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Camargo LM, Lima PCTM, Janot K, Maldonado IL. Safety of Oral P2Y12 Inhibitors in Interventional Neuroradiology: Current Status and Perspectives. AJNR Am J Neuroradiol 2021; 42:2119-2126. [PMID: 34674995 DOI: 10.3174/ajnr.a7303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/22/2021] [Indexed: 11/07/2022]
Abstract
In the field of interventional neuroradiology, antiplatelet agents are commonly used to prepare patients before the implantation of permanent endovascular materials. Among the available drugs, clopidogrel is the most frequently used one, but resistance phenomena are considered to be relatively common. Prasugrel and ticagrelor were recently added to the pharmacologic arsenal, but the safety of these agents in patients undergoing neurointerventional procedures is still a subject of discussion. The cumulative experience with both drugs is less extensive than that with clopidogrel, and the experience with patients in the neurology field is less extensive than in the cardiology domain. In the present article, we provide a narrative review of studies that investigated safety issues of oral P2Y12 inhibitors in interventional neuroradiology and discuss potential routes for future research.
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Affiliation(s)
- L M Camargo
- From the Faculdade de Medicina (L.M.C.), Universidade Salvador, Salvador, Brazil
| | - P C T M Lima
- Serviço de Clínica Médica (P.C.T.M.L.), Hospital Santo Antônio, Associação Obras Sociais Irmã Dulce, Salvador, Brazil
| | - K Janot
- Service de Neuroradiologie (K.J.), Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - I L Maldonado
- U1253, iBrain (I.L.M.), Université de Tours, Institut National de la Santé et de la Recherche Médicale, Tours, France
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Bruckmueller H, Cascorbi I. ABCB1, ABCG2, ABCC1, ABCC2, and ABCC3 drug transporter polymorphisms and their impact on drug bioavailability: what is our current understanding? Expert Opin Drug Metab Toxicol 2021; 17:369-396. [PMID: 33459081 DOI: 10.1080/17425255.2021.1876661] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Interindividual differences in drug response are a frequent clinical challenge partly due to variation in pharmacokinetics. ATP-binding cassette (ABC) transporters are crucial determinants of drug disposition. They are subject of gene regulation and drug-interaction; however, it is still under debate to which extend genetic variants in these transporters contribute to interindividual variability of a wide range of drugs. AREAS COVERED This review discusses the current literature on the impact of genetic variants in ABCB1, ABCG2 as well as ABCC1, ABCC2, and ABCC3 on pharmacokinetics and drug response. The aim was to evaluate if results from recent studies would increase the evidence for potential clinically relevant pharmacogenetic effects. EXPERT OPINION Although enormous efforts have been made to investigate effects of ABC transporter genotypes on drug pharmacokinetics and response, the majority of studies showed only weak if any associations. Despite few unique results, studies mostly failed to confirm earlier findings or still remained inconsistent. The impact of genetic variants on drug bioavailability is only minor and other factors regulating the transporter expression and function seem to be more critical. In our opinion, the findings on the so far investigated genetic variants in ABC efflux transporters are not suitable as predictive biomarkers.
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Affiliation(s)
- Henrike Bruckmueller
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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Kupka D, Sibbing D. P2Y 12 receptor inhibitors: an evolution in drug design to prevent arterial thrombosis. Expert Opin Drug Metab Toxicol 2018; 14:303-315. [PMID: 29338536 DOI: 10.1080/17425255.2018.1428557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION P2Y12 inhibitors are a critical component of dual antiplatelet therapy (DAPT), which is the superior strategy to prevent arterialthrombosis in patients with acute coronary syndromes (ACS) and undergoing stent implantation.. Areas covered: Basic science articles, clinical studies, and reviews from 1992-2017 were searched using Pubmed library to collet impactful literature. After an introduction to the purinergic receptor biology, this review summarizes current knowledge on P2Y12 receptor inhibitors. Furthermore, we describe the subsequent improvements of next-generation P2Y12 receptor inhibitors facing the ambivalent problem of bleeding events versus prevention of arterial thrombosis in a variety of clinical settings. Therefore, we summarize data from relevant preclinical and clinical trials of currently approved P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor, cangrelor) and provide strategies of drug switching and management of bleeding events. Expert opinion: An enormous amount of pharmacologic and clinical data is available for the application of P2Y12 receptor inhibitors. Today prasugrel, ticagrelor and clopidogrel are the standard of care drugs during dual antiplatelet therapy for ACS patients, but have considerable rates of bleeding. Recent and future clinical trials will provide evidence for subsequent escalation and de-escalation strategies of P2Y12 receptor inhibition. These data may pave the way for an evidence-based, individualized P2Y12 receptor inhibitor therapy.
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Affiliation(s)
- Danny Kupka
- a Department of Cardiology , LMU München , Munich , Germany.,b DZHK (German Centre for Cardiovascular Research) , Munich Heart Alliance , Munich , Germany
| | - Dirk Sibbing
- a Department of Cardiology , LMU München , Munich , Germany.,b DZHK (German Centre for Cardiovascular Research) , Munich Heart Alliance , Munich , Germany
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Krupinski J, Carrera C, Muiño E, Torres N, Al-Baradie R, Cullell N, Fernandez-Cadenas I. DNA Methylation in Stroke. Update of Latest Advances. Comput Struct Biotechnol J 2017; 16:1-5. [PMID: 29321829 PMCID: PMC5751876 DOI: 10.1016/j.csbj.2017.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/24/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022] Open
Abstract
Epigenetic modifications are hereditable and modifiable factors that do not alter the DNA sequence. These epigenetic factors include DNA methylation, acetylation of histones and non-coding RNAs. Epigenetic factors have mainly been associated with cancer but also with other diseases and conditions such as diabetes or obesity. In addition, epigenetic modifications could play an important role in cardiovascular diseases, including stroke. We review the latest advances in stroke epigenetics, focusing on DNA methylation studies and the future perspectives in this field.
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Affiliation(s)
- Jerzy Krupinski
- Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Barcelona, Spain
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Caty Carrera
- Neurovascular Research Laboratory, Institut de Recerca, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Nuria Torres
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Raid Al-Baradie
- Applied Medical Sciences College Majmaah University, Majmaah, Saudi Arabia
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
- Stroke Pharmacogenomics and Genetics, Sant Pau Institute of Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Corresponding author at: Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, C/ Sant Antoni 19, 08221 Terrassa, Barcelona, Spain.
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Ji JZ, Tai T, Huang BB, Gu TT, Mi QY, Xie HG. Mrp3 Transports Clopidogrel Acyl Glucuronide from the Hepatocytes into Blood. Drug Metab Dispos 2017; 46:151-154. [DOI: 10.1124/dmd.117.078329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022] Open
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Pharmacokinetic and Pharmacodynamic Responses to Clopidogrel: Evidences and Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030301. [PMID: 28335443 PMCID: PMC5369137 DOI: 10.3390/ijerph14030301] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 12/15/2022]
Abstract
Clopidogrel has significantly reduced the incidence of recurrent atherothrombotic events in patients with acute coronary syndrome (ACS) and in those undergoing percutaneous coronary intervention (PCI). However, recurrence events still remain, which may be partly due to inadequate platelet inhibition by standard clopidogrel therapy. Genetic polymorphisms involved in clopidogrel’s absorption, metabolism, and the P2Y12 receptor may interfere with its antiplatelet activity. Recent evidence indicated that epigenetic modification may also affect clopidogrel response. In addition, non-genetic factors such as demographics, disease complications, and drug-drug interactions can impair the antiplatelet effect of clopidogrel. The identification of factors contributing to the variation in clopidogrel response is needed to improve platelet inhibition and to reduce risk for cardiovascular events. This review encompasses the most recent updates on factors influencing pharmacokinetic and pharmacodynamic responses to clopidogrel.
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Luchessi AD, Concheiro M, Germano JDF, Silbiger VN, Bortolin RH, Cruz A, Quintela O, Brion M, Carracedo A, Iñiguez A, Bravo M, López-Rivadulla M, Hirata RDC, Sousa AGMR, Hirata MH. ABCC3 Polymorphisms and mRNA Expression Influence the Concentration of a Carboxylic Acid Metabolite in Patients on Clopidogrel and Aspirin Therapy. Basic Clin Pharmacol Toxicol 2017; 120:466-474. [PMID: 27862978 DOI: 10.1111/bcpt.12703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/06/2016] [Indexed: 12/13/2022]
Abstract
Acetylsalicylic acid (ASA) and clopidogrel combined therapy has been reported to be beneficial in patients with acute coronary syndrome (ACS). Antiplatelet drug resistance, especially to clopidogrel, is a multifactorial phenomenon that affects a large number of ACS patients. The genetic contribution to this drug response is not fully elucidated. We investigated the relationship of ABC-type efflux subfamily C member 3 (ABCC3) polymorphisms and mRNA expression with plasma concentrations of clopidogrel, salicylic acid (SA) and a carboxylic acid metabolite (CAM). Clopidogrel, CAM and SA plasma concentrations were measured simultaneously by liquid chromatography-tandem mass spectrometry (LCMS/MS) from 83 ACS patients undergoing percutaneous coronary intervention. ABCC3 (rs757421, rs733392 and rs739923) and CYP2C19*2 (rs4244285) polymorphisms as well as mRNA expression were evaluated. A positive correlation was found between CAM concentrations and ABCC3 mRNA expression (r = 0.494, p < 0.0001). Patients carrying genotype AA (rs757421 variant) had higher CAM concentrations and ABCC3 mRNA expression as compared to those of GG + GA carriers (p = 0.017). A multiple linear regression analysis revealed that ABCC3 mRNA expression (p = 0.017), rs757421 AA genotype (p = 0.001), blood collection time (p = 0.018) and clopidogrel dose (p = 0.001) contributed to the concentration of CAM. No associations were observed for the CYP2C19*2 polymorphism. These results suggest that up-regulation of ABCC3 mRNA expression leads to increased plasma CAM levels through MRP3-mediated cell efflux. The ABCC3 rs757421 polymorphism may contribute to gene expression. Therefore, ABCC3 may be a potential biomarker for the response to clopidogrel.
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Affiliation(s)
- André Ducati Luchessi
- School of Pharmaceutical Science, University of Sao Paulo, Sao Paulo, Brazil.,Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Marta Concheiro
- Luis Concheiro Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Vivian Nogueira Silbiger
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Raul Hernandes Bortolin
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Angelines Cruz
- Luis Concheiro Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Oscar Quintela
- Department of Madrid, National Institute of Toxicology and Forensic Science, Madrid, Spain
| | - Maria Brion
- Genetics of Cardiovascular and Ophthalmological Diseases, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Genomic Medicine, University of Santiago de Compostela, IDIS, CIBERER, Santiago de Compostela, Spain
| | - Angel Carracedo
- Genomic Medicine, University of Santiago de Compostela, IDIS, CIBERER, Santiago de Compostela, Spain
| | - Andres Iñiguez
- Cardiology Service, Alvaro Cunqueiro Hospital, Vigo, Spain
| | - Marisol Bravo
- Cardiology Service, Alvaro Cunqueiro Hospital, Vigo, Spain
| | - Manuel López-Rivadulla
- Luis Concheiro Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
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Enhanced Platelet Response to Clopidogrel in Abcc3-deficient Mice Due to Its Increased Bioactivation. J Cardiovasc Pharmacol 2016; 68:433-440. [DOI: 10.1097/fjc.0000000000000428] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Integrated analysis of miRNA and mRNA gene expression microarrays: Influence on platelet reactivity, clopidogrel response and drug-induced toxicity. Gene 2016; 593:172-178. [DOI: 10.1016/j.gene.2016.08.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/17/2016] [Accepted: 08/15/2016] [Indexed: 01/01/2023]
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Siller-Matula JM, Trenk D, Schrör K, Gawaz M, Kristensen SD, Storey RF, Huber K. Response Variability to P2Y12 Receptor Inhibitors. JACC Cardiovasc Interv 2013; 6:1111-28. [DOI: 10.1016/j.jcin.2013.06.011] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/20/2013] [Indexed: 12/19/2022]
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Zou JJ, Fan HW, Chen SL, Tan J, He BS, Xie HG. Efffect of the ABCC3-211 C/Tpolymorphism on clopidogrel responsiveness in patients with percutaneous coronary intervention. Clin Exp Pharmacol Physiol 2013; 40:504-509. [DOI: 10.1111/1440-1681.12118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Jian-Jun Zou
- Division of Clinical Pharmacology; Nanjing First Hospital; Nanjing Medical University
- Division of Cardiology; Department of Medicine; Nanjing First Hospital; Nanjing Medical University
| | - Hong-Wei Fan
- Division of Clinical Pharmacology; Nanjing First Hospital; Nanjing Medical University
| | - Shao-Liang Chen
- Division of Cardiology; Department of Medicine; Nanjing First Hospital; Nanjing Medical University
| | - Jie Tan
- Division of Clinical Pharmacology; Nanjing First Hospital; Nanjing Medical University
| | - Bang-Shun He
- Central Laboratory; General Clinical Research Center; Nanjing First Hospital; Nanjing Medical University
| | - Hong-Guang Xie
- Central Laboratory; General Clinical Research Center; Nanjing First Hospital; Nanjing Medical University
- Department of Pharmacology; Nanjing Medical University School of Pharmacy; Nanjing China
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Luchessi AD, Silbiger VN, Hirata RDC, Lima-Neto LG, Cavichioli D, Iñiguez A, Bravo M, Bastos G, Sousa AGMR, Brión M, Carracedo A, Hirata MH. Pharmacogenomics of anti-platelet therapy focused on peripheral blood cells of coronary arterial disease patients. Clin Chim Acta 2013; 425:9-17. [PMID: 23832067 DOI: 10.1016/j.cca.2013.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/20/2013] [Accepted: 06/23/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND To investigate genes differentially expressed in peripheral blood cells (PBCs) from patients with coronary arterial disease (CAD) under double anti-platelet therapy. METHODS Twenty-six CAD patients that were submitted to percutaneous coronary intervention (PCI) were selected to participate in this study. These patients took 100mg/day of acetylsalicylic acid (ASA) and 75mg/day of clopidogrel. Blood samples were collected before PCI to evaluate platelet reactivity using VerifyNow ASA and P2Y12 assays (Accumetrics). The patients were stratified into 4 quartiles based on ASA reaction units (ARUs) and P2Y12 reaction units (PRUs). Quartile 1 (Q1) patients were classified as responders and quartile 4 (Q4) patients as non-responders. Global mRNA expression from Q1 to Q4 was analyzed by microarray using the GeneChip Exon 1.0 ST array (Affymetrix) and was confirmed by RT-qPCR. RESULTS Patients with ARU or PRU values within the first quartile (Q1, ARU<390 and PRU<151) were considered responders, while those who had ARU or PRU within the fourth quartile (Q4, ARU>467 and PRU>260) were considered nonresponders. The risk factors associated for CAD showed expected frequencies and no difference was found between Q1 and Q4. Microarray analysis identified 117 genes differentially expressed for ASA and 29 for clopidogrel between Q1 and Q4 groups (p<0.01, FC>1.2). CONCLUSION The variation in response to ASA may be related with an increased expression of IGF1 and IGF1R, as well as a response to clopidogrel can be affected by pharmacokinetic change related to the reverse transport pathway by increased expression of ABCC3.
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