 29725907 DOI: 10.1007/s11605-018-3788-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/16/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND In previous studies, there seems to be a relationship between different genetic polymorphisms and postoperative nausea and vomiting (PONV). We perform a systematic review of the current literature about the relationship between genetic polymorphisms and the presence of PONV. METHODS Two bibliographic searches were carried out in three databases (PubMed, Web of Science, and Scopus) of studies, preferably prospective, about PONV following abdominal surgery. It was completed with a backward citation searching. A total of 73 articles were found of which 6 were selected after their critical lecture using CASPe network criteria. Relative frequency and relative risk were taken in each study according to the polymorphism. RESULTS Studies about 5-HT3B gene receptor polymorphisms, ABCB1 transporter, and dopamine D2 receptor showed a significant association with the presence of PONV (p = 0.02, 0.01, and 0.034 respectively). In relation to cytochrome P-450 2D6 (CYP2D6) polymorphisms, two of the three analysed articles showed a significant association with postoperative vomiting (p = 0.007). CONCLUSION Genetic polymorphisms could play an important role in PONV. The AAG deletion in both alleles of the 5-HT3B receptor gene, the Taq IA polymorphism of the dopamine D2 receptor, and the presence of three or more functional alleles of CYP2D6 seem to be related with a higher incidence of PONV, especially in the first 24 h after surgery. The 2677TT and 3435TT genotypes of the ABCB1 transporter could reduce the PONV due to their association with a greater effectiveness of ondansetron. However, new quality studies are needed to consider this relationship.
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18
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Dong AN, Tan BH, Pan Y, Ong CE. Cytochrome P450 genotype-guided drug therapies: An update on current states. Clin Exp Pharmacol Physiol 2018; 45:991-1001. [PMID: 29858511 DOI: 10.1111/1440-1681.12978] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 01/07/2023]
Abstract
Over the past 2 decades, knowledge of the role and clinical value of pharmacogenetic markers has expanded so that individualized pre-emptive therapy based on genetic background of patients could be within reach for clinical implementation. This is evidenced from the frequent updating of drug labels that incorporates pharmacogenetic information (where compelling data become available) by the regulatory agencies (such as the US FDA), and the periodical publication of guidelines of specific therapeutic recommendations based on the results of pharmacogenetic tests by the pharmacogenetics working groups or consortiums of professional bodies. Clinical relevance of the cytochrome P450 (CYP) polymorphism related to dose, effectiveness and/or toxicity of key drugs are presented in this review, including that of warfarin, clopidogrel, tricyclic antidepressants, and proton pump inhibitors. Prospect for routine clinical application of CYP genotyping before prescribing drugs is still currently unclear due to challenges and barriers associated with availability of well-defined and validated pharmacogenetic studies, the interpretation, result reporting and potential error of genotype testing, involvement of non-genetic factors, and other patient's demographic and disease conditions. Further studies to provide additional supporting clinical data and acceleration of pharmacogenetic testing standards and techniques should help improve the evidence base needed for clinical utility and hence move the implementation of genotype-guided therapy in clinical practice a step closer to reality.
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Affiliation(s)
- Amelia Nathania Dong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Boon Hooi Tan
- Division of Applied Biomedical Sciences and Biotechnology, International Medical University, Kuala Lumpur, Malaysia
| | - Yan Pan
- Department of Biomedical Science, University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia
| | - Chin Eng Ong
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
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19
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Koopmans AB, Vinkers DJ, Poulina IT, Gelan PJA, van Schaik RHN, Hoek HW, van Harten PN. No Effect of Dose Adjustment to the CYP2D6 Genotype in Patients With Severe Mental Illness. Front Psychiatry 2018; 9:349. [PMID: 30131727 PMCID: PMC6090167 DOI: 10.3389/fpsyt.2018.00349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background: The CYP2D6 enzyme is involved in the metabolism of numerous psychopharmacological drugs. Guidelines recommend how to adjust the dose of medication based on the CYP2D6 genotype. Aims: To evaluate the effect of dose adjustment to the CYP2D6 genotype and phenotype, in patients with severe mental illness (SMI) already receiving psychopharmacological treatment. Methods: A total of 269 psychiatric patients (on the island Curaçao) receiving antipsychotic treatment were genotyped for CYP2D6. Of these, 45 patients were included for dose adjustment according to the clinical guideline of the Royal Dutch Association for the Advancement of Pharmacy, i.e., 17 CYP2D6 poor metabolizers, 26 intermediate metabolizers, and 2 ultrarapid metabolizers. These 45 patients were matched for age, gender, and type of medication with a control group of 41 patients who were CYP2D6 extensive metabolizers (i.e., with a normal CYP2D6 function). At baseline and at 4 months after dose adjustment, subjective experience, psychopathology, extrapyramidal side-effects, quality of life, and global functioning were assessed in these two groups. Results: At baseline, there were no differences between the groups regarding the prescribed dosage of antipsychotics, the number of side-effects, psychiatric symptoms, global functioning, or quality of life. After dose adjustment, no significant improvement in these parameters was reported. Conclusion: In psychiatric patients with SMI already receiving antipsychotic treatment, dose adjustment to the CYP2D6 genotype or phenotype according to the guidelines showed no beneficial effect. This suggests that dose adjustment guidelines are currently not applicable for patients already using antipsychotics. ClinicalTrials.gov: Cost-effectiveness of CYP2D6 and CYP2C19 Genotyping in Psychiatric Patients in Curacao; Identifier: NCT02713672; https://clinicaltrials.gov/ct2/show/NCT02713672?term=CYP2D6&rank=5.
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Affiliation(s)
- Anne B Koopmans
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - David J Vinkers
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Igmar T Poulina
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hans W Hoek
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Peter N van Harten
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Innova, Psychiatric Centre GGz Centraal, Amersfoort, Netherlands
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20
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Zhou Y, Ingelman-Sundberg M, Lauschke VM. Worldwide Distribution of Cytochrome P450 Alleles: A Meta-analysis of Population-scale Sequencing Projects. Clin Pharmacol Ther 2017; 102:688-700. [PMID: 28378927 PMCID: PMC5600063 DOI: 10.1002/cpt.690] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/28/2017] [Accepted: 03/11/2017] [Indexed: 12/23/2022]
Abstract
Genetic polymorphisms in cytochrome P450 (CYP) genes can result in altered metabolic activity toward a plethora of clinically important medications. Thus, single nucleotide variants and copy number variations in CYP genes are major determinants of drug pharmacokinetics and toxicity and constitute pharmacogenetic biomarkers for drug dosing, efficacy, and safety. Strikingly, the distribution of CYP alleles differs considerably between populations with important implications for personalized drug therapy and healthcare programs. To provide a global distribution map of CYP alleles with clinical importance, we integrated whole‐genome and exome sequencing data from 56,945 unrelated individuals of five major human populations. By combining this dataset with population‐specific linkage information, we derive the frequencies of 176 CYP haplotypes, providing an extensive resource for major genetic determinants of drug metabolism. Furthermore, we aggregated this dataset into spectra of predicted functional variability in the respective populations and discuss the implications for population‐adjusted pharmacological treatment strategies.
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Affiliation(s)
- Y Zhou
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, Stockholm, Sweden
| | - M Ingelman-Sundberg
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, Stockholm, Sweden
| | - V M Lauschke
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, Stockholm, Sweden
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21
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Taranu A, Colle R, Gressier F, El Asmar K, Becquemont L, Corruble E, Verstuyft C. Should a routine genotyping of CYP2D6 and CYP2C19 genetic polymorphisms be recommended to predict venlafaxine efficacy in depressed patients treated in psychiatric settings? Pharmacogenomics 2017; 18:639-650. [PMID: 28480819 DOI: 10.2217/pgs-2017-0003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM The antidepressant venlafaxine (VEN) is metabolized by CYP2D6 and CYP2C19. The aim of this study was to assess the relevance of generalizing to daily practice the genotyping of CYP2D6 and CYP2C19 to predict VEN efficacy in depressed patients treated in psychiatric settings. PATIENTS & METHODS This study was nested in a naturalistic cohort, with 206 patients requiring a new antidepressant treatment and genotyped for CYP2D6 *3, *4, *5 del, *6, *2xN, *10, *41 and CYP2C19 *2, *3, *4, *5, *17 alleles. RESULTS CYP2D6 and CYP2C19 phenotypes were associated neither with the Hamilton depression rating scale score improvement, nor with response and remission. CONCLUSION Routine CYP2D6 and CYP2C19 genotyping cannot be recommended to predict VEN efficacy in depressed patients treated in psychiatry settings.
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Affiliation(s)
- Adela Taranu
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France
| | - Romain Colle
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Psychiatrie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Florence Gressier
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Psychiatrie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Khalil El Asmar
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France
| | - Laurent Becquemont
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Centre de Recherche Clinique (CRC), Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Emmanuelle Corruble
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Psychiatrie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Céline Verstuyft
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France.,Centre de Ressources Biologiques, CRB Paris-Sud, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
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22
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Hicks JK, Sangkuhl K, Swen JJ, Ellingrod VL, Müller DJ, Shimoda K, Bishop JR, Kharasch ED, Skaar TC, Gaedigk A, Dunnenberger HM, Klein TE, Caudle KE, Stingl JC. Clinical pharmacogenetics implementation consortium guideline (CPIC) for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants: 2016 update. Clin Pharmacol Ther 2017; 102:37-44. [PMID: 27997040 DOI: 10.1002/cpt.597] [Citation(s) in RCA: 388] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/21/2016] [Accepted: 12/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
- J K Hicks
- DeBartolo Family Personalized Medicine Institute, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - K Sangkuhl
- Department of Genetics, Stanford University, Stanford, California, USA
| | - J J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - V L Ellingrod
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, and Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - D J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - K Shimoda
- Department of Psychiatry, Dokkyo Medical University, Japan
| | - J R Bishop
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, and Department of Psychiatry, College of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - E D Kharasch
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University in St, Louis, St, Louis, Missouri, USA
| | - T C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - A Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy, Kansas City, Missouri and Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - H M Dunnenberger
- Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - T E Klein
- Department of Genetics, Stanford University, Stanford, California, USA
| | - K E Caudle
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - J C Stingl
- Division of Research, Federal Institute of Drugs and Medical Devices, Bonn, Germany
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23
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Pharmacogenetics and Imaging-Pharmacogenetics of Antidepressant Response: Towards Translational Strategies. CNS Drugs 2016; 30:1169-1189. [PMID: 27752945 DOI: 10.1007/s40263-016-0385-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Genetic variation underlies both the response to antidepressant treatment and the occurrence of side effects. Over the past two decades, a number of pharmacogenetic variants, among these the SCL6A4, BDNF, FKBP5, GNB3, GRIK4, and ABCB1 genes, have come to the forefront in this regard. However, small effects sizes, mixed results in independent samples, and conflicting meta-analyses results led to inherent difficulties in the field of pharmacogenetics translating these findings into clinical practice. Nearly all antidepressant pharmacogenetic variants have potentially pleiotropic effects in which they are associated with major depressive disorder, intermediate phenotypes involved in emotional processes, and brain areas affected by antidepressant treatment. The purpose of this article is to provide a comprehensive review of the advances made in the field of pharmacogenetics of antidepressant efficacy and side effects, imaging findings of antidepressant response, and the latest results in the expanding field of imaging-pharmacogenetics studies. We suggest there is mounting evidence that genetic factors exert their impact on treatment response by influencing brain structural and functional changes during antidepressant treatment, and combining neuroimaging and genetic methods may be a more powerful way to detect biological mechanisms of response than either method alone. The most promising imaging-pharmacogenetics findings exist for the SCL6A4 gene, with converging associations with antidepressant response, frontolimbic predictors of affective symptoms, and normalization of frontolimbic activity following antidepressant treatment. More research is required before imaging-pharmacogenetics informed personalized medicine can be applied to antidepressant treatment; nevertheless, inroads have been made towards assessing genetic and neuroanatomical liability and potential clinical application.
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24
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Panza F, Lozupone M, Stella E, Miscio G, La Montagna M, Daniele A, di Mauro L, Bellomo A, Logroscino G, Greco A, Seripa D. The pharmacogenetic road to avoid adverse drug reactions and therapeutic failures in revolving door patients with psychiatric illnesses: focus on the CYP2D6 isoenzymes. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1232148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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25
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Stephens DB, de Leon J. CYP2D6 ultra-rapid metabolizer phenotype not associated with attempted suicide in a large sample of psychiatric inpatients. Pharmacogenomics 2016; 17:1295-304. [PMID: 27463022 DOI: 10.2217/pgs-2016-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Suicide accounts for over 800,000 deaths per year worldwide and is the tenth-leading cause of mortality in USA. Several studies have investigated cytochrome P450 CYP2D6 ultra-rapid metabolizer (UM) phenotype in relation to suicidality, with mixed results. This study tested the hypothesis of increased suicide risk among CYP2D6 UMs. PATIENTS & METHODS Among the 4264 state psychiatric hospital inpatients included, 2435 (57%) reported a prior suicide attempt. RESULTS No association between UM status and attempted suicide was observed in bivariate (odds ratio: 0.87; 95% CI: 0.53-1.25), multivariate (adjusted odds ratio: 0.89; 95% CI: 0.55-1.46), or risk-stratified analyses. CONCLUSION These results contrast with prior reports of increased suicidality among CYP2D6 UMs and highlight the pressing need to identify reliable screening methods to better address this persistent public health problem.
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Affiliation(s)
- Dustin B Stephens
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jose de Leon
- Department of Psychiatry, University of Kentucky College of Medicine, Lexington, KY, USA
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Panza F, Lozupone M, Stella E, Lofano L, Gravina C, Urbano M, Daniele A, Bellomo A, Logroscino G, Greco A, Seripa D. Psychiatry meets pharmacogenetics for the treatment of revolving door patients with psychiatric disorders. Expert Rev Neurother 2016; 16:1357-1369. [DOI: 10.1080/14737175.2016.1204913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Francesco Panza
- a Geriatric Unit and Geriatric Research Laboratory, Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza , Foggia , Italy.,b Neurodegenerative Diseases Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,c Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology , University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico" , Lecce , Italy
| | - Madia Lozupone
- b Neurodegenerative Diseases Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,d Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Eleonora Stella
- d Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Lucia Lofano
- e Psychiatric Unit, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy
| | - Carolina Gravina
- a Geriatric Unit and Geriatric Research Laboratory, Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza , Foggia , Italy
| | - Maria Urbano
- a Geriatric Unit and Geriatric Research Laboratory, Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza , Foggia , Italy
| | - Antonio Daniele
- f Institute of Neurology , Catholic University of Sacred Heart , Rome , Italy
| | - Antonello Bellomo
- d Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Giancarlo Logroscino
- b Neurodegenerative Diseases Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,c Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology , University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico" , Lecce , Italy
| | - Antonio Greco
- a Geriatric Unit and Geriatric Research Laboratory, Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza , Foggia , Italy
| | - Davide Seripa
- a Geriatric Unit and Geriatric Research Laboratory, Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza , Foggia , Italy
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Fabbri C, Crisafulli C, Calabrò M, Spina E, Serretti A. Progress and prospects in pharmacogenetics of antidepressant drugs. Expert Opin Drug Metab Toxicol 2016; 12:1157-68. [DOI: 10.1080/17425255.2016.1202237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Concetta Crisafulli
- Department of Biomedical Science, Odontoiatric and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Marco Calabrò
- Department of Biomedical Science, Odontoiatric and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Biomedical Science, Odontoiatric and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
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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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29
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Andersen RL, Johnson DJ, Patel JN. Personalizing supportive care in oncology patients using pharmacogenetic-driven treatment pathways. Pharmacogenomics 2016; 17:417-34. [PMID: 26871520 DOI: 10.2217/pgs.15.178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cancer patients frequently suffer from disease- and treatment-related pain, nausea and depression, which severely reduces patients' quality of life. It is critical that clinicians are aware of drug-gene interactions and recognize the utility of applying pharmacogenetic information to personalize and improve supportive care. Pharmacogenetic-based algorithms may enhance clinical outcomes by allowing the clinician to select the 'least genetically vulnerable' drug. This review summarizes clinically relevant drug-gene interactions and presents pharmacogenetic-driven treatment pathways for depression, nausea/vomiting and pain. Ideally, this review provides a resource for clinicians to consult when selecting pharmacotherapy for a patient who presents with limited pharmacogenetic test results, with the hope of better controlling burdensome symptoms and improving the quality of life for cancer patients.
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Affiliation(s)
- Rebecca L Andersen
- Wingate University School of Pharmacy, 515 N Main St, Wingate, NC 28174, USA
| | - Daniel J Johnson
- University of North Carolina Eshelman School of Pharmacy, CB #7355, Chapel Hill, NC 27599, USA
| | - Jai N Patel
- University of North Carolina Eshelman School of Pharmacy, CB #7355, Chapel Hill, NC 27599, USA.,Levine Cancer Institute, Carolinas HealthCare System, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA
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30
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Fabbri C, Serretti A. Pharmacogenetics of major depressive disorder: top genes and pathways toward clinical applications. Curr Psychiatry Rep 2015; 17:50. [PMID: 25980509 DOI: 10.1007/s11920-015-0594-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The pharmacogenetics of antidepressants has been not only a challenging but also frustrating research field since its birth in the 1990s. Indeed, great expectations followed the first evidence of familiar aggregation of antidepressant response. Despite the progress from candidate gene studies to genome-wide association studies (GWAS), results fell out the expectations and they were often inconsistent. Anyway, the cumulative evidence supports the involvement of some genes and molecular pathways in antidepressant efficacy. The best single genes are SLC6A4, HTR2A, BDNF, GNB3, FKBP5, ABCB1, and cytochrome P450 genes (CYP2D6 and CYP2C19). Molecular pathways involved in inflammation and neuroplasticity show the greatest support. The first studies evaluating benefits of genotype-guided antidepressant treatments provided encouraging results and confirmed the relevance of SLC6A4, HTR2A, ABCB1, and cytochrome P450 genes. Further progress in genotyping and data analysis would allow to move forward and complete the understanding of antidepressant pharmacogenetics and its translation into clinical applications.
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Affiliation(s)
- Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123, Bologna, Italy,
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31
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Rodieux F, Piguet V, Berney P, Desmeules J, Besson M. Pharmacogenetics and analgesic effects of antidepressants in chronic pain management. Per Med 2015; 12:163-175. [DOI: 10.2217/pme.14.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Antidepressants are widely administered to chronic pain patients, but there is large interindividual variability in their efficacy and adverse effect rates that may be attributed to genetic factors. Studies have attempted to determine the impact of genetic polymorphisms in enzymes and transporters that are involved in antidepressant pharmacokinetics, for example, cytochrome P450 and P-gp. The impacts of genetic polymorphisms in the targets of antidepressants, such as the serotonin receptor or transporter, the noradrenaline transporter and the COMT and monoamine oxydase enzymes, have also been described. This manuscript discusses the current knowledge of the influence of genetic factors on the plasma concentrations, efficacy and adverse effects of the major antidepressants used in pain management.
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Affiliation(s)
- Frédérique Rodieux
- Clinical Pharmacology & Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Valérie Piguet
- Clinical Pharmacology & Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Patricia Berney
- Clinical Pharmacology & Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Jules Desmeules
- Clinical Pharmacology & Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Marie Besson
- Clinical Pharmacology & Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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32
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Spina E, de Leon J. Clinical applications of CYP genotyping in psychiatry. J Neural Transm (Vienna) 2014; 122:5-28. [DOI: 10.1007/s00702-014-1300-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/18/2014] [Indexed: 12/13/2022]
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Peñas-Lledó E, Guillaume S, Naranjo MEG, Delgado A, Jaussent I, Blasco-Fontecilla H, Courtet P, LLerena A. A combined high CYP2D6-CYP2C19 metabolic capacity is associated with the severity of suicide attempt as measured by objective circumstances. THE PHARMACOGENOMICS JOURNAL 2014; 15:172-6. [PMID: 25113522 DOI: 10.1038/tpj.2014.42] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/10/2014] [Accepted: 06/18/2014] [Indexed: 12/18/2022]
Abstract
This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort. Survivors of a suicide attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS). Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe suicide attempt (P<0.01) as measured by the SIS-objective circumstance subscale (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.05-1.78; P=0.02) after adjusting for confounders (gender, age, level of studies, marital status, mental disorders, tobacco use, family history of suicide, personal history of attempts and violence of the attempt). Importantly, the risk was greater in those without a family history of suicide (OR=1.82; CI=1.19-2.77; P=0.002). Further research is warranted to evaluate whether the observed relationship is mediated by the role of CYP2D6 and CYP2C19 involvement in the endogenous physiology or drug metabolism or both.
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Affiliation(s)
- E Peñas-Lledó
- CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - S Guillaume
- 1] CHU Montpellier, Hôpital Lapeyronie, Psychiatric Emergency and Post Emergency Department, Pole Urgence, Montpellier, France [2] Inserm, U1061 Montpellier, France [3] Université Montpellier I, Montpellier, France
| | - M E G Naranjo
- CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - A Delgado
- CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - I Jaussent
- 1] Inserm, U1061 Montpellier, France [2] Université Montpellier I, Montpellier, France
| | - H Blasco-Fontecilla
- 1] Department of Psychiatry, IDIPHIM-Puerta de Hierro Hospital, Madrid, Spain [2] CIBERSAM, Instituto de Salud Carlos III, Spain
| | - P Courtet
- 1] CHU Montpellier, Hôpital Lapeyronie, Psychiatric Emergency and Post Emergency Department, Pole Urgence, Montpellier, France [2] Inserm, U1061 Montpellier, France [3] Université Montpellier I, Montpellier, France
| | - A LLerena
- 1] CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain [2] CIBERSAM, Instituto de Salud Carlos III, Spain
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O'Leary OF, O'Brien FE, O'Connor RM, Cryan JF. Drugs, genes and the blues: Pharmacogenetics of the antidepressant response from mouse to man. Pharmacol Biochem Behav 2014; 123:55-76. [DOI: 10.1016/j.pbb.2013.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/04/2013] [Accepted: 10/16/2013] [Indexed: 12/11/2022]
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35
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Response to CYP2D6 substrate antidepressants is predicted by a CYP2D6 composite phenotype based on genotype and comedications with CYP2D6 inhibitors. J Neural Transm (Vienna) 2014; 122:35-42. [DOI: 10.1007/s00702-014-1273-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
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36
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Salloum NC, McCarthy MJ, Leckband SG, Kelsoe JR. Towards the clinical implementation of pharmacogenetics in bipolar disorder. BMC Med 2014; 12:90. [PMID: 24885933 PMCID: PMC4039055 DOI: 10.1186/1741-7015-12-90] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/29/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a psychiatric illness defined by pathological alterations between the mood states of mania and depression, causing disability, imposing healthcare costs and elevating the risk of suicide. Although effective treatments for BD exist, variability in outcomes leads to a large number of treatment failures, typically followed by a trial and error process of medication switches that can take years. Pharmacogenetic testing (PGT), by tailoring drug choice to an individual, may personalize and expedite treatment so as to identify more rapidly medications well suited to individual BD patients. DISCUSSION A number of associations have been made in BD between medication response phenotypes and specific genetic markers. However, to date clinical adoption of PGT has been limited, often citing questions that must be answered before it can be widely utilized. These include: What are the requirements of supporting evidence? How large is a clinically relevant effect? What degree of specificity and sensitivity are required? Does a given marker influence decision making and have clinical utility? In many cases, the answers to these questions remain unknown, and ultimately, the question of whether PGT is valid and useful must be determined empirically. Towards this aim, we have reviewed the literature and selected drug-genotype associations with the strongest evidence for utility in BD. SUMMARY Based upon these findings, we propose a preliminary panel for use in PGT, and a method by which the results of a PGT panel can be integrated for clinical interpretation. Finally, we argue that based on the sufficiency of accumulated evidence, PGT implementation studies are now warranted. We propose and discuss the design for a randomized clinical trial to test the use of PGT in the treatment of BD.
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Affiliation(s)
| | | | | | - John R Kelsoe
- Department of Psychiatry (0603), University of California San Diego, La Jolla, CA 92093, USA.
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Abstract
BACKGROUND There is wide variation in antidepressant efficacy and tolerability during the treatment of major depressive disorder, a brain disease associated with significant morbidity and mortality risk. The ability to rapidly identify optimal treatment, thereby shortening the time to symptomatic remission, could reduce these risks and associated costs. CONTENT Up to 42% of variance in antidepressant response is associated with common genetic variation, and there are over 10 psychotropic medications for which the US Food and Drug Administration-approved labeling reflects a genetic test. Most published studies have examined functional variations in genes of the cytochrome p450 system, relevant to metabolism of many antidepressants. However, there are few data supporting the clinical usefulness of specific pharmacogenetic tests. Randomized trials and cost-effectiveness studies are emerging, but larger-scale studies are needed. Specific challenges in translating genetic association results to clinical practice include need for replication to address risk of type I error, overestimation of effect sizes, absence of data from generalizable cohorts, and absence of comparative data that would suggest one specific intervention over another. Several opportunities to accelerate development and validation of new tools for stratification remain, including integration of these tests with clinical data or other biomarkers and application of electronic health records for test development and investigation. SUMMARY Although common genetic variation, particularly in genes of the cytochrome p450 system, has been associated with antidepressant response, evidence that this variation may be successfully applied to guide treatment selection is just emerging. Larger-scale studies facilitated by informatics tools will clarify the usefulness of such tests.
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Affiliation(s)
- Roy H Perlis
- Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Boston, MA
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Altar CA, Hornberger J, Shewade A, Cruz V, Garrison J, Mrazek D. Clinical validity of cytochrome P450 metabolism and serotonin gene variants in psychiatric pharmacotherapy. Int Rev Psychiatry 2013; 25:509-33. [PMID: 24151799 DOI: 10.3109/09540261.2013.825579] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adverse events, response failures and medication non-compliance are common in patients receiving medications for the treatment of mental illnesses. A systematic literature review assessed whether pharmacokinetic (PK) or pharmacodynamic (PD) responses to 26 commonly prescribed antipsychotic and antidepressant medications, including efficacy or side effects, are associated with nucleotide polymorphisms in eight commonly studied genes in psychiatric pharmacotherapy: CYP2D6, CYP2C19, CYP2C9, CYP1A2, CYP3A4, HTR2C, HTR2A, and SLC6A4. Of the 294 publications included in this review, 168 (57%) showed significant associations between gene variants and PK or PD outcomes. Other studies that showed no association often had insufficient control for confounding variables, such as co-medication use, or analysis of medications not substrates of the target gene. The strongest gene-outcome associations were for the PK profiles of CYP2C19 and CYP2D6 (93% and 90%, respectively), for the PD associations between HTR2C and weight gain (57%), and for SLC6A4 and clinical response (54%), with stronger SLC6A4 response associations for specific drug classes (60-83%). The preponderance of evidence supports the validity of analyzing nucleotide polymorphisms in CYP and pharmacodynamic genes to predict the metabolism, safety, or therapeutic efficacy of psychotropic medications commonly used for the treatment of depression, schizophrenia, and bipolar illness.
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Han KM, Chang HS, Choi IK, Ham BJ, Lee MS. CYP2D6 P34S Polymorphism and Outcomes of Escitalopram Treatment in Koreans with Major Depression. Psychiatry Investig 2013; 10:286-93. [PMID: 24302953 PMCID: PMC3843022 DOI: 10.4306/pi.2013.10.3.286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/19/2012] [Accepted: 01/05/2013] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Cytochrome P450 (CYP) enzymatic activity, which is influenced by CYP genetic polymorphism, is known to affect the inter-individual variation in the efficacy and tolerability of antidepressants in major depressive disorder (MDD). Escitalopram is metabolized by CYP2D6, and recent studies have reported a correlation between clinical outcomes and CYP2D6 genetic polymorphism. The purpose of this study was to determine the relationship between the CYP2D6 P34S polymorphism (C188T, rs1065852) and the efficacy of escitalopram treatment in Korean patients with MDD. METHODS A total of 94 patients diagnosed with MDD were recruited for the study and their symptoms were evaluated using the 21-item Hamilton Depression Rating scale (HAMD-21). The association between the CYP2D6 P34S polymorphism and the clinical outcomes (remission and response) was investigated after 1, 2, 4, 8, and 12 weeks of escitalopram treatment using multiple logistic regression analysis and χ(2) test. RESULTS The proportion of P allele carriers (PP, PS) in remission status was greater than that of S allele homozygotes (SS) after 8 and 12 weeks of escitalopram treatment. Similarly, P allele carriers exhibited a greater treatment response after 8 and 12 weeks of escitalopram treatment than S allele homozygotes. CONCLUSION Our results suggest that the P allele of the CYP2D6 P34S polymorphism is a favorable factor in escitalopram treatment for MDD, and that the CYP2D6 P34S polymorphism may be a good genetic marker for predicting escitalopram treatment outcomes.
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Affiliation(s)
- Kyu-Man Han
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
- Pharmacogenetic Research Center for Psychotropic Drugs, Korea University, Seoul, Republic of Korea
| | - Hun Soo Chang
- Pharmacogenetic Research Center for Psychotropic Drugs, Korea University, Seoul, Republic of Korea
| | - In-Kwang Choi
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
- Pharmacogenetic Research Center for Psychotropic Drugs, Korea University, Seoul, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
- Pharmacogenetic Research Center for Psychotropic Drugs, Korea University, Seoul, Republic of Korea
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
- Pharmacogenetic Research Center for Psychotropic Drugs, Korea University, Seoul, Republic of Korea
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40
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The impact of Cytochrome P450 CYP1A2, CYP2C9, CYP2C19 and CYP2D6 genes on suicide attempt and suicide risk-a European multicentre study on treatment-resistant major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2013; 263:385-91. [PMID: 23081704 DOI: 10.1007/s00406-012-0375-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
Recently published data have reported associations between cytochrome P450 metabolizer status and suicidality. The aim of our study was to investigate the role of genetic polymorphisms of the cytochrome P450 genes on suicide risk and/or a personal history of suicide attempts. Two hundred forty-three major depressive disorder patients were collected in the context of a European multicentre resistant depression study and treated with antidepressants at adequate doses for at least 4 weeks. Suicidality was assessed using the Mini International Neuropsychiatric Interview and the Hamilton Rating Scale for Depression (HAM-D). Treatment response was defined as HAM-D ≤ 17 and remission as HAM-D ≤ 7 after 4 weeks of treatment with antidepressants at adequate dose. Genotyping was performed for all relevant variations of the CYP1A2 gene (*1A, *1F, *1C, *1 J, *1 K), the CYP2C9 gene (*2, *3), the CYP2C19 gene (*2, *17) and the CYP2D6 gene (*3, *4, *5, *6, *9, *19, *XN). No association between both suicide risk and personal history of suicide attempts, and the above mentioned metabolic profiles were found after multiple testing corrections. In conclusion, the investigated cytochrome gene polymorphisms do not seem to be associated with suicide risk and/or a personal history of suicide attempts, though methodological and sample size limitations do not allow definitive conclusions.
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Gregoor JG, van der Weide K, van der Weide J, van Megen HJGM, Egberts ACG, Heerdink ER. The association between CYP2D6 genotype and switching antipsychotic medication to clozapine. Eur J Clin Pharmacol 2013; 69:1927-32. [DOI: 10.1007/s00228-013-1553-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/18/2013] [Indexed: 12/01/2022]
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Samer CF, Lorenzini KI, Rollason V, Daali Y, Desmeules JA. Applications of CYP450 testing in the clinical setting. Mol Diagn Ther 2013; 17:165-84. [PMID: 23588782 PMCID: PMC3663206 DOI: 10.1007/s40291-013-0028-5] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Interindividual variability in drug response is a major clinical problem. Polymedication and genetic polymorphisms modulating drug-metabolising enzyme activities (cytochromes P450, CYP) are identified sources of variability in drug responses. We present here the relevant data on the clinical impact of the major CYP polymorphisms (CYP2D6, CYP2C19 and CYP2C9) on drug therapy where genotyping and phenotyping may be considered, and the guidelines developed when available. CYP2D6 is responsible for the oxidative metabolism of up to 25% of commonly prescribed drugs such as antidepressants, antipsychotics, opioids, antiarrythmics and tamoxifen. The ultrarapid metaboliser (UM) phenotype is recognised as a cause of therapeutic inefficacy of antidepressant, whereas an increased risk of toxicity has been reported in poor metabolisers (PMs) with several psychotropics (desipramine, venlafaxine, amitriptyline, haloperidol). CYP2D6 polymorphism influences the analgesic response to prodrug opioids (codeine, tramadol and oxycodone). In PMs for CYP2D6, reduced analgesic effects have been observed, whereas in UMs cases of life-threatening toxicity have been reported with tramadol and codeine. CYP2D6 PM phenotype has been associated with an increased risk of toxicity of metoprolol, timolol, carvedilol and propafenone. Although conflicting results have been reported regarding the association between CYP2D6 genotype and tamoxifen effects, CYP2D6 genotyping may be useful in selecting adjuvant hormonal therapy in postmenopausal women. CYP2C19 is responsible for metabolising clopidogrel, proton pump inhibitors (PPIs) and some antidepressants. Carriers of CYP2C19 variant alleles exhibit a reduced capacity to produce the active metabolite of clopidogrel, and are at increased risk of adverse cardiovascular events. For PPIs, it has been shown that the mean intragastric pH values and the Helicobacter pylori eradication rates were higher in carriers of CYP2C19 variant alleles. CYP2C19 is involved in the metabolism of several antidepressants. As a result of an increased risk of adverse effects in CYP2C19 PMs, dose reductions are recommended for some agents (imipramine, sertraline). CYP2C9 is responsible for metabolising vitamin K antagonists (VKAs), non-steroidal anti-inflammatory drugs (NSAIDs), sulfonylureas, angiotensin II receptor antagonists and phenytoin. For VKAs, CYP2C9 polymorphism has been associated with lower doses, longer time to reach treatment stability and higher frequencies of supratherapeutic international normalised ratios (INRs). Prescribing algorithms are available in order to adapt dosing to genotype. Although the existing data are controversial, some studies have suggested an increased risk of NSAID-associated gastrointestinal bleeding in carriers of CYP2C9 variant alleles. A relationship between CYP2C9 polymorphisms and the pharmacokinetics of sulfonylureas and angiotensin II receptor antagonists has also been observed. The clinical impact in terms of hypoglycaemia and blood pressure was, however, modest. Finally, homozygous and heterozygous carriers of CYP2C9 variant alleles require lower doses of phenytoin to reach therapeutic plasma concentrations, and are at increased risk of toxicity. New diagnostic techniques made safer and easier should allow quicker diagnosis of metabolic variations. Genotyping and phenotyping may therefore be considered where dosing guidelines according to CYP genotype have been published, and help identify the right molecule for the right patient.
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Affiliation(s)
- C F Samer
- Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
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Influence of CYP2D6 and CYP2C19 gene variants on antidepressant response in obsessive-compulsive disorder. THE PHARMACOGENOMICS JOURNAL 2013; 14:176-81. [PMID: 23545896 DOI: 10.1038/tpj.2013.12] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/29/2013] [Accepted: 02/04/2013] [Indexed: 12/31/2022]
Abstract
Numerous studies have reported on pharmacogenetics of antidepressant response in depression. In contrast, little is known of response predictors in obsessive-compulsive disorder (OCD), a disorder with among the lowest proportion of responders to medication (40-60%). Our study is the largest investigation to date (N=184) of treatment response and side effects to antidepressants in OCD based on metabolizer status for CYP2D6 and CYP2C19. We observed significantly more failed medication trials in CYP2D6 non-extensive compared with extensive metabolizers (P=0.007). CYP2D6 metabolizer status was associated with side effects to venlafaxine (P=0.022). There were nonsignificant trends for association of CYP2D6 metabolizer status with response to fluoxetine (P=0.056) and of CYP2C19 metabolizer status with response to sertraline (P=0.064). Our study is the first to indicate that CYP genes may have a role in antidepressant response in OCD. More research is required for a future clinical application of genetic testing, which could lead to improved treatment outcomes.
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Genetic variability of drug-metabolizing enzymes: the dual impact on psychiatric therapy and regulation of brain function. Mol Psychiatry 2013; 18:273-87. [PMID: 22565785 DOI: 10.1038/mp.2012.42] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Polymorphic drug-metabolizing enzymes (DMEs) are responsible for the metabolism of the majority of psychotropic drugs. By explaining a large portion of variability in individual drug metabolism, pharmacogenetics offers a diagnostic tool in the burgeoning era of personalized medicine. This review updates existing evidence on the influence of pharmacogenetic variants on drug exposure and discusses the rationale for genetic testing in the clinical context. Dose adjustments based on pharmacogenetic knowledge are the first step to translate pharmacogenetics into clinical practice. However, also clinical factors, such as the consequences on toxicity and therapeutic failure, must be considered to provide clinical recommendations and assess the cost-effectiveness of pharmacogenetic treatment strategies. DME polymorphisms are relevant not only for clinical pharmacology and practice but also for research in psychiatry and neuroscience. Several DMEs, above all the cytochrome P (CYP) enzymes, are expressed in the brain, where they may contribute to the local biochemical homeostasis. Of particular interest is the possibility of DMEs playing a physiological role through their action on endogenous substrates, which may underlie the reported associations between genetic polymorphisms and cognitive function, personality and vulnerability to mental disorders. Neuroimaging studies have recently presented evidence of an effect of the CYP2D6 polymorphism on basic brain function. This review summarizes evidence on the effect of DME polymorphisms on brain function that adds to the well-known effects of DME polymorphisms on pharmacokinetics in explaining the range of phenotypes that are relevant to psychiatric practice.
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Lam YF, Fukui N, Sugai T, Watanabe J, Watanabe Y, Suzuki Y, Someya T. Pharmacogenomics in Psychiatric Disorders. Pharmacogenomics 2013. [DOI: 10.1016/b978-0-12-391918-2.00006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Peñas-Lledó EM, Trejo HD, Dorado P, Ortega A, Jung H, Alonso E, Naranjo MEG, López-López M, Llerena A. CYP2D6 ultrarapid metabolism and early dropout from fluoxetine or amitriptyline monotherapy treatment in major depressive patients. Mol Psychiatry 2013; 18:8-9. [PMID: 22733128 DOI: 10.1038/mp.2012.91] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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47
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Sim SC, Kacevska M, Ingelman-Sundberg M. Pharmacogenomics of drug-metabolizing enzymes: a recent update on clinical implications and endogenous effects. THE PHARMACOGENOMICS JOURNAL 2012; 13:1-11. [PMID: 23089672 DOI: 10.1038/tpj.2012.45] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Interindividual differences in drug disposition are important causes for adverse drug reactions and lack of drug response. The majority of phase I and phase II drug-metabolizing enzymes (DMEs) are polymorphic and constitute essential factors for the outcome of drug therapy. Recently, both genome-wide association (GWA) studies with a focus on drug response, as well as more targeted studies of genes encoding DMEs have revealed in-depth information and provided additional information for variation in drug metabolism and drug response, resulting in increased knowledge that aids drug development and clinical practice. In addition, an increasing number of meta-analyses have been published based on several original and often conflicting pharmacogenetic studies. Here, we review data regarding the pharmacogenomics of DMEs, with particular emphasis on novelties. We conclude that recent studies have emphasized the importance of CYP2C19 polymorphism for the effects of clopidogrel, whereas the CYP2C9 polymorphism appears to have a role in anticoagulant treatment, although inferior to VKORC1. Furthermore, the analgesic and side effects of codeine in relation to CYP2D6 polymorphism are supported and the influence of CYP2D6 genotype on breast cancer recurrence during tamoxifen treatment appears relevant as based on three large studies. The influence of CYP2D6 polymorphism on the effect of antidepressants in a clinical setting is yet without any firm evidence, and the relation between CYP2D6 ultrarapid metabolizers and suicide behavior warrants further studies. There is evidence for the influence of CYP3A5 polymorphism on tacrolimus dose, although the influence on response is less studied. Recent large GWA studies support a link between CYP1A2 polymorphism and blood pressure as well as coffee consumption, and between CYP2A6 polymorphism and cigarette consumption, which in turn appears to influence the lung cancer incidence. Regarding phase II enzyme polymorphism, the anticancer treatment with mercaptopurines and irinotecan is still considered important in relation to the polymorphism of TPMT and UGT1A1, respectively. There is a need for further clarification of the clinical importance and use of all these findings, but the recent research in the field that encompasses larger studies and a whole genome perspective, improves the possibilities be able to make firm and cost-effective recommendations for drug treatment in the future.
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Affiliation(s)
- S C Sim
- Section of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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48
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An innovative software solution for personalized pharmacotherapy. Ther Deliv 2012; 1:643-50. [PMID: 22833954 DOI: 10.4155/tde.10.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Drug-drug and drug-gene interactions are an important issue in healthcare. In the USA, in 1994-1995, it was estimated that there were approximately 2 million severe adverse drug reactions resulting in 76,000-137,000 deaths. A more recent study published in 2004 shows that 5% of hospital admissions in the UK are directly attributable to adverse drug reactions. Moreover, adverse drug reactions in the USA contribute to significant hospital costs of between US$1.5 and 4 billion per year. Drug metabolism is one determinant of how our bodies respond to drugs. Polymorphisms of the six major cytochrome drug metabolizing genes can lead to either poor metabolism of drugs, hence, increasing probability of toxic reactions, or enhanced metabolism leading to decreased efficacy; with opposite affects for prodrugs. Also, there are the potentially increased costs due to wastage, lack of therapeutic response, repeat doctor visits and poor patient compliance. In addition, when multiple drugs are co-administered some may act as enzyme inducers or enzyme inhibitors further complicating expected drug responses. Considering today's polypharmacy, the number of over-the-counter drugs used, environmental exotoxins, which may inhibit or induce drug metabolism (cigarette smoke), nutrients and other foods, the combination of possibilities of cytochrome P450 interactions and drug-drug interactions affecting a patient response to therapy is overwhelming. A dedicated pharmaceutical decision support software solution, designed to be intuitive, informative and provide ease of use, would greatly increase the probabilities that patients could receive much more individualized treatment. The Rx Factor, through proprietary algorithms, provides the clinician with a dosage modification recommendation for all major substrate medications being prescribed or taken, by an individual.
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Garg U, Ferguson A. Challenges in Therapeutic Drug Monitoring of Classical Tricyclic and Newer Antidepressants. Ther Drug Monit 2012. [DOI: 10.1016/b978-0-12-385467-4.00013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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50
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Qumsieh RY, Ali BR, Abdulrazzaq YM, Osman O, Akawi NA, Bastaki SMA. Identification of new alleles and the determination of alleles and genotypes frequencies at the CYP2D6 gene in Emiratis. PLoS One 2011; 6:e28943. [PMID: 22216145 PMCID: PMC3245235 DOI: 10.1371/journal.pone.0028943] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 11/17/2011] [Indexed: 02/05/2023] Open
Abstract
CYP2D6 belongs to the cytochrome P450 superfamily of enzymes and plays an important role in the metabolism of 20–25% of clinically used drugs including antidepressants. It displays inter-individual and inter-ethnic variability in activity ranging from complete absence to excessive activity which causes adverse drug reactions and toxicity or therapy failure even at normal drug doses. This variability is due to genetic polymorphisms which form poor, intermediate, extensive or ultrarapid metaboliser phenotypes. This study aimed to determine CYP2D6 alleles and their frequencies in the United Arab Emirates (UAE) local population. CYP2D6 alleles and genotypes were determined by direct DNA sequencing in 151 Emiratis with the majority being psychiatric patients on antidepressants. Several new alleles have been identified and in total we identified seventeen alleles and 49 genotypes. CYP2D6*1 (wild type) and CYP2D6*2 alleles (extensive metaboliser phenotype) were found with frequencies of 39.1% and 12.2%, respectively. CYP2D6*41 (intermediate metaboliser) occurred in 15.2%. Homozygous CYP2D6*4 allele (poor metaboliser) was found with a frequency of 2% while homozygous and heterozygous CYP2D6*4 occurred with a frequency of 9%. CYP2D6*2xn, caused by gene duplication (ultrarapid metaboliser) had a frequency of 4.3%. CYP2D6 gene duplication/multiduplication occurred in 16% but only 11.2% who carried more than 2 active functional alleles were considered ultrarapid metabolisers. CYP2D6 gene deletion in one copy occurred in 7.5% of the study group. In conclusion, CYP2D6 gene locus is heterogeneous in the UAE national population and no significant differences have been identified between the psychiatric patients and controls.
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Affiliation(s)
- Rula Y. Qumsieh
- Department of Pharmacology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Bassam R. Ali
- Department of Pathology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Yousef M. Abdulrazzaq
- Department of Pediatrics, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ossama Osman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Nadia A. Akawi
- Department of Pathology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Salim M. A. Bastaki
- Department of Pharmacology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- * E-mail:
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