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Hu J, Song Y, Huang X, Li C, Jin X, Cen L, Zhang C, Ding B, Lian J. Opioids-Induced Long QT Syndrome: A Challenge to Cardiac Health. Cardiovasc Toxicol 2024; 24:472-480. [PMID: 38630336 PMCID: PMC11076354 DOI: 10.1007/s12012-024-09853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024]
Abstract
The challenge posed by opioid overdose has become a significant concern for health systems due to the complexities associated with drug prohibition, widespread clinical use, and potential abuse. In response, healthcare professionals have primarily concentrated on mitigating the hallucinogenic and respiratory depressant consequences of opioid overdose to minimize associated risks. However, it is crucial to acknowledge that most opioids possess the capacity to prolong the QT interval, particularly in cases of overdose, thereby potentially resulting in severe ventricular arrhythmias and even sudden death if timely intervention is not implemented. Consequently, alongside addressing the typical adverse effects of opioids, it is imperative to consider their cardiotoxicity. To enhance comprehension of the correlation between opioids and arrhythmias, identify potential targets for prompt intervention, and mitigate the hazards associated with clinical utilization, an exploration of the interaction between drugs and ion channels, as well as their underlying mechanisms, becomes indispensable. This review primarily concentrates on elucidating the impact of opioid drugs on diverse ion channels, investigating recent advancements in this domain, and attaining a deeper understanding of the mechanisms underlying the prolongation of the QT interval by opioid drugs, along with potential interventions.
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Affiliation(s)
- Jiale Hu
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
| | - Yongfei Song
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
- Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo Medical Center Lihuili Hospital, Ningbo University, No. 378 Dongqing Road, Yinzhou District, Ningbo, 315000, Zhejiang, China
| | - Xiaoyan Huang
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
- Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo Medical Center Lihuili Hospital, Ningbo University, No. 378 Dongqing Road, Yinzhou District, Ningbo, 315000, Zhejiang, China
| | - Chongrong Li
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
| | - Xiaojun Jin
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
| | - Lichao Cen
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
| | - Chuanjin Zhang
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
| | - Beilei Ding
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China
| | - Jiangfang Lian
- Department of Cardiology, Ningbo University Health Science Center Affiliated Lihuili Hospital, Ningbo University, Zhejiang, China.
- Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo Medical Center Lihuili Hospital, Ningbo University, No. 378 Dongqing Road, Yinzhou District, Ningbo, 315000, Zhejiang, China.
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Chen Z, Xu Z, Gao C, Chen L, Tan T, Jiang W, Chen B, Yuan Y, Zhang Z. Escitalopram-induced QTc prolongation and its relationship with KCNQ1, KCNE1, and KCNH2 gene polymorphisms. J Affect Disord 2024; 347:399-405. [PMID: 38000475 DOI: 10.1016/j.jad.2023.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Escitalopram can cause prolongation of the QT interval on the electrocardiogram (ECG). However, only some patients get pathological QTc prolongation in clinic. We investigated the influence of KCNQ1, KCNE1, and KCNH2 gene polymorphisms along with clinical factors on escitalopram-induced QTc prolongation. METHODS A total of 713 patients prescribed escitalopram were identified and had at least one ECG recording in this retrospective study. 472 patients with two or more ECG data were divided into QTc prolongation (n = 119) and non-prolongation (n = 353) groups depending on the threshold change in QTc of 30 ms above baseline value (∆QTc ≥ 30 ms). 45 patients in the QTc prolongation group and 90 patients in the QTc non-prolongation group were genotyped for 43 single nucleotide polymorphisms (SNPs) of KCNQ1, KCNE1, and KCNH2 genes. RESULTS Patients with QTc prolongation (∆QTc ≥ 30 ms) got higher escitalopram dose (10.3 mg) than patients without QTc prolongation (9.4 mg), although no significant relationship was found between QTc interval and escitalopram dose in the linear mixed model. Patients who were older/coronary disease/hypertension or carried with KCNE1 rs1805127 C allele, KCNE1 rs4817668 C allele, KCNH2 rs3807372 AG/GG genotype were significantly at risk for QTc prolongation (∆QTc ≥ 30 ms). Concomitant antipsychotic treatment was associated with a longer QTc interval. LIMITATIONS A relatively small sample size and lack of the blood concentration of escitalopram restricted the accurate relationship between escitalopram dose and QTc interval. CONCLUSION Our study revealed that KCNQ1, KCNE1, and KCNH2 gene polymorphisms along with clinical factors provide a complementary effect in escitalopram-induced QTc prolongation.
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Affiliation(s)
- Zimu Chen
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University Nanjing, China
| | - Zhi Xu
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University Nanjing, China; Department of General Practice, Zhongda Hospital, Southeast University, Nanjing, China.
| | - Chenjie Gao
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University Nanjing, China
| | - Lei Chen
- Department of Psychiatry, General Hospital of Eastern Theater Command, Nanjing, China
| | - Tingting Tan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University Nanjing, China
| | - Wenhao Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University Nanjing, China
| | - Bingwei Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University Nanjing, China; Key Laboratory of Developmental Genes and Human Disease, Ministry of Education, Institute of Life Sciences, Southeast University, Nanjing, China
| | - Zhijun Zhang
- Department of Neurology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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Isaza C, Castaño-Ramírez OM, Vélez JP, Henao J, Beltrán-Angarita L, Sepúlveda-Arias JC. Influence of CYP2B6 Genotype on Methadone Dosage in Patients from the Methadone Maintenance Treatment (MMT) Program in Pereira, Colombia. Life (Basel) 2023; 13:life13041038. [PMID: 37109567 PMCID: PMC10145268 DOI: 10.3390/life13041038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Methadone treatment reduces the use of heroin and withdrawal symptoms; however, methadone is an expensive medication with a narrow safety margin. We compared the retention rates, persistence of heroin use, and quality of life of a group of patients undergoing conventional Methadone Maintenance Treatment (MMT) with a group for whom the CYP2B6 516G>T polymorphism was used in addition to the MMT to calculate the required methadone dose. Over 12 weeks, the retention rate, heroin usage, and quality of life of patients under conventional treatment (n = 34) were compared with those of patients for whom we used genetic markers to calculate methadone dosage (n = 38). At the end of the study, 26.4% of patients abandoned the program, and neither demographic nor clinical variables were associated with treatment adherence. Of the remaining patients, 16% of the control group and 8% of patients in the pharmacogenetic group reported heroin use, while both groups showed a 64% reduction in the use of cocaine/crack (no significant differences between the groups were found). Starting in the second week, the methadone dosage was lower among the patients for whom methadone was prescribed based on genotype. Although there were six individuals in the control group and three in the pharmacogenetic group with QTc intervals > 450 ms (a threshold that is considered dangerous), we did not find a relationship between the QTc interval and methadone dosage. There were no differences in the perception of quality of life between the two groups. The results of this pilot study suggest that concerning methadone therapy, the CYP2B6 genotype contributes to reduced effective doses and treatment costs.
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Affiliation(s)
- Carlos Isaza
- Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira 660003, Colombia
| | | | | | - Julieta Henao
- Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira 660003, Colombia
| | | | - Juan Carlos Sepúlveda-Arias
- Grupo Infección e Inmunidad, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira 660003, Colombia
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Nagamatsu ST, Rompala G, Hurd YL, Núñez-Rios DL, Montalvo-Ortiz JL. CpH methylome analysis in human cortical neurons identifies novel gene pathways and drug targets for opioid use disorder. Front Psychiatry 2023; 13:1078894. [PMID: 36745154 PMCID: PMC9892724 DOI: 10.3389/fpsyt.2022.1078894] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction DNA methylation (DNAm), an epigenetic mechanism, has been associated with opioid use disorder (OUD) in preclinical and human studies. However, most of the studies have focused on DNAm at CpG sites. DNAm at non-CpG sites (mCpHs, where H indicates A, T, or C) has been recently shown to have a role in gene regulation and to be highly abundant in neurons. However, its role in OUD is unknown. This work aims to evaluate mCpHs in the human postmortem orbital frontal cortex (OFC) in the context of OUD. Methods A total of 38 Postmortem OFC samples were obtained from the VA Brain Bank (OUD = 12; Control = 26). mCpHs were assessed using reduced representation oxidative bisulfite sequencing in neuronal nuclei. Differential analysis was performed using the "methylkit" R package. Age, ancestry, postmortem interval, PTSD, and smoking status were included as covariates. Significant mCpHs were set at q-value < 0.05. Gene Ontology (GO) and KEGG enrichment analyses were performed for the annotated genes of all differential mCpH loci using String, ShinyGO, and amiGO software. Further, all annotated genes were analyzed using the Drug gene interaction database (DGIdb). Results A total of 2,352 differentially methylated genome-wide significant mCpHs were identified in OUD, mapping to 2,081 genes. GO analysis of genes with differential mCpH loci showed enrichment for nervous system development (p-value = 2.32E-19). KEGG enrichment analysis identified axon guidance and glutamatergic synapse (FDR 9E-4-2.1E-2). Drug interaction analysis found 3,420 interactions between the annotated genes and drugs, identifying interactions with 15 opioid-related drugs, including lofexidine and tizanidine, both previously used for the treatment of OUD-related symptoms. Conclusion Our findings suggest a role of mCpHs for OUD in cortical neurons and reveal important biological pathways and drug targets associated with the disorder.
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Affiliation(s)
- Sheila T. Nagamatsu
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut (VA CT) Healthcare Center, West Haven, CT, United States
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, West Haven, CT, United States
| | - Gregory Rompala
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yasmin L. Hurd
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Diana L. Núñez-Rios
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut (VA CT) Healthcare Center, West Haven, CT, United States
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, West Haven, CT, United States
| | - Janitza L. Montalvo-Ortiz
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut (VA CT) Healthcare Center, West Haven, CT, United States
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, West Haven, CT, United States
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Gu QL, Xue FL, Zheng ZL, Wang HN, Guan YP, Wen YZ, Ye F, Huang M, Huang WQ, Wang ZX, Li JL. Nongenetic and genetic predictors of haemodynamic instability induced by propofol and opioids: A retrospective clinical study. Br J Clin Pharmacol 2023; 89:209-221. [PMID: 35939394 DOI: 10.1111/bcp.15480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022] Open
Abstract
AIM Propofol and opioids are commonly used in anaesthesia, but are highly susceptible to haemodynamic instability, thereby threatening the patient's surgical safety and prognosis. The purpose of this study was to investigate the predictors of haemodynamic instability and establish its predictive model. METHODS A total of 150 Chinese patients undergoing thyroid or breast surgery participated in the study, with target-controlled infusion concentrations of propofol, opioids dosage, heart rate (HR), mean arterial pressure (MAP) and Narcotrend Index recorded at key points throughout the procedure. The Agena MassARRAY system was used to genotype candidate single nucleotide polymorphisms related to pharmacodynamics and pharmacokinetics of propofol and opioids. RESULTS Among nongenetic factors, baseline HR (R = -.579, P < .001) and baseline MAP (R = -.725, P < .001) had a significant effect on the haemodynamic instability. Among genetic factors, the CT/CC genotype of GABRB1 rs4694846 (95% confidence interval [CI]: -11.309 to -3.155), AA/AG of OPRM1 rs1799971 (95%CI: 0.773 to 10.290), AA of CES2 rs8192925 (95%CI: 1.842 to 9.090) were associated with higher HR instability; the AA/GG genotype of NR1I2 rs6438550 (95%CI: 0.351 to 7.761), AA of BDNF rs2049046 (95%CI: -9.039 to -0.640) and GG of GABBR2 rs1167768 (95%CI: -10.146 to -1.740) were associated with higher MAP instability. The predictive models of HR and MAP fluctuations were developed, accounting for 45.0 and 59.2% of variations, respectively. CONCLUSION We found that cardiovascular fundamentals and genetic variants of GABRB1, GABBR2, OPRM1, BDNF, CES2 and NR1I2 are associated with cardiovascular susceptibility, which can provide a reference for haemodynamic management in clinical anaesthesia.
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Affiliation(s)
- Qing-Ling Gu
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fa-Ling Xue
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhuo-Ling Zheng
- Department of Pharmacy, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hai-Ni Wang
- Department of Pharmacy, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yan-Ping Guan
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yong-Zi Wen
- Junzhi Biomedical Research Laboratory (Foshan) Co., Ltd., Foshan, Guangdong, China
| | - Fang Ye
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Min Huang
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen-Qi Huang
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhong-Xing Wang
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jia-Li Li
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
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Titus-Lay EN, Jaynes HA, Tomaselli Muensterman E, Walroth TA, Ott CA, Desta Z, Williams G, Moe PR, Wilbrandt M, Tisdale JE. Methadone-associated QT interval prolongation in patients undergoing maintenance therapy in an urban opioid treatment program. Pharmacotherapy 2021; 41:238-246. [PMID: 33345336 DOI: 10.1002/phar.2498] [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: 08/24/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVE Methadone is associated with QT interval prolongation and torsades de pointes. The objective of this study was to (a) determine the incidence of QT interval prolongation among patients on maintenance methadone therapy in an urban opioid treatment program (OTP), (b) compare characteristics of patients who developed methadone-associated QT prolongation with those who did not develop QT prolongation, and (c) investigate the relationship between QT interval prolongation and stereospecific serum methadone and metabolite [2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP)] concentrations. DESIGN Prospective study. SETTING Urban opioid treatment program (OTP). PATIENTS n = 93 patients on maintenance methadone therapy in an urban OTP. INTERVENTION Patients underwent a 12-lead electrocardiogram (ECG) prior to initiating methadone and again during steady-state maintenance methadone therapy. In a subset (n = 43), blood was obtained to determine serum (S)- and (R)-methadone and (S)- and (R)-EDDP concentrations, which were compared in patients who developed Bazett's-corrected QT (QTc) prolongation [≥470 ms (men) or ≥480 ms (women) and/or ≥60 ms lengthening from pretreatment value] with those who did not have QTc prolongation. MEASUREMENTS AND MAIN RESULTS Mean [± standard deviation (SD)] age was 36 ± 12 years; 73% were female, and 74% were white. QTc prolongation occurred in 14 (15.1%) patients. Patients who developed QTc prolongation were older (41 ± 13 vs. 35 ± 9 years, p = 0.03) and had a longer pre-methadone QTc compared with those who did not have QTc prolongation (429 ± 11 vs. 420 ± 20 ms, respectively, p = 0.02). Serum (S)-methadone concentrations were higher in patients with QTc prolongation compared to patients without prolongation (199 ± 81 vs. 128 ± 68 ng/ml, respectively, p = 0.01), whereas the difference in serum (R)-methadone concentrations between the groups did not reach significance (189 ± 68 vs. 125 ± 60 ng/ml, respectively, p = 0.08). Serum (R)-methadone concentrations correlated with QTc intervals [R2 = 0.15 (95% confidence interval (CI) 0.11-0.62, p = 0.0009)]. The correlation between serum (S)-methadone concentrations and QTc did not reach significance [R2 = 0.08 (95% CI -0.01 to 0.54, p = 0.06)]. Serum (S)-and (R)-EDDP concentrations were not significantly different between the groups and did not significantly correlate with QTc intervals. CONCLUSIONS Approximately 15% of patients taking maintenance methadone therapy developed QT interval prolongation. Both serum (S)- and (R)-methadone concentrations, but not (S)- or (R)-EDDP, contribute to methadone-associated QT prolongation.
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Affiliation(s)
- Erika N Titus-Lay
- Department of Pharmacy, Eskenazi Health, Indianapolis, Indiana, USA.,College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,College of Pharmacy, California Northstate University, Elk Grove, California, USA
| | - Heather A Jaynes
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA
| | - Elena Tomaselli Muensterman
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,AbbVie Inc., North Chicago, Illinois, USA
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, Indiana, USA
| | - Carol A Ott
- Department of Pharmacy, Eskenazi Health, Indianapolis, Indiana, USA.,College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Zeruesenay Desta
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | | | - Paul R Moe
- Sandra Eskenazi Health Mental Health Center Opioid Treatment Program, Indianapolis, Indiana, USA
| | - Michelle Wilbrandt
- Sandra Eskenazi Health Mental Health Center Opioid Treatment Program, Indianapolis, Indiana, USA
| | - James E Tisdale
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
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Zerdazi EH, Vorspan F, Marees AT, Naccache F, Lepine JP, Laplanche JL, Prince N, Marie-Claire C, Bellivier F, Mouly S, Bloch V. QT length during methadone maintenance treatment: gene × dose interaction. Fundam Clin Pharmacol 2019; 33:96-106. [DOI: 10.1111/fcp.12405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/04/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Affiliation(s)
- El-Hadi Zerdazi
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
- APHP; Service d'addictologie; DHU Pe-PSY; Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires; Henri Mondor; F94000 Créteil France
| | - Florence Vorspan
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
- APHP; Département de Psychiatrie et de Médecine Addictologigue; Hôpital Fernand Widal; 75010 Paris France
| | - Andries T. Marees
- Department of Psychiatry, Amsterdam Neuroscience; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
- QIMR Berghofer; Translational Neurogenomics Group; Brisbane Australia
| | - François Naccache
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
- APHP; Département de Psychiatrie et de Médecine Addictologigue; Hôpital Fernand Widal; 75010 Paris France
| | - Jean-Pierre Lepine
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
- APHP; Département de Psychiatrie et de Médecine Addictologigue; Hôpital Fernand Widal; 75010 Paris France
| | - Jean-Louis Laplanche
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
| | - Nathalie Prince
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
| | - Cynthia Marie-Claire
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
| | - Frank Bellivier
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
- APHP; Département de Psychiatrie et de Médecine Addictologigue; Hôpital Fernand Widal; 75010 Paris France
- Fondation FondaMental; Fondation de coopération scientifique; Hôpital Albert Chenevier; 94000 Créteil France
| | - Stéphane Mouly
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
- Département de Médecine Interne; Hôpital Lariboisière; APHP; 75010 Paris France
| | - Vanessa Bloch
- INSERM U1144 Variabilité de réponse aux psychotropes; Université Paris Descartes; Université Paris Diderot; Université Sorbonne Paris Cité; Faculté de Pharmacie; 4 avenue de l'observatoire - 75006 Paris France
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Abstract
Opioid use disorder (OUD) is a significant health problem in the United States and many other countries. A combination of issues, most notably increased prescription of opioid analgesics, has resulted in climbing rates of opioid abuse and overdose over the last decade. This ongoing epidemic has produced a growing population of patients requiring treatment for OUD. Medications such as methadone and buprenorphine have well documented success rates in treating the disorder compared with placebo. However, significant percentages of the population still fail to maintain abstinence or reduce illicit opioid use while using such medications. Genetic variation may play a role in this variability in outcome through pharmacokinetic or pharmacodynamic effects on OUD medications, or by affecting the rate of negative side effects and adverse events. This review focuses on the existing literature on the pharmacogenetics of OUD treatment, with specific focus on medication metabolism, treatment outcomes, and adverse events.
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10
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Mijatović V, Samojlik I, Petković S, Vukmirović S, Uvelin A, Dickov A. Cardiovascular effects of methadone and concomitant use of diazepam during methadone maintenance treatment induction: low concentration risk. Expert Opin Drug Saf 2017; 16:1323-1328. [PMID: 28934555 DOI: 10.1080/14740338.2017.1382470] [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: 10/18/2022]
Abstract
BACKGROUND The aim is to evaluate the role of diazepam concentrations in development of low-concentration-methadone-associated QTc prolongation in patients with opioid use disorder during methadone maintenance treatment (MMT) induction. RESEARCH DESIGN AND METHODS Individuals with addiction disorder on MMT were studied before the beginning of MMT and after one and six months of MMT. Serum concentrations of methadone, diazepam, electrolytes and ECG were analyzed. RESULTS Thirty patients were enrolled. The mean methadone concentration at time points was 177 ± 119 ng/ml and 343 ± 182 ng/ml, while the mean diazepam concentration was 561 ± 437 ng/ml and 1045 ± 933 ng/ml. The QTc interval before the introduction of MMT, after 1 and 6 months of MMT were 412 ± 27 ms, 425 ± 18 ms and 424 ± 15 ms, respectively, showing statistically significant increase in the length of QTc interval after 1 and 6 months of MMT. Statistically significant correlation between the concentration of methadone and QTc interval length at observed time points (R2 = 0.239, p = 0.018; R2 = 0.513, p = 0.006) was shown, and it remained so if the concentration of diazepam was included (R2 = 0.347, p = 0.026, R2 = 0.513, p = 0.009). CONCLUSIONS The prolongation of QTc below the risk threshold in low methadone therapeutic doses has been recorded and concomitant use of diazepam could be a co-factor in such issue.
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Affiliation(s)
- Vesna Mijatović
- a Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine , University of Novi Sad , Novi Sad , Serbia
| | - Isidora Samojlik
- a Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine , University of Novi Sad , Novi Sad , Serbia
| | - Stojan Petković
- b Department of Forensic Medicine, Faculty of Medicine , University of Novi Sad , Novi Sad , Serbia
| | - Saša Vukmirović
- a Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine , University of Novi Sad , Novi Sad , Serbia
| | - Arsen Uvelin
- c Department of Anesthesia and Perioperative Medicine, Faculty of Medicine , University of Novi Sad , Novi Sad , Serbia
| | - Aleksandra Dickov
- d Department of Psychiatry, Faculty of Medicine , University of Novi Sad , Novi Sad , Serbia
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Baillif-Couniou V, Sastre C, Hennart B, Dhaenens MC, Allorge D, Gaulier JM, Artaud A, Lebreton C, Piercecchi-Marti MD, Léonetti G, Pélissier-Alicot AL. Décès sous méthadone chez une adolescente : apport de la pharmacogénétique à l’identification des causes du décès. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Fabbri C, Boriani G, Diemberger I, Filippi MG, Ravegnini G, Hrelia P, Minarini A, Albani D, Forloni G, Angelini S, Serretti A. Electrocardiogram Alterations Associated With Psychotropic Drug Use and CACNA1C Gene Variants in Three Independent Samples. Basic Clin Pharmacol Toxicol 2016; 120:482-490. [PMID: 27893184 DOI: 10.1111/bcpt.12720] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022]
Abstract
Several antipsychotics and antidepressants have been associated with QTc prolongation or other electrocardiogram (ECG) alterations, but their impact is still debated and other risk factors are known to affect QTc. We investigated the effect of antidepressants and antipsychotics on QTc and other ECG intervals/waves in three samples. Two discovery samples (cross-sectional sample n = 145 and prospective sample n = 68, naturalistic treatment) and a replication prospective sample (Clinical Antipsychotic Trials of Intervention Effectiveness, n = 515, randomized treatment) were analysed. In both prospective samples, baseline/follow-up changes in ECG parameters were analysed in relation to the number of psychotropic drugs stratified according to their known cardiovascular risk. In the cross-sectional sample, ECG parameters were compared among drugs with different risk profile. The possible effect of single nucleotide polymorphisms (SNPs) in the CACNA1C gene on QTc was also investigated. There was no evidence of mean QTc prolongation or increased risk of clinically relevant QTc prolongation (≥20 msec.) in association with psychotropic drugs stratified according to their known cardiovascular risk. The prescription of drugs with cardiovascular risk was less common in older individuals or individuals with cardiovascular comorbidities. Other factors (gender, baseline QTc, renal function) affected QTc. rs1006737 and SNPs in linkage disequilibrium with it modulated QTc duration/changes in all samples. An association between risk drugs and shorter RR interval or higher heart rate was found in all samples. A relevant effect of psychotropic drugs with cardiovascular risk on QTc duration was not observed. A number of factors other than psychotropic drugs may influence QTc. CACNA1C rs1006737 may modulate QTc in patients treated with psychotropic drugs.
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Affiliation(s)
- Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Boriani
- Department of Cardiology, Modena University Hospital, University of Modena and Reggio Emilia, Modena MO, Italy
| | - Igor Diemberger
- Department of Specialist, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | | | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Alessandro Minarini
- Department of Diagnostic, Clinical and Public Health Medicine, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Diego Albani
- IRCCS - Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | - Gianluigi Forloni
- IRCCS - Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | - Sabrina Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
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Rai V, Agrawal DK. Role of risk stratification and genetics in sudden cardiac death. Can J Physiol Pharmacol 2016; 95:225-238. [PMID: 27875062 DOI: 10.1139/cjpp-2016-0457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sudden cardiac death (SCD) is a major public health issue due to its increasing incidence in the general population and the difficulty in identifying high-risk individuals. Nearly 300 000 - 350 000 patients in the United States and 4-5 million patients in the world die annually from SCD. Coronary artery disease and advanced heart failure are the main etiology for SCD. Ischemia of any cause precipitates lethal arrhythmias, and ventricular tachycardia and ventricular fibrillation are the most common lethal arrhythmias precipitating SCD. Pulseless electrical activity, bradyarrhythmia, and electromechanical dissociation also result in SCD. Most SCDs occur outside of the hospital setting, so it is difficult to estimate the public burden, which results in overestimating the incidence of SCD. The insufficiency and limited predictive value of various indicators and criteria for SCD result in the increasing incidence. As a result, there is a need to develop better risk stratification criteria and find modifiable variables to decrease the incidence. Primary and secondary prevention and treatment of SCD need further research. This critical review is focused on the etiology, risk factors, prognostic factors, and importance of risk stratification of SCD.
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Affiliation(s)
- Vikrant Rai
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA.,Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
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Abstract
A prolonged QT interval is an important risk factor for ventricular arrhythmias and sudden cardiac death. QT prolongation can be caused by drugs. There are multiple risk factors for drug-induced QT prolongation, including genetic variation. QT prolongation is one of the most common reasons for withdrawal of drugs from the market, despite the fact that these drugs may be beneficial for certain patients and not harmful in every patient. Identifying genetic variants associated with drug-induced QT prolongation might add to tailored pharmacotherapy and prevent beneficial drugs from being withdrawn unnecessarily. In this review, our objective was to provide an overview of the genetic background of drug-induced QT prolongation, distinguishing pharmacokinetic and pharmacodynamic pathways. Pharmacokinetic-mediated genetic susceptibility is mainly characterized by variation in genes encoding drug-metabolizing cytochrome P450 enzymes or drug transporters. For instance, the P-glycoprotein drug transporter plays a role in the pharmacokinetic susceptibility of drug-induced QT prolongation. The pharmacodynamic component of genetic susceptibility is mainly characterized by genes known to be associated with QT interval duration in the general population and genes in which the causal mutations of congenital long QT syndromes are located. Ethnicity influences susceptibility to drug-induced QT interval prolongation, with Caucasians being more sensitive than other ethnicities. Research on the association between pharmacogenetic interactions and clinical endpoints such as sudden cardiac death is still limited. Future studies in this area could enable us to determine the risk of arrhythmias more adequately in clinical practice.
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Marie-Claire C, Crettol S, Cagnard N, Bloch V, Mouly S, Laplanche JL, Bellivier F, Lepine JP, Eap C, Vorspan F. Variability of response to methadone: genome-wide DNA methylation analysis in two independent cohorts. Epigenomics 2016; 8:181-95. [DOI: 10.2217/epi.15.110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim: Methadone maintenance treatment is characterized by large interindividual dose variability. The aim of this study was to evaluate whether DNA methylations are associated with daily dose of methadone. Materials & methods: Subjects stabilized at high (n = 12) or low (n = 12) methadone doses were selected from two independent cohorts (French and Swiss). DNA methylation patterns were analyzed using HumanMethylation450 BeadChips. Results: In total, 584 differentially methylated sites were identified in the French cohort corresponding to 352 genes. Of these, 26 were replicated in the Swiss cohort. The methylation status of 13 genes varied similarly in both cohorts and calcium signaling pathway was significantly enriched. Conclusion: Our results indicate that differentially methylated sites are associated with methadone daily dose and give insights into the molecular pathways underlying this interindividual dose variability.
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Affiliation(s)
- Cynthia Marie-Claire
- Inserm, UMR-S 1144, Paris, F-75006, France
- Université Paris Descartes, UMR-S 1144, Paris, F-75006, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Severine Crettol
- Unit of Pharmacogenetics & Clinical Psychopharmacology, Centre for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University, Hospital of Cery, Prilly-Lausanne, Switzerland
| | - Nicolas Cagnard
- Bioinformatics Platform Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Vanessa Bloch
- Inserm, UMR-S 1144, Paris, F-75006, France
- Université Paris Descartes, UMR-S 1144, Paris, F-75006, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Stéphane Mouly
- Inserm, UMR-S 1144, Paris, F-75006, France
- Université Paris Descartes, UMR-S 1144, Paris, F-75006, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Jean-Louis Laplanche
- Inserm, UMR-S 1144, Paris, F-75006, France
- Université Paris Descartes, UMR-S 1144, Paris, F-75006, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Frank Bellivier
- Inserm, UMR-S 1144, Paris, F-75006, France
- Université Paris Descartes, UMR-S 1144, Paris, F-75006, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
- Psychiatry Department, Fernand Widal Hospital, Assistance Publique - Hôpitaux de Paris, France
| | - Jean-Pierre Lepine
- Inserm, UMR-S 1144, Paris, F-75006, France
- Université Paris Descartes, UMR-S 1144, Paris, F-75006, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
- Psychiatry Department, Fernand Widal Hospital, Assistance Publique - Hôpitaux de Paris, France
| | - Chin Eap
- Unit of Pharmacogenetics & Clinical Psychopharmacology, Centre for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University, Hospital of Cery, Prilly-Lausanne, Switzerland
| | - Florence Vorspan
- Inserm, UMR-S 1144, Paris, F-75006, France
- Université Paris Descartes, UMR-S 1144, Paris, F-75006, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
- Psychiatry Department, Fernand Widal Hospital, Assistance Publique - Hôpitaux de Paris, France
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Vorspan F, Bloch V, Mouly S. La méthadone à l’heure de la médecine personnalisée : prédiction de la dose efficace ? Prédiction des effets secondaires ? Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RationnelLa méthadone est prescrite comme traitement de substitution de la dépendance aux opiaces depuis les années 1960 . Néanmoins, l’expérience des cliniciens montre que la réponse thérapeutique est obtenue à des doses extrêmement variables d’un patient à l’autre et qu’il est également difficile de prédire les effets secondaires.MéthodeEn collaboration avec plusieurs centres de soins d’Île-de-France (CSAPA Espace Murger, AP–HP, hôpital Fernand-Widal, Dr Gaël Dupuy ; clinique Liberté, hôpital Paul-Guiraud, Dr Didier Touzeau ; CSAPA Moreau de Tours, centre hospitalier Sainte-Anne, Dr Xavier Laqueille ; CSAPA Monte Cristo, AP–HP, HEGP, Dr Cyrille Orizet ; CSAPA EGO, association Aurore, Dr Philippe Coeuru ; ECIMUD, AP–HP, hôpital Louis-Mourier, Dr Anne-Marie Simonpoli ; CSAPA 110 Les Halles, PSA 75, Dr Pierrre Polomeni ; Bus Méthadone Gaia, Dr Elisabeth Avril) nous avons conduit une étude recueillant des données cliniques et génétiques chez des patients héroïnomanes stabilisés sous traitement par méthadone.RésultatsDeux cent seize patients ont été inclus entre 2008 et 2013. Nous présenterons ici des résultats concernant la prédiction des doses nécessaires à l’équilibre thérapeutique chez 80 patients ayant complété une hospitalisation de jour comprenant une exploration fonctionnelle du métabolisme hépatique . Nous présenterons également des résultats sur 161 patients ayant bénéficié d’une mesure de l’espace Qt par un cardiologue et du recueil de facteurs de risque cliniques et génétiques de Torsades de pointes, complétant des données préliminaires que nous avons publié . Ces résultats permettront de discuter les données à recueillir pour une prescription optimisée de méthadone à l’heure de la médecine personnalisée.
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Computational investigations of hERG channel blockers: New insights and current predictive models. Adv Drug Deliv Rev 2015; 86:72-82. [PMID: 25770776 DOI: 10.1016/j.addr.2015.03.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/13/2015] [Accepted: 03/04/2015] [Indexed: 01/08/2023]
Abstract
Identification of potential human Ether-a-go-go Related-Gene (hERG) potassium channel blockers is an essential part of the drug development and drug safety process in pharmaceutical industries or academic drug discovery centers, as they may lead to drug-induced QT prolongation, arrhythmia and Torsade de Pointes. Recent reports also suggest starting to address such issues at the hit selection stage. In order to prioritize molecules during the early drug discovery phase and to reduce the risk of drug attrition due to cardiotoxicity during pre-clinical and clinical stages, computational approaches have been developed to predict the potential hERG blockage of new drug candidates. In this review, we will describe the current in silico methods developed and applied to predict and to understand the mechanism of actions of hERG blockers, including ligand-based and structure-based approaches. We then discuss ongoing research on other ion channels and hERG polymorphism susceptible to be involved in LQTS and how systemic approaches can help in the drug safety decision.
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