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Lewandrowski KU, Sharafshah A, Elfar J, Schmidt SL, Blum K, Wetzel FT. A Pharmacogenomics-Based In Silico Investigation of Opioid Prescribing in Post-operative Spine Pain Management and Personalized Therapy. Cell Mol Neurobiol 2024; 44:47. [PMID: 38801645 PMCID: PMC11129978 DOI: 10.1007/s10571-024-01466-5] [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: 12/07/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024]
Abstract
Considering the variability in individual responses to opioids and the growing concerns about opioid addiction, prescribing opioids for postoperative pain management after spine surgery presents significant challenges. Therefore, this study undertook a novel pharmacogenomics-based in silico investigation of FDA-approved opioid medications. The DrugBank database was employed to identify all FDA-approved opioids. Subsequently, the PharmGKB database was utilized to filter through all variant annotations associated with the relevant genes. In addition, the dpSNP ( https://www.ncbi.nlm.nih.gov/snp/ ), a publicly accessible repository, was used. Additional analyses were conducted using STRING-MODEL (version 12), Cytoscape (version 3.10.1), miRTargetLink.2, and NetworkAnalyst (version 3). The study identified 125 target genes of FDA-approved opioids, encompassing 7019 variant annotations. Of these, 3088 annotations were significant and pertained to 78 genes. During variant annotation assessments (VAA), 672 variants remained after filtration. Further in-depth filtration based on variant functions yielded 302 final filtered variants across 56 genes. The Monoamine GPCRs pathway emerged as the most significant signaling pathway. Protein-protein interaction (PPI) analysis revealed a fully connected network comprising 55 genes. Gene-miRNA Interaction (GMI) analysis of these 55 candidate genes identified miR-16-5p as a pivotal miRNA in this network. Protein-Drug Interaction (PDI) assessment showed that multiple drugs, including Ibuprofen, Nicotine, Tramadol, Haloperidol, Ketamine, L-Glutamic Acid, Caffeine, Citalopram, and Naloxone, had more than one interaction. Furthermore, Protein-Chemical Interaction (PCI) analysis highlighted that ABCB1, BCL2, CYP1A2, KCNH2, PTGS2, and DRD2 were key targets of the proposed chemicals. Notably, 10 chemicals, including carbamylhydrazine, tetrahydropalmatine, Terazosin, beta-methylcholine, rubimaillin, and quinelorane, demonstrated dual interactions with the aforementioned target genes. This comprehensive review offers multiple strong, evidence-based in silico findings regarding opioid prescribing in spine pain management, introducing 55 potential genes. The insights from this report can be applied in exome analysis as a pharmacogenomics (PGx) panel for pain susceptibility, facilitating individualized opioid prescribing through genotyping of related variants. The article also points out that African Americans represent an important group that displays a high catabolism of opioids and suggest the need for a personalized therapeutic approach based on genetic information.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Division of Personalized Pain Therapy Research & Education, Center for Advanced Spine Care of Southern Arizona, Arizona, USA.
- Department of Orthopaedics, Fundación Universitaria Sanitas and Member of Colombian National Academy of Medicine, Bogotá, DC, Colombia.
- Department of Orthopedics, Doctor honoris causa Hospital Universitário Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, and Member of the Brazilian National Academy of Medicine, Rio de Janeiro, Brazil.
- Center for Advanced Spine Care of Southern Arizona, 4787 E Camp Lowell Drive, Tucson, USA.
| | - Alireza Sharafshah
- Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - John Elfar
- Department of Orthopaedics and Sports Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sergio Luis Schmidt
- Department of Neurology, Federal University of Rio de Janeiro (UNIRIO), University Hospital, Rua Mariz e Barros 750, Tijuca, Rio de Janeiro, RJ, Brazil
| | - Kenneth Blum
- Division of Nutrigenomics, SpliceGen, Therapeutics, Inc., Austin, TX, 78701, USA
- Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, 45435, USA
- Division of Addiction Research & Education, Center for Sports, Exercise, & Mental Health, Western University Health Sciences, Pomona, CA, 91766, USA
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX, 78701, USA
| | - Franklin Todd Wetzel
- Department of Orthopaedic Surgery & Sports Medicine, Director of Musculoskeletal Services Bassett Healthcare Network 1 Atwell Road, Cooperstown, NY, 13326, USA
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Ferreira do Couto ML, Fonseca S, Pozza DH. Pharmacogenetic Approaches in Personalized Medicine for Postoperative Pain Management. Biomedicines 2024; 12:729. [PMID: 38672085 PMCID: PMC11048650 DOI: 10.3390/biomedicines12040729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Despite technical and pharmacological advancements in recent years, including optimized therapies and personalized medicine, postoperative pain management remains challenging and sometimes undertreated. This review aims to summarize and update how genotype-guided therapeutics within personalized medicine can enhance postoperative pain management. Several studies in the area have demonstrated that genotype-guided therapy has the ability to lower opioid consumption and improve postoperative pain. Gene mutations, primarily OPRM1, CYP2D6, CYP2C9, COMT and ABCB1, have been shown to exert nuanced influences on analgesic response and related pharmacological outcomes. This review underscores the integration of pharmacogenetic-guided personalized medicine into perioperative care, particularly when there is uncertainty regarding opioid prescriptions. This approach leads to superior outcomes in terms of postoperative pain relief and reduced morbidity for numerous patients.
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Affiliation(s)
- Maria Leonor Ferreira do Couto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
| | - Sara Fonseca
- Anesthesiology Department, São João University Hospital Centre, 4200-135 Porto, Portugal;
| | - Daniel Humberto Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
- Institute for Research and Innovation in Health and IBMC (i3S), University of Porto, 4200-135 Porto, Portugal
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Lilic J, Marjanovic VG, Budic I, Stefanovic N, Stokanovic D, Marjanovic GT, Jevtovic-Stoimenov T, Golubovic M, Zecevic M, Velickovic-Radovanovic R. The Impact of Opioid Receptor Gene Polymorphism on Fentanyl and Alfentanil's Analgesic Effects in the Pediatric Perioperative Period. Pharmgenomics Pers Med 2024; 17:41-49. [PMID: 38313794 PMCID: PMC10838050 DOI: 10.2147/pgpm.s443035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction The polymorphism of the gene coding mu-opioid receptor (OPRM1) is one of the factors contributing to the variability in the response to opioid analgesics in children. The goal of this study is to investigate its role in association with postoperative acute pain in children of various ages. Methods This prospective study analyzed 110 pediatric patients, after plastic or orthopedic surgery, who were genotyped and randomly assigned to receive fentanyl or alfentanil. Postoperative pain was rated using Numerical Rating Scale (0-10). All the patients were genotyped forOPRM1 118A>G (rs1799971) gene polymorphism. Results School children under the age of 11 with the OPRM1 AA genotype were shown to have a higher BMI (p<0.05). Children over the age of 12 carrying G allele OPRM1, had increased postoperative pain sensitivity and intensity (3.28±1.95 vs 4.91±2.17; p<0.05), as compared to AA allele carriers. Discussion OPRM1 118A>G polymorphism may explain the variation in the perception of postoperative pain in children over the age of 12 and may be a useful predictor for adjusting the dose of analgesics, but the dose is relative to the patient's needs regardless of his genetic characteristics. In younger children, carriers of polymorphic OPRM1 118G allele may be protected from obesity, due to diminished MOP expression.
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Affiliation(s)
- Jelena Lilic
- Clinic for Anesthesia and Intensive Therapy, University Clinical Centre Nis, Nis, Serbia
| | - Vesna G Marjanovic
- Clinic for Anesthesia and Intensive Therapy, University Clinical Centre Nis, Nis, Serbia
- Department of Surgery and Anesthesiology with Reanimatology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Ivana Budic
- Clinic for Anesthesia and Intensive Therapy, University Clinical Centre Nis, Nis, Serbia
- Department of Surgery and Anesthesiology with Reanimatology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Nikola Stefanovic
- Department of Pharmacy, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Dragana Stokanovic
- Department of Pharmacology with Toxicology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Goran T Marjanovic
- Department of Immunology, Faculty of Medicine, University of Nis, Nis, Serbia
- Department of Hematology and Clinical Immunology, University Clinical Centre Nis, Nis, Serbia
| | | | - Mladjan Golubovic
- Department of Surgery and Anesthesiology with Reanimatology, Faculty of Medicine, University of Nis, Nis, Serbia
- Clinic of Cardiovascular and Transplant Surgery, University Clinical Centre Nis, Nis, Serbia
| | - Maja Zecevic
- Clinic of Pediatric Surgery, University Clinical Centre Nis, Nis, Serbia
| | - Radmila Velickovic-Radovanovic
- Department of Pharmacology with Toxicology, Faculty of Medicine, University of Nis, Nis, Serbia
- Clinic of Nephrology, University Clinical Centre Nis, Nis, Serbia
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Wong AK, Klepstad P, Somogyi AA, Vogrin S, Le B, Philip J, Rubio JP. Effect of gene variants on opioid dose, pain and adverse effect outcomes in advanced cancer: an explorative study. Pharmacogenomics 2023; 24:901-913. [PMID: 38126330 DOI: 10.2217/pgs-2023-0207] [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] [Indexed: 12/23/2023] Open
Abstract
Aim: Associations between gene variants and opioid net effect are unclear. We conducted an exploratory pharmacogenetic analysis of 35 gene variants and opioid response in advanced cancer. Patients & methods: This multi-center prospective cohort study included clinical data, questionnaires (pain and adverse effects) and DNA (blood). Negative binomial regression and logistic regression were used. Results: Within 54 participants, eight statistically significant associations (p = 0.002-0.038) were observed between gene variants and opioid dose, pain scores or adverse effects, the majority being within the neuroimmune TLR4 pathway (IL1B [rs1143634], IL2 [rs2069762], IL6 [rs1800795], BDNF [rs6265]) and ARRB2 pathway (ARRB2 [rs3786047], DRD2 [rs6275]). Conclusion: Neuroimmune pathway genes may contribute to differences in opioid response in cancer and may be included in future similar studies.
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Affiliation(s)
- Aaron K Wong
- Peter MacCallum Cancer center, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia
- Department of Medicine, University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Pal Klepstad
- Department Intensive Care Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Andrew A Somogyi
- Professor of Clinical & Experimental Pharmacology, Discipline of Pharmacology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, 5005, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Brian Le
- Peter MacCallum Cancer center, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia
| | - Jennifer Philip
- Peter MacCallum Cancer center, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia
- Department of Medicine, University of Melbourne Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, 3065, Australia
- St Vincent's Hospital, Palliative Care Service Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Justin P Rubio
- Principal Research Fellow Florey Institute of Neuroscience & Mental Health, 30 Royal Parade, Victoria, 3052, Australia
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Frangakis SG, MacEachern M, Akbar TA, Bolton C, Lin V, Smith AV, Brummett CM, Bicket MC. Association of Genetic Variants with Postsurgical Pain: A Systematic Review and Meta-analyses. Anesthesiology 2023; 139:827-839. [PMID: 37774411 PMCID: PMC10859728 DOI: 10.1097/aln.0000000000004677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Postsurgical pain is a key component of surgical recovery. However, the genetic drivers of postsurgical pain remain unclear. A broad review and meta-analyses of variants of interest will help investigators understand the potential effects of genetic variation. METHODS This article is a systematic review of genetic variants associated with postsurgical pain in humans, assessing association with postsurgical pain scores and opioid use in both acute (0 to 48 h postoperatively) and chronic (at least 3 months postoperatively) settings. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from 2000 to 2022 for studies using search terms related to genetic variants and postsurgical pain in humans. English-language studies in adult patients examining associations of one or more genetic variants with postsurgical pain were included. The primary outcome was association of genetic variants with either acute or chronic postsurgical pain. Pain was measured by patient-reported pain score or analgesic or opioid consumption. RESULTS A total of 163 studies were included, evaluating 129 unique genes and 594 unique genetic variants. Many of the reported significant associations fail to be replicated in other studies. Meta-analyses were performed for seven variants for which there was sufficient data (OPRM1 rs1799971; COMT rs4680, rs4818, rs4633, and rs6269; and ABCB1 rs1045642 and rs2032582). Only two variants were associated with small differences in postsurgical pain: OPRM1 rs1799971 (for acute postsurgical opioid use standard mean difference = 0.25; 95% CI, 0.16 to 0.35; cohort size, 8,227; acute postsurgical pain score standard mean difference = 0.20; 95% CI, 0.09 to 0.31; cohort size, 4,619) and COMT rs4680 (chronic postsurgical pain score standard mean difference = 0.26; 95% CI, 0.08 to 0.44; cohort size, 1,726). CONCLUSIONS Despite much published data, only two alleles have a small association with postsurgical pain. Small sample sizes, potential confounding variables, and inconsistent findings underscore the need to examine larger cohorts with consistent outcome measures. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Stephan G Frangakis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - T Adam Akbar
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan. Current Position: Department of Anesthesiology, Northwestern Medicine, Chicago, Illinois
| | - Christian Bolton
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Victor Lin
- Victor Lin, D.O., Ph.D.; Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Albert V Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Opioid Prescribing and Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Opioid Prescribing and Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan
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Chappell K, Colle R, Ait Tayeb AEK, Bouligand J, El-Asmar K, Deflesselle E, Fève B, Becquemont L, Corruble E, Verstuyft C. The ERICH3 rs11580409 polymorphism is associated with 6-month antidepressant response in depressed patients. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110608. [PMID: 35878676 DOI: 10.1016/j.pnpbp.2022.110608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Major Depressive Disorder (MDD) is the current leading cause of disability worldwide. The effect of its main treatment option, antidepressant drugs (AD), is influenced by genetic and metabolic factors. The ERICH3 rs11580409(A > C) genetic polymorphism was identified as a factor influencing serotonin (5HT) levels in a pharmacometabolomics-informed genome-wide association study. It was also associated with response following AD treatment in several cohorts of depressed patients. OBJECTIVE Our aim was to analyze the association of the ERICH3 rs11580409(A > C) genetic polymorphism with response following AD treatment and plasma 5HT levels in METADAP, a cohort of 6-month AD-treated depressed patients. METHODS Clinical (n = 377) and metabolic (n = 150) data were obtained at baseline and after 3 (M3) and 6 months (M6) of treatment. Linear mixed-effects models and generalized logistic mixed-effects models were used to assess the association of the rs11580409 polymorphism with the Hamilton Depression Rating Scale (HDRS) score, response and remission rates, and plasma 5HT levels. RESULTS The interaction between the ERICH3 rs11580409 polymorphism and time was an overall significant factor in mixed-effects models of the HDRS score (F3,870 = 3.35, P = 0.019). At M6, CC homozygotes had a significantly lower HDRS score compared to A allele carriers (coefficient = -3.50, 95%CI [-6.00--0.99], P = 0.019). No association between rs11580409 and 5HT levels was observed. CONCLUSION Our results suggest an association of rs11580409 with response following long-term AD treatment. The rs11580409 genetic polymorphism may be a useful biomarker for treatment response in major depression.
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Affiliation(s)
- Kenneth Chappell
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France.
| | - Romain Colle
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France; Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - Abd El Kader Ait Tayeb
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France; Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - Jérôme Bouligand
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France; Plateforme d'Expertises Maladies Rares Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), France; Université Paris-Saclay, Faculté de Médecine, Unité Inserm UMRS 1185, Physiologie et Physiopathologie Endocriniennes, 94276 Le Kremlin-Bicêtre, France
| | - Khalil El-Asmar
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France; Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Eric Deflesselle
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France
| | - Bruno Fève
- Sorbonne Université-INSERM, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire ICAN, Service d'Endocrinologie, CRMR PRISIS, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris F-75012, France
| | - Laurent Becquemont
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France; Centre de recherche clinique, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - Emmanuelle Corruble
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France; Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - Céline Verstuyft
- CESP, MOODS Team, INSERM UMR 1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre F-94275, France; Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
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Yee L, Capule FR, Makmor-Bakry M. Genetic polymorphisms of OPRM1 on the efficacy and safety of anesthetic and analgesic agents: a systematic review. Pharmacogenomics 2022; 23:609-617. [PMID: 35735174 DOI: 10.2217/pgs-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This systematic review aimed to outline the outcome of OPRMI (A118G) variants on the effects of anesthetic and analgesic agents used in various procedures. Materials & methods: Literature was obtained from reliable, established databases and reference tracking. Efficacy and side/adverse effects of anesthetic and analgesic drugs intraoperatively or within 48 h postsurgery were the key outcome measures for all populations. Animal studies were excluded. Results: Twenty-nine studies were chosen for inclusion. In association with the efficacy and safety of anesthetic and analgesic agents, gene polymorphism in OPRM1 displayed a strong correlation in reduced analgesic effect and protection against adverse reactions. Conclusion: This systematic review summarized the correlation between genetic polymorphism in the OPRM1 gene and anesthetic/analgesic effects.
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Affiliation(s)
- Liew Yee
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Francis R Capule
- College of Pharmacy. University of the Philippines Manila, Manila, 1000, Philippines
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
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8
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Gloor Y, Czarnetzki C, Curtin F, Gil-Wey B, Tramèr MR, Desmeules JA. Genetic Susceptibility Toward Nausea and Vomiting in Surgical Patients. Front Genet 2022; 12:816908. [PMID: 35173765 PMCID: PMC8842269 DOI: 10.3389/fgene.2021.816908] [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] [Received: 11/17/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative nausea and vomiting (PONV) are frequently occurring adverse effects following surgical procedures. Despite predictive risk scores and a pallet of prophylactic antiemetic treatments, it is still estimated to affect around 30% of the patients, reducing their well-being and increasing the burden of post-operative care. The aim of the current study was to characterize selected genetic risk factors of PONV to improve the identification of at risk patients. We genotyped 601 patients followed during the first 24 h after surgery for PONV symptoms in the absence of any antiemetic prophylaxis. These patients were recruited in the frame of a randomized, placebo controlled clinical study aiming to test the efficacy of dexamethasone as a treatment of established PONV. We examined the impact of selected single nucleotide polymorphisms (SNPs) located around 13 different genes and the predicted activity of 6 liver drug metabolizing enzymes from the cytochromes P450 family (CYP) on the occurrence and recurrence of PONV. Our genetic study confirms the importance of genetic variations in the type 3B serotonin receptor in the occurrence of PONV. Our modelling shows that integration of rs3782025 genotype in preoperative risk assessments may help improve the targeting of antiemetic prophylaxis towards patients at risk of PONV.
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Affiliation(s)
- Yvonne Gloor
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Christoph Czarnetzki
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - François Curtin
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Personalized Health Programs, Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland
| | - Béatrice Gil-Wey
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Martin R Tramèr
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Jules A Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
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9
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The GG genotype of the serotonin 4 receptor genetic polymorphism, rs1345697, is associated with lower remission rates after antidepressant treatment: Findings from the METADAP cohort. J Affect Disord 2022; 299:335-343. [PMID: 34906639 DOI: 10.1016/j.jad.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pharmacological studies have yielded valuable insights into the role of the serotonin 4 receptor (HTR4) in major depressive episodes (MDE) and response to antidepressant drugs (AD). A genetic association has been shown between HTR4 and susceptibility to mood disorders. Our study aims at assessing the association between the HTR4 genetic polymorphism, rs1345697, and improvement in depressive symptoms and remission after antidepressant treatment in MDE patients. METHODS 492 depressed patients from the METADAP cohort were treated prospectively for 6 months with ADs. The clinical outcomes according to HTR4 rs1345697 were compared after 1 (M1), 3 (M3), and 6 (M6) months of treatment. Mixed-effects logistic regression and adjusted linear models assessed the association between rs1345697 and 17-item Hamilton Depression Rating Scale (HDRS) score improvement and response/remission. RESULTS Over the 6 months of treatment, mixed-effects regressions showed lower improvements in HDRS scores (Coefficient=1.52; Confident Interval (CI) 95% [0.37-2.67]; p = 0.009) and lower remission rates (Odds Ratio=2.0; CI95% [1.0-4.1]; p = 0.05) in GG homozygous patients as compared to allele A carriers. LIMITATIONS The major limitations of our study are the uncertainty of the rs1345697 effect on HTR4 function, the substantial drop-out rate, and the fact that analysis is not based on randomization between polymorphism groups. CONCLUSIONS In our study, patients who were homozygous carriers of the variant G of the HTR4 rs1345697 had lower depressive symptoms improvement and 2-fold lower remission rates after antidepressant treatment as compared to allele A carriers. Randomization study should be done to confirm these results.
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10
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Sachtleben EP, Rooney K, Haddad H, Lassiegne VL, Boudreaux M, Cornett EM, Kaye AD. The Role of Pharmacogenomics in Postoperative Pain Management. Methods Mol Biol 2022; 2547:505-526. [PMID: 36068475 DOI: 10.1007/978-1-0716-2573-6_18] [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] [Indexed: 06/15/2023]
Abstract
Pharmacogenomics can improve pain management by considering individual variations in pain perception and susceptibility and sensitivity to medicines related to genetic diversity. Due to the subjective nature of pain and the fact that people respond differently to medicines, it can be challenging to develop a consistent and successful regimen for pain disorders. Numerous factors influence the outcome of pain treatment programs, but two stand out: altered perception of pain and varying responsiveness to analgesic medicines. Numerous polymorphisms in genes such as CYP2D6, OPRM1, and ABCB1 have been identified, culminating in a heterogeneous response to pain medication in people who have these genetic polymorphisms. Improved treatment regimens that factor in pharmacogenetic differences in patients would help reduce the risk of opioid dependency and help effectively treat postoperative pain.
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Affiliation(s)
| | | | - Hannah Haddad
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | - Megan Boudreaux
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, Shreveport, LA, USA
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11
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Karbownik A, Szkutnik-Fiedler D, Grabowski T, Wolc A, Stanisławiak-Rudowicz J, Jaźwiec R, Grześkowiak E, Szałek E. Pharmacokinetic Drug Interaction Study of Sorafenib and Morphine in Rats. Pharmaceutics 2021; 13:pharmaceutics13122172. [PMID: 34959453 PMCID: PMC8707786 DOI: 10.3390/pharmaceutics13122172] [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] [Received: 11/19/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/02/2022] Open
Abstract
A combination of the tyrosine kinase inhibitor—sorafenib—and the opioid analgesic—morphine—can be found in the treatment of cancer patients. Since both are substrates of P-glycoprotein (P-gp), and sorafenib is also an inhibitor of P-gp, their co-administration may affect their pharmacokinetics, and thus the safety and efficacy of cancer therapy. Therefore, the aim of this study was to evaluate the potential pharmacokinetic drug–drug interactions between sorafenib and morphine using an animal model. The rats were divided into three groups that Received: sorafenib and morphine (ISOR+MF), sorafenib (IISOR), and morphine (IIIMF). Morphine caused a significant increase in maximum plasma concentrations (Cmax) and the area under the plasma concentration–time curves (AUC0–t, and AUC0–∞) of sorafenib by 108.3 (p = 0.003), 55.9 (p = 0.0115), and 62.7% (p = 0.0115), respectively. Also, the Cmax and AUC0–t of its active metabolite—sorafenib N-oxide—was significantly increased in the presence of morphine (p = 0.0022 and p = 0.0268, respectively). Sorafenib, in turn, caused a significant increase in the Cmax of morphine (by 0.5-fold, p = 0.0018). Moreover, in the presence of sorafenib the Cmax, AUC0–t, and AUC0–∞ of the morphine metabolite M3G increased by 112.62 (p < 0.0001), 46.82 (p = 0.0124), and 46.78% (p = 0.0121), respectively. Observed changes in sorafenib and morphine may be of clinical significance. The increased exposure to both drugs may improve the response to therapy in cancer patients, but on the other hand, increase the risk of adverse effects.
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Affiliation(s)
- Agnieszka Karbownik
- Department of Clinical Pharmacy and Biopharmacy, Poznań University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861 Poznań, Poland; (A.K.); (J.S.-R.); (E.G.); (E.S.)
| | - Danuta Szkutnik-Fiedler
- Department of Clinical Pharmacy and Biopharmacy, Poznań University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861 Poznań, Poland; (A.K.); (J.S.-R.); (E.G.); (E.S.)
- Correspondence: ; Tel.: +48-6166-87865
| | - Tomasz Grabowski
- Preclinical Development, Polpharma Biologics SA, Trzy Lipy 3, 80-172 Gdańsk, Poland;
| | - Anna Wolc
- Department of Animal Science, Iowa State University, 239E Kildee Hall, Ames, IA 50011, USA;
- Research and Development, Hy-Line International, 2583 240th Street, Dallas Center, IA 50063, USA
| | - Joanna Stanisławiak-Rudowicz
- Department of Clinical Pharmacy and Biopharmacy, Poznań University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861 Poznań, Poland; (A.K.); (J.S.-R.); (E.G.); (E.S.)
- Department of Gynecological Oncology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, 84/86 Szamarzewskiego Str., 60-101 Poznań, Poland
| | - Radosław Jaźwiec
- Laboratory of Mass Spectrometry, Institute of Biochemistry and Biophysics PAS, Polish Academy of Sciences, 5A Pawińskiego Str., 02-106 Warsaw, Poland;
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy, Poznań University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861 Poznań, Poland; (A.K.); (J.S.-R.); (E.G.); (E.S.)
| | - Edyta Szałek
- Department of Clinical Pharmacy and Biopharmacy, Poznań University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861 Poznań, Poland; (A.K.); (J.S.-R.); (E.G.); (E.S.)
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12
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Tanaka R, Sato J, Ishikawa H, Sato T, Shino M, Ohde Y, Sato T, Mori K, Notsu A, Ohnami S, Mizuguchi M, Nagashima T, Yamaguchi K. Influence of genetic variants of opioid-related genes on opioid-induced adverse effects in patients with lung cancer: A STROBE-compliant observational study. Medicine (Baltimore) 2021; 100:e27565. [PMID: 34871222 PMCID: PMC8568420 DOI: 10.1097/md.0000000000027565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/02/2021] [Indexed: 01/05/2023] Open
Abstract
Despite the dramatic advancement of cancer chemotherapy and immunotherapy, the insufficient progress has been made in basic or translational research on personalization of opioid therapy. Predicting the effectiveness of opioid analgesic therapy and the risk of adverse effects prior to therapy are expected to enable safer and more appropriate opioid therapy for cancer patients. In this study, we compared the incidence of opioid-induced adverse effects between patients with different variants of the genes related to responsiveness to opioid analgesics.Participants were 88 patients with lung cancer who provided general consent for exome sequencing and were treated with morphine or oxycodone at Shizuoka Cancer Center Hospital between April 2014 and August 2018. Incidence rates for 6 adverse effects of opioid therapy (somnolence, nausea, constipation, delirium, urinary retention, and pruritus) were determined and the influence of single nucleotide polymorphisms in coding regions of the opioid μ receptor 1 (OPRM1) (rs1799971), opioid δ receptor 1 (rs2234918), opioid κ receptor 1 (rs1051660), catechol-O-methyltransferase (COMT) (rs4680), dopamine receptor D2 (rs6275), adenosine triphosphate binding cassette B1 (rs1045642), G-protein regulated inward rectifier potassium channel 2 (rs2070995), and fatty acid amide hydrolase (rs324420) genes on those adverse effects were analyzed.Analysis of OPRM1 gene variant status (Asn133Asp A > G) showed that G/G homozygotes were at significantly lower risk of somnolence compared with A allele carriers (0% vs 28.4%; Fisher exact test, P = .005; OR, 0; 95% CI, 0-0.6), and analysis of COMT gene variant status (Val158Met, G > A) showed that G/G homozygotes were at significantly higher risk of somnolence compared with A allele carriers (35.0% vs 10.4%; Fisher exact test, P = .008; OR, 4.5; 95% CI, 1.4-18.1). No relationship between variant status and adverse effects was found for the other genes.These findings demonstrate that OPRM1 and COMT gene variants influence the risk of somnolence as an adverse effect of opioid analgesic therapy.
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Affiliation(s)
- Rei Tanaka
- Department of Pharmacy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| | - Junya Sato
- Department of Pharmacy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
- Department of Pharmacy, International University of Health and Welfare Hospital, Tochigi, Japan
- Faculty of Pharmacy, International University of Health and Welfare, Tochigi, Japan
| | - Hiroshi Ishikawa
- Department of Pharmacy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tetsu Sato
- Department of Pharmacy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Michihiro Shino
- Department of Pharmacy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tetsumi Sato
- Division of Palliative Medicine, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Sumiko Ohnami
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Maki Mizuguchi
- Office of the Project HOPE, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takeshi Nagashima
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
- SRL Inc, Tokyo, Japan
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13
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Liew Y, Capule FR, Makmor-Bakry M. Effects of genetic polymorphisms of ABCB1 on the efficacy of anesthetic and analgesic agents: a systematic review. Pharmacogenomics 2021; 22:1099-1106. [PMID: 34590490 DOI: 10.2217/pgs-2021-0079] [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: 01/12/2023] Open
Abstract
Aim: To perform a systematic review to determine the effect of ABCB1 (1236C>T, 2677G>T/A and 3435C>T) variants on the effects of anesthetic and analgesic agents in various surgical procedures. Materials & methods: Literature was obtained from established databases and reference tracking. The main outcome measures were efficacy of anesthetic and analgesic agents intraoperative or within 48 h post surgery of human population. Results: Seventeen studies were included for data extraction from 1127 screened studies. The influences of ABCB1 gene polymorphisms on analgesic effects showed conflicting results. The mutational homozygous TT genotypes of 1236C>T and 3435C>T polymorphisms demonstrated significant association with the anesthetic effects. Conclusion: The mutational homozygous TT genotype in both ABCB1 1236C>T and 3435C>T is associated with weaker anesthetic effect but there are no clearly demonstrated analgesic effects.
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Affiliation(s)
- Yee Liew
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Francis R Capule
- College of Pharmacy, University of the Philippines, Manila, Philippines
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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14
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Magarbeh L, Gorbovskaya I, Le Foll B, Jhirad R, Müller DJ. Reviewing pharmacogenetics to advance precision medicine for opioids. Biomed Pharmacother 2021; 142:112060. [PMID: 34523422 DOI: 10.1016/j.biopha.2021.112060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adequate opioid prescribing is critical for therapeutic success of pain management. Despite the widespread use of opioids, optimized opioid therapy remains unresolved with risk of accidental lethal overdosing. With the emergence of accumulating evidence linking genetic variation to opioid response, pharmacogenetic based treatment recommendations have been proposed. OBJECTIVE The aim of this review is to evaluate pharmacogenetic evidence and provide an overview on genes involved in the pharmacokinetics and pharmacodynamics of opioids. METHODS For this review, a systematic literature search of published articles was used in PubMed®, with no language restriction and between the time period of January 2000 to December 2020. We reviewed randomized clinical studies, study cohorts and case reports that investigated the influence of genetic variants on selected opioid pharmacokinetics and pharmacodynamics. In addition, we reviewed current CPIC clinical recommendations for pharmacogenetic testing. RESULTS Results of this review indicate consistent evidence supporting the association between selected genetic variants of CYP2D6 for opioid metabolism. CPIC guidelines include recommendations that indicate the avoidance of tramadol use, in addition to codeine, in CYP2D6 poor metabolizers and ultrarapid metabolizers, and to monitor intermediate metabolizers for less-than-optimal response. While there is consistent evidence for OPRM1 suggesting increased postoperative morphine dosing requirements in A118G G-allele carriers, the clinical relevance remains limited. CONCLUSION There is emerging evidence of clinical relevance of CYP2D6 and, to a lesser extent, OPRM1 polymorphism in personalized opioid drug dosing. As a result, first clinics have started to implement pharmacogenetic guidelines for CYP2D6 and codeine.
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Affiliation(s)
- Leen Magarbeh
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ilona Gorbovskaya
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Reuven Jhirad
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Office of the Chief Coroner and Ontario Forensic Pathology Service, Toronto, ON, Canada
| | - Daniel J Müller
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
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15
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Ofoegbu A, B. Ettienne E. Pharmacogenomics and Morphine. J Clin Pharmacol 2021; 61:1149-1155. [PMID: 33847389 PMCID: PMC8453761 DOI: 10.1002/jcph.1873] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/06/2021] [Indexed: 11/10/2022]
Abstract
Morphine is an opioid analgesic indicated in the treatment of acute and chronic moderate to severe pain. From a pharmacodynamic standpoint, morphine exerts its effects by agonizing mu-opioid receptors predominantly, resulting in analgesia and sedation. Pharmacokinetically, morphine is primarily metabolized in the liver via glucuronidation by the enzyme uridine diphosphate glucuronosyltransferase family 2 member B7 and encounters the transporter proteins organic cation transporter isoform 1 and P-glycoprotein (adenosine triphosphate-binding cassette subfamily B member 1) as it is being distributed throughout the body. The genes coding for the proteins impacting either the pharmacokinetics or pharmacodynamics of morphine may bear genetic variations, also known as polymorphisms, which may alter the function of the proteins in such a manner that an individual may have disparate treatment outcomes. The purpose of this review is to highlight some of the genes coding for proteins that impact morphine pharmacokinetics and pharmacodynamics and present some treatment considerations.
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Affiliation(s)
- Adaku Ofoegbu
- Department of Clinical and Administrative SciencesHoward University College of PharmacyWashingtonDistrict of ColumbiaUSA
| | - Earl B. Ettienne
- Department of Clinical and Administrative SciencesHoward University College of PharmacyWashingtonDistrict of ColumbiaUSA
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16
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Cheng H, Zeng R, Kong L, Ding C, He Y, Zhuang W, Sun Y. Establishment of predicting equation for individual sufentanil dosage postoperatively based on gene polymorphisms. Pain Pract 2021; 22:39-46. [PMID: 33977649 DOI: 10.1111/papr.13030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative analgesia is widely used for patients undergoing major surgeries. Individual differences in genetic polymorphisms may be obstructive factors for accurately anesthetics using. However, the equation for predicting sufentanil dosage postoperatively based on genetic design has been established yet. Our aim was to establish sufentanil dosage postoperatively prediction equation based on patients' genetic polymorphisms. METHODS One hundred forty patients with total gastrectomy and radical resection of pulmonary carcinoma were included. To establish sufentanil dosage postoperatively for patients with gastric cancer, we collected patients' basic information and CYP3A4*1G, COMTVal158Met, OPRM1A118G, and ABCB1C3435T gene sequencing results. To verify this equation, we put patients' with lung cancer surgeries information into it. RESULTS The sufentanil dosage prediction equation postoperatively was y = 4.104 - 0.222 × (gender) + 0.021 × (OPRM1A118G) + 0.249 × (ABCB1C3435T). Patients' with lung cancer surgeries information were substituted into it. The results showed no significant differences between predicted and actual sufentanil dosage (p > 0.05). CONCLUSION We established the prediction equation for individual sufentanil dosage postoperatively based on gene polymorphisms. The results showed this prediction equation was valid, which might be used for different types of surgeries. We established an equation for individual dosage of sufentanil for postoperative analgesia based on gene polymorphisms. The results show that the prediction equation is valid, the information might be used for different types of postoperative analgesia, and the painful patients will have great potential safe and personalized pain control after analgesic therapy. It might also have potential as a clinical tool.
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Affiliation(s)
- Huawei Cheng
- Division of Life Sciences and Medicine, Department of Pharmacy, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Rong Zeng
- Division of Life Sciences and Medicine, Department of Anesthesiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Lingsuo Kong
- Division of Life Sciences and Medicine, Department of Anesthesiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Conglan Ding
- Division of Life Sciences and Medicine, Department of Medical Oncology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yifu He
- Division of Life Sciences and Medicine, Department of Medical Oncology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Wei Zhuang
- Division of Life Sciences and Medicine, Department of Pharmacy, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yancai Sun
- Division of Life Sciences and Medicine, Department of Pharmacy, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
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17
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Inoue R, Nishizawa D, Hasegawa J, Nakayama K, Fukuda KI, Ichinohe T, Mieda T, Tsujita M, Nakagawa H, Kitamura A, Sumikura H, Ikeda K, Hayashida M. Effects of rs958804 and rs7858836 single-nucleotide polymorphisms of the ASTN2 gene on pain-related phenotypes in patients who underwent laparoscopic colectomy and mandibular sagittal split ramus osteotomy. Neuropsychopharmacol Rep 2021; 41:82-90. [PMID: 33476460 PMCID: PMC8182957 DOI: 10.1002/npr2.12159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Opioids are widely used as effective analgesics, but opioid sensitivity varies widely among individuals. The underlying genetic and nongenetic factors are not fully understood. Based on the results of our previous genome‐wide association study, we investigated the effects of single nucleotide polymorphisms (SNPs) of the astrotactin 2 (ASTN2) gene on pain‐related phenotypes in surgical patients. Methods We investigated the effects of two SNPs, rs958804 T/C and rs7858836 C/T, of the ASTN2 gene on eight and seven pain‐related phenotypes in 350 patients who underwent laparoscopic colectomy (LAC) and 358 patients who underwent mandibular sagittal split ramus osteotomy (SSRO), respectively. In both surgical groups, intravenous fentanyl patient‐controlled analgesia (PCA) was used for postoperative analgesia, and 24‐hour postoperative PCA fentanyl use was the primary endpoint. Results The association analyses among the two SNPs and pain‐related traits showed that 24‐hour fentanyl use was significantly associated with the two SNP genotypes in both surgical groups. The Mann‐Whitney test showed that 24‐hour fentanyl use was lower in patients with the C allele than in patients with the TT genotype of the rs958804 T/C SNP (P = .0019 and .0200 in LAC and SSRO patients, respectively), and it was lower in patients with the T allele than in patients with the CC genotype of the rs7858836 C/T SNP (P = .0017 and .0098 in LAC and SSRO patients, respectively). Conclusion The two SNPs of the ASTN2 gene were consistently associated with fentanyl requirements after two different types of surgery. These findings may contribute to personalized pain control. We investigated the effects of two SNPs, rs958804 T/C and rs7858836 C/T, which are located in the same LD block of the ASTN2 gene, on pain‐related phenotypes in two groups of patients who underwent laparoscopic colectomy and mandibular sagittal split ramus osteotomy. We found that these SNPs consistently reduced fentanyl requirements for postoperative analgesia, possibly by enhancing the analgesic effect of fentanyl.![]()
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Affiliation(s)
- Rie Inoue
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Junko Hasegawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kyoko Nakayama
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ken-Ichi Fukuda
- Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
| | - Tatsuya Ichinohe
- Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan
| | - Miki Tsujita
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideyuki Nakagawa
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akira Kitamura
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroyuki Sumikura
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
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18
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Singh A, Zai C, Mohiuddin AG, Kennedy JL. The pharmacogenetics of opioid treatment for pain management. J Psychopharmacol 2020; 34:1200-1209. [PMID: 32715846 DOI: 10.1177/0269881120944162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Opioids are widely used as an analgesic for the treatment of moderate to severe pain. However, there are interindividual variabilities in opioid response. Current evidence suggests that these variabilities can be attributed to single nucleotide polymorphisms in genes involved in opioid pharmacodynamics and pharmacokinetics. Knowledge of these genetic factors through pharamacogenetic (PGx) testing can help clinicians to more consistently prescribe opioids that can provide patients with maximal clinical benefit and minimal risk of adverse effects. AIM The research outlined in this literature review identifies variants involved in opioid PGx, which may be an important tool to achieving the goal of personalized pain management. RESULTS Cytochrome P450 (CYP) 2D6, CYP3A4, CYP3A5, catechol-o-methyltransferase (COMT), adenosine triphosphate binding cassette transporter B1 (ABCB1), opioid receptor mu 1 (OPRM1), and opioid receptor delta 1 (OPRD1) are all important genes involved in opioid drug response, side effect profile and risk of dependence; these are important genetic factors that should be included in potential opioid PGx tests for pain management. CONCLUSIONS Employing a PGx-guided strategy for prescribing opioids can improve response rate, reduce side effects and increase adherence to treatment plans for pain; more research is needed to explore opioid-related PGx factors for the development and validation of an opioid genetic panel. Optimal prescriptions could also provide healthcare payers with beneficial savings, while reducing the risk of propagating the current opioid crisis.
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Affiliation(s)
- Ashley Singh
- Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Clement Zai
- Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Ayeshah G Mohiuddin
- Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James L Kennedy
- Molecular Brain Science, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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19
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Packiasabapathy S, Rangasamy V, Horn N, Hendrickson M, Renschler J, Sadhasivam S. Personalized pediatric anesthesia and pain management: problem-based review. Pharmacogenomics 2020; 21:55-73. [PMID: 31849281 DOI: 10.2217/pgs-2019-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pharmacogenetics, the genetic influence on the interpersonal variability in drug response, has enabled tailored pharmacotherapy and emerging 'personalized medicine.' Although oncology spearheaded the clinical implementation of personalized medicine, other specialties are rapidly catching up. In anesthesia, classical examples of genetically mediated idiosyncratic reactions have been long known (e.g., malignant hyperthermia and prolonged apnea after succinylcholine). The last two decades have witnessed an expanding body of pharmacogenetic evidence in anesthesia. This review highlights some of the prominent pharmacogenetic associations studied in anesthesia and pain management, with special focus on pediatric anesthesia.
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Affiliation(s)
- Senthil Packiasabapathy
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Valluvan Rangasamy
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Nicole Horn
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Michele Hendrickson
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Janelle Renschler
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
| | - Senthilkumar Sadhasivam
- Department of Anesthesia, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, USA
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Patel JN, Hamadeh IS. Pharmacogenomics-guided opioid management. BMJ Support Palliat Care 2020; 10:374-378. [PMID: 32826269 DOI: 10.1136/bmjspcare-2020-002589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jai N Patel
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Issam S Hamadeh
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Charlotte, North Carolina, USA
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Chaturvedi R, Alexander B, A'Court AM, Waterman RS, Burton BN, Urman RD, Gabriel RA. Genomics testing and personalized medicine in the preoperative setting: Can it change outcomes in postoperative pain management? Best Pract Res Clin Anaesthesiol 2020; 34:283-295. [PMID: 32711834 DOI: 10.1016/j.bpa.2020.05.008] [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: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
Postoperative pain and opioid use are major challenges in perioperative medicine. Pain perception and its response to opioid use are multi-faceted and include pharmacological, psychological, and genetic components. Precision medicine is a unique approach to individualized health care in which decisions in management are based on genetics, lifestyle, and environment of each person. Genetic variations can have an impact on the perception of pain and response to treatment. This can have an effect on pain management in both acute and chronic settings. Although there is currently not enough evidence for making recommendations about genetic testing to guide pain management in the acute care setting, there are some known polymorphisms that play a role in surgical pain and opioid-related postoperative adverse outcomes. In this review, we describe the potential use of pharmacogenomics (PGx) for improving perioperative pain management. We first review a number of genotypes that have shown correlations with pain and opioid use and then describe the importance of PGx-guided analgesic protocols and implementation of screening in a preoperative evaluation clinical setting.
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Affiliation(s)
- Rahul Chaturvedi
- School of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Brenton Alexander
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA.
| | - Alison M A'Court
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.
| | - Ruth S Waterman
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.
| | - Brittany N Burton
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA.
| | - Rodney A Gabriel
- Department of Anesthesiology and Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA.
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Ho KWD, Wallace MR, Staud R, Fillingim RB. OPRM1, OPRK1, and COMT genetic polymorphisms associated with opioid effects on experimental pain: a randomized, double-blind, placebo-controlled study. THE PHARMACOGENOMICS JOURNAL 2020; 20:471-481. [PMID: 31806881 PMCID: PMC7260086 DOI: 10.1038/s41397-019-0131-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 01/13/2023]
Abstract
Genetic polymorphisms have been shown to affect opioid requirement for pain relief. However, true genetic effect is often difficult to assess due to underlying pain conditions and placebo effects. The goal of this study was to understand how common polymorphisms affect opioid effects while controlling for these factors. A randomized, double-blind, placebo-controlled study was implemented to assess how opioid effects are modulated by COMT (rs6269, rs4633, rs4848, rs4680), OPRM1 (A118G), and OPRK1 (rs1051660, rs702764, rs16918875). One hundred and eight healthy subjects underwent experimental pain testing before and after morphine, butorphanol, and placebo (saline). Association analysis was performed between polymorphisms/haplotypes and opioid response, while correcting for race, gender, placebo effects, and multiple comparisons. Pressure pain was significantly associated with rs6269 and rs4633 following butorphanol. The AA genotype of rs4680 or A_T_C_A/ A_T_C_A (rs6269_rs4633_ rs4818_rs4680) diplotype of COMT, combined with the AG genotype of OPRM1 A118G, showed significantly increased pressure pain threshold from butorphanol. Opioid effects on pressure, ischemic, heat pain, and side effects were nominally associated with several SNPs and haplotypes. Effects were often present in one opioid but not the other. This indicates that these polymorphisms affect pain relief from opioids, and that their effects are opioid and pain modality specific.
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Affiliation(s)
- Kwo Wei David Ho
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University, Redwood City, CA, USA.
- Department of Neurology, University of Florida, Gainesville, FL, USA.
| | - Margaret R Wallace
- Department of Molecular Genetics & Microbiology, and UF Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
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Lee MY, Chang WK, Wu HL, Lin SP, Tsou MY, Chang KY. Dynamic analysis of variations in postoperative pain trajectories over time in patients receiving epidural analgesia using latent curve models. J Chin Med Assoc 2020; 83:89-94. [PMID: 31904743 DOI: 10.1097/jcma.0000000000000200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although epidural analgesia (EA) provides reliable pain relief after major operations, few studies have explored how postoperative pain trajectories change over time in patients receiving EA and the associated factors. This study aimed to model the dynamic features of pain trajectories after surgery and investigate factors associated with their variations using latent curve analysis. METHODS This retrospective study was conducted at a single medical center in Taiwan, and data were obtained from patients receiving perioperative EA by electronic chart review. Mean numeric rating pain scores were recorded daily in the first five postoperative days. Patient demographics, surgical sites, and infusion pump settings were also collected. Latent curve models using two latent variables, intercept and slope, were developed to explain the variations in postoperative pain scores over time. The influences of potential predictors of postoperative pain trajectories were further evaluated for the final model determination. RESULTS Of the 1294 collected patients, the daily pain scores averaged 2.0 to 2.9 for different surgical sites. Among the nine significant factors influencing pain trajectories, chest and lower extremity surgery tended to induce less and more baseline pain, respectively, than those with abdomen surgery (both p < 0.001). In addition, male patients and those with a shorter anesthesia time had less baseline pain (p < 0.001 and p = 0.016, respectively). The older and lighter patients and those with chest surgery or American Society of Anesthesiologists class ≥ 3 tended to have milder decreasing trends in pain trajectories. A higher infusion rate was associated with an elevated baseline level and smoother decreasing trend in pain trajectory. The final model fit our data acceptably (root mean square error of approximation = 0.05, comparative fit index = 0.97). CONCLUSION Latent curve analysis provided insights into the dynamic nature of variations in postoperative pain trajectories. Further studies investigating more factors associated with pain trajectories are warranted to elucidate the mechanisms behind the transitions of pain scores over time after surgery.
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Affiliation(s)
- Ming-Ying Lee
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Surgery, Taipei Veterans General Hospital, Yuli Branch, Hualien, Taiwan, ROC
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, ROC
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Pin Lin
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Martin S, Colle R, El Asmar K, Rigal A, Vievard A, Feve B, Becquemont L, Verstuyft C, Corruble E. HOMA-IR increase after antidepressant treatment in depressed patients with the Met allele of the Val66Met BDNF genetic polymorphism. Psychol Med 2019; 49:2364-2369. [PMID: 30526722 DOI: 10.1017/s0033291718003240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with response to antidepressant drugs in depressed patients and with metabolic side effects after antipsychotic treatment. This study aims to assess the association between this polymorphism and insulin resistance after antidepressant treatment in depressed patients. METHODS One hundred forty-eight Caucasian patients with a current unipolar major depressive episode (DSM IV-TR) were genotyped for the BDNF Val66Met polymorphism and assessed at baseline and after 3 and 6 months of antidepressant treatment for the 'Homoeostasis model assessment of insulin resistance' (HOMA-IR) index, a valid measure of insulin resistance based on fasting plasma insulinaemia and glycaemia. Because validity assumptions were fulfilled, data were analysed using analysis of variance for repeated measures. RESULTS The 52 (35%) Met carriers and 96 (65%) Val/Val patients were not different at baseline for clinical characteristics and HOMA-IR. A significant Val66Met × time interaction (p = 0.02), a significant time effect (p = 0.03) and a significant Val66Met effect (p = 0.0497) were shown for HOMA-IR. A significant Val66Met × time interaction (p = 0.01) and a significant time effect (p = 0.003) were shown for fasting glycaemia. HOMA-IR and fasting glycaemia changes after antidepressant treatment were significantly higher in Met carrier than in Val/Val patients (HOMA-IR changes: Met: 0.71 ± 3.29 v. Val/Val: -0.16 ± 1.34, t = 2.3, df = 146, p = 0.02, glycaemia changes: Met: 0.09 ± 0.30 v. Val/Val: 0.02 ± 0.16, t = -2.0, df = 146, p = 0.045). CONCLUSIONS The Met allele of the Val66Met BDNF polymorphism confers to depressed patients a higher risk of insulin-resistance after antidepressant treatment. These patients could benefit from specific monitoring of metabolism and preventive measures.
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Affiliation(s)
- Séverine Martin
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Romain Colle
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Khalil El Asmar
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
| | - Adrien Rigal
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Albane Vievard
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Bruno Feve
- Service d'endocrinologie, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
- Sorbonne Université, INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | - Laurent Becquemont
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
- Centre de Recherche Clinique Paris Sud, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Céline Verstuyft
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
- Centre de Recherche Clinique Paris Sud, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- Centre de Ressources Biologiques Paris Sud, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Emmanuelle Corruble
- INSERM UMR-1178, CESP, Equipe "Dépression et Antidépresseurs", Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
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Kaye AD, Garcia AJ, Hall OM, Jeha GM, Cramer KD, Granier AL, Kallurkar A, Cornett EM, Urman RD. Update on the pharmacogenomics of pain management. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:125-143. [PMID: 31308726 PMCID: PMC6613192 DOI: 10.2147/pgpm.s179152] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/09/2019] [Indexed: 12/30/2022]
Abstract
Pharmacogenomics is the study of genetic variants that impact drug effects through changes in a drug’s pharmacokinetics and pharmacodynamics. Pharmacogenomics is being integrated into clinical pain management practice because variants in individual genes can be predictive of how a patient may respond to a drug treatment. Pain is subjective and is considered challenging to treat. Furthermore, pain patients do not respond to treatments in the same way, which makes it hard to issue a consistent treatment regimen for all pain conditions. Pharmacogenomics would bring consistency to the subjective nature of pain and could revolutionize the field of pain management by providing personalized medical care tailored to each patient based on their gene variants. Additionally, pharmacogenomics offers a solution to the opioid crisis by identifying potentially opioid-vulnerable patients who could be recommended a nonopioid treatment for their pain condition. The integration of pharmacogenomics into clinical practice creates better and safer healthcare practices for patients. In this article, we provide a comprehensive history of pharmacogenomics and pain management, and focus on up to date information on the pharmacogenomics of pain management, describing genes involved in pain, genes that may reduce or guard against pain and discuss specific pain management drugs and their genetic correlations.
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Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology, LSU Health Sciences Center, New Orleans, LA, USA
| | - Andrew Jesse Garcia
- Department of Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - O Morgan Hall
- Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - George M Jeha
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Kelsey D Cramer
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Amanda L Granier
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Anusha Kallurkar
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Opioid-related genetic polymorphisms do not influence postoperative opioid requirement: A prospective observational study. Eur J Anaesthesiol 2019; 35:496-504. [PMID: 29474345 DOI: 10.1097/eja.0000000000000793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest. OBJECTIVES To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics. DESIGN A single centre prospective study. SETTING University Hospital, Paris, France, from 2 January 2007 to 15 November 2011. PATIENTS A total of 438 white adults scheduled for major orthopaedic surgery (spine, hip and knee) under general anaesthesia. The main exclusion criteria were receiving opioids for chronic pain, nonopioid drugs within 2 days prior to surgery, pregnancy, renal insufficiency, sleep apnoea obstruction syndrome, morbid obesity, severe hepatic impairment, cognitive dysfunction. INTERVENTIONS Assays of plasma concentrations of morphine and metabolites (morphine 3-glucuronide and morphine 6-glucuronide) were performed and common polymorphisms in four candidate genes [OPRM1 A118G rs1799971; P-glycoprotein (ABCB1) T3435C (rs1045642) and G2677T/A (rs2032582); COMT Val 158 Met (rs4680)] were analysed.Morphine was titrated by staff in the postanaesthesia care unit (PACU) and in the ward patient-controlled intravenous analgesia was used for 24 h. MAIN OUTCOME MEASURES The dose of morphine required to achieve pain relief and the influence of SNP in genes involved in morphine pharmacodynamics and kinetics on morphine dose requirements. Secondary endpoints were the concentrations of morphine, morphine 6-glucuronide and morphine 3-gluguronide, the proportion of patients requiring a rescue analgesic and the proportion of morphine-related adverse events. RESULTS A total of 404 patients completed the study to final analysis. The mean ± SD morphine dose to achieve pain relief was 15.8 ± 8.8 mg in the PACU and 22.7 ± 18.6 mg during patient-controlled intravenous administration. Morphine-related adverse events were observed in 37%. There was no relationship between any genetic polymorphisms and morphine dose, morphine 3-gluguronide and morphine 6-glucuronide concentration, morphine-related adverse events or pain level. In the PACU only, P-glycoprotein polymorphisms (ex-21; ex-26) were significantly associated with morphine concentration but the prediction of the model was poor (R = 0.04) CONCLUSION: No major relationship has been demonstrated between SNP of OPRM1, ABCB1, COMT and morphine requirement, pain level or adverse effects in the postoperative period. TRIAL REGISTRATION NCT00822549 (www.clinicaltrials.gov).
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Candidate gene analyses for acute pain and morphine analgesia after pediatric day surgery: African American versus European Caucasian ancestry and dose prediction limits. THE PHARMACOGENOMICS JOURNAL 2019; 19:570-581. [PMID: 30760877 PMCID: PMC6693985 DOI: 10.1038/s41397-019-0074-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/30/2018] [Accepted: 12/21/2018] [Indexed: 12/17/2022]
Abstract
Acute pain and opioid analgesia demonstrate inter-individual variability and polygenic influence. In 241 children of African American and 277 of European Caucasian ancestry, we sought to replicate select candidate gene associations with morphine dose and postoperative pain and then to estimate dose prediction limits. Twenty-seven single-nucleotide polymorphisms (SNPs) from nine genes (ABCB1, ARRB2, COMT, DRD2, KCNJ6, MC1R, OPRD1, OPRM1, and UGT2B7) met selection criteria and were analyzed along with TAOK3. Few associations replicated: morphine dose (mcg/kg) in African American children and ABCB1 rs1045642 (A allele, β = -9.30, 95% CI: -17.25 to -1.35, p = 0.02) and OPRM1 rs1799971 (G allele, β = 23.19, 95% CI: 3.27-43.11, p = 0.02); KCNJ6 rs2211843 and high pain in African American subjects (T allele, OR 2.08, 95% CI: 1.17-3.71, p = 0.01) and in congruent European Caucasian pain phenotypes; and COMT rs740603 for high pain in European Caucasian subjects (A allele, OR: 0.69, 95% CI: 0.48-0.99, p = 0.046). With age, body mass index, and physical status as covariates, simple top SNP candidate gene models could explain theoretical maximums of 24.2% (European Caucasian) and 14.6% (African American) of morphine dose variances.
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Deflesselle E, Colle R, Rigal L, David DJ, Vievard A, Martin S, Becquemont L, Verstuyft C, Corruble E. The TRKB rs2289656 genetic polymorphism is associated with acute suicide attempts in depressed patients: A transversal case control study. PLoS One 2018; 13:e0205648. [PMID: 30308049 PMCID: PMC6181406 DOI: 10.1371/journal.pone.0205648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/29/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Suicide Attempts (SA) are the main complications of Major Depressive Episodes (MDE) and are difficult to predict. Suicide is associated with the expression of Receptor Tyrosin-Kinase B (TRKB), the receptor of the Brain Derived Neurotrophic Factor (BDNF) involved in MDE. However, the impact of its genetic polymorphisms as predictive factors of SA should be clarified. Our main aim is to assess the association of 8 TRKB genetic polymorphisms and SA in depressed patients. MATERIAL AND METHODS In 624 patients currently experiencing an MDE in the context of Major Depressive Disorder (MDD) (METADAP study), we assessed the association between 8 TRKB genetic polymorphisms (rs1778933, rs1187352, rs2289658, rs2289657, rs2289656, rs3824519, rs56142442 and rs1439050) and acute (previous month) or past (older than one month) SA. Bonferroni corrections and multivariate analysis adjusted for age, sex, level of education, marital status, Hamilton Depression Rating Scale score and previous MDE were used. RESULTS The rs2289656 was associated with acute SA (CC = 28.5%, CT = 15.0% and TT = 11.5%, p = 0.0008). However, the other SNPs were not. Patients with the CC genotype had a higher rate of acute SA (28.5%) as compared to T carriers (14.6%) (adjusted OR = 2.2, CI95% [1.4; 3.5], p<0.0001). CONCLUSION The TRKB rs2289656 CC genotype is associated with a 2.2 fold higher risk of acute SA in depressed patients. If this result could be confirmed, this TRKB SNP may be assessed to contribute to the prediction of SA in depressed patients.
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Affiliation(s)
- Eric Deflesselle
- INSERM UMR_S1178, Equipe “Dépression et Antidépresseurs”, Faculté de Médecine, CESP, Université Paris-Sud, Le Kremlin Bicêtre, France
- Département de Médecine Générale, Université Paris-Sud, Faculté de Médecine, Le Kremlin Bicêtre, France
| | - Romain Colle
- INSERM UMR_S1178, Equipe “Dépression et Antidépresseurs”, Faculté de Médecine, CESP, Université Paris-Sud, Le Kremlin Bicêtre, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Laurent Rigal
- Département de Médecine Générale, Université Paris-Sud, Faculté de Médecine, Le Kremlin Bicêtre, France
| | - Denis J. David
- INSERM UMR-S1178, Université Paris-Sud, Faculté de Pharmacie, CESP, Université Paris-Saclay, Chatenay-Malabry, France
| | - Albane Vievard
- INSERM UMR_S1178, Equipe “Dépression et Antidépresseurs”, Faculté de Médecine, CESP, Université Paris-Sud, Le Kremlin Bicêtre, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Séverine Martin
- INSERM UMR_S1178, Equipe “Dépression et Antidépresseurs”, Faculté de Médecine, CESP, Université Paris-Sud, Le Kremlin Bicêtre, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Laurent Becquemont
- INSERM UMR_S1178, Equipe “Dépression et Antidépresseurs”, Faculté de Médecine, CESP, Université Paris-Sud, Le Kremlin Bicêtre, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Céline Verstuyft
- INSERM UMR_S1178, Equipe “Dépression et Antidépresseurs”, Faculté de Médecine, CESP, Université Paris-Sud, Le Kremlin Bicêtre, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- Centre de Ressources Biologiques Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Emmanuelle Corruble
- INSERM UMR_S1178, Equipe “Dépression et Antidépresseurs”, Faculté de Médecine, CESP, Université Paris-Sud, Le Kremlin Bicêtre, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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Colle R, Trabado S, David DJ, Brailly-Tabard S, Hardy P, Falissard B, Fève B, Becquemont L, Verstuyft C, Corruble E. Plasma BDNF Level in Major Depression: Biomarker of the Val66Met BDNF Polymorphism and of the Clinical Course in Met Carrier Patients. Neuropsychobiology 2018; 75:39-45. [PMID: 28848102 DOI: 10.1159/000478862] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 06/19/2017] [Indexed: 12/18/2022]
Abstract
AIMS Despite the involvement of the brain-derived neurotrophic factor (BDNF) in the physiopathology of major depressive disorder (MDD), the coherence between the components of the BDNF pathway and their link with the clinical features of MDD are insufficiently studied. We aimed to assess in Caucasian depressed patients the impact of the BDNF Val66Met polymorphism on plasma BDNF levels taking into account the clinical characteristics of MDD. METHODS A total of 328 Caucasian adult MDD patients with a current major depressive episode (MDE) were assessed for the BDNF Val66Met polymorphism, plasma BDNF levels and clinical characteristics of the MDD. RESULTS Plasma BDNF levels were linearly associated with the BDNF Val66Met genotypes (ValVal: 1,525.9 ± 1,183.3 pg/mL vs. ValMet: 1,248.7 ± 1,081.8 vs. MetMet: 1,004.9 ± 952.8; p = 0.04), Met carriers having lower BDNF levels than ValVal ones. Significant interactions between the Val66Met polymorphism and 3 clinical characteristics - age at onset (p = 0.03), MDD duration (p = 0.04), and number of previous MDE (p = 0.04) - were evidenced for plasma BDNF levels. Indeed, in Met carriers, but not in ValVal ones, plasma BDNF levels were negatively correlated with age at onset and positively correlated with MDD duration and number of previous MDE. CONCLUSION Our results show a measurable, coherent, and functional BDNF pathway based on the BDNF Val66Met polymorphism and plasma BDNF levels in patients with a current MDE. This pathway is related to the clinical course of major depression, plasma BDNF levels being associated with the long-term history of MDD in Met carriers. Further studies assessing central BDNF are needed to understand the underlying mechanisms of this association.
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Affiliation(s)
- Romain Colle
- INSERM UMR 1178, Université Paris Sud, Service de Psychiatrie, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris, France
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Yu C, Yuan M, Yang H, Zhuang X, Li H. P-Glycoprotein on Blood-Brain Barrier Plays a Vital Role in Fentanyl Brain Exposure and Respiratory Toxicity in Rats. Toxicol Sci 2018; 164:353-362. [DOI: 10.1093/toxsci/kfy093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Chenchen Yu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Mei Yuan
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Haiying Yang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Xiaomei Zhuang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Hua Li
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
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Muraoka W, Nishizawa D, Fukuda K, Kasai S, Hasegawa J, Wajima K, Nakagawa T, Ikeda K. Association between UGT2B7 gene polymorphisms and fentanyl sensitivity in patients undergoing painful orthognathic surgery. Mol Pain 2018; 12:1744806916683182. [PMID: 28256933 PMCID: PMC5521342 DOI: 10.1177/1744806916683182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Fentanyl is often used instead of morphine for the treatment of pain because it has fewer side effects. The metabolism of morphine by glucuronidation is known to be influenced by polymorphisms of the UGT2B7 gene. Some metabolic products of fentanyl are reportedly metabolized by glucuronate conjugation. The genes that are involved in the metabolic pathway of fentanyl may also influence fentanyl sensitivity. We analyzed associations between fentanyl sensitivity and polymorphisms of the UGT2B7 gene to clarify the hereditary determinants of individual differences in fentanyl sensitivity. Results This study examined whether single-nucleotide polymorphisms (SNPs) of the UGT2B7 gene affect cold pain sensitivity and the analgesic effects of fentanyl, evaluated by a standardized pain test and fentanyl requirements in healthy Japanese subjects who underwent uniform surgical procedures. The rs7439366 SNP of UGT2B7 is reportedly associated with the metabolism and analgesic effects of morphine. We found that this SNP is also associated with the analgesic effects of fentanyl in the cold pressor-induced pain test. It suggested that the C allele of the rs7439366 SNP may enhance analgesic efficacy. Two SNPs of UGT2B7, rs4587017 and rs1002849, were also found to be novel SNPs that may influence the analgesic effects of fentanyl in the cold pressor-induced pain test. Conclusions Fentanyl sensitivity for cold pressor-induced pain was associated with the rs7439366, rs4587017, and rs1002849 SNPs of the UGT2B7 gene. Our findings may provide valuable information for achieving satisfactory pain control and open to new avenues for personalized pain treatment.
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Affiliation(s)
- Wataru Muraoka
- 1 Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan.,2 Department of Dentistry and Oral Surgery, School of Medicine, Keio University, Shinjyuku-ku, Japan
| | - Daisuke Nishizawa
- 1 Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Kenichi Fukuda
- 3 Department of Oral Health and Clinical Science, Tokyo Dental College, Chiyoda-ku, Japan
| | - Shinya Kasai
- 1 Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Junko Hasegawa
- 1 Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Koichi Wajima
- 2 Department of Dentistry and Oral Surgery, School of Medicine, Keio University, Shinjyuku-ku, Japan
| | - Taneaki Nakagawa
- 2 Department of Dentistry and Oral Surgery, School of Medicine, Keio University, Shinjyuku-ku, Japan
| | - Kazutaka Ikeda
- 1 Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
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Yoshida K, Nishizawa D, Ide S, Ichinohe T, Fukuda KI, Ikeda K. A pharmacogenetics approach to pain management. Neuropsychopharmacol Rep 2018; 38:2-8. [PMID: 30106264 PMCID: PMC7292326 DOI: 10.1002/npr2.12003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 01/22/2023] Open
Abstract
Introduction Opioid analgesics are widely used as effective analgesics for the treatment of moderate‐to‐severe pain. However, the analgesic efficacy of opioids is well known to vary widely among individuals, and effective pain treatment is hampered by vast individual differences. Although these differences in opioid requirements have been attributed to various factors, genetic factors are becoming increasingly relevant to the development of genome science. Aim This review covers the association between opioid analgesic requirements and particularly gene polymorphisms. Future perspectives Personalized pain treatment has begun using prediction formulas based on associated gene polymorphisms. Improvements in personalized pain treatment are expected as scientific knowledge further expands in the future. The analgesic efficacy of opioids is well known to vary widely among individuals, and effective pain treatment is hampered by vast individual differences. Although these differences in opioid requirements have been attributed to various factors, genetic factors are becoming increasingly relevant to the development of genome science. This review covers the association between opioid analgesic requirements and particularly gene polymorphisms.
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Affiliation(s)
- Kaori Yoshida
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Soichiro Ide
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Tatsuya Ichinohe
- Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Ken-Ichi Fukuda
- Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Petit AC, El Asmar K, David DJ, Gardier AM, Becquemont L, Fève B, Verstuyft C, Corruble E. The association of β-arrestin2 polymorphisms with response to antidepressant treatment in depressed patients. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:74-79. [PMID: 29031912 DOI: 10.1016/j.pnpbp.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 01/04/2023]
Abstract
The study of genetic polymorphisms involved in antidepressants (AD) response is essential to provide a personalized medicine approach in the field of depression. β-arrestin 2 (ARRB2) is a candidate gene in the pharmacogenetics of AD as it is involved in the signaling cascade downstream of numerous neurotransmitter receptors. We investigated the association between five ARRB2 single nucleotide polymorphisms (SNPs): rs1045280, rs2036657, rs4790694, rs3786047 and rs452246, and response to AD treatment in a sample of 569 patients with a major depressive episode treated for 6months. We show that GG/GT patients for rs4522461 (n=534) and AA/AC patients for rs4790694 (n=244) have a lower response to AD than other genotype groups (HDRS score of 10.9 vs 8.0 after 6months, multivariate analysis: p=0.03; 12.2 vs 9.6, p=0.02, respectively). These data provide additional evidence that β-arrestin 2 is a regulator of intracellular signal transduction processes involved in AD treatment.
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Affiliation(s)
- Anne-Cécile Petit
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, Le Kremlin Bicêtre, France; Service de Psychiatrie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
| | - Khalil El Asmar
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, Le Kremlin Bicêtre, France
| | - Denis J David
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Pharmacie, INSERM, Université Paris-Saclay, 92296 Chatenay-Malabry, France
| | - Alain M Gardier
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Pharmacie, INSERM, Université Paris-Saclay, 92296 Chatenay-Malabry, France
| | - Laurent Becquemont
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, Le Kremlin Bicêtre, France; Centre de Recherche Clinique Paris Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Bruno Fève
- Sorbonne Universities, Pierre and Marie Curie University Paris 6, INSERM, Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France; Hospitalo-Universitary Institute, ICAN, Paris, France; Department of Endocrinology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Céline Verstuyft
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, Le Kremlin Bicêtre, France; Service de Génétique Moléculaire, pharmacogénétique et hormonologie, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France; Centre de Ressources Biologiques Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Emmanuelle Corruble
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, Le Kremlin Bicêtre, France; Service de Psychiatrie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
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Pharmacogenetic study of pruritus induced by epidural morphine for post cesarean section analgesia. Taiwan J Obstet Gynecol 2018; 57:89-94. [DOI: 10.1016/j.tjog.2017.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 01/12/2023] Open
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Thümmler S, Dor E, David R, Leali G, Battista M, David A, Askenazy F, Verstuyft C. Pharmacoresistant Severe Mental Health Disorders in Children and Adolescents: Functional Abnormalities of Cytochrome P450 2D6. Front Psychiatry 2018; 9:2. [PMID: 29472872 PMCID: PMC5810290 DOI: 10.3389/fpsyt.2018.00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/08/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Severe mental health disorders in children and adolescents represent a major public health problem. Despite adequate drug treatment, some patients develop pharmacoresistant disease. As a consequence, physicians are confronted with prescribing challenges, prolonged hospitalization and increased risk of adverse events, thus aggravating short-, medium-, and long-term prognosis. The majority of psychotropic treatments, particularly antipsychotics and antidepressants, are metabolized at hepatic level by cytochrome P450 (CYP), particularly by CYP3A4 and CYP2D6. Several CYP2D6 genetic polymorphisms are described to be associated with ultrarapid (UM) or poor drug metabolism (PM), inducing clinical resistance and/or adverse events, and might therefore be related to pharmacoresistant severe mental health disease. CASE PRESENTATION A total of nine pharmacoresistant patients (four females, five males) aged 11-16 (mean 14.1) years have been genotyped for CYP2D6 between January, 2015 and April, 2016. Patients were diagnosed with schizophrenia (n = 5), autism spectrum disorders (n = 2), intellectual disability with challenging behavior (n = 2), oppositional defiant disorder (n = 1), and post-traumatic stress and borderline personality disorders (n = 1). They had a treatment history with on average 6.1 (3-9) psychotropic, 5 (3-7) antipsychotic, and 3.4 (2-5) CYP2D6-metabolized antipsychotic and antidepressant molecules. Five patients (56%) presented functional anomalies of the CYP2D6 gene: three patients were UM metabolizers with gene duplication and two patients were PM with *4/*41 and *3/*4 polymorphisms. CONCLUSION Functional anomalies of CYP2D6 concerned more than half of our pediatric inpatient sample with pharmacoresistant disease. However, our case reports are limited by the low sample size. Nevertheless, knowledge of individual metabolism and in particular CYP2D6 genotyping should be considered for clinical workup and therapy adjustment in resistant patients in child and adolescent psychiatry and might permit better treatment outcome, increased treatment adherence and diminished adverse events.
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Affiliation(s)
- Susanne Thümmler
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,CoBTek, Université Côte d'Azur, Nice, France
| | - Emmanuelle Dor
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,CoBTek, Université Côte d'Azur, Nice, France
| | | | - Graziella Leali
- Department of Child Psychiatry, Nice Children's Hospitals CHU-Lenval, Nice, France
| | - Michele Battista
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,Department of Child and Adolescent Psychiatry, Hospital of Fréjus, Fréjus, France
| | - Alexia David
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,CoBTek, Université Côte d'Azur, Nice, France
| | - Céline Verstuyft
- Service de génétique moléculaire, pharmacogénétique et hormonologie, Centre de Ressource Biologie Paris-Sud, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, Nice, France.,Université Paris-Sud, UMR 1184, Faculté de médecine, Paris, France
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Jannetto PJ, Bratanow NC, Clark WA, Hamill-Ruth RJ, Hammett-Stabler CA, Huestis MA, Kassed CA, McMillin GA, Melanson SE, Langman LJ. Executive Summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline—Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients. ACTA ACUST UNITED AC 2017; 2:489-526. [DOI: 10.1373/jalm.2017.023341] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/12/2017] [Indexed: 11/06/2022]
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Nishizawa D, Mieda T, Tsujita M, Nakagawa H, Yamaguchi S, Kasai S, Hasegawa J, Fukuda KI, Kitamura A, Hayashida M, Ikeda K. Genome-wide scan identifies candidate loci related to remifentanil requirements during laparoscopic-assisted colectomy. Pharmacogenomics 2017; 19:113-127. [PMID: 29207912 DOI: 10.2217/pgs-2017-0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM Opioids are widely used as effective analgesics, but opioid sensitivity is well known to vary widely among individuals. We explored the genetic factors that contribute to individual differences in intraoperative opioid sensitivity by performing a genome-wide association study. PATIENTS & METHODS We conducted a multistage genome-wide association study in subjects who underwent laparoscopic-assisted colectomy. RESULTS A nonsynonymous SNP, rs199670311, within the TMEM8A gene region and intronic SNPs, including rs4839603, within the SLC9A9 gene region were significantly associated with intraoperative opioid requirements (p = 3.409 × 10-8 in the dominant model for rs199670311; p = 4.162 × 10-6 and p = 4.229 × 10-6 in the additive and recessive models, respectively, for rs4839603). The A and T alleles of the rs199670311 and rs4839603 SNPs, respectively, were associated with lower opioid sensitivity in patients. CONCLUSION Our findings provide valuable information for personalized pain treatment during laparoscopic-assisted colectomy.
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Affiliation(s)
- Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6, Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, 38, Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Miki Tsujita
- Department of Anesthesiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hideyuki Nakagawa
- Department of Anesthesiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shinya Kasai
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6, Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Junko Hasegawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6, Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Ken-Ichi Fukuda
- Department of Oral Health & Clinical Science, Tokyo Dental College, 2-9-18, Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Akira Kitamura
- Department of Anesthesiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Masakazu Hayashida
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6, Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.,Department of Anesthesiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.,Department of Anesthesiology & Pain Medicine, Juntendo University School of Medicine, 2-1-1, Hongou, Bunkyou-ku, Tokyo 113-8421, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6, Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
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Longrange PCR-based next-generation sequencing in pharmacokinetics and pharmacodynamics study of propofol among patients under general anaesthesia. Sci Rep 2017; 7:15399. [PMID: 29133890 PMCID: PMC5684313 DOI: 10.1038/s41598-017-15657-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 10/30/2017] [Indexed: 11/10/2022] Open
Abstract
The individual response of patients to propofol results from the influence of genetic factors. However, the state of knowledge in this matter still remains insufficient. The aim of our study was to determine genetic predictors of variable pharmacokinetics and pharmacodynamics of propofol within selected 9 genes coding for propofol biotransformation enzymes, receptors and transporters. Our studies are the first extensive pharmaocgenetics research of propofol using high throughput sequencing technology. After the design and optimization of long range PCR-based next-generation sequencing experiment, we screened promoter and coding sequences of all genes analyzed among 87 Polish patients undergoing general anaesthesia with propofol. Initially we found that two variants, c.516 G > T in the CYP2B6 gene and c.2677 T > G in the ABCB1 gene, significantly correlate with propofol’s metabolic profile, however after Bonferroni correction the P-values were not statistically significant. Our results suggest, that variants within the CYP2B6 and ABCB1 genes correlate stronger with propofol’s metabolic profile compared to other 7 genes. CYP2B6 and ABCB1 variants can play a potentially important role in response to this anaesthetic and they are promising object for further studies.
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40
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Owusu Obeng A, Hamadeh I, Smith M. Review of Opioid Pharmacogenetics and Considerations for Pain Management. Pharmacotherapy 2017; 37:1105-1121. [DOI: 10.1002/phar.1986] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Aniwaa Owusu Obeng
- The Charles Bronfman Institute for Personalized Medicine; Icahn School of Medicine at Mount Sinai; New York NY
- Pharmacy Department; The Mount Sinai Hospital; New York New York
- Division of General Internal Medicine; Department of Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Michael Smith
- University of Michigan College of Pharmacy; Ann Arbor Michigan
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Persson AKM, Pettersson FD, Åkeson J. Single Nucleotide Polymorphisms Associated with Pain Sensitivity After Laparoscopic Cholecystectomy. PAIN MEDICINE 2017; 19:1271-1279. [DOI: 10.1093/pm/pnx164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Anna K M Persson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Halland Hospital, Halmstad, Sweden
| | - Fatimah Dabo Pettersson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
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Matic M, de Wildt SN, Tibboel D, van Schaik RHN. Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice. Clin Chem 2017. [DOI: 10.1373/clinchem.2016.264986] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The use of opioids to alleviate pain is complicated by the risk of severe adverse events and the large variability in dose requirements. Pharmacogenetics (PGx) could possibly be used to tailor pain medication based on an individual's genetic background. Many potential genetic markers have been described, and the importance of genetic predisposition in opioid efficacy and toxicity has been demonstrated in knockout mouse models and human twin studies. Such predictors are especially of value for neonates and young children, in whom the assessment of efficacy or side effects is complicated by the inability of the patient to communicate this properly. The current problem is determining which of the many potential candidates to focus on for clinical implementation.
CONTENT
We systematically searched publications on PGx for opioids in 5 databases, aiming to identify PGx markers with sufficient robust data and high enough occurrence for potential clinical application. The initial search yielded 4257 unique citations, eventually resulting in 852 relevant articles covering 24 genes. From these genes, we evaluated the evidence and selected the most promising 10 markers: cytochrome P450 family 2 subfamily D member 6 (CYP2D6), cytochrome P450 family 3 subfamily A member 4 (CYP3A4), cytochrome P450 family 3 subfamily A member 5 (CYP3A5), UDP glucuronosyltransferase family 2 member B7 (UGT2B7), ATP binding cassette subfamily B member 1 (ABCB1), ATP binding cassette subfamily C member 3 (ABCC3), solute carrier family 22 member 1 (SLC22A1), opioid receptor kappa 1 (OPRM1), catechol-O-methyltransferase (COMT), and potassium voltage-gated channel subfamily J member 6 (KCNJ6). Treatment guidelines based on genotype are already available only for CYP2D6.
SUMMARY
The application of PGx in the management of pain with opioids has the potential to improve therapy. We provide a shortlist of 10 genes that are the most promising markers for clinical use in this context.
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Affiliation(s)
- Maja Matic
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center–Sophia Children Hospital, Rotterdam, the Netherlands
| | - Saskia N de Wildt
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center–Sophia Children Hospital, Rotterdam, the Netherlands
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center–Sophia Children Hospital, Rotterdam, the Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
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Chen LK, Wang MH, Yang HJ, Fan SZ, Chen SS. Prospective observational pharmacogenetic study of side effects induced by intravenous morphine for postoperative analgesia. Medicine (Baltimore) 2017. [PMID: 28640078 PMCID: PMC5484186 DOI: 10.1097/md.0000000000007009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Nausea and vomiting are probably the most unpleasant side effects that occur when morphine used. A number of studies have investigated the effect on pain relief of single nucleotide polymorphisms (SNPs) in genes involved in morphine's metabolism, distribution, binding, and cellular action. The mechanism through which morphine causes nausea and vomiting has not been elucidated clearly. We examined all the reported SNPs which are associated with the complications of morphine, including SNPs in genes for phase I and phase II metabolic enzymes, ABC binding cassette drug transporters, κ and δ opioid receptors, and ion channels implicated in the postreceptor action of morphine.A prospective, observational study in 129 female patients was conducted to investigate the effect of 14 SNPs on nausea or vomiting induced by intravenous patient-controlled analgesia (IVPCA) with morphine after gynecology surgery. Clinical phenotype, subjective complaints, and objective observations were recorded. DNA from blood samples was used to record the SNPs. Eleven SNPs were then analyzed further.No significant association with the presence of phenotype (nausea or vomiting) versus genotype was observed (all P > .05). No significant association with severity of phenotype versus genotype of the 11 SNPs was observed except for unadjusted data for rs2737703.There was no significant difference between severity or incidence of IVPCA morphine-induced nausea and vomiting and genotype (11 SNPs). Further study should perhaps be focused on mRNA and proteinomics rather than SNPs.
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Affiliation(s)
- Li-Kuei Chen
- Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City Department of Anesthesiology, National Taiwan University Hospital, Taipei Department of Anesthesiology, Chung Shan Medical University, Taichung City Department of Anesthesiology, En-Chu-Kon Hospital, Taipei Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei Department of Urology, School of Medicine, National Yang-Ming University, Taipei Division of Urology, Taipei City Hospital Heping Fuyou Branch, Taipei National United University Commission for General Education, Miaoli, Taiwan
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Taranu A, Colle R, Gressier F, El Asmar K, Becquemont L, Corruble E, Verstuyft C. Should a routine genotyping of CYP2D6 and CYP2C19 genetic polymorphisms be recommended to predict venlafaxine efficacy in depressed patients treated in psychiatric settings? Pharmacogenomics 2017; 18:639-650. [PMID: 28480819 DOI: 10.2217/pgs-2017-0003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM The antidepressant venlafaxine (VEN) is metabolized by CYP2D6 and CYP2C19. The aim of this study was to assess the relevance of generalizing to daily practice the genotyping of CYP2D6 and CYP2C19 to predict VEN efficacy in depressed patients treated in psychiatric settings. PATIENTS & METHODS This study was nested in a naturalistic cohort, with 206 patients requiring a new antidepressant treatment and genotyped for CYP2D6 *3, *4, *5 del, *6, *2xN, *10, *41 and CYP2C19 *2, *3, *4, *5, *17 alleles. RESULTS CYP2D6 and CYP2C19 phenotypes were associated neither with the Hamilton depression rating scale score improvement, nor with response and remission. CONCLUSION Routine CYP2D6 and CYP2C19 genotyping cannot be recommended to predict VEN efficacy in depressed patients treated in psychiatry settings.
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Affiliation(s)
- Adela Taranu
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France
| | - Romain Colle
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Psychiatrie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Florence Gressier
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Psychiatrie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Khalil El Asmar
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France
| | - Laurent Becquemont
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Centre de Recherche Clinique (CRC), Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Emmanuelle Corruble
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Psychiatrie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Céline Verstuyft
- INSERM UMR1178, Team (Depression & Antidepressants), Faculté de Médecine Paris-Sud, Univ. Paris-Sud, Le Kremlin Bicêtre, France.,Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France.,Centre de Ressources Biologiques, CRB Paris-Sud, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France
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Hajj A, Halepian L, Osta NE, Chahine G, Kattan J, Rabbaa Khabbaz L. OPRM1 c.118A>G Polymorphism and Duration of Morphine Treatment Associated with Morphine Doses and Quality-of-Life in Palliative Cancer Pain Settings. Int J Mol Sci 2017; 18:ijms18040669. [PMID: 28346387 PMCID: PMC5412267 DOI: 10.3390/ijms18040669] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 01/08/2023] Open
Abstract
Despite increased attention on assessment and management, pain remains the most persistent symptom in patients with cancer, in particular in end-of-life settings, with detrimental impact on their quality-of-life (QOL). We conducted this study to evaluate the added value of determining some genetic and non-genetic factors to optimize cancer pain treatment. Eighty-nine patients were included in the study for the evaluation of palliative cancer pain management. The regression analysis showed that age, OPRM1 single nucleotide polymorphism (SNP), as well as the duration of morphine treatment were significantly associated with morphine doses at 24 h (given by infusion pump; p = 0.043, 0.029, and <0.001, respectively). The mean doses of morphine decreased with age but increased with the duration of morphine treatment. In addition, patients with AG genotype c.118A>G OPRM1 needed a higher dose of morphine than AA patients. Moreover, metastases, OPRM1 SNP, age, and gender were significantly associated with the QOL in our population. In particular, AA patients for OPRM1 SNP had significantly lower cognitive function than AG patients, a result not previously reported in the literature. These findings could help increase the effectiveness of morphine treatment and enhance the QOL of patients in regards to personalized medicine.
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Affiliation(s)
- Aline Hajj
- Laboratory of Pharmacology, Clinical Pharmacy and Quality Control of Drugs, Pôle Technologie- Santé (PTS), Faculty of Pharmacy, Saint-Joseph University, Beirut 1107 2180, Lebanon.
| | - Lucine Halepian
- Laboratory of Pharmacology, Clinical Pharmacy and Quality Control of Drugs, Pôle Technologie- Santé (PTS), Faculty of Pharmacy, Saint-Joseph University, Beirut 1107 2180, Lebanon.
| | - Nada El Osta
- Department of Public Health, Faculty of Medicine, Saint-Joseph University, Beirut 1107 2180, Lebanon.
- Department of Prosthodontics, Faculty of Dental Medicine, Saint-Joseph University, Beirut 1107 2180, Lebanon.
- University of Auvergne, CROC-EA4847, Centre de Recherche en Odontologie Clinique, BP 10448, Clermont-Ferrand F-63000, France.
| | - Georges Chahine
- Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1107 2180, Lebanon.
| | - Joseph Kattan
- Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1107 2180, Lebanon.
| | - Lydia Rabbaa Khabbaz
- Laboratory of Pharmacology, Clinical Pharmacy and Quality Control of Drugs, Pôle Technologie- Santé (PTS), Faculty of Pharmacy, Saint-Joseph University, Beirut 1107 2180, Lebanon.
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Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, Tan SC, Mohamad N, Ismail R. Relationship Between ABCB1
Polymorphisms and Cold Pain Sensitivity Among Healthy Opioid-naive Malay Males. Pain Pract 2017; 17:930-940. [DOI: 10.1111/papr.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/21/2016] [Accepted: 10/26/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Zalina Zahari
- Department of Pharmacy; Hospital Universiti Sains Malaysia; Kelantan Malaysia
- Pharmacogenetics and Novel Therapeutics Cluster; Institute for Research in Molecular Medicine; Universiti Sains Malaysia; Kelantan Malaysia
| | - Chee Siong Lee
- Department of Emergency Medicine; School of Medical Sciences; Universiti Sains Malaysia; Kelantan Malaysia
| | - Muslih Abdulkarim Ibrahim
- Pharmacogenetics and Novel Therapeutics Cluster; Institute for Research in Molecular Medicine; Universiti Sains Malaysia; Kelantan Malaysia
- Department of Pharmacology and Toxicology; College of Pharmacy; Hawler Medical University; Hawler Iraq
| | - Nurfadhlina Musa
- Pharmacogenetics and Novel Therapeutics Cluster; Institute for Research in Molecular Medicine; Universiti Sains Malaysia; Kelantan Malaysia
| | - Mohd Azhar Mohd Yasin
- Pharmacogenetics and Novel Therapeutics Cluster; Institute for Research in Molecular Medicine; Universiti Sains Malaysia; Kelantan Malaysia
- Department of Psychiatry; School of Medical Sciences; Universiti Sains Malaysia; Kelantan Malaysia
| | - Yeong Yeh Lee
- School of Medical Sciences; Universiti Sains Malaysia; Kelantan Malaysia
| | - Soo Choon Tan
- Pharmacogenetics and Novel Therapeutics Cluster; Institute for Research in Molecular Medicine; Universiti Sains Malaysia; Kelantan Malaysia
| | - Nasir Mohamad
- Pharmacogenetics and Novel Therapeutics Cluster; Institute for Research in Molecular Medicine; Universiti Sains Malaysia; Kelantan Malaysia
- Faculty of Medicine & Health Sciences; Universiti Sultan Zainal Abidin; Terengganu Malaysia
| | - Rusli Ismail
- Pharmacogenetics and Novel Therapeutics Cluster; Institute for Research in Molecular Medicine; Universiti Sains Malaysia; Kelantan Malaysia
- Centre of Excellence for Research in AIDS; University of Malaya; Kuala Lumpur Malaysia
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Hu YJ, Ku TH, Yang YH, Shen JY. Prediction of Patient-Controlled Analgesic Consumption: A Multimodel Regression Tree Approach. IEEE J Biomed Health Inform 2017; 22:265-275. [PMID: 28212102 DOI: 10.1109/jbhi.2017.2668393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several factors contribute to individual variability in postoperative pain, therefore, individuals consume postoperative analgesics at different rates. Although many statistical studies have analyzed postoperative pain and analgesic consumption, most have identified only the correlation and have not subjected the statistical model to further tests in order to evaluate its predictive accuracy. In this study involving 3052 patients, a multistrategy computational approach was developed for analgesic consumption prediction. This approach uses data on patient-controlled analgesia demand behavior over time and combines clustering, classification, and regression to mitigate the limitations of current statistical models. Cross-validation results indicated that the proposed approach significantly outperforms various existing regression methods. Moreover, a comparison between the predictions by anesthesiologists and medical specialists and those of the computational approach for an independent test data set of 60 patients further evidenced the superiority of the computational approach in predicting analgesic consumption because it produced markedly lower root mean squared errors.
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Abstract
The 21st century has been billed as the era of "precision/personalized medicine." Genetic investigation of clinical syndromes may guide therapy as well as reveal previously unknown biological or pharmacological pathways that may result in novel drug therapies. Several clinical issues in obstetrics and obstetric anesthesiology have been targets for genetic investigations. These include evaluation of the genetic effects on preterm labor and the progression of labor, spinal anesthesia-induced hypotension and the response to medications used to treat hypotension, and the effect of gene variants on pain and analgesic responses. Most studies have examined specific single nucleotide polymorphisms. Findings have revealed modest effects of genetic variation without tangible impact on current clinical practice. Over the next decade, increased availability of whole exome and genome sequencing, epigenetics, large genetic databases, computational biology and other information technology, and more rapid methods of real-time genotyping may increase the impact of genetics in the clinical arena of obstetrics and obstetric anesthesia.
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Affiliation(s)
- Ruth Landau
- Columbia University Medical Center, Center for Precision Medicine, Department of Anesthesiology, Columbia University College of Physicians & Surgeons, 630 West 168th St PH-5 (5th Floor Office PH-546, 11th Floor Office CHN-1118), New York, NY 10032, USA.
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Dzambazovska-Trajkovska V, Nojkov J, Kartalov A, Kuzmanovska B, Spiroska T, Seljmani R, Trajkovski G, Matevska-Geshkovska N, Dimovski A. Association of Single-Nucleotide Polymorhism C3435T in the ABCB1 Gene with Opioid Sensitivity in Treatment of Postoperative Pain. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2016; 37:73-80. [PMID: 27883323 DOI: 10.1515/prilozi-2016-0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The minimal effective analgesic concentration of opioids required for satisfactory analgesia may differ significantly among the patients. Genetic factors may contribute to the variable response to opioids by affecting their pharmacokinetics or pharmacodynamics. METHODS Ninety nine patients undergoing abdominal surgery with colorectal anastomosis because of colorectal carcinoma were enrolled in the present study. C34535T was genotyped in all subjects and the patients were divided into three groups according to their genotype: CC-wild type homozygous, CT-mutant heterozygous and TT-mutant homozygous. Intravenous fentanyl, patient controlled analgesia was provided postoperatively for pain control in the first 24 hour after surgery. Opioid consumption, pain scores and the adverse side effects were evaluated. RESULTS Our main result is that the patients in the CC genotype group consumed significantly more fentanyl (375.0 μg ± 43.1) than the patients in the TT group (295.0 μg ± 49.1) and the CT (356.4 μg ± 41.8) group in the treatment of postoperative pain. The patients in the TT group had lower VAS scores at 6h, 12h, 18 h and 24h postoperatively. There were no significant differences in the side effects among the three groups regarding the vomiting and the sedation score. The patients in the TT group had more frequently nausea score 1, than the patients in the other two groups. CONCLUSION Our study indicates that the C3435T SNPs of the ABCB1 gene is associated with differences in the opioid sensitivity. The ABCB1 polymorphism may serve as an important genetic predictor to guide the acute pain therapy in postoperative patients.
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Intravenous Ibuprofen for Treatment of Post-Operative Pain: A Multicenter, Double Blind, Placebo-Controlled, Randomized Clinical Trial. PLoS One 2016; 11:e0154004. [PMID: 27152748 PMCID: PMC4859493 DOI: 10.1371/journal.pone.0154004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs are often used as components of multimodal therapy for postoperative pain management, but their use is currently limited by its side effects. The specific objective of this study was to evaluate the efficacy and safety of a new formulation of intravenous (IV) ibuprofen for the management of postoperative pain in a European population. METHODS AND FINDINGS A total of 206 patients from both abdominal and orthopedic surgery, were randomly assigned in 1:1 ratio to receive 800 mg IV-ibuprofen or placebo every 6 hours; all patients had morphine access through a patient controlled analgesia pump. The primary outcome measure was median morphine consumption within the first 24 hours following surgery. The mean±SEM of morphine requirements was reduced from 29,8±5,25 mg to 14,22±3,23 mg (p = 0,015) and resulted in a decrease in pain at rest (p = 0,02) measured by Visual Analog Scale (VAS) from mean±SEM 3.34±0,35 to 0.86±0.24, and also in pain during movement (p = 0,02) from 4.32±0,36 to 1.90±0,30 in the ibuprofen treatment arm; while in the placebo group VAS score at rest ranged from 4.68±0,40 to 2.12±0,42 and during movement from 5.66±0,42 to 3.38±0,44. Similar treatment-emergent adverse events occurred across both study groups and there was no difference in the overall incidence of these events. CONCLUSIONS Perioperative administration of IV-Ibuprofen 800 mg every 6 hours in abdominal surgery patient's decreases morphine requirements and pain score. Furthermore IV-Ibuprofen was safe and well tolerate. Consequently we consider appropriate that protocols for management of postoperative pain include IV-Ibuprofen 800 mg every 6 hours as an option to offer patients an analgesic benefit while reducing the potentially risks associated with morphine consumption. TRIAL REGISTRATION EU Clinical Trials Register 2011-005007-33.
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