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Decaix T, Gautier S, Royer L, Laprévote O, Tritz T, Siguret V, Teillet L, Sellier C, Pépin M. Importance of cytochrome 3A4 and 2D6-mediated drug-drug interactions in oxycodone consumption among older adults hospitalized for hip fracture: a cross-sectional study. Aging Clin Exp Res 2023; 35:2471-2481. [PMID: 37861957 DOI: 10.1007/s40520-023-02569-7] [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: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
Hip fracture is a common injury and represents a major health problem with an increasing incidence. In older adults, opioids such as oxycodone are often preferred to other analgesics such as tramadol because of a lower risk of delirium. Different parameters, such as inhibition of cytochrome P450 (CYP450) 2D6 and/or 3A4, can potentially lead to pharmacokinetic variations of oxycodone representing a risk of adverse drugs effects or lack of drug response. There is a risk of drug-drug interactions involving CYP450 in older adults due to the high prevalence of polypharmacy. This study sought to identify patient characteristics that influence oxycodone administration. A single-center observational study included 355 patients with a hip fracture hospitalized in a geriatric postoperative unit. Composite endpoint based on form, duration, and timing to intake separated patients into three groups: "no oxycodone", "low oxycodone ", and "high oxycodone ". CYP450 interactions were studied based on a composite variable defining the most involved CYP450 pathways between CYP2D6 and CYP3A4. CYP450 interactions with CYP2D6 pathway involved were associated with the risk of "high oxycodone" [odds ratio adjusted on age and the type of hip fracture (OR*) 4.52, 95% confidence interval (CI) 1.39-16.83, p = 0.02)], as well as serum albumin levels (OR* 1.09, 95% CI 1.02-1.17, p = 0.01). Cognitive impairment was negatively associated with the risk of "high oxycodone" (OR* 0.38, 95% CI 0.18-0.77, p = 0.02). This study showed an association between CYP2D6 interactions and higher oxycodone consumption indirectly reflecting the existence of uncontrolled postoperative pain.
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Affiliation(s)
- Théodore Decaix
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France.
- CNRS, CiTCoM, Paris-Cité University, 75006, Paris, France.
| | - Sylvain Gautier
- Epidemiology and Public Health Department, AP-HP, GHU Paris-Saclay University, Raymond Poincaré Hospital, Garches, France
- Primary Care and Prevention Team, UVSQ, Inserm U1018, CESP, Paris-Saclay University, Villejuif, France
| | - Luca Royer
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Olivier Laprévote
- CNRS, CiTCoM, Paris-Cité University, 75006, Paris, France
- Department of Biochemistry, APHP, GHU Paris-Cité University, European Georges Pompidou Hospital, Paris, France
| | - Thomas Tritz
- Department of Pharmacy, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Virginie Siguret
- Hematology Laboratory, APHP, Hospital Group Lariboisière-Fernand Widal, Paris-Cité University, Paris, France
- Therapeutic Innovations in Hemostasis, Inserm UMR-S 1140, Paris-Cité University, Paris, France
| | - Laurent Teillet
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Cyril Sellier
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Marion Pépin
- Department of Geriatrics, APHP, GHU Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
- Clinical Epidemiology, UVSQ, Inserm U1018, CESP, Paris-Saclay University, Villejuif, France
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Cataldi M, Celentano C, Bencivenga L, Arcopinto M, Resnati C, Manes A, Dodani L, Comnes L, Vander Stichele R, Kalra D, Rengo G, Giallauria F, Trama U, Ferrara N, Cittadini A, Taglialatela M. Identification of Drugs Acting as Perpetrators in Common Drug Interactions in a Cohort of Geriatric Patients from Southern Italy and Analysis of the Gene Polymorphisms That Affect Their Interacting Potential. Geriatrics (Basel) 2023; 8:84. [PMID: 37736884 PMCID: PMC10514861 DOI: 10.3390/geriatrics8050084] [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: 07/04/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Pharmacogenomic factors affect the susceptibility to drug-drug interactions (DDI). We identified drug interaction perpetrators among the drugs prescribed to a cohort of 290 older adults and analysed the prevalence of gene polymorphisms that can increase their interacting potential. We also pinpointed clinical decision support systems (CDSSs) that incorporate pharmacogenomic factors in DDI risk evaluation. METHODS Perpetrator drugs were identified using the Drug Interactions Flockhart Table, the DRUGBANK website, and the Mayo Clinic Pharmacogenomics Association Table. Allelic variants affecting their activity were identified with the PharmVar, PharmGKB, dbSNP, ensembl and 1000 genome databases. RESULTS Amiodarone, amlodipine, atorvastatin, digoxin, esomperazole, omeprazole, pantoprazole, simvastatin and rosuvastatin were perpetrator drugs prescribed to >5% of our patients. Few allelic variants affecting their perpetrator activity showed a prevalence >2% in the European population: CYP3A4/5*22, *1G, *3, CYP2C9*2 and *3, CYP2C19*17 and *2, CYP2D6*4, *41, *5, *10 and *9 and SLC1B1*15 and *5. Few commercial CDSS include pharmacogenomic factors in DDI-risk evaluation and none of them was designed for use in older adults. CONCLUSIONS We provided a list of the allelic variants influencing the activity of drug perpetrators in older adults which should be included in pharmacogenomics-oriented CDSSs to be used in geriatric medicine.
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Affiliation(s)
- Mauro Cataldi
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (C.C.); (C.R.); (A.M.); (L.D.); (M.T.)
| | - Camilla Celentano
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (C.C.); (C.R.); (A.M.); (L.D.); (M.T.)
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (L.B.); (M.A.); (G.R.); (F.G.); (N.F.); (A.C.)
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Cité de la Santé, Place Lange, 31300 Toulouse, France
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (L.B.); (M.A.); (G.R.); (F.G.); (N.F.); (A.C.)
| | - Chiara Resnati
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (C.C.); (C.R.); (A.M.); (L.D.); (M.T.)
| | - Annalaura Manes
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (C.C.); (C.R.); (A.M.); (L.D.); (M.T.)
| | - Loreta Dodani
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (C.C.); (C.R.); (A.M.); (L.D.); (M.T.)
| | - Lucia Comnes
- Datawizard, Via Salaria 719a, 00138 Rome, Italy;
| | - Robert Vander Stichele
- Heymans Institute of Pharmacology, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; (R.V.S.); (D.K.)
- European Institute for Innovation through Health Data, c/o Department Medical Informatics and Statistics, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Dipak Kalra
- Heymans Institute of Pharmacology, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; (R.V.S.); (D.K.)
- European Institute for Innovation through Health Data, c/o Department Medical Informatics and Statistics, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (L.B.); (M.A.); (G.R.); (F.G.); (N.F.); (A.C.)
- Istituti Clinici Scientifici—ICS Maugeri S.p.A., Via Bagni Vecchi 1, 82037 Telese, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (L.B.); (M.A.); (G.R.); (F.G.); (N.F.); (A.C.)
| | - Ugo Trama
- General Directorate for Health Protection and Coordination of the Regional Health System, Regione Campania, Centro Direzionale Is. C3, 80132 Naples, Italy;
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (L.B.); (M.A.); (G.R.); (F.G.); (N.F.); (A.C.)
- Istituti Clinici Scientifici—ICS Maugeri S.p.A., Via Bagni Vecchi 1, 82037 Telese, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (L.B.); (M.A.); (G.R.); (F.G.); (N.F.); (A.C.)
| | - Maurizio Taglialatela
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (C.C.); (C.R.); (A.M.); (L.D.); (M.T.)
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Marwa KJ, Kapesa A, Kamugisha E, Swedberg G. The Influence of Cytochrome P450 Polymorphisms on Pharmacokinetic Profiles and Treatment Outcomes Among Malaria Patients in Sub-Saharan Africa: A Systematic Review. Pharmgenomics Pers Med 2023; 16:449-461. [PMID: 37223718 PMCID: PMC10202199 DOI: 10.2147/pgpm.s379945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 04/24/2023] [Indexed: 05/25/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) population is genetically diverse and heterogenous thus variability in drug response among individuals is predicted to be high. Cytochrome P450 (CYP450) polymorphisms is a major source of variability in drug response. This systematic review presents the influence of CYP450 single nucleotide polymorphisms (SNPs), particularly CYP3A4*1B, CYP2B6*6 and CYP3A5*3 on antimalarial drug plasma concentrations, efficacy and safety in SSA populations. Methods Searching for relevant studies was done through Google Scholar, Cochrane Central Register of controlled trials (CENTRAL), PubMed, Medline, LILACS, and EMBASE online data bases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. Two independent reviewers extracted data from the studies. Results Thirteen studies reporting the influence of CYP450 SNPs on plasma concentrations, efficacy and safety were included in the final data synthesis. CYP3A4*1B, CYP3A5*5, CYP2B6*6 and CYP2C8*2 did not affect antimalarial drug plasma concentration significantly. There was no difference in treatment outcomes between malaria patients with variant alleles and those with wild type alleles. Conclusion This review reports lack of influence of CYP3A4*1B, CYP3A5*3, CYP2C8*3 and CYP2B6*6 SNPs on PK profiles, efficacy and safety in SSA among P. falciparum malaria patients.
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Affiliation(s)
- Karol J Marwa
- Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Anthony Kapesa
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Erasmus Kamugisha
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Göte Swedberg
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
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4
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Bottino R, Carbone A, D'Andrea A, Liccardo B, Cimmino G, Imbalzano E, Russo V. Pharmacokinetic determinants for the right dose of antiarrhythmic drugs. Expert Opin Drug Metab Toxicol 2022; 18:165-176. [PMID: 35209796 DOI: 10.1080/17425255.2022.2046733] [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: 11/04/2022]
Abstract
INTRODUCTION Antiarrhythmic drugs (AADs) show a narrow therapeutic range and marked intersubject variability in pharmacokinetics (PK), which may lead to inappropriate dosing and drug toxicity. AREAS COVERED The aim of the present review is to describe PK properties of AADs, discussing the main changes in different clinical scenarios, such as the elderly and patients with obese, chronic kidney, liver, and cardiac disease, in order to guide their right prescription in clinical practice. EXPERT OPINION There are few data about PK properties of AADs in a special population or challenging clinical setting. The use and dose of AADs is commonly based on physicians' clinical experience observing the clinical effects rather than being personalized on the individual patients PK profiles. More and updated studies are needed to validate a patient centered approach in the pharmacological treatment of arrhythmias based on patients' clinical features, including pharmacogenomics, and AAD pharmacokinetics.
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Affiliation(s)
- Roberta Bottino
- Division of Cardiology, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
| | - Andreina Carbone
- Division of Cardiology, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Division of Cardiology, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy.,Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Biagio Liccardo
- Division of Cardiology, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy.,Department of Cardiology, Umberto I° Hospital Nocera Inferiore, Italy
| | - Giovanni Cimmino
- Division of Cardiology, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Russo
- Division of Cardiology, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
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5
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Scarfò M, Sciandra C, Ruberto S, Santovito A. GSTT1, GSTP1 and XPC genes are associated with longevity in an Italian cohort. Ann Hum Biol 2021; 48:443-447. [PMID: 34565252 DOI: 10.1080/03014460.2021.1985170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Longevity is a complex process controlled by environmental and genetic factors. We evaluated the association of seven drug metabolising and DNA-repair gene polymorphisms with longevity in an Italian cohort. A sample of 756 subjects aged 18-98 was genotyped for CYP1A1 (rs1048943, A>G), GSTM1 (rs 1183423000, presence/absence), GSTT1 (rs1601993659, presence/absence), GSTP1 (rs1695, A>G), XRCC1 (rs1799782, C>T), XRCC1 (rs25489, A>G) and XPC (rs2228001, A>C) gene polymorphisms. The association between the studied gene polymorphisms and longevity was evaluated by dividing the sample into three age groups: 18-50, 51-85, and 86-98. We observed a significant decrease in the frequency of the GSTT1 null, GSTP1 G and XPC C alleles in the oldest group with respect to the youngest one. We also obtained the same results when dividing the sample into 18-85 and 86-98 age groups. The general linear model analyses confirmed a significant decreasing trend with age of the above mentioned alleles. We hypothesised that these minor alleles, being important in the sensitivity against the development of different types of cancer, may reflect a reduced life-expectancy in carrier subjects and may explain their significantly lower frequency observed among subjects belonging to the oldest age group.
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Affiliation(s)
- Manuel Scarfò
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
| | - Chiara Sciandra
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
| | - Stefano Ruberto
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
| | - Alfredo Santovito
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
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6
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Song Y, Li C, Liu G, Liu R, Chen Y, Li W, Cao Z, Zhao B, Lu C, Liu Y. Drug-Metabolizing Cytochrome P450 Enzymes Have Multifarious Influences on Treatment Outcomes. Clin Pharmacokinet 2021; 60:585-601. [PMID: 33723723 DOI: 10.1007/s40262-021-01001-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
Drug metabolism is a critical process for the removal of unwanted substances from the body. In humans, approximately 80% of oxidative metabolism and almost 50% of the overall elimination of commonly used drugs can be attributed to one or more of various cytochrome P450 (CYP) enzymes from CYP families 1-3. In addition to the basic metabolic effects for elimination, CYP enzymes in vivo are capable of affecting the treatment outcomes in many cases. Drug-metabolizing CYP enzymes are mainly expressed in the liver and intestine, the two principal drug oxidation and elimination organs, where they can significantly influence the drug action, safety, and bioavailability by mediating phase I metabolism and first-pass metabolism. Furthermore, CYP-mediated local drug metabolism in the sites of action may also have the potential to impact drug response, according to the literature in recent years. This article underlines the ability of CYP enzymes to influence treatment outcomes by discussing CYP-mediated diversified drug metabolism in primary metabolic sites (liver and intestine) and typical action sites (brain and tumors) according to their expression levels and metabolic activity. Moreover, intrinsic and extrinsic factors of personal differential CYP phenotypes that contribute to interindividual variation of treatment outcomes are also reviewed to introduce the multifarious pivotal role of CYP-mediated metabolism and clearance in drug therapy.
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Affiliation(s)
- Yurong Song
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Chenxi Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Guangzhi Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Rui Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Youwen Chen
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Wen Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zhiwen Cao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Baosheng Zhao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Cheng Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Yuanyan Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China.
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7
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Macho LP, Center SA, Randolph JF, Dumars LA, Rush SE, Cameron MK, Lucy JM, Hall-Fonte DL, McDonough SP, Peters-Kennedy J, Marinoff J, Harrison J, Sabatino B, Deitz K. Clinical, clinicopathologic, and hepatic histopathologic features associated with probable ketoconazole-induced liver injury in dogs: 15 cases (2015-2018). J Am Vet Med Assoc 2020; 256:1245-1256. [PMID: 32412870 DOI: 10.2460/javma.256.11.1245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize clinical, clinicopathologic, and hepatic histopathologic features and outcome for dogs with probable ketoconazole-induced liver injury. ANIMALS 15 dogs with suspected ketoconazole-induced liver injury that underwent liver biopsy. PROCEDURES Medical record data were summarized regarding signalment, clinical signs, clinicopathologic and hepatic histopathologic findings, concurrent medications, ketoconazole dose, treatment duration, and outcome. RESULTS Median age and body weight were 8.2 years (range, 5 to 15 years) and 13.0 kg (28.6 lb; range, 8.2 to 38.0 kg [18.0 to 83.6 lb]), respectively. The most common breed was Cocker Spaniel (n = 5). All dogs received ketoconazole to treat cutaneous Malassezia infections. Median daily ketoconazole dose was 7.8 mg/kg (3.5 mg/lb; range, 4.4 to 26.0 mg/kg [2.0 to 11.8 mg/lb]), PO. Treatment duration ranged from 0.3 to 100 cumulative weeks (intermittent cyclic administration in some dogs); 6 dogs were treated for ≤ 10 days. Common clinical signs included lethargy, anorexia, and vomiting. All dogs developed high serum liver enzyme activities. Hepatic histopathologic findings included variable lobular injury, mixed inflammatory infiltrates, and conspicuous aggregates of ceroid-lipofuscin-engorged macrophages that marked regions of parenchymal damage. Five dogs developed chronic hepatitis, including 3 with pyogranulomatous inflammation. Of the 10 dogs reported to have died at last follow-up, survival time after illness onset ranged from 0.5 to 165 weeks, with 7 dogs dying of liver-related causes. CONCLUSIONS AND CLINICAL RELEVANCE Findings for dogs with hepatotoxicosis circumstantially associated with ketoconazole treatment suggested proactive monitoring of serum liver enzyme activities is advisable before and sequentially after initiation of such treatment.
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8
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James CL, Turnbull MT, Freeman WD. Nimodipine-induced junctional bradycardia in an elderly patient with subarachnoid hemorrhage. Pharmacogenomics 2020; 21:387-392. [PMID: 32284009 DOI: 10.2217/pgs-2019-0136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Subarachnoid hemorrhage is a devastating form of stroke with often detrimental outcomes for patients. Here we describe a patient with subarachnoid hemorrhage treated with nimodipine, which resulted in marked bradycardia with junctional atrioventricular heart block. Nimodipine is metabolized predominantly by the cytochrome P450 3A subfamily, and its use is often associated with adverse events, such as hypotension and bradycardia, which can be exacerbated by advanced age. Our patient had the CYP3A5*3/*3 genotype, possibly predisposing her to poor metabolism of this drug. Our case report demonstrates the potential for pharmacogenomics in patients with subarachnoid hemorrhage to help predict their response to nimodipine, minimize adverse drug reactions, and potentially individualize dosing to improve future clinical outcomes.
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Affiliation(s)
- Courtney L James
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Marion T Turnbull
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - William D Freeman
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.,Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.,Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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9
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Verde Z, García de Diego L, Chicharro LM, Bandrés F, Velasco V, Mingo T, Fernández-Araque A. Physical Performance and Quality of Life in Older Adults: Is There Any Association between Them and Potential Drug Interactions in Polymedicated Octogenarians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214190. [PMID: 31671923 PMCID: PMC6862508 DOI: 10.3390/ijerph16214190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 01/16/2023]
Abstract
Older adults are at increased risk of several cytochrome P450 (CYP) drug interactions that can result in drug toxicity, reduced pharmacological effect, and adverse drug reactions. This study aimed to assess the prevalence of potential CYP interactions referring to the most clinically relevant drugs and exploring the relationship between them and quality of life and physical performance in Spanish octogenarians. Institutionalized and community-dwelling octogenarians (n = 102) treated at three primary care centers, were recruited by a research nurse. Anthropometric measurements, chronic diseases, prescribed drugs, quality of life, physical performance, mobility skills, hand grip strength and cognitive status data were collected. Potential CYP drug-drug interactions (DDIs) were selected referring to the main CYP implicated in their metabolism. The 72.2% of recruited octogenarians presented potentially inappropriate CYP inhibitor-substrate or CYP inductor-substrate combinations. Analyzing the EuroQol Visual Analogue scale (EQ-VAS) results, patients with a potential CYP DDI perceived worse health status than patients without it (p = 0.004). In addition, patients with a potential CYP DDI presented worse exercise capacity, kinesthetic abilities, or mobility than those who didn’t present a potential interaction (p = 0.01, p = 0.047, and p = 0.02, respectively). To investigate and control factors associated with loss of muscle strength and poor quality of life, polypharmacy and DDIs could help institutions in the management of physical frailty.
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Affiliation(s)
- Zoraida Verde
- Department of Biochemistry, Molecular Biology and Physiology, Universidad de Valladolid, Campus Duques de Soria, 42004 Soria, Spain.
| | - Laura García de Diego
- Department of Nursery, Universidad de Valladolid, Campus Duques de Soria, 42004 Soria, Spain.
| | - Luis M Chicharro
- Cátedra Complutense Diagnostic and Innovation, Universidad Complutense, 28040 Madrid, Spain.
| | - Fernando Bandrés
- Cátedra Complutense Diagnostic and Innovation, Universidad Complutense, 28040 Madrid, Spain.
- Department of Toxicology and Health Sanitary, Universidad Complutense, 28040 Madrid, Spain.
| | - Verónica Velasco
- Department of Nursery, Universidad de Valladolid, 47005 Valladolid, Spain.
| | - Teresa Mingo
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Universidad de Valladolid, Campus Duques de Soria, 42004 Soria, Spain.
| | - Ana Fernández-Araque
- Department of Nursery, Universidad de Valladolid, Campus Duques de Soria, 42004 Soria, Spain.
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10
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Distribution of the cytochrome P450 CYP2C8*2 allele in Brazzaville, Republic of Congo. Int J Infect Dis 2019; 85:49-53. [DOI: 10.1016/j.ijid.2019.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 01/03/2023] Open
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11
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Bain KT, Matos A, Knowlton CH, McGain D. Genetic variants and interactions from a pharmacist-led pharmacogenomics service for PACE. Pharmacogenomics 2019; 20:709-718. [DOI: 10.2217/pgs-2019-0047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: Evaluate results of pharmacogenomics testing for participants enrolled in the Program of All-inclusive Care for the Elderly (PACE). Materials & methods: A convenience sample of 100 participants from the PHARM-GENOME-PACE study. Genetic variants were determined by pharmacogenomics testing. Drug–gene interactions (DGIs), drug–drug–gene interactions (DDGIs) and phenoconversions were interrogated from a clinical decision support system. Results: In total, 146 genetic variants, 169 DGIs and 125 DDGIs were detected. DGIs and DDGIs occurred most commonly with the CYP2D6 gene (36.1 and 39.2%, respectively). There were 280 instances of phenoconversions; majority (62.9%) affecting the CYP3A4 isoenzyme. Conclusion: Prevalence of exposures to DGIs and DDGIs among PACE participants is high. Pharmacists using a clinical decision support system can support PACE practitioners with assessing multidrug simultaneous interactions. Clinical trial registration: NCT03257605
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Affiliation(s)
- Kevin T Bain
- Tabula Rasa HealthCare, Department of Research & Development, 228 Strawbridge Drive, Moorestown, NJ 08057, USA
- University of the Sciences, Philadelphia College of Pharmacy, Department of Pharmacy Practice and Administration, 600 South 43rd Street, Philadelphia, PA 19104, USA
| | - Adriana Matos
- Tabula Rasa HealthCare, Department of Research & Development, 228 Strawbridge Drive, Moorestown, NJ 08057, USA
| | - Calvin H Knowlton
- Tabula Rasa HealthCare, Executive Department, 228 Strawbridge Drive, Moorestown, NJ 08057, USA
| | - David McGain
- Tabula Rasa HealthCare, Department of Research & Development, 228 Strawbridge Drive, Moorestown, NJ 08057, USA
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12
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Suwinski P, Ong C, Ling MHT, Poh YM, Khan AM, Ong HS. Advancing Personalized Medicine Through the Application of Whole Exome Sequencing and Big Data Analytics. Front Genet 2019; 10:49. [PMID: 30809243 PMCID: PMC6379253 DOI: 10.3389/fgene.2019.00049] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
There is a growing attention toward personalized medicine. This is led by a fundamental shift from the ‘one size fits all’ paradigm for treatment of patients with conditions or predisposition to diseases, to one that embraces novel approaches, such as tailored target therapies, to achieve the best possible outcomes. Driven by these, several national and international genome projects have been initiated to reap the benefits of personalized medicine. Exome and targeted sequencing provide a balance between cost and benefit, in contrast to whole genome sequencing (WGS). Whole exome sequencing (WES) targets approximately 3% of the whole genome, which is the basis for protein-coding genes. Nonetheless, it has the characteristics of big data in large deployment. Herein, the application of WES and its relevance in advancing personalized medicine is reviewed. WES is mapped to Big Data “10 Vs” and the resulting challenges discussed. Application of existing biological databases and bioinformatics tools to address the bottleneck in data processing and analysis are presented, including the need for new generation big data analytics for the multi-omics challenges of personalized medicine. This includes the incorporation of artificial intelligence (AI) in the clinical utility landscape of genomic information, and future consideration to create a new frontier toward advancing the field of personalized medicine.
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Affiliation(s)
- Pawel Suwinski
- Malaysian Genomics Resource Centre Berhad, Kuala Lumpur, Malaysia
| | - ChuangKee Ong
- Centre for Bioinformatics, School of Data Sciences, Perdana University, Serdang, Malaysia.,Centre of Genomics Research, Precision Medicine and Genomics, AstraZeneca UK Limited, London, United Kingdom
| | - Maurice H T Ling
- Centre for Bioinformatics, School of Data Sciences, Perdana University, Serdang, Malaysia
| | - Yang Ming Poh
- Centre for Bioinformatics, School of Data Sciences, Perdana University, Serdang, Malaysia
| | - Asif M Khan
- Centre for Bioinformatics, School of Data Sciences, Perdana University, Serdang, Malaysia.,Graduate School of Medicine, Perdana University, Serdang, Malaysia
| | - Hui San Ong
- Centre for Bioinformatics, School of Data Sciences, Perdana University, Serdang, Malaysia
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13
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García-Ramos A, Pérez-Castilla A, Villar Macias FJ, Latorre-Román PÁ, Párraga JA, García-Pinillos F. Differences in the one-repetition maximum and load-velocity profile between the flat and arched bench press in competitive powerlifters. Sports Biomech 2018; 20:261-273. [PMID: 30526366 DOI: 10.1080/14763141.2018.1544662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to compare the one-repetition maximum (1RM) and the velocity outcomes obtained against the same absolute and relative (%1RM) loads between the flat and arched bench press (BP) variants. Eleven competitive male powerlifters were evaluated in one session with the flat BP (natural lumbar arch and moderate scapular retraction) and in another session with the arched BP (pronounced lumbar arch and scapular retraction). An incremental loading test was used to determine the 1RM as well as the barbell's velocity against the different external loads. The main findings revealed that the 1RM did not significantly differ between the flat (115.9 ± 17.9 kg) and arched (115.7 ± 18.4 kg) BP variants (p = 0.942, effect size = 0.01), while there were no significant differences between BP variants either for the velocity outcomes obtained against the individual loads nor for the velocities associated with each %1RM (p > 0.05). These results suggest that competitive powerlifters do not necessarily present their higher 1RM performance using the arched BP variant. Finally, both BP variants could be used interchangeably when using movement velocity for testing upper-body strength as well as for prescribing the load during velocity-based resistance training routines.
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Affiliation(s)
- Amador García-Ramos
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada , Granada, Spain.,Department of Sports Sciences and Physical Conditioning, Faculty of Education, CIEDE, Catholic University of the Most Holy Concepción , Concepción, Chile
| | - Alejandro Pérez-Castilla
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada , Granada, Spain
| | | | | | - Juan A Párraga
- Department of Corporal Expression, University of Jaen , Jaen, Spain
| | - Felipe García-Pinillos
- Department of Physical Education, Sports and Recreation. Universidad de La Frontera , Temuco, Chile
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14
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Hassani Idrissi H, El Khorb N, Akoudad A, Habbal R, Nadifi S. Association of CYP2B6 ( G15631T ) polymorphism with Clopidogrel resistance and genetic predisposition to Acute Coronary Syndromes (ACSs) in Morocco. GENE REPORTS 2018. [DOI: 10.1016/j.genrep.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Bukvić Mokos Z, Jović A, Čeović R, Kostović K, Mokos I, Marinović B. Therapeutic challenges in the mature patient. Clin Dermatol 2018; 36:128-139. [PMID: 29566917 DOI: 10.1016/j.clindermatol.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
With the tremendous increase in the proportion of seniors in the global population, geriatric health care has become of greater interest and concern. Increased emphasis on geriatric medicine, along with the growth in the development of age-related skin disorders, has led to particular attention for geriatric, dermatology and dermatopharmacology. An aging population has brought many therapeutic challenges that we need to recognize and overcome by applying geropharmacologic principles. The purpose of this paper is to inform dermatologists of the age-related changes in the pharmacokinetics of common dermatologic drugs, their various interactions potentially occurring in the elderly, and the principles and evidence-based strategies for detection, management, and prevention to improve medication adherence. By implementing these principles and strategies, we can ensure the best and the safest treatment to promote the desired therapeutic outcome and improved quality of life for this fragile subpopulation.
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Affiliation(s)
- Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia.
| | - Anamaria Jović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Romana Čeović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Krešimir Kostović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Ivica Mokos
- Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
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16
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Santini SA, Panza F, Lozupone M, Bellomo A, Greco A, Seripa D. Genetics of tailored medicine: Focus on CNS drugs. Microchem J 2018. [DOI: 10.1016/j.microc.2017.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Dermatology Medications in Older Adults: Common Medications and Considerations. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Huang W, Ji CM, Guo M, Ni WW, Meng L, Wei JF. Pharmacogenomics of proton pump inhibitors. Shijie Huaren Xiaohua Zazhi 2016; 24:4458-4466. [DOI: 10.11569/wcjd.v24.i33.4458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
At present, proton pump inhibitors (PPIs), as a class of strong antacid agents, are widely used in the clinical treatment of gastrointestinal diseases. PPIs achieved a strong effect of acid suppression with high specificity and long duration. However, the issue of PPI abuse exists worldwide because of the lack of relevant knowledge. Due to tremendous inter-individual differences in uptake, the clinical application of PPIs appears to be limited. Therefore, rational use of PPIs in daily clinical practice is an important research topic. In addition, PPIs were found with many side effects. CYP2C19, as one of the most important enzymes in cytochrome P450 enzyme family, is responsible for the metabolism of over 10% of drugs. The bioavailability and metabolism of PPIs are mainly affected by drug-metabolizing enzymes CYP2C19 and CYP3A4, which are located in the liver. By suppressing cytochrome P450 isoenzyme, PPIs may affect the metabolism of multiple drugs, thus leading to unwanted side effects in case of combined medication. What's more, the individual difference in PPI administration is derived from distinct molecular mechanisms mediated by CYP3A4 and/or CYP2C19. Non-genetic factors, such as combined medication and food pyramid, also impact on the effectiveness of PPIs. Gene mutations can also alter the enzymatic activity of CY2C19, thereby resulting in different blood concentrations of drugs metabolized by CYP2C19. In conclusion, PPIs have the advantages of safety and effectiveness; however, the problem of drug resistance still exists, which indicates their selective application in clinical practice. In this paper, we review the advances in pharmacogenomics of PPIs, with an aim to provide reference to individualized clinical medication.
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Lozupone M, Panza F, Stella E, La Montagna M, Bisceglia P, Miscio G, Galizia I, Daniele A, di Mauro L, Bellomo A, Logroscino G, Greco A, Seripa D. Pharmacogenetics of neurological and psychiatric diseases at older age: has the time come? Expert Opin Drug Metab Toxicol 2016; 13:259-277. [DOI: 10.1080/17425255.2017.1246533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Madia Lozupone
- Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro,’, Bari, Italy
| | - Francesco Panza
- Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro,’, Bari, Italy
- Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’ at ‘Pia Fondazione Card. G. Panico,’, Tricase, Lecce, Italy
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Eleonora Stella
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Paola Bisceglia
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Miscio
- Laboratory of Clinical Chemistry, Department of Clinical Pathology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Ilaria Galizia
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Lazzaro di Mauro
- Laboratory of Clinical Chemistry, Department of Clinical Pathology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giancarlo Logroscino
- Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro,’, Bari, Italy
- Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’ at ‘Pia Fondazione Card. G. Panico,’, Tricase, Lecce, Italy
| | - Antonio Greco
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Davide Seripa
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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20
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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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21
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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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Khanna IK, Pillarisetti S. Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain. J Pain Res 2015; 8:859-70. [PMID: 26672499 PMCID: PMC4675640 DOI: 10.2147/jpr.s85951] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Despite proven clinical utility, buprenorphine has not been used widely for the treatment of chronic pain. Questions about “ceiling effect” or bell-shaped curve observed for analgesia in preclinical studies and potential withdrawal issues on combining with marketed μ-agonists continue to hinder progress in expanding full potential of buprenorphine in the treatment of cancer and noncancer pain. Mounting evidence from clinical studies and conclusions drawn by a panel of experts strongly support superior safety and efficacy profile of buprenorphine vs marketed opioids. No ceiling on analgesic effect has been reported in clinical studies. The receptor pharmacology and pharmacokinetics profile of buprenorphine is complex but unique and contributes to its distinct safety and efficacy. The buprenorphine pharmacology also allows it to be combined with other μ-receptor opioids for additivity in efficacy. Transdermal delivery products of buprenorphine have been preferred choices for the management of pain but new delivery options are under investigation for the treatment of both opioid dependence and chronic pain.
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Seripa D, Panza F, Daragjati J, Paroni G, Pilotto A. Measuring pharmacogenetics in special groups: geriatrics. Expert Opin Drug Metab Toxicol 2015; 11:1073-88. [PMID: 25990744 DOI: 10.1517/17425255.2015.1041919] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The cytochrome P450 (CYP) enzymes oxidize about 80% of the most commonly used drugs. Older patients form a very interesting clinical group in which an increased prevalence of adverse drug reactions (ADRs) and therapeutic failures (TFs) is observed. Might CYP drug metabolism change with age, and justify the differences in drug response observed in a geriatric setting? AREAS COVERED A complete overview of the CYP pharmacogenetics with a focus on the epigenetic CYP gene regulation by DNA methylation in the context of advancing age, in which DNA methylation might change. EXPERT OPINION Responder phenotypes consist of a continuum spanning from ADRs to TFs, with the best responders at the midpoint. CYP genetics is the basis of this continuum on which environmental and physiological factors act, modeling the phenotype observed in clinical practice. Physiological age-related changes in DNA methylation, the main epigenetic mechanisms regulating gene expression in humans, results in a physiological decrease in CYP gene expression with advancing age. This may be one of the physiological changes that, together with increased drug use, contributed to the higher prevalence of ADRs and TFs observed in the geriatric setting, thus, making geriatrics a special group for pharmacogenetics.
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Affiliation(s)
- Davide Seripa
- IRCCS Casa Sollievo della Sofferenza, Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences , San Giovanni Rotondo, Foggia , Italy
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Marwa KJ, Schmidt T, Sjögren M, Minzi OMS, Kamugisha E, Swedberg G. Cytochrome P450 single nucleotide polymorphisms in an indigenous Tanzanian population: a concern about the metabolism of artemisinin-based combinations. Malar J 2014; 13:420. [PMID: 25363545 PMCID: PMC4228099 DOI: 10.1186/1475-2875-13-420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/25/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Artemisinin-based combinations currently recommended for treatment of uncomplicated Plasmodium falciparum malaria in many countries of sub-Saharan Africa are substrates of CYP enzymes. The cytochrome enzyme system is responsible for metabolism of about 80-90% of clinically used drugs. It is, therefore, important to obtain the pharmacogenetics of the population in the region with respect to these combinations and thereby enable practitioners to predict treatment outcomes. The aim of this study was to detect and determine allelic frequencies of CYP2C8*2, CYP2C8*3, CYP3A4*1B, CYP3A5*3 and CYP2B6*6 variant alleles in a Tanzanian indigenous population. METHODS Genomic DNA extraction from blood obtained from 256 participants who escorted patients at Karume Health Centre in Mwanza Tanzania, was carried out using the Gene JET™ Genomic DNA purification kit (Thermo Scientific). Genotyping for the cytochrome P450 variant alleles was performed using predesigned primers. Amplification was done by PCR while differentiation between alleles was done by restriction fragment length polymorphism (PCR-RFLP) (for CYP2C8*2, CYP2C8*3) and sequencing (for CYP2B6*6, CYP3A5*3 and CYP3A4*1B). RESULTS CYP2C8*2, CYP2C8*3, CYP3A5*3, CYP3A4*1B and CYP2B6*6 variant allelic frequencies were found to be 19,10,16,78 and 36% respectively. CONCLUSION Prevalence of CYP2C8*2, CYP3A5*3, CYP3A4*1B and CYP2B6*6 mutations in a Tanzanian population/subjects are common. The impact of these point mutations on the metabolism of anti-malarial drugs, particularly artemisinin-based combinations, and their potential drug-drug interactions (DDIs) needs to be further evaluated.
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Affiliation(s)
- Karol J Marwa
- Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
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Abstract
Concomitant administration of multiple drugs can lead to unanticipated drug interactions and resultant adverse drug events with their associated costs. A more thorough understanding of the different cytochrome P450 isoenzymes and drug transporters has led to new methods to try to predict and prevent clinically relevant drug interactions. There is also an increased recognition of the need to identify the impact of pharmacogenetic polymorphisms on drug interactions. More stringent regulatory requirements have evolved for industry to classify cytochrome inhibitors and inducers, test the effect of drug interactions in the presence of polymorphic enzymes, and evaluate multiple potentially interacting drugs simultaneously. In clinical practice, drug alert software programs have been developed. This review discusses drug interaction mechanisms and strategies for screening and minimizing exposure to drug interactions. We also provide future perspectives for reducing the risk of clinically significant drug interactions.
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Affiliation(s)
- Cara Tannenbaum
- Université de Montreal, Centre de Recherche de l’Institut universitaire de gériatrie de Montréal,
4565 Queen Mary Road #4824, Montreal, Québec H3W 1W5, Canada
| | - Nancy L Sheehan
- Université de Montréal, and Chronic Viral Illness Service, McGill University Health Centre,
3650 St. Urbain, D2.01, Montréal, Québec H2X 2P4, Canada
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Karlsson J, Söderström A, Augustini BG, Berggren AC. Is buprenorphine transdermal patch equally safe and effective in younger and elderly patients with osteoarthritis-related pain? Results of an age-group controlled study. Curr Med Res Opin 2014; 30:575-87. [PMID: 24320787 DOI: 10.1185/03007995.2013.873714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A recent pharmacokinetic study with buprenorphine transdermal patches showed similar systemic exposures of buprenorphine in subjects aged ≥75 and 50-60 years. The current prospective, open-label study aimed to verify this in a clinical setting by evaluating efficacy and safety of buprenorphine patches in patients with chronic osteoarthritis (OA) pain. METHODS Patients with chronic, moderate to severe osteoarthritic pain (hip and/or knee) were enrolled: 50-60 years (younger group, N = 65) and ≥75 years (elderly group, N = 57). After 2 weeks on paracetamol only, patients received buprenorphine patches (5-40 µg/h) for 12 weeks. Paracetamol rescue was provided. Primary endpoint was the Box-Scale-11 (BS-11) score for pain on average over the last week. WOMAC OA Index, EQ-5D, Patients' and Investigators' Global Assessment of Pain Relief, rescue medication use, sleep disturbance and quality of sleep were secondary efficacy endpoints. RESULTS Both groups showed a statistically significant (p < 0.0001) and clinically relevant change from baseline to last visit in BS-11 score, with no significant difference between groups. The least squares (LS) mean change from baseline was 2.20 in elderly and 1.87 in younger patients, with an age group difference of 0.33 (95% CI: -0.42, 1.07). Non-inferiority of the elderly versus the younger group was shown. Both age groups showed a significant improvement in WOMAC total score, patients' overall health state (EQ-5D visual analogue scale) and sleep quality, and a significant reduction in rescue use and nights woken due to pain, with no significant differences between groups. Elderly patients tolerated buprenorphine patches at least as well as younger patients. CONCLUSIONS Efficacy and tolerability of buprenorphine patches was demonstrated in chronic pain patients, regardless of age, supporting the conclusion that no age-related dose adjustment of transdermal buprenorphine is needed. A study limitation is lack of active control but no other opioid was appropriate in elderly patients or this indication.
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Affiliation(s)
- J Karlsson
- Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University , Gothenburg , Sweden
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Albani D, Ateri E, Mazzuco S, Ghilardi A, Rodilossi S, Biella G, Ongaro F, Antuono P, Boldrini P, Di Giorgi E, Frigato A, Durante E, Caberlotto L, Zanardo A, Siculi M, Gallucci M, Forloni G. Modulation of human longevity by SIRT3 single nucleotide polymorphisms in the prospective study "Treviso Longeva (TRELONG)". AGE (DORDRECHT, NETHERLANDS) 2014; 36:469-478. [PMID: 23839864 PMCID: PMC3889902 DOI: 10.1007/s11357-013-9559-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/24/2013] [Indexed: 06/02/2023]
Abstract
Human sirtuins are seven proteins with deacetylase activity that are emerging as key modulators of basic physiological functions. Some evidence links SIRT3 to longevity in mammals. This study aimed to investigate whether variants within SIRT3 gene were associated to human longevity. We analyzed 549 genomic DNA collected during the prospective study "Treviso Longeva," including elderly over 70 years of age from the municipality of Treviso, a small city in the northeast of Italy. We genotyped SIRT3 rs3825075, rs4980329, and rs11555236 single nucleotide polymorphisms (SNPs) by real-time polymerase chain reaction allelic discrimination assay. A cross-sectional analysis performed by comparing people over and under 85 years of age did not evidence association among the SIRT3 SNPs and longevity. However, when we performed a longitudinal analysis considering mortality as a dependent variable, we observed an association of SIRT3 rs11555236 and rs4980329 with longevity in the whole population (p values corrected for potential confounders = 0.04 and 0.03, respectively). After stratification according to gender, the same SNPs were associated to female longevity only (p values corrected for potential confounders = 0.03 and 0.02, respectively). Finally, as rs11555236 was reported to be in linkage disequilibrium with a putative functional enhancer within the SIRT3 gene, we assessed whether rs11555236 genotypes correlated with a different level of SIRT3 protein in peripheral blood mononuclear cells. We found an increased level of SIRT3 in subjects homozygous for the (T) allele. We suggest that SIRT3 genetic variability might be relevant for the modulation of human longevity in the Italian population.
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Affiliation(s)
- Diego Albani
- />Department of Neuroscience, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, via La Masa 19, 20156 Milan, Italy
| | - Eleonora Ateri
- />Department of Neuroscience, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, via La Masa 19, 20156 Milan, Italy
| | - Stefano Mazzuco
- />Department of Statistics, University of Padova, Via Cesare Battisti, 241, 35121 Padova, Italy
| | - Alice Ghilardi
- />Department of Neuroscience, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, via La Masa 19, 20156 Milan, Italy
| | - Serena Rodilossi
- />Department of Neuroscience, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, via La Masa 19, 20156 Milan, Italy
| | - Gloria Biella
- />Department of Neuroscience, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, via La Masa 19, 20156 Milan, Italy
| | - Fausta Ongaro
- />Department of Statistics, University of Padova, Via Cesare Battisti, 241, 35121 Padova, Italy
| | - Piero Antuono
- />Dementia Research Center, The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Paolo Boldrini
- />Department of Rehabilitative Medicine, General Hospital of Treviso, Treviso, Italy
- />Cognitive Impairment Centre, General Hospital of Treviso, Piazza Ospedale, 1, 31100 Treviso, Italy
| | - Enrico Di Giorgi
- />Territorial Health Services of Treviso, Via Isola di Mezzo, 37, 31100 Treviso, Italy
| | - Andrea Frigato
- />Transfusional Department, General Hospital of Treviso, Piazza Ospedale, 1, 31100 Treviso, Italy
| | - Elisabetta Durante
- />Transfusional Department, General Hospital of Treviso, Piazza Ospedale, 1, 31100 Treviso, Italy
| | - Livio Caberlotto
- />Department of Pathology, General Hospital of Treviso, Piazza Ospedale, 1, 31100 Treviso, Italy
| | - Andrea Zanardo
- />Department of Pathology, General Hospital of Treviso, Piazza Ospedale, 1, 31100 Treviso, Italy
- />FORGEI, Interdisciplinary Geriatric Research Foundation, Viale Trento Trieste 19, 31100 Treviso, Italy
| | - Marinella Siculi
- />Department of Pathology, General Hospital of Treviso, Piazza Ospedale, 1, 31100 Treviso, Italy
| | - Maurizio Gallucci
- />Department of Rehabilitative Medicine, General Hospital of Treviso, Treviso, Italy
- />Cognitive Impairment Centre, General Hospital of Treviso, Piazza Ospedale, 1, 31100 Treviso, Italy
- />FORGEI, Interdisciplinary Geriatric Research Foundation, Viale Trento Trieste 19, 31100 Treviso, Italy
| | - Gianluigi Forloni
- />Department of Neuroscience, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, via La Masa 19, 20156 Milan, Italy
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Abstract
Cytochrome P450 2D6 (CYP2D6) plays an important role in the metabolism and bioactivation of about 25% of clinically used drugs including many antidepressants, antipsychotics and opioids. CYP2D6 activity is highly variably ranging from no activity in so-called poor metabolizers to ultrarapid metabolism at the other end of the extreme of the activity distribution. A large portion of this variability can be explained by the highly polymorphic nature of the CYP2D6 gene locus for which > 100 variants and subvariants identified to date. Allele frequencies vary markedly between ethnic groups; some have exclusively or predominantly only been observed in certain populations. Pharmacogenetic testing holds the promise of individualizing drug therapy by identifying patients with CYP2D6 diplotypes that puts them at an increased risk of experiencing dose-related adverse events or therapeutic failure. Inferring a patient's CYP2D6 metabolic capacity, or phenotype, however, is a challenging task due to the complexity of the CYP2D6 gene locus. Allelic variation includes SNPs, small insertions and deletions, gene copy number variation and rearrangements with CYP2D7, a highly related non-functional gene. This review provides a summary of the intricacies of CYP2D6 variation and genotype analysis, knowledge that is invaluable for the translation of genotype into clinically useful information.
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Affiliation(s)
- Andrea Gaedigk
- Children's Mercy Hospital and Clinics, Division of Clinical Pharmacology and Innovative Therapeutics , Kansas City, Missouri , USA
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Martiny VY, Miteva MA. Advances in molecular modeling of human cytochrome P450 polymorphism. J Mol Biol 2013; 425:3978-92. [PMID: 23856621 DOI: 10.1016/j.jmb.2013.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 01/08/2023]
Abstract
Cytochrome P450 (CYP) is a supergene family of metabolizing enzymes involved in the phase I metabolism of drugs and endogenous compounds. CYP oxidation often leads to inactive drug metabolites or to highly toxic or carcinogenic metabolites involved in adverse drug reactions (ADR). During the last decade, the impact of CYP polymorphism in various drug responses and ADR has been demonstrated. Of the drugs involved in ADR, 56% are metabolized by polymorphic phase I metabolizing enzymes, 86% among them being CYP. Here, we review the major CYP polymorphic forms, their impact for drug response and current advances in molecular modeling of CYP polymorphism. We focus on recent studies exploring CYP polymorphism performed by the use of sequence-based and/or protein-structure-based computational approaches. The importance of understanding the molecular mechanisms related to CYP polymorphism and drug response at the atomic level is outlined.
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Affiliation(s)
- Virginie Y Martiny
- Université Paris Diderot, Sorbonne Paris Cité, Molécules Thérapeutiques In Silico, Inserm UMR-S 973, 35 rue Helene Brion, 75013 Paris, France; Inserm, U973, F-75205 Paris, France
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30
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Endo JO, Wong JW, Norman RA, Chang ALS. Geriatric dermatology. J Am Acad Dermatol 2013; 68:521.e1-521.e10. [DOI: 10.1016/j.jaad.2012.10.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/03/2012] [Accepted: 10/04/2012] [Indexed: 02/09/2023]
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Davis MP. Twelve Reasons for Considering Buprenorphine as a Frontline Analgesic in the Management of Pain. ACTA ACUST UNITED AC 2012; 10:209-19. [DOI: 10.1016/j.suponc.2012.05.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/14/2012] [Accepted: 05/18/2012] [Indexed: 11/17/2022]
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Wang CM, Xu SY, Lai S, Geng D, Huang JM, Huo XY. Curculigo orchioides (Xian Mao) modifies the activity and protein expression of CYP3A in normal and Kidney-Yang Deficiency model rats. JOURNAL OF ETHNOPHARMACOLOGY 2012; 144:33-38. [PMID: 22974543 DOI: 10.1016/j.jep.2012.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/17/2012] [Accepted: 08/17/2012] [Indexed: 06/01/2023]
Abstract
AIM OF THE STUDY In Chinese medicine clinics, traditional Chinese herbs are used to treat disorders of Yin and Yang balance, including Kidney-Yang Deficiency. The activity of the hepatic cytochrome P450 3A (CYP3A) is closely associated with body status. The aim of the present study is to investigate CYP3A enzymatic activity and CYP3A4 protein expression using a Kidney-Yang Deficiency rat model and furthermore to investigate the intervention effects of the Pungent-hot herb Xian Mao. This work contributes rationale for personalized medicine and enhances our understanding of herb-drug interactions. MATERIALS AND METHODS Rats were randomly divided into three groups: the model group, the Xian Mao group and the intervention group (model rats treated with Xian Mao). The model rats were given an intramuscular injection of hydrocortisone for 14 days, and the control rats were given normal saline. The Xian Mao group consisted of normal rats treated with Xian Mao by oral gavage for 7 days. The intervention group was given Xian Mao for 7 days after treatment with hydrocortisone. The activity of CYP3A was detected by using the erythromycin-N-demethylase method. CYP3A4 protein expression level was detected by Western-blot. RESULTS CYP3A enzymatic activity in the Kidney-Yang Deficiency rat was decreased by 44% compared to normal animals. The relative CYP3A4 protein expression level of the Kidney-Yang Deficiency rat (mean value 0.663±0.188) was 20% lower than that of normal rat (0.830±0.199). The in vitro data showed that CYP3A activity was significantly (P<0.001) inhibited (decreased by 59%) by Xian Mao concentrations of 1mg/mL. The in vivo data also showed that CYP3A activity was significantly decreased in the rats treated with the three doses of Xian Mao. The CYP3A4 protein expression was significantly decreased by Xian Mao treatment at the high and intermediate doses (30 and 20 g/kg, respectively) compared with the normal group. However, the intervention group (the Kidney-Yang Deficiency rat treated with Xian Mao at 20 and 30 g/kg) showed an increased CYP3A activity and CYP3A4 protein expression compared with the herb-untreated model rats. CONCLUSION CYP3A enzymatic activity and CYP3A4 protein expression could be inhibited by Xian Mao. The CYP3A activity and CYP3A4 expression in the Kidney-Yang Deficiency model rat were lower than that of normal rat but this deficiency could be rescued by treatment with Xian Mao.
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Affiliation(s)
- Chun-Mei Wang
- Department of Biological Pharmaceutics, School of Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China.
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Desta Z, Moaddel R, Ogburn ET, Xu C, Ramamoorthy A, Venkata SLV, Sanghvi M, Goldberg ME, Torjman MC, Wainer IW. Stereoselective and regiospecific hydroxylation of ketamine and norketamine. Xenobiotica 2012; 42:1076-87. [PMID: 22612619 DOI: 10.3109/00498254.2012.685777] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The objective was to determine the cytochrome P450s (CYPs) responsible for the stereoselective and regiospecific hydroxylation of ketamine [(R,S)-Ket] to diastereomeric hydroxyketamines, (2S,6S;2R,6R)-HK (5a) and (2S,6R;2R,6S)-HK (5b) and norketamine [(R,S)-norKet] to hydroxynorketamines, (2S,6S;2R,6R)-HNK (4a), (2S,6R;2R,6S)-HNK (4b), (2S,5S;2R,5R)-HNK (4c), (2S,4S;2R,4R)-HNK (4d), (2S,4R;2R,4S)-HNK (4e), (2S,5R;2R,5S)-HNK (4f). The enantiomers of Ket and norKet were incubated with characterized human liver microsomes (HLMs) and expressed CYPs. Metabolites were identified and quantified using LC/MS/MS and apparent kinetic constants estimated using single-site Michaelis-Menten, Hill or substrate inhibition equation. 5a was predominantly formed from (S)-Ket by CYP2A6 and N-demethylated to 4a by CYP2B6. 5b was formed from (R)- and (S)-Ket by CYP3A4/3A5 and N-demethylated to 4b by multiple enzymes. norKet incubation produced 4a, 4c and 4f and minor amounts of 4d and 4e. CYP2A6 and CYP2B6 were the major enzymes responsible for the formation of 4a, 4d and 4f, and CYP3A4/3A5 for the formation of 4e. The 4b metabolite was not detected in the norKet incubates. 5a and 4b were detected in plasma samples from patients receiving (R,S)-Ket, indicating that 5a and 5b are significant Ket metabolites. Large variations in HNK concentrations were observed suggesting that pharmacogenetics and/or metabolic drug interactions may play a role in therapeutic response.
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Affiliation(s)
- Zeruesenay Desta
- Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA
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Cacabelos R, Martínez R, Fernández-Novoa L, Carril JC, Lombardi V, Carrera I, Corzo L, Tellado I, Leszek J, McKay A, Takeda M. Genomics of Dementia: APOE- and CYP2D6-Related Pharmacogenetics. Int J Alzheimers Dis 2012; 2012:518901. [PMID: 22482072 PMCID: PMC3312254 DOI: 10.1155/2012/518901] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 11/12/2011] [Indexed: 01/05/2023] Open
Abstract
Dementia is a major problem of health in developed societies. Alzheimer's disease (AD), vascular dementia, and mixed dementia account for over 90% of the most prevalent forms of dementia. Both genetic and environmental factors are determinant for the phenotypic expression of dementia. AD is a complex disorder in which many different gene clusters may be involved. Most genes screened to date belong to different proteomic and metabolomic pathways potentially affecting AD pathogenesis. The ε4 variant of the APOE gene seems to be a major risk factor for both degenerative and vascular dementia. Metabolic factors, cerebrovascular disorders, and epigenetic phenomena also contribute to neurodegeneration. Five categories of genes are mainly involved in pharmacogenomics: genes associated with disease pathogenesis, genes associated with the mechanism of action of a particular drug, genes associated with phase I and phase II metabolic reactions, genes associated with transporters, and pleiotropic genes and/or genes associated with concomitant pathologies. The APOE and CYP2D6 genes have been extensively studied in AD. The therapeutic response to conventional drugs in patients with AD is genotype specific, with CYP2D6-PMs, CYP2D6-UMs, and APOE-4/4 carriers acting as the worst responders. APOE and CYP2D6 may cooperate, as pleiotropic genes, in the metabolism of drugs and hepatic function. The introduction of pharmacogenetic procedures into AD pharmacological treatment may help to optimize therapeutics.
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Affiliation(s)
- Ramón Cacabelos
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Rocío Martínez
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Lucía Fernández-Novoa
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Juan C. Carril
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Valter Lombardi
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Iván Carrera
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Lola Corzo
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Iván Tellado
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Jerzy Leszek
- Department of Psychiatry, Medical University of Wroclaw, Pasteura 10, 50-229 Wroclaw, Poland
| | - Adam McKay
- EuroEspes Biomedical Research Center, Institute for CNS Disorders and Genomic Medicine, EuroEspes Chair of Biotechnology and Genomics, Camilo José Cela University, 15165 Bergondo, Spain
| | - Masatoshi Takeda
- Department of Psychiatry and Behavioral Sciences, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
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Trigo P, Fischer GW. Managing atrial fibrillation in the elderly: critical appraisal of dronedarone. Clin Interv Aging 2012; 7:1-13. [PMID: 22291468 PMCID: PMC3267401 DOI: 10.2147/cia.s16677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Atrial fibrillation is the most commonly seen arrhythmia in the geriatric population and is associated with increased cardiovascular morbidity and mortality. Treatment of the elderly with atrial fibrillation remains challenging for physicians, because this unique subpopulation is characterized by multiple comorbidities requiring chronic use of numerous medications, which can potentially lead to severe drug interactions. Furthermore, age-related changes in the cardiovascular system as well as other physiological changes result in altered drug pharmacokinetics. Dronedarone is a new drug recently approved for the treatment of arrhythmias, such as atrial fibrillation and/or atrial flutter. Dronedarone is a benzofuran amiodarone analog which lacks the iodine moiety and contains a methane sulfonyl group that decreases its lipophilicity. These differences in chemical structure are responsible for making dronedarone less toxic than amiodarone which, in turn, results in fewer side effects. Adverse events for dronedarone include gastrointestinal side effects and rash. No dosage adjustments are required for patients with renal impairment. However, the use of dronedarone is contraindicated in the presence of severe hepatic dysfunction.
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Affiliation(s)
- Paula Trigo
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA
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Abstract
Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.
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Affiliation(s)
- Roschelle Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt Pleasant, Michigan 48859, USA.
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Zhai H, Meier-Davis SR, Cayme B, Shudo J, Maibach H. Allergic contact dermatitis: effect of age. Cutan Ocul Toxicol 2011; 31:20-5. [DOI: 10.3109/15569527.2011.595749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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