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Chen S, Li X, Wu Q, Li Y, Puig M, Moulin F, Choudhuri S, Gingrich J, Guo L. Investigation of cannabidiol-induced cytotoxicity in human hepatic cells. Toxicology 2024; 506:153884. [PMID: 39004336 DOI: 10.1016/j.tox.2024.153884] [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: 04/25/2024] [Revised: 06/23/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
Cannabidiol (CBD) is one of the primary cannabinoids present in extracts of the plant Cannabis sativa L. A CBD-based drug, Epidiolex, has been approved by the U.S. FDA for the treatment of seizures in childhood-onset epileptic disorders. Although CBD-associated liver toxicity has been reported in clinical studies, the underlying mechanisms remain unclear. In this study, we demonstrated that CBD causes cytotoxicity in primary human hepatocytes and hepatic HepG2 cells. A 24-h CBD treatment induced cell cycle disturbances, cellular apoptosis, and endoplasmic reticulum (ER) stress in HepG2 cells. A potent ER stress inhibitor, 4-phenylbutyrate, markedly attenuated CBD-induced apoptosis and cell death. Additionally, we investigated the role of cytochrome P450 (CYP)-mediated metabolism in CBD-induced cytotoxicity using HepG2 cell lines engineered to express 14 individual CYPs. We identified CYP2C9, 2C19, 2D6, 2C18, and 3A5 as participants in CBD metabolism. Notably, cells overexpressing CYP2C9, 2C19, and 2C18 produced 7-hydroxy-CBD, while cells overexpressing CYP2C9, 2C19, 2D6, and 2C18 generated 7-carboxy-CBD. Furthermore, CBD-induced cytotoxicity was significantly attenuated in the cells expressing CYP2D6. Taken together, these data suggest that cell cycle disturbances, apoptosis, and ER stress are associated with CBD-induced cytotoxicity, and CYP2D6-mediated metabolism plays a critical role in decreasing the cytotoxicity of CBD.
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Affiliation(s)
- Si Chen
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), U.S. Food and Drug Administration (FDA), Jefferson, AR 72079, USA.
| | - Xilin Li
- Division of Genetic and Molecular Toxicology, NCTR, U.S. FDA, Jefferson, AR 72079, USA
| | - Qiangen Wu
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), U.S. Food and Drug Administration (FDA), Jefferson, AR 72079, USA
| | - Yuxi Li
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), U.S. Food and Drug Administration (FDA), Jefferson, AR 72079, USA
| | - Montserrat Puig
- Division of Biotechnology Review and Research III, Office of Biotechnology Products, Center for Drug Evaluation and Research, U.S. FDA, Silver Spring, MD 20993, USA
| | - Frederic Moulin
- Division of Hepatology and Nutrition, Office of New Drugs, Center for Drug Evaluation and Research, U.S. FDA, Silver Spring, MD 20993, USA
| | - Supratim Choudhuri
- Division of Food Ingredients, Office of Food Additive Safety, Center for Food Safety and Applied Nutrition, U.S. FDA, College Park, MD 20740, USA
| | - Jeremy Gingrich
- Division of Food Ingredients, Office of Food Additive Safety, Center for Food Safety and Applied Nutrition, U.S. FDA, College Park, MD 20740, USA
| | - Lei Guo
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), U.S. Food and Drug Administration (FDA), Jefferson, AR 72079, USA.
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2
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Mustafa NF, Cheng KK, Nadri MH, Razali SA, Zakaria II, Salin NH, Amran SI. Discovery of azaleatin as a potential allosteric inhibitor for dengue NS2B-NS3 protease using in vitro and in silico studies. J Biomol Struct Dyn 2024:1-12. [PMID: 38881303 DOI: 10.1080/07391102.2024.2335296] [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: 11/30/2023] [Accepted: 03/21/2024] [Indexed: 06/18/2024]
Abstract
The rise in dengue cases in tropical and sub-tropical areas has become a significant health concern. At present, there is no definitive cure for dengue fever, which underscores the importance of identifying potent inhibitors. Dengue NS2B-NS3 protease is the prime drug target due to its vital function for replication. Quercetin, a flavone, has anti-dengue virus properties but is limited by low bioavailability. Previous studies have shown that methoxy substitution in flavones improves bioavailability and metabolic stability. Azaleatin is a derivative of quercetin with a methoxy substitution at the C5 position, however its ability to inhibit dengue is unknown. In this study, azaleatin was investigated for its inhibition against dengue NS2B-NS3 protease using in vitro and in silico techniques. The fluorescence assay was used to determine the IC50 value and inhibition kinetics. The molecular interaction between azaleatin and NS2B-NS3 was studied using CB-Dock2 and AutoDock Vina. The complex's stability was then analysed using GROMACS. Besides, the ADMETlab 2.0 was utilized to predict pharmacokinetic of the azaleatin. Results showed that azaleatin inhibits dengue NS2B-NS3 protease non-competitively with a Ki of 26.82 µg/ml and an IC50 of 38 µg/ml. Molecular docking indicated binding of the azaleatin to the allosteric pocket of NS2B-NS3 with a docking score of -8.2 kcal/mol. Azaleatin was found stable in the pocket along 100 ns, supporting its inhibitory mode. The compound has favourable pharmacokinetic profiles and conformed to Lipinski's Rule of Five. Taken together, azaleatin inhibits NS2B-NS3 protease in a non-competitive mode, suggesting its potential as safer anti-dengue compound.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Nur Farhana Mustafa
- Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Kian-Kai Cheng
- Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Muhammad Helmi Nadri
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Siti Aisyah Razali
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Nerus, Kuala, Terengganu, Malaysia
| | - Iffah Izzati Zakaria
- Malaysia Genome and Vaccine Institute, National Institutes of Biotechnology Malaysia, Jalan Bangi, Kajang Selangor, Malaysia
| | - Nurul Hanim Salin
- Malaysian Institute of Pharmaceuticals and Nutraceuticals, National Institutes of Biotechnology Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Syazwani Itri Amran
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Johor, Malaysia
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3
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Hughes TD, Nowak J, Sottung E, Mustafa A, Lingechetty G. Empowering Pharmacists: Strategies for Addressing the Opioid Crisis through a Public Health Lens. PHARMACY 2024; 12:82. [PMID: 38921958 PMCID: PMC11207300 DOI: 10.3390/pharmacy12030082] [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: 04/10/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The opioid crisis in the US is a severe public health issue, prompting pharmacists to adopt various strategies for prevention, harm reduction, treatment, and recovery. Despite progress, barriers persist. RESULTS This commentary examines five determinants of public health in relation to pharmacist-led interventions for the opioid crisis: individual behavior, social factors, policymaking, health service accessibility, and biological/genetic considerations. Pharmacists can influence individual behavior through education and support, address social determinants like stigma, advocate for policy changes, ensure health service accessibility, and personalize opioid prescriptions based on biological factors. CONCLUSION Pharmacists play a crucial role in addressing the opioid crisis by navigating these determinants. Pharmacists' engagement is essential for reducing opioid-related harms and improving public health outcomes through advocacy, service provision, and education.
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Affiliation(s)
- Tamera D. Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (J.N.); (E.S.); (A.M.); (G.L.)
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4
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Evans W, Meslin EM, Kai J, Qureshi N. Precision Medicine-Are We There Yet? A Narrative Review of Precision Medicine's Applicability in Primary Care. J Pers Med 2024; 14:418. [PMID: 38673045 PMCID: PMC11051552 DOI: 10.3390/jpm14040418] [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: 03/06/2024] [Revised: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Precision medicine (PM), also termed stratified, individualised, targeted, or personalised medicine, embraces a rapidly expanding area of research, knowledge, and practice. It brings together two emerging health technologies to deliver better individualised care: the many "-omics" arising from increased capacity to understand the human genome and "big data" and data analytics, including artificial intelligence (AI). PM has the potential to transform an individual's health, moving from population-based disease prevention to more personalised management. There is however a tension between the two, with a real risk that this will exacerbate health inequalities and divert funds and attention from basic healthcare requirements leading to worse health outcomes for many. All areas of medicine should consider how this will affect their practice, with PM now strongly encouraged and supported by government initiatives and research funding. In this review, we discuss examples of PM in current practice and its emerging applications in primary care, such as clinical prediction tools that incorporate genomic markers and pharmacogenomic testing. We look towards potential future applications and consider some key questions for PM, including evidence of its real-world impact, its affordability, the risk of exacerbating health inequalities, and the computational and storage challenges of applying PM technologies at scale.
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Affiliation(s)
- William Evans
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (J.K.); (N.Q.)
| | - Eric M. Meslin
- PHG Foundation, Cambridge University, Cambridge CB1 8RN, UK;
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Joe Kai
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (J.K.); (N.Q.)
| | - Nadeem Qureshi
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK; (J.K.); (N.Q.)
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5
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Dua P, Seth S, Prasher B, Mukerji M, Maulik SK, Reeta KH. Pharmacogenomic biomarkers in coronary artery disease: a narrative review. Biomark Med 2024; 18:191-202. [PMID: 38456296 DOI: 10.2217/bmm-2023-0476] [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: 03/09/2024] Open
Abstract
Coronary artery disease (CAD) has a high mortality rate. Despite various therapeutic targets, non-responsiveness to drugs remains a prevalent issue. Pharmacogenomics assesses the way an individual's genetic attributes affect their likely response to drug therapy. Single-nucleotide polymorphisms play a crucial role in determining these outcomes. This review offers an overview of single-nucleotide polymorphisms investigated in clinical studies and their associations with drug response/nonresponse in the treatment of CAD. A total of 104 studies of whole sets of chromosomes and several genes were explored. A total of 161 polymorphisms exhibited associations with drug response/nonresponse in CAD across diverse ethnic populations. This pool can serve as a pharmacogenomic biomarker for predicting response to drug therapy in patients with CAD.
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Affiliation(s)
- Pamila Dua
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sandeep Seth
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | - Mitali Mukerji
- Indian Institute of Technology, Jodhpur, Rajasthan, India
| | | | - K H Reeta
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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6
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Zhang M, Rottschäfer V, C M de Lange E. The potential impact of CYP and UGT drug-metabolizing enzymes on brain target site drug exposure. Drug Metab Rev 2024; 56:1-30. [PMID: 38126313 DOI: 10.1080/03602532.2023.2297154] [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: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
Drug metabolism is one of the critical determinants of drug disposition throughout the body. While traditionally associated with the liver, recent research has unveiled the presence and functional significance of drug-metabolizing enzymes (DMEs) within the brain. Specifically, cytochrome P-450 enzymes (CYPs) and UDP-glucuronosyltransferases (UGTs) enzymes have emerged as key players in drug biotransformation within the central nervous system (CNS). This comprehensive review explores the cellular and subcellular distribution of CYPs and UGTs within the CNS, emphasizing regional expression and contrasting profiles between the liver and brain, humans and rats. Moreover, we discuss the impact of species and sex differences on CYPs and UGTs within the CNS. This review also provides an overview of methodologies for identifying and quantifying enzyme activities in the brain. Additionally, we present factors influencing CYPs and UGTs activities in the brain, including genetic polymorphisms, physiological variables, pathophysiological conditions, and environmental factors. Examples of CYP- and UGT-mediated drug metabolism within the brain are presented at the end, illustrating the pivotal role of these enzymes in drug therapy and potential toxicity. In conclusion, this review enhances our understanding of drug metabolism's significance in the brain, with a specific focus on CYPs and UGTs. Insights into the expression, activity, and influential factors of these enzymes within the CNS have crucial implications for drug development, the design of safe drug treatment strategies, and the comprehension of drug actions within the CNS. To that end, CNS pharmacokinetic (PK) models can be improved to further advance drug development and personalized therapy.
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Affiliation(s)
- Mengxu Zhang
- Division of Systems Pharmacology and Pharmacy, Predictive Pharmacology Group, Leiden Academic Centre of Drug Research, Leiden University, Leiden, The Netherlands
| | - Vivi Rottschäfer
- Mathematical Institute, Leiden University, Leiden, The Netherlands
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth C M de Lange
- Division of Systems Pharmacology and Pharmacy, Predictive Pharmacology Group, Leiden Academic Centre of Drug Research, Leiden University, Leiden, The Netherlands
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7
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Sivadas A, Rathore S, Sahana S, Jolly B, Bhoyar RC, Jain A, Sharma D, Imran M, Senthilvel V, Divakar MK, Mishra A, Sivasubbu S, Scaria V. The genomic landscape of CYP2D6 variation in the Indian population. Pharmacogenomics 2024; 25:147-160. [PMID: 38426301 DOI: 10.2217/pgs-2023-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Aim: The CYP2D6 gene is highly polymorphic, causing large interindividual variability in the metabolism of several clinically important drugs. Materials & methods: The authors investigated the diversity and distribution of CYP2D6 alleles in Indians using whole genome sequences (N = 1518). Functional consequences were assessed using pathogenicity scores and molecular dynamics simulations. Results: The analysis revealed population-specific CYP2D6 alleles (*86, *7, *111, *112, *113, *99) and remarkable differences in variant and phenotype frequencies with global populations. The authors observed that one in three Indians could benefit from a dose alteration for psychiatric drugs with accurate CYP2D6 phenotyping. Molecular dynamics simulations revealed large conformational fluctuations, confirming the predicted reduced function of *86 and *113 alleles. Conclusion: The findings emphasize the utility of comprehensive CYP2D6 profiling for aiding precision public health.
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Affiliation(s)
- Ambily Sivadas
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, 560034, India
| | - Surabhi Rathore
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - S Sahana
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Bani Jolly
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Rahul C Bhoyar
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Abhinav Jain
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Disha Sharma
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Mohamed Imran
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Vigneshwar Senthilvel
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Mohit Kumar Divakar
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Anushree Mishra
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Sridhar Sivasubbu
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
- Vishwanath Cancer Care Foundation, B 702, 7th Floor, Neelkanth Business Park Kirol Village, Vidya Vihar, West Mumbai, 400086, India
| | - Vinod Scaria
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
- Vishwanath Cancer Care Foundation, B 702, 7th Floor, Neelkanth Business Park Kirol Village, Vidya Vihar, West Mumbai, 400086, India
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8
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Sakaguchi T, Kajiyama T, Miyake M, Katayama T. Tramadol for moderate cancer pain: a reappraisal. BMJ Support Palliat Care 2024; 13:e749-e750. [PMID: 35940870 DOI: 10.1136/spcare-2022-003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | - Toru Kajiyama
- Department of Palliative Care, Kitano Hospital, Osaka, Japan
| | - Mafumi Miyake
- Department of Pharmacology, Kitano Hospital, Osaka, Japan
| | - Toshiro Katayama
- Department of Medical Engineering, Morinomiya University of Medical Sciences, Osaka, Japan
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9
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Madrid-Gambin F, Fabregat-Safont D, Gomez-Gomez A, Olesti E, Mason NL, Ramaekers JG, Pozo OJ. Present and future of metabolic and metabolomics studies focused on classical psychedelics in humans. Biomed Pharmacother 2023; 169:115775. [PMID: 37944438 DOI: 10.1016/j.biopha.2023.115775] [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: 08/07/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
Psychedelics are classical hallucinogen drugs that induce a marked altered state of consciousness. In recent years, there has been renewed attention to the possible use of classical psychedelics for the treatment of certain mental health disorders. However, further investigation to better understand their biological effects in humans, their mechanism of action, and their metabolism in humans is needed when considering the development of future novel therapeutic approaches. Both metabolic and metabolomics studies may help for these purposes. On one hand, metabolic studies aim to determine the main metabolites of the drug. On the other hand, the application of metabolomics in human psychedelics studies can help to further understand the biological processes underlying the psychedelic state and the mechanisms of action underlying their therapeutic potential. This review presents the state of the art of metabolic and metabolomic studies after lysergic acid diethylamide (LSD), mescaline, N,N-dimethyltryptamine (DMT) and β-carboline alkaloids (ayahuasca brew), 5-methoxy-DMT and psilocybin administrations in humans. We first describe the characteristics of the published research. Afterward, we reviewed the main results obtained by both metabolic and metabolomics (if available) studies in classical psychedelics and we found out that metabolic and metabolomics studies in psychedelics progress at two different speeds. Thus, whereas the main metabolites for classical psychedelics have been robustly established, the main metabolic alterations induced by psychedelics need to be explored. The integration of metabolomics and pharmacokinetics for investigating the molecular interaction between psychedelics and multiple targets may open new avenues in understanding the therapeutic role of psychedelics.
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Affiliation(s)
- Francisco Madrid-Gambin
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain.
| | - David Fabregat-Safont
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain; Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, 12071 Castelló, Spain
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain; CERBA Internacional, Chromatography Department, 08203 Sabadell, Spain
| | - Eulàlia Olesti
- Department of Clinical Pharmacology, Area Medicament, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; Clinical Pharmacology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Natasha L Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Oscar J Pozo
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain.
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10
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Virelli CR, Ebrahimi M, Mohiuddin AG, Tomasi J, Lisoway AJ, Herbert D, Marshe VS, Kidd SA, Ferenbok J, Kennedy JL. User Experiences of Pharmacogenomic Testing and Opinions among Psychiatry Patients. J Pers Med 2023; 14:22. [PMID: 38248723 PMCID: PMC10817619 DOI: 10.3390/jpm14010022] [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: 11/17/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Pharmacogenomic testing (PGx) is a tool used to guide physicians in selecting an optimal medication for clients based on their genetic profile. The objective of this qualitative study is to understand patients' experiences with PGx testing as well as their opinions regarding the clinical adoption of such tests in psychiatry. A focus group was conducted to assess the needs of clients who had experience using a PGx test. Participants were recruited from a large study on PGx testing that offered physicians an opportunity to use PGx reports to guide psychotropic prescriptions. The focus group discussions were recorded, transcribed, and coded using NVivo to identify core themes. A total of 11 people participated in the focus group. Our analysis revealed that many participants were in favour of implementing PGx testing in psychiatric practice, and all expressed important considerations for patient-centred optimization of PGx testing. The main themes captured were: education and awareness among clinicians, cost considerations, PGx results-sharing and accessibility, and prospective benefits. The results of this study suggest that patients are keen to see PGx testing in widespread clinical care, but they report important opportunities to improve knowledge mobilization of PGx testing.
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Affiliation(s)
- Catherine R. Virelli
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Translational Research Program, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Mahbod Ebrahimi
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ayeshah G. Mohiuddin
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Translational Research Program, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Julia Tomasi
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Amanda J. Lisoway
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Deanna Herbert
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
| | | | - Sean A. Kidd
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Joseph Ferenbok
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - James L. Kennedy
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
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11
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Roberts B, Cooper Z, Lu S, Stanley S, Majda BT, Collins KRL, Gilkes L, Rodger J, Akkari PA, Hood SD. Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review. Front Pharmacol 2023; 14:1267294. [PMID: 37795032 PMCID: PMC10545970 DOI: 10.3389/fphar.2023.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.
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Affiliation(s)
- Bradley Roberts
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Zahra Cooper
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Stephanie Lu
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Khan R. L. Collins
- Western Australian Department of Health, North Metropolitan Health Service, Perth, WA, Australia
| | - Lucy Gilkes
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
- Divison of General Practice, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - P. Anthony Akkari
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
- Division of Neurology, Duke University Medical Centre, Duke University, Durham, United States
| | - Sean D. Hood
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
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12
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Pjevac M, Redenšek Trampuž S, Blagus T, Dolžan V, Bon J. Case report: application of pharmacogenetics in the personalized treatment of an elderly patient with a major depressive episode. Front Psychiatry 2023; 14:1250253. [PMID: 37608991 PMCID: PMC10440381 DOI: 10.3389/fpsyt.2023.1250253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Pharmacogenetic analyses can predict interpersonal differences in response to psychopharmacotherapy, which greatly facilitates the selection of the most effective medication at optimal doses. By personalizing therapy in this way, we can minimize adverse drug reactions (ADR) and prevent polypharmacy. Most psychotropic medications are metabolized by the cytochrome P450 enzymes CYP2D6, CYP2C19, and CYPA3A4, which influence drug metabolism and concentration, affecting both efficacy and the occurrence of ADR. The relationships between genetic variations and enzymatic activity allow pharmacogenetic analysis to provide important data for optimal drug selection. The following case report illustrates the impact of pharmacogenetic analysis on the course of pharmacologic treatment in an elderly patient with a major depressive episode. Methods We present a case of a 79-year-old patient treated for severe depression with psychotic symptoms. We collected data on treatment selection and response to treatment before and after pharmacogenetic analysis. For pharmacogenetic analysis, common functional variants in CYP1A2, CYP3A4, CYP2B6, CYP2C19, and CYP2D6 were genotyped, and corresponding evidence-based treatment recommendations were prepared. Results The patient suffered from lack of efficacy and serious ADR of several medications, resulting in worsening depression and treatment resistance over the course of several months of treatment. Pharmacogenetic analysis provided important insights into the patient's pharmacokinetic phenotype and allowed us to personalize treatment and achieve remission of the depressive episode. Conclusion In the case presented, we have shown how consideration of pharmacogenetic characteristics in an individual patient can improve treatment outcome and patient well-being. Knowledge of the patient's pharmacogenetic characteristics helped us to personalize treatment, resulting in complete remission of psychopathology. Due to the complexity of psychiatric disorders, the efficacy of combinations of different medications, which are often required in individual patients, cannot be clearly explained. Therefore, it is of great importance to conduct further pharmacokinetic and pharmacogenetic studies to better assess gene-drug interactions in psychopharmacotherapy.
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Affiliation(s)
- Milica Pjevac
- Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Sara Redenšek Trampuž
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Blagus
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jurij Bon
- Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Schmidt MA, Jones JA, Mason CE. Optimizing human performance in extreme environments through precision medicine: From spaceflight to high-performance operations on Earth. CAMBRIDGE PRISMS. PRECISION MEDICINE 2023; 1:e27. [PMID: 38550927 PMCID: PMC10953751 DOI: 10.1017/pcm.2023.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 04/12/2024]
Abstract
Humans operating in extreme environments often conduct their operations at the edges of the limits of human performance. Sometimes, they are required to push these limits to previously unattained levels. As a result, their margins for error in execution are much smaller than that found in the general public. These same small margins for error that impact execution may also impact risk, safety, health, and even survival. Thus, humans operating in extreme environments have a need for greater refinement in their preparation, training, fitness, and medical care. Precision medicine (PM) is uniquely suited to address the needs of those engaged in these extreme operations because of its depth of molecular analysis, derived precision countermeasures, and ability to match each individual (and his or her specific molecular phenotype) with any given operating context (environment). Herein, we present an overview of a systems approach to PM in extreme environments, which affords clinicians one method to contextualize the inputs, processes, and outputs that can form the basis of a formal practice. For the sake of brevity, this overview is focused on molecular dynamics, while providing only a brief introduction to the also important physiologic and behavioral phenotypes in PM. Moreover, rather than a full review, it highlights important concepts, while using only selected citations to illustrate those concepts. It further explores, by demonstration, the basic principles of using functionally characterized molecular networks to guide the practical application of PM in extreme environments. At its core, PM in extreme environments is about attention to incremental gains and losses in molecular network efficiency that can scale to produce notable changes in health and performance. The aim of this overview is to provide a conceptual overview of one approach to PM in extreme environments, coupled with a selected suite of practical considerations for molecular profiling and countermeasures.
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Affiliation(s)
- Michael A. Schmidt
- Sovaris Aerospace, Boulder, CO, USA
- Advanced Pattern Analysis & Human Performance Group, Boulder, CO, USA
| | - Jeffrey A. Jones
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christopher E. Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
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Wang X, Bao Q, Wang R, Li T, Wang Y, Qin B, Li Q, Burgess DJ. In Vivo Characterization of Perseris and Compositionally Equivalent Formulations. Int J Pharm 2023:123170. [PMID: 37354927 DOI: 10.1016/j.ijpharm.2023.123170] [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: 05/05/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
Perseris is asubcutaneous extended-release risperidone in situ forming implant (suspension) indicated for the treatment of adult schizophrenia. Owing to the release rate controlling polymer poly(lactide-co-glycolide) (PLGA), one injection of Perseris can deliver risperidone for one month, which significantly reduces the administration frequency and improves patient compliance. The PLGA and drug used in Perseris was previously identified through reverse engineering and two compositionally equivalent formulations (F-1 and F-2) showing similar in vitro drug release were developed. The current work focuses on in vivo exploration of Perseris and the developed compositionally equivalent formulations using a rabbit model and further evaluate the sameness of the developed formulations compared to Perseris. The in vivo pharmacokinetic (PK) profiles, drug absorption rate, phase separation rate, macro appearance, weight loss as well as the water uptake of the solidified drug depots at different time points were investigated and compared with the in vitro release data as well as with dog and human in vivo data available in literature. Results show that the rabbit PK profile of Perseris was relevant with those obtained from both the dog model and the clinical data, indicating that the rabbit model is appropriate for investigation of the in vivo performance of risperidone implants. Consistent with their similar in vitro drug release, the two compositionally equivalent formulations demonstrated similar PK profiles, drug absorption rates, weight loss and swelling in vivo compared to Perseris. Although the erosion mechanism appeared to be similar between in vitro and in vivo, there were in vitro-in vivo differences concerning the drug release kinetics, phase separation rates and swelling behavior. This work provides a comprehensive in vitro/in vivo understanding of Perseris and the developed compositionally equivalent formulations, which will be beneficial for future development of generic as well as novel PLGA in situ forming implant products.
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Affiliation(s)
- Xiaoyi Wang
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Quanying Bao
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Ruifeng Wang
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Tingting Li
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Yan Wang
- U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Bin Qin
- U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Qi Li
- U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Diane J Burgess
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT 06269, USA.
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Animaw Z, Asres K, Abebe A, Taye S, Seyoum G. Acute and developmental toxicity of embelin isolated from Embelia schimperi Vatke fruit: In vivo and in silico studies. Toxicol Rep 2023; 10:714-722. [PMID: 37362226 PMCID: PMC10285041 DOI: 10.1016/j.toxrep.2023.06.006] [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: 04/14/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Background Embelin is a hydroxybenzoquinone constituent of the Embelia species that has anti-disease properties. However, its toxicity, particularly the in silico, acute, and developmental toxicity profiles, has yet to be thoroughly investigated. Hence, this study aims to assess these toxicity profiles. Materials and Methods In silico and in vivo experimental studies were conducted on embelin isolated from the fruits of Embelia schimperi Vatke. In silico toxicity predictions were computed using the ProTox model. The in vivo experiment was done by administering 5000 mg/kg of embelin to a single female albino Wistar rat, followed by three female rats in the absence of death, to determine the mean lethal dose (LD50). Afterwards, three groups of pregnant rats were treated with embelin at doses of 250 mg/kg, 500 mg/kg, and 1000 mg/kg for the developmental toxicity test. Vehicle and ad libitum control groups were used to compare the acute and developmental toxicity variables. Results In silico toxicity predicted that embelin is free from hepatotoxic, carcinogenic, mutagenic, and cytotoxic effects. No inhibitory effect on hERG channels was observed. It has an immunotoxic property and an inhibitory effect on the CYP2D6 enzyme. Since mortality and signs of toxicities were not observed after treatment with 5000 mg/kg, the mean lethal dose (LD50) is determined to be > 5000 mg/kg. There was no significant difference in the morphological scores or number of somites among experimental animals. None of the embryonic systems possessed developmental delays. Nevertheless, the crown-rump length of the high-dose group became significantly shorter. Maternal food intake and weight gain exhibited significant dose-dependent differences between embelin-treated animals and controls. The number of implantations was significantly low in the treatment group, accompanied by a higher frequency of prior resorption. Conclusion Embelin is predicted to have a high probability of immunotoxicity potential and affect drug metabolism by inhibiting CYP2D6. In addition, it affects food intake, weight gain, and the number of implantations in pregnant rats. Therefore, it is highly recommended not to take embelin and embelin-rich plants during pregnancy. Further in vitro and in vivo studies need to be conducted to understand the mechanism behind the toxicity of embelin.
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Affiliation(s)
- Zelalem Animaw
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kaleab Asres
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abiy Abebe
- Traditional and Modern Drug Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Samson Taye
- Traditional and Modern Drug Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girma Seyoum
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kibitov AA, Kiryanova EM, Salnikova LI, Bure IV, Shmukler AB, Kibitov AO. The ANKK1/DRD2 gene TaqIA polymorphism (rs1800497) is associated with the severity of extrapyramidal side effects of haloperidol treatment in CYP2D6 extensive metabolizers with schizophrenia spectrum disorders. Drug Metab Pers Ther 2023; 38:133-142. [PMID: 36437548 DOI: 10.1515/dmpt-2022-0143] [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: 06/10/2022] [Accepted: 09/12/2022] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Extrapyramidal symptoms (EPS) are one of the most prominent side effects of haloperidol. Variability of EPS severity may be associated with the genetic factors, affecting both haloperidol pharmacokinetics (e.g., CYP2D6) and pharmacodynamics (e.g., DRD2, ANKK1). We conducted a 3-week prospective study to investigate the associations of ANKK1/DRD2 TaqIA (rs1800497), DRD2 -141C Ins/Del (rs1799732) polymorphisms and CYP2D6 metabolic phenotype on the efficacy of haloperidol treatment and severity of EPS in patients with schizophrenia spectrum disorders. METHODS In total, 57 inpatients with schizophrenia spectrum disorders (24 (42.1%)) females; age -46.7 (11.8) years (M(SD)) of European ancestry were enrolled. BARS and SAS scales were used to assess EPS. PANSS and CGI scales - to assess the efficacy of haloperidol treatment. Genotyping was performed by real-time PCR. CYP2D6 metabolic phenotype was predicted by the CYP2D6 *3, *4, *5, *6, *9, *10, *41 and xN genotypes. RESULTS Minor C allele of TaqIA was associated with higher scores of BARS (p=0.029) and SAS (p=0.024) on day 21 and minor Del allele of -141C Ins/Del - with more prominent clinical improvement by CGI scale (p=0.007) but not by PANSS. These differences were observed only in extensive CYP2D6 metabolizers, although no associations with the metabolic type itself were found. General linear model showed that the combination of TaqIA genotype and metabolic type was significantly associated with BARS score on day 21 (p=0.013). CONCLUSIONS Our results highlight the importance of using both pharmacokinetic and pharmacodynamic genetic markers for predicting haloperidol treatment response to personalize schizophrenia spectrum disorders treatment.
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Affiliation(s)
- Andrey Alexandrovitch Kibitov
- Resident of Translational Psychiatry Department, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russian Federation
| | - Elena Mikhaylovna Kiryanova
- Department of Psychotic Spectrum Disorders, Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russian Federation
| | - Ludmila Ivanovna Salnikova
- Department of Psychotic Spectrum Disorders, Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russian Federation
| | - Irina Vladimirovna Bure
- Institute for Molecular and Personalized Medicine, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
- Department of Medical Genetics, Institute of Molecular Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Alexander Borisovitch Shmukler
- Deputy General Director for Research, Serbsky Medical Research Center on Psychiatry and Addictions, Moscow, Russian Federation
| | - Alexander Olegovitch Kibitov
- Molecular Genetics Laboratory, Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russian Federation
- Translational Psychiatry Department, Bekhterev National Medical Research Center on Psychiatry and Neurology, Saint Petersburg, Russian Federation
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Jin J, Zhong XB. Epigenetic Mechanisms Contribute to Intraindividual Variations of Drug Metabolism Mediated by Cytochrome P450 Enzymes. Drug Metab Dispos 2023; 51:672-684. [PMID: 36973001 PMCID: PMC10197210 DOI: 10.1124/dmd.122.001007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 02/24/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Significant interindividual and intraindividual variations on cytochrome P450 (CYP)-mediated drug metabolism exist in the general population globally. Genetic polymorphisms are one of the major contribution factors for interindividual variations, but epigenetic mechanisms mainly contribute to intraindividual variations, including DNA methylation, histone modifications, microRNAs, and long non-coding RNAs. The current review provides analysis of advanced knowledge in the last decade on contributions of epigenetic mechanisms to intraindividual variations on CYP-mediated drug metabolism in several situations, including (1) ontogeny, the developmental changes of CYP expression in individuals from neonates to adults; (2) increased activities of CYP enzymes induced by drug treatment; (3) increased activities of CYP enzymes in adult ages induced by drug treatment at neonate ages; and (4) decreased activities of CYP enzymes in individuals with drug-induced liver injury (DILI). Furthermore, current challenges, knowledge gaps, and future perspective of the epigenetic mechanisms in development of CYP pharmacoepigenetics are discussed. In conclusion, epigenetic mechanisms have been proven to contribute to intraindividual variations of drug metabolism mediated by CYP enzymes in age development, drug induction, and DILI conditions. The knowledge has helped understanding how intraindividual variation are generated. Future studies are needed to develop CYP-based pharmacoepigenetics to guide clinical applications for precision medicine with improved therapeutic efficacy and reduced risk of adverse drug reactions and toxicity. SIGNIFICANCE STATEMENT: Understanding epigenetic mechanisms in contribution to intraindividual variations of CYP-mediated drug metabolism may help to develop CYP-based pharmacoepigenetics for precision medicine to improve therapeutic efficacy and reduce adverse drug reactions and toxicity for drugs metabolized by CYP enzymes.
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Affiliation(s)
- Jing Jin
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Connecticut, Storrs, Connecticut
| | - Xiao-Bo Zhong
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Connecticut, Storrs, Connecticut
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18
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Atiq MA, Peterson SE, Langman LJ, Baudhuin LM, Black JL, Moyer AM. Determination of the Duplicated CYP2D6 Allele Using Real-Time PCR Signal: An Alternative Approach. J Pers Med 2023; 13:883. [PMID: 37373874 DOI: 10.3390/jpm13060883] [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: 04/07/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
CYP2D6 duplication has important pharmacogenomic implications. Reflex testing with long-range PCR (LR-PCR) can resolve the genotype when a duplication and alleles with differing activity scores are detected. We evaluated whether visual inspection of plots from real-time-PCR-based targeted genotyping with copy number variation (CNV) detection could reliably determine the duplicated CYP2D6 allele. Six reviewers evaluated QuantStudio OpenArray CYP2D6 genotyping results and the TaqMan Genotyper plots for seventy-three well-characterized cases with three copies of CYP2D6 and two different alleles. Reviewers blinded to the final genotype visually assessed the plots to determine the duplicated allele or opt for reflex sequencing. Reviewers achieved 100% accuracy for cases with three CYP2D6 copies that they opted to report. Reviewers did not request reflex sequencing in 49-67 (67-92%) cases (and correctly identified the duplicated allele in each case); all remaining cases (6-24) were marked by at least one reviewer for reflex sequencing. In most cases with three copies of CYP2D6, the duplicated allele can be determined using a combination of targeted genotyping using real-time PCR with CNV detection without need for reflex sequencing. In ambiguous cases and those with >3 copies, LR-PCR and Sanger sequencing may still be necessary for determination of the duplicated allele.
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Affiliation(s)
- Mazen A Atiq
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Sandra E Peterson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Loralie J Langman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Linnea M Baudhuin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - John L Black
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Singh AV, Chandrasekar V, Paudel N, Laux P, Luch A, Gemmati D, Tissato V, Prabhu KS, Uddin S, Dakua SP. Integrative toxicogenomics: Advancing precision medicine and toxicology through artificial intelligence and OMICs technology. Biomed Pharmacother 2023; 163:114784. [PMID: 37121152 DOI: 10.1016/j.biopha.2023.114784] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023] Open
Abstract
More information about a person's genetic makeup, drug response, multi-omics response, and genomic response is now available leading to a gradual shift towards personalized treatment. Additionally, the promotion of non-animal testing has fueled the computational toxicogenomics as a pivotal part of the next-gen risk assessment paradigm. Artificial Intelligence (AI) has the potential to provid new ways analyzing the patient data and making predictions about treatment outcomes or toxicity. As personalized medicine and toxicogenomics involve huge data processing, AI can expedite this process by providing powerful data processing, analysis, and interpretation algorithms. AI can process and integrate a multitude of data including genome data, patient records, clinical data and identify patterns to derive predictive models anticipating clinical outcomes and assessing the risk of any personalized medicine approaches. In this article, we have studied the current trends and future perspectives in personalized medicine & toxicology, the role of toxicogenomics in connecting the two fields, and the impact of AI on personalized medicine & toxicology. In this work, we also study the key challenges and limitations in personalized medicine, toxicogenomics, and AI in order to fully realize their potential.
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Affiliation(s)
- Ajay Vikram Singh
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), 10589 Berlin, Germany
| | | | - Namuna Paudel
- Department of Chemistry, Amrit Campus, Institute of Science and Technology, Tribhuvan University, Lainchaur, Kathmandu 44600 Nepal
| | - Peter Laux
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), 10589 Berlin, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), 10589 Berlin, Germany
| | - Donato Gemmati
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Centre Hemostasis & Thrombosis, University of Ferrara, 44121 Ferrara, Italy; Centre for Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Veronica Tissato
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Centre Hemostasis & Thrombosis, University of Ferrara, 44121 Ferrara, Italy; Centre for Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Kirti S Prabhu
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Shahab Uddin
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
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Himmerich H, Lewis YD, Conti C, Mutwalli H, Karwautz A, Sjögren JM, Uribe Isaza MM, Tyszkiewicz-Nwafor M, Aigner M, McElroy SL, Treasure J, Kasper S. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders. World J Biol Psychiatry 2023:1-64. [PMID: 37350265 DOI: 10.1080/15622975.2023.2179663] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES This 2023 update of the WFSBP guidelines for the pharmacological treatment of eating disorders (EDs) reflects the latest diagnostic and psychopharmacological progress and the improved WFSBP recommendations for the assessment of the level of evidence (LoE) and the grade of recommendation (GoR). METHODS The WFSBP Task Force EDs reviewed the relevant literature and provided a timely grading of the LoE and the GoR. RESULTS In anorexia nervosa (AN), only a limited recommendation (LoE: A; GoR: 2) for olanzapine can be given, because the available evidence is restricted to weight gain, and its effect on psychopathology is less clear. In bulimia nervosa (BN), the current literature prompts a recommendation for fluoxetine (LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1). In binge-eating disorder (BED), lisdexamfetamine (LDX; LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1) can be recommended. There is only sparse evidence for the drug treatment of avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD). CONCLUSION In BN, fluoxetine, and topiramate, and in BED, LDX and topiramate can be recommended. Despite the published evidence, olanzapine and topiramate have not received marketing authorisation for use in EDs from any medicine regulatory agency.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Yael Doreen Lewis
- Hadarim Eating Disorders Unit, Shalvata Mental Health Center, Hod HaSharon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Hiba Mutwalli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Andreas Karwautz
- Eating Disorders Care & Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | | | - Marta Tyszkiewicz-Nwafor
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznań, Poland
| | - Martin Aigner
- Universitätsklinikum Tulln, Tulln an der Donau, Austria
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Myers AL, Jeske AH. Provider-directed analgesia for dental pain. Expert Rev Clin Pharmacol 2023; 16:435-451. [PMID: 37083548 DOI: 10.1080/17512433.2023.2206118] [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: 04/22/2023]
Abstract
INTRODUCTION Extraction of impacted molar teeth is a common procedure performed by oral surgeons and general dentists, with postoperative pain being a significant adverse event post-surgery. If mismanaged, pain can lead to complications that impact oral and systemic health. The current scourge of the opioid epidemic has ushered in a new era of provider-directed analgesic (PDA) therapy in dentistry. AREAS COVERED This article provides an in-depth review on the major pharmacological and therapeutic properties of established and alternative analgesics used to manage dental pain. EXPERT OPINION Substantial evidence-based literature shows combination of a non-steroidal anti-inflammatory drug (NSAID; e.g. ibuprofen) and acetaminophen provides superior pain relief than single-agent or combination opioid regimens. However, there are clinical scenarios (e.g. severe pain) when short-course opioid prescription is appropriate in select patients, in which a 2-3-day treatment duration is typically sufficient. Alternative agents (e.g. caffeine, gabapentin, phytotherapies), typically in combination with established agents, can mitigate postoperative dental pain. Some evidence suggests preemptive therapies (e.g. corticosteroids, NSAIDs) reduce amounts of postsurgical analgesic consumption and might lessen opioid prescription burden. In summary, this comprehensive review provides an opportune update on the evolving landscape of pharmacotherapy for acute postsurgical dental pain, informing best practices for PDA in the dental setting.
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Affiliation(s)
- Alan L Myers
- Department of Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arthur H Jeske
- Office of the Dean, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
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22
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Reeves AA, Hopefl R, Deb S. Evaluation of pharmacogenomic evidence for drugs related to ADME genes in CPIC database. Drug Metab Pers Ther 2023; 38:65-78. [PMID: 36257916 DOI: 10.1515/dmpt-2022-0123] [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: 03/16/2022] [Accepted: 08/19/2022] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Clinical Pharmacogenetics Implementation Consortium (CPIC) is a platform that advances the pharmacogenomics (PGx) practice by developing evidence-based guidelines. The purpose of this study was to analyze the CPIC database for ADME related genes and their corresponding drugs, and evidence level for drug-gene pairs; and to determine the presence of these drug-gene pairs in the highest mortality diseases in the United States. METHODS CPIC database was evaluated for drug-gene pairs related to absorption, distribution, metabolism, and excretion (ADME) properties. National Vital Statistics from Centers for Disease Control and Prevention was used to identify the diseases with the highest mortality. CPIC levels are assigned to different drug-gene pairs based on varying levels of evidence as either A, B, C, or D. All drug-gene pairs assigned with A/B, B/C, or C/D mixed levels were excluded from this study. A stepwise exclusion process was followed to determine the prevalence of various ADME drug-gene pairs among phase I/II enzymes or transporters and stratify the drug-gene pairs relevant to different disease conditions most commonly responsible for death in the United States. RESULTS From a total of 442 drug-gene pairs in the CPIC database, after exclusion of 86 drug-gene pairs with levels A/B, B/C, or C/D, and 211 non-ADME related genes, 145 ADME related drug-gene pairs resulted. From the 145 ADME related drug-genes pairs, the following were the distribution of levels: Level A: 43 (30%), Level B: 22 (15%), Level C: 59 (41%), Level D: 21 (14%). The most prevalent ADME gene with CPIC level A classification was cytochrome P450 2C9 (CYP2C9) (26%) and overall, the most prevalent ADME gene in the CPIC database was CYP2D6 (30%). The most prevalent diseases related to the CPIC evidence related drugs were cancer and depression. CONCLUSIONS We found that there is an abundance of ADME related genes in the CPIC database, including in the high mortality disease states of cancer and depression. There is a differential level of pharmacogenomic evidence in drug-gene pairs enlisted in CPIC where levels A and D having the greatest number of drug-gene pairs. CYP2D6 was the most common ADME gene with CPIC evidence for drug-gene pairs. Pharmacogenomic applications of CPIC evidence can be leveraged to individualize patient therapy and lower adverse effect events.
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Affiliation(s)
- Anthony Allen Reeves
- Department of Pharmaceutical Sciences, College of Pharmacy, Larkin University, Miami, FL, USA
| | - Robert Hopefl
- Department of Pharmaceutical Sciences, College of Pharmacy, Larkin University, Miami, FL, USA
| | - Subrata Deb
- Department of Pharmaceutical Sciences, College of Pharmacy, Larkin University, Miami, FL, USA
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23
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Chamboko CR, Veldman W, Tata RB, Schoeberl B, Tastan Bishop Ö. Human Cytochrome P450 1, 2, 3 Families as Pharmacogenes with Emphases on Their Antimalarial and Antituberculosis Drugs and Prevalent African Alleles. Int J Mol Sci 2023; 24:ijms24043383. [PMID: 36834793 PMCID: PMC9961538 DOI: 10.3390/ijms24043383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Precision medicine gives individuals tailored medical treatment, with the genotype determining the therapeutic strategy, the appropriate dosage, and the likelihood of benefit or toxicity. Cytochrome P450 (CYP) enzyme families 1, 2, and 3 play a pivotal role in eliminating most drugs. Factors that affect CYP function and expression have a major impact on treatment outcomes. Therefore, polymorphisms of these enzymes result in alleles with diverse enzymatic activity and drug metabolism phenotypes. Africa has the highest CYP genetic diversity and also the highest burden of malaria and tuberculosis, and this review presents current general information on CYP enzymes together with variation data concerning antimalarial and antituberculosis drugs, while focusing on the first three CYP families. Afrocentric alleles such as CYP2A6*17, CYP2A6*23, CYP2A6*25, CYP2A6*28, CYP2B6*6, CYP2B6*18, CYP2C8*2, CYP2C9*5, CYP2C9*8, CYP2C9*9, CYP2C19*9, CYP2C19*13, CYP2C19*15, CYP2D6*2, CYP2D6*17, CYP2D6*29, and CYP3A4*15 are implicated in diverse metabolic phenotypes of different antimalarials such as artesunate, mefloquine, quinine, primaquine, and chloroquine. Moreover, CYP3A4, CYP1A1, CYP2C8, CYP2C18, CYP2C19, CYP2J2, and CYP1B1 are implicated in the metabolism of some second-line antituberculosis drugs such as bedaquiline and linezolid. Drug-drug interactions, induction/inhibition, and enzyme polymorphisms that influence the metabolism of antituberculosis, antimalarial, and other drugs, are explored. Moreover, a mapping of Afrocentric missense mutations to CYP structures and a documentation of their known effects provided structural insights, as understanding the mechanism of action of these enzymes and how the different alleles influence enzyme function is invaluable to the advancement of precision medicine.
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Affiliation(s)
- Chiratidzo R Chamboko
- Research Unit in Bioinformatics (RUBi), Department of Biochemistry and Microbiology, Rhodes University, Makhanda 6139, South Africa
| | - Wayde Veldman
- Research Unit in Bioinformatics (RUBi), Department of Biochemistry and Microbiology, Rhodes University, Makhanda 6139, South Africa
| | - Rolland Bantar Tata
- Research Unit in Bioinformatics (RUBi), Department of Biochemistry and Microbiology, Rhodes University, Makhanda 6139, South Africa
| | - Birgit Schoeberl
- Translational Medicine, Novartis Institutes for BioMedical Research, 220 Massachusetts Ave, Cambridge, MA 02139, USA
| | - Özlem Tastan Bishop
- Research Unit in Bioinformatics (RUBi), Department of Biochemistry and Microbiology, Rhodes University, Makhanda 6139, South Africa
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24
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Samayoa-Reyes G, Flaherty SM, Wickham KS, Viera-Morilla S, Strauch PM, Roth A, Padrón L, Jackson CM, Meireles P, Calvo D, Roobsoong W, Kangwanrangsan N, Sattabongkot J, Reichard G, Lafuente-Monasterio MJ, Rochford R. Development of an ectopic huLiver model for Plasmodium liver stage infection. PLoS One 2023; 18:e0279144. [PMID: 36928885 PMCID: PMC10019673 DOI: 10.1371/journal.pone.0279144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Early Plasmodium falciparum and P. vivax infection requires parasite replication within host hepatocytes, referred to as liver stage (LS). However, limited understanding of infection dynamics in human LS exists due to species-specificity challenges. Reported here is a reproducible, easy-to-manipulate, and moderate-cost in vivo model to study human Plasmodium LS in mice; the ectopic huLiver model. Ectopic huLiver tumors were generated through subcutaneous injection of the HC-04 cell line and shown to be infectible by both freshly dissected sporozoites and through the bite of infected mosquitoes. Evidence for complete LS development was supported by the transition to blood-stage infection in mice engrafted with human erythrocytes. Additionally, this model was successfully evaluated for its utility in testing antimalarial therapeutics, as supported by primaquine acting as a causal prophylactic against P. falciparum. Presented here is a new platform for the study of human Plasmodium infection with the potential to aid in drug discovery.
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Affiliation(s)
- Gabriela Samayoa-Reyes
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Siobhan M. Flaherty
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Kristina S. Wickham
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Sara Viera-Morilla
- Diseases of the Developing World, Infectious Diseases-Centre for Excellence in Drug Discovery (ID CEDD), GlaxoSmithKline, Tres Cantos, Madrid, Spain
| | - Pamela M. Strauch
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Alison Roth
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Laura Padrón
- Diseases of the Developing World, Infectious Diseases-Centre for Excellence in Drug Discovery (ID CEDD), GlaxoSmithKline, Tres Cantos, Madrid, Spain
| | - Conner M. Jackson
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Patricia Meireles
- Diseases of the Developing World, Infectious Diseases-Centre for Excellence in Drug Discovery (ID CEDD), GlaxoSmithKline, Tres Cantos, Madrid, Spain
| | - David Calvo
- Diseases of the Developing World, Infectious Diseases-Centre for Excellence in Drug Discovery (ID CEDD), GlaxoSmithKline, Tres Cantos, Madrid, Spain
| | - Wanlapa Roobsoong
- Faculty of Tropical Medicine, Mahidol Vivax Research Unit, Mahidol University, Bangkok, Thailand
| | - Niwat Kangwanrangsan
- Faculty of Science, Pathobiology Department, Mahidol University, Bangkok, Thailand
| | - Jetsumon Sattabongkot
- Faculty of Tropical Medicine, Mahidol Vivax Research Unit, Mahidol University, Bangkok, Thailand
| | - Gregory Reichard
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Maria José Lafuente-Monasterio
- Diseases of the Developing World, Infectious Diseases-Centre for Excellence in Drug Discovery (ID CEDD), GlaxoSmithKline, Tres Cantos, Madrid, Spain
| | - Rosemary Rochford
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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25
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Lukanov T, Ivanova M, Yankova P, Al Hadra B, Mihaylova A, Genova M, Svinarov D, Naumova E. Impact of CYP3A7, CYP2D6 and ABCC2/ABCC3 polymorphisms on tacrolimus steady state concentrations in Bulgarian kidney transplant recipients. BIOTECHNOL BIOTEC EQ 2022. [DOI: 10.1080/13102818.2022.2081517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Tsvetelin Lukanov
- Department of Clinical Immunology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
- Department of Clinical Immunology and Stem Cell Bank, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Milena Ivanova
- Department of Clinical Immunology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Petya Yankova
- Department of Clinical Immunology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Bushra Al Hadra
- Department of Clinical Immunology and Stem Cell Bank, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Anastasiya Mihaylova
- Department of Clinical Immunology and Stem Cell Bank, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Marianka Genova
- Department of Clinical Laboratory & Clinical Pharmacology, University Hospital Alexandrovska, Sofia, Bulgaria
- Department of Clinical Laboratory, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Dobrin Svinarov
- Department of Clinical Laboratory & Clinical Pharmacology, University Hospital Alexandrovska, Sofia, Bulgaria
- Department of Clinical Laboratory, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Elisaveta Naumova
- Department of Clinical Immunology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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26
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Satkunananthan SE, Suppiah V, Toh GT, Yow HY. Pharmacogenomics of Cancer Pain Treatment Outcomes in Asian Populations: A Review. J Pers Med 2022; 12:1927. [PMID: 36422103 PMCID: PMC9694298 DOI: 10.3390/jpm12111927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 08/26/2023] Open
Abstract
In advanced cancer, pain is a poor prognostic factor, significantly impacting patients' quality of life. It has been shown that up to 30% of cancer patients in Southeast Asian countries may receive inadequate analgesia from opioid therapy. This significant under-management of cancer pain is largely due to the inter-individual variability in opioid dosage and relative efficacy of available opioids, leading to unpredictable clinical responses to opioid treatment. Single nucleotide polymorphisms (SNPs) cause the variability in opioid treatment outcomes, yet their association in Asian populations remains unclear. Therefore, this review aimed to evaluate the association of SNPs with variability in opioid treatment responses in Asian populations. A literature search was conducted in Medline and Embase databases and included primary studies investigating the association of SNPs in opioid treatment outcomes, namely pharmacokinetics, opioid dose requirements, and pain control among Asian cancer patients. The results show that CYP2D6*10 has the most clinical relevance in tramadol treatment. Other SNPs such as rs7439366 (UGT2B7), rs1641025 (ABAT) and rs1718125 (P2RX7) though significant have limited pharmacogenetic implications due to insufficient evidence. OPRM1 rs1799971, COMT rs4680 and ABCB1 (rs1045642, rs1128503, and rs2032582) need to be further explored in future for relevance in Asian populations.
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Affiliation(s)
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Gaik-Theng Toh
- School of Medicine, Faculty of Health and Medical Sciences, Centre for Drug Discovery and Molecular Pharmacology, Taylor’s University, Subang Jaya 47500, Malaysia
| | - Hui-Yin Yow
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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27
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New Onset of Seizures and Psychosis in a Patient Who Is Coprescribed Atomoxetine and Bupropion: A Case Report. J Clin Psychopharmacol 2022; 42:600-602. [PMID: 36193909 DOI: 10.1097/jcp.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Kammala AK, Lintao RC, Vora N, Mosebarger A, Khanipov K, Golovko G, Yaklic JL, Peltier MR, Conrads TP, Menon R. Expression of CYP450 enzymes in human fetal membranes and its implications in xenobiotic metabolism during pregnancy. Life Sci 2022; 307:120867. [DOI: 10.1016/j.lfs.2022.120867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
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29
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Malik FI, Robertson LA, Armas DR, Robbie EP, Osmukhina A, Xu D, Li H, Solomon SD. A Phase 1 Dose-Escalation Study of the Cardiac Myosin Inhibitor Aficamten in Healthy Participants. JACC Basic Transl Sci 2022; 7:763-775. [PMID: 36061336 PMCID: PMC9436819 DOI: 10.1016/j.jacbts.2022.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
Certain genetic hypertrophic cardiomyopathies may result from hypercontractility of cardiac muscle, caused by pathogenic variants in genes encoding proteins of the cardiac sarcomere. Aficamten (formerly CK-3773274) is a small-molecule selective inhibitor of the cardiac myosin ATPase, which reduces the contractility of cardiomyocytes in vitro and decreases measures of ventricular contractility in animal studies. In this first-in-human, phase 1 study in healthy adults, aficamten was well tolerated; adverse events were generally mild and comparable in frequency to those seen with placebo. Aficamten demonstrated dose-proportional pharmacokinetics with a half-life of 75 to 85 hours. Pharmacodynamically active doses of aficamten decreased left ventricular ejection fraction from baseline in a concentration-dependent manner, informing the design of a phase 2 trial in patients with hypertrophic cardiomyopathy.
This phase 1, randomized, double-blind, placebo-controlled study of aficamten (formerly CK-3773274) in healthy adults identified a pharmacologically active range of doses and exposures. At doses that were pharmacologically active (single doses of ≤50 mg or daily dosing of ≤10 mg for 14 or 17 days), aficamten appeared to be safe and well tolerated. Adverse events were generally mild and no more frequent than with placebo. Pharmacokinetic assessments showed dose proportionality over the range of single doses administered, and pharmacokinetics were not affected by administration with food or in otherwise healthy individuals with a cytochrome P450 2D6 poor metabolizer phenotype. (A Single and Multiple Ascending Dose Study of CK-3773274 in Health Adult Subjects; NCT03767855)
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Key Words
- AE, adverse event
- AUC24, area under the plasma concentration–time curve from time 0 to 24 hours
- CV%,, percent coefficient of variation
- CYP, cytochrome P450
- CYP2D6-PM, cytochrome P450 2D6 poor metabolizer phenotype
- Cmax, maximum plasma drug concentration
- DLRC, Dose Level Review Committee
- ECG, electrocardiogram
- HCM, hypertrophic cardiomyopathy
- LV contractility
- LV, left ventricle
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- MAD, multiple ascending dose
- PD, pharmacodynamic
- PK, pharmacokinetic
- QTcF, QT interval corrected for heart rate using Fridericia’s formula
- SAD, single ascending dose
- TEAE, treatment-emergent adverse event
- aficamten
- cardiac myosin inhibitor
- hypertrophic cardiomyopathy
- phase 1
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Affiliation(s)
- Fady I Malik
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Laura A Robertson
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | | | - Edward P Robbie
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Anna Osmukhina
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Donghong Xu
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Hanbin Li
- Certara, Inc, Menlo Park, California, USA
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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30
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Palladium(II) Complexes of Substituted Salicylaldehydes: Synthesis, Characterization and Investigation of Their Biological Profile. Pharmaceuticals (Basel) 2022; 15:ph15070886. [PMID: 35890184 PMCID: PMC9323974 DOI: 10.3390/ph15070886] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
Five palladium(II) complexes of substituted salicylaldehydes (X-saloH, X = 4-Et2N (for 1), 3,5-diBr (for 2), 3,5-diCl (for 3), 5-F (for 4) or 4-OMe (for 5)) bearing the general formula [Pd(X-salo)2] were synthesized and structurally characterized. The crystal structure of complex [Pd(4-Et2N-salo)2] was determined by single-crystal X-ray crystallography. The complexes can scavenge 1,1-diphenyl-picrylhydrazyl and 2,2′-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) radicals and reduce H2O2. They are active against two Gram-positive (Staphylococcus aureus and Bacillus subtilis) and two Gram-negative (Escherichia coli and Xanthomonas campestris) bacterial strains. The complexes interact strongly with calf-thymus DNA via intercalation, as deduced by diverse techniques and via the determination of their binding constants. Complexes interact reversibly with bovine and human serum albumin. Complementary insights into their possible mechanisms of bioactivity at the molecular level were provided by molecular docking calculations, exploring in silico their ability to bind to calf-thymus DNA, Escherichia coli and Staphylococcus aureus DNA-gyrase, 5-lipoxygenase, and membrane transport lipid protein 5-lipoxygenase-activating protein, contributing to the understanding of the role complexes 1–5 can play both as antioxidant and antibacterial agents. Furthermore, in silico predictive tools have been employed to study the chemical reactivity, molecular properties and drug-likeness of the complexes, and also the drug-induced changes of gene expression profile (as protein- and mRNA-based prediction results), the sites of metabolism, the substrate/metabolite specificity, the cytotoxicity for cancer and non-cancer cell lines, the acute rat toxicity, the rodent organ-specific carcinogenicity, the anti-target interaction profiles, the environmental ecotoxicity, and finally the activity spectra profile of the compounds.
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31
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Sarparast A, Thomas K, Malcolm B, Stauffer CS. Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review. Psychopharmacology (Berl) 2022; 239:1945-1976. [PMID: 35253070 PMCID: PMC9177763 DOI: 10.1007/s00213-022-06083-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVES ± 3,4-Methylenedioxymethamphetamine (MDMA) and psilocybin are currently moving through the US Food and Drug Administration's phased drug development process for psychiatric treatment indications: posttraumatic stress disorder and depression, respectively. The current standard of care for these disorders involves treatment with psychiatric medications (e.g., selective serotonin reuptake inhibitors), so it will be important to understand drug-drug interactions between MDMA or psilocybin and psychiatric medications. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we queried the MEDLINE database via PubMed for publications of human studies in English spanning between the first synthesis of psilocybin (1958) and December 2020. We used 163 search terms containing 22 psychiatric medication classes, 135 specific psychiatric medications, and 6 terms describing MDMA or psilocybin. RESULTS Forty publications were included in our systematic review: 26 reporting outcomes from randomized controlled studies with healthy adults, 3 epidemiologic studies, and 11 case reports. Publications of studies describe interactions between MDMA (N = 24) or psilocybin (N = 5) and medications from several psychiatric drug classes: adrenergic agents, antipsychotics, anxiolytics, mood stabilizers, NMDA antagonists, psychostimulants, and several classes of antidepressants. We focus our results on pharmacodynamic, physiological, and subjective outcomes of drug-drug interactions. CONCLUSIONS As MDMA and psilocybin continue to move through the FDA drug development process, this systematic review offers a compilation of existing research on psychiatric drug-drug interactions with MDMA or psilocybin.
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Affiliation(s)
- Aryan Sarparast
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Kelan Thomas
- College of Pharmacy, Touro University California, Vallejo, CA, 94592, USA
| | | | - Christopher S Stauffer
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA.
- Department of Mental Health, VA Portland Health Care System, Portland, OR, 97239, USA.
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32
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Vollger MR, Guitart X, Dishuck PC, Mercuri L, Harvey WT, Gershman A, Diekhans M, Sulovari A, Munson KM, Lewis AP, Hoekzema K, Porubsky D, Li R, Nurk S, Koren S, Miga KH, Phillippy AM, Timp W, Ventura M, Eichler EE. Segmental duplications and their variation in a complete human genome. Science 2022; 376:eabj6965. [PMID: 35357917 PMCID: PMC8979283 DOI: 10.1126/science.abj6965] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite their importance in disease and evolution, highly identical segmental duplications (SDs) are among the last regions of the human reference genome (GRCh38) to be fully sequenced. Using a complete telomere-to-telomere human genome (T2T-CHM13), we present a comprehensive view of human SD organization. SDs account for nearly one-third of the additional sequence, increasing the genome-wide estimate from 5.4 to 7.0% [218 million base pairs (Mbp)]. An analysis of 268 human genomes shows that 91% of the previously unresolved T2T-CHM13 SD sequence (68.3 Mbp) better represents human copy number variation. Comparing long-read assemblies from human (n = 12) and nonhuman primate (n = 5) genomes, we systematically reconstruct the evolution and structural haplotype diversity of biomedically relevant and duplicated genes. This analysis reveals patterns of structural heterozygosity and evolutionary differences in SD organization between humans and other primates.
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Affiliation(s)
- Mitchell R Vollger
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Xavi Guitart
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Philip C Dishuck
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ludovica Mercuri
- Department of Biology, University of Bari, Aldo Moro, Bari 70125, Italy
| | - William T Harvey
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ariel Gershman
- Department of Molecular Biology and Genetics, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Diekhans
- UC Santa Cruz Genomics Institute, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Arvis Sulovari
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Katherine M Munson
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexandra P Lewis
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kendra Hoekzema
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - David Porubsky
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ruiyang Li
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Sergey Nurk
- Genome Informatics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sergey Koren
- Genome Informatics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Karen H Miga
- UC Santa Cruz Genomics Institute, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Adam M Phillippy
- Genome Informatics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Winston Timp
- Department of Molecular Biology and Genetics, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Mario Ventura
- Department of Biology, University of Bari, Aldo Moro, Bari 70125, Italy
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
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33
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Choudhuri S. Toxicological Implications of Biological Heterogeneity. Int J Toxicol 2022; 41:132-142. [PMID: 35311363 DOI: 10.1177/10915818211066492] [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: 11/15/2022]
Abstract
From a micro to macro scale of biological organization, macromolecular diversity and biological heterogeneity are fundamental properties of biological systems. Heterogeneity may result from genetic, epigenetic, and non-genetic characteristics (e.g., tissue microenvironment). Macromolecular diversity and biological heterogeneity are tolerated as long as the sustenance and propagation of life are not disrupted. They also provide the raw materials for microevolutionary changes that may help organisms adapt to new selection pressures arising from the environment. Sequence evolution, functional divergence, and positive selection of gene and promoter dosage play a major role in the evolution of life's diversity including complex metabolic networks, which is ultimately reflected in changes in the allele frequency over time. Robustness in evolvable biological systems is conferred by functional redundancy that is often created by macromolecular diversity and biological heterogeneity. The ability to investigate biological macromolecules at an increasingly finer level has uncovered a wealth of information in this regard. Therefore, the dynamics of biological complexity should be taken into consideration in biomedical research.
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Affiliation(s)
- Supratim Choudhuri
- Division of Food Ingredients, Office of Food Additive Safety, US Food and Drug Administration, College Park, MD, USA
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In silico study of potential antiviral activity of copper(II) complexes with non–steroidal anti–inflammatory drugs on various SARS–CoV–2 target proteins. J Inorg Biochem 2022; 231:111805. [PMID: 35334392 PMCID: PMC8930182 DOI: 10.1016/j.jinorgbio.2022.111805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Abstract
In silico molecular docking studies, in vitro toxicity and in silico predictions on the biological activity profile, pharmacokinetic properties, drug–likeness, ADMET (absorption, distribution, metabolism, excretion, and toxicity) physicochemical pharmacokinetic data, and target proteins and toxicity predictions were performed on six copper(II) complexes with the non–steroidal anti–inflammatory drugs ibuprofen, loxoprofen, fenoprofen and clonixin as ligands, in order to investigate the ability of these complexes to interact with the key therapeutic target proteins of SARS–CoV–2 (Severe Acute Respiratory Syndrome Coronavirus 2) 3C–like cysteine main protease (3CLpro/Mpro), viral papain–like protease (PLpro), RNA–dependent RNA polymerase (RdRp), and non–structural proteins (Nsps) Nsp16–Nsp10 2′–O–methyltransferase complex, and their capacity to act as antiviral agents, contributing thus to understanding the role they can play in the context of coronavirus 2019 (COVID–19) pandemic. Cytotoxic activity against five human cancer and normal cell lines were also evaluated.
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Raasch JR, Vargas TG, Santos ASD, Hahn RZ, Silva ACCD, Antunes MV, Linden R, Betti AH, Perassolo MS. Analysis of Adherence to Fluoxetine Treatment through its Plasma Concentration. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Li YH, Huang W, Xiao MY, Huang SQ, Chen H, Li ZF, Li XS, Cheng Y. CYP2D6 Gene Polymorphisms and Variable Metabolic Activity in Schizophrenia Patients of Han and Tibetan Populations. Neuropsychiatr Dis Treat 2022; 18:731-736. [PMID: 35401003 PMCID: PMC8986482 DOI: 10.2147/ndt.s355985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It has been suggested that the pharmacogenomic response to antipsychotics in schizophrenia patients partially contributed by drug metabolism enzyme polymorphism, including P450 2D6 (CYP2D6). However, CYP2D6 gene polymorphism across populations is largely unknown. MATERIALS AND METHODS Here, we investigated the differences of CYP2D6 gene polymorphism between Chinese Han and Tibetan schizophrenia patients. We analyzed five CYP2D6 gene related polymorphic locus in 103 patients with schizophrenia, including 60 Han ethnicity and 43 of Tibetan ethnicity, by nucleic acid MALDI-TOF. RESULTS Polymorphisms of rs1065852, rs1135840 and rs16947 were significantly different between Han and Tibetan patients. rs1065852 AA genotype had a low frequency of 9.3% in Tibetan patients in comparison with a frequency of 41.7% in Han patients, whereas rs16947 AA genotype had a low frequency of 3.3% in Han patients in comparison with a frequency of 34.9% in Tibetan patients. Additionally, the two patient groups showed distinct distribution of CYP2D6 haplotypes, with the highest frequency of *10/*10 and *1/*2 in Han and Tibetan patients, respectively. Furthermore, Han and Tibetan patients showed differential CYP2D6 metabolic activity. DISCUSSION Taken together, this exploratory study showed the differences of CYP2D6 gene and metabolic polymorphism between Han and Tibetan schizophrenia patients, and therefore may improve our understanding of the pharmacogenomic response to antipsychotics in schizophrenia patients across populations.
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Affiliation(s)
- Yong-Hang Li
- The Third People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Wei Huang
- The Third People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Man-Yu Xiao
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, People's Republic of China
| | - Shi-Qing Huang
- The Third People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Hui Chen
- The Third People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Zai-Fang Li
- The Third People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Xue-Song Li
- The Third People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Yong Cheng
- The Third People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China.,Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, People's Republic of China
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Farmacogenética en psiquiatría: estudio de variantes alélicas del CYP450 en pacientes chilenos con patología psiquiátrica. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zastrozhin MS, Efimova AV, Skryabin VY, Smirnov VV, Petukhov AE, Pankratenko EP, Pozdniakov SA, Kaverina EV, Klepikov DA, Grishina EA, Ryzhikova KA, Bure IV, Bryun EA, Sychev DA. Influence of Plasma Concentration of Hsa-Mir-370-3p and Cyp2d6*4 On Equilibrium Concentration of Phenazepam in Patients with Recurrent Depressive Disorder. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:87-104. [PMID: 34887601 PMCID: PMC8601761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Phenazepam is commonly administered to patients diagnosed with major depressive disorder. Some proportion of such patients do not show adequate response to treatment regimen containing phenazepam, whereas many of them experience type A adverse drug reactions. Previous studies showed that CYP2D6 IS involved in the biotransformation of phenazepam, the activity of which is highly dependent on the polymorphism of the gene encoding it. Objective. The objective of the study was to evaluate the impact of 1846G>A polymorphism of the CYP2D6 gene on the concentration/dose indicator of phenazepam, using findings on enzymatic activity of CYP2D6 (as evaluated by the 6M-THBC/pinoline ratio measurement) and on CYP2D6 expression level obtained by measuring the hsa-miR-370-3p plasma concentration levels in patients suffering from major depressive disorder. MATERIAL AND METHODS The study enrolled 191 patients with recurrent depressive disorder (age -40.0 ± 16.3 years). Treatment regimen included phenazepam in an average daily dose of 6.0 ± 2.3 mg per day. Treatment efficacy was assessed using the validated psychometric scales. Therapy safety was assessed using the UKU Side-Effect Rating Scale. For genotyping and estimation of the microRNA (miRNA) plasma levels we performed the real-time polymerase chain reaction (PCR Real-time). The activity of CYP2D6 was evaluated using the HPLC-MS/MS method by the content of the endogenous substrate of given isoenzyme and its metabolite in urine (6M-THBC/pinoline). Therapeutic drug monitoring has been performed using HPLC-MS/MS. RESULTS Our findings didn't reveal the statistically significant results in terms of the treatment efficacy evaluation (HAMA scores at the end of the treatment course): (GG) 6.0 [4.0; 8.0] and (GA) 6.0 [5.0; 7.8], p > 0.999; the statistical significance in the safety profile was not obtained (the UKU scores): (GG) 3.0 [2.0; 4.0] and (GA) 3.0 [3.0; 3.0], p > 0.999. We didn't reveal a statistical significance for concentration/dose indicator of phenazepam in patients with different genotypes: (GG) 0.812 [0.558; 1.348] and (GA) 0.931 [0.630; 1.271], p = 0.645). Analysis of the results of the pharmacotranscriptomic part of the study didn't show the statistically significant difference in the hsa-miR-370-3p plasma levels in patients with different genotypes: (GG) 22.5 [16.9; 29.8], (GA) 22.7 [15.7; 31.5], p = 0.695. At the same time, correlation analysis didn't reveal a statistically significant relationship between the phenazepam efficacy profile evaluated by changes in HAMA scale scores and the hsa-miR-370-3p plasma concentration: rs = -0.01, p = 0.866. Also, we didn't reveal the correlation between the miRNA concentration and safety profile: rs = 0.07, p = 0.348. Also we did not reveal the relationship between the CYP2D6 enzymatic activity (as evaluated by 6M-THBC/pinoline ratio measurement) and the hsa-miR-370-3p plasma concentration: rs = -0.14, p = 0.056. At the same time, correlation analysis did not reveal a statistically significant relationship between the phenazepam concentration and the hsa-miR-370-3p plasma concentration: rs = -0.05, p = 0.468. CONCLUSION The effect of genetic polymorphism of the CYP2D6 gene on the efficacy and safety profiles of phenazepam was not demonstrated in a group of 191 patients with recurrent depressive disorder. At the same time, hsa-miR-370-3p does not remain a promising biomarker for assessing the level of CYP2D6 expression, because it does not correlate with encoded isoenzyme activity.
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Affiliation(s)
- M S Zastrozhin
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - A V Efimova
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - VYu Skryabin
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - V V Smirnov
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - A E Petukhov
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - E P Pankratenko
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - S A Pozdniakov
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - E V Kaverina
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - D A Klepikov
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - E A Grishina
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - K A Ryzhikova
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - I V Bure
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - E A Bryun
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - D A Sychev
- Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of Addiction Psychiatry Department, Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. Efimova, M.D., Physician of Clinical Department, Balashikha Regional Hospital. Skryabin, M.D., Head of Clinical Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department, Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. Petukhov, M.D., PhD, Clinical Laboratory Diagnostician of the Analytical Toxicology lab of the Reference Center for Psychoactive Substances use Monitoring, Associate Professor of Pharmaceutical and Toxicological Chemistry, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. Pankratenko, Paramedic-Laboratory Assistant of the Analytical Toxicology Lab of the Reference Center for Psychoactive Substances use Monitoring, Pozdniakov, Researcher of the Laboratory of Genetics and Fundamental Studies, M.D., the Researcher of the Department of Dermatovenerology and Cosmetology, M.D., PhD, Associate Professor of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation. Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation, Peoples Friendship University of Russia. Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan. Grishina, PhD, Head of Biomolecular Researchers Department of the Research Center, Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research Center, Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center, Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
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Eap CB, Gründer G, Baumann P, Ansermot N, Conca A, Corruble E, Crettol S, Dahl ML, de Leon J, Greiner C, Howes O, Kim E, Lanzenberger R, Meyer JH, Moessner R, Mulder H, Müller DJ, Reis M, Riederer P, Ruhe HG, Spigset O, Spina E, Stegman B, Steimer W, Stingl J, Suzen S, Uchida H, Unterecker S, Vandenberghe F, Hiemke C. Tools for optimising pharmacotherapy in psychiatry (therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests): focus on antidepressants. World J Biol Psychiatry 2021; 22:561-628. [PMID: 33977870 DOI: 10.1080/15622975.2021.1878427] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives: More than 40 drugs are available to treat affective disorders. Individual selection of the optimal drug and dose is required to attain the highest possible efficacy and acceptable tolerability for every patient.Methods: This review, which includes more than 500 articles selected by 30 experts, combines relevant knowledge on studies investigating the pharmacokinetics, pharmacodynamics and pharmacogenetics of 33 antidepressant drugs and of 4 drugs approved for augmentation in cases of insufficient response to antidepressant monotherapy. Such studies typically measure drug concentrations in blood (i.e. therapeutic drug monitoring) and genotype relevant genetic polymorphisms of enzymes, transporters or receptors involved in drug metabolism or mechanism of action. Imaging studies, primarily positron emission tomography that relates drug concentrations in blood and radioligand binding, are considered to quantify target structure occupancy by the antidepressant drugs in vivo. Results: Evidence is given that in vivo imaging, therapeutic drug monitoring and genotyping and/or phenotyping of drug metabolising enzymes should be an integral part in the development of any new antidepressant drug.Conclusions: To guide antidepressant drug therapy in everyday practice, there are multiple indications such as uncertain adherence, polypharmacy, nonresponse and/or adverse reactions under therapeutically recommended doses, where therapeutic drug monitoring and cytochrome P450 genotyping and/or phenotyping should be applied as valid tools of precision medicine.
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Affiliation(s)
- C B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Switzerland, Geneva, Switzerland
| | - G Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - P Baumann
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - N Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A Conca
- Department of Psychiatry, Health Service District Bolzano, Bolzano, Italy.,Department of Child and Adolescent Psychiatry, South Tyrolean Regional Health Service, Bolzano, Italy
| | - E Corruble
- INSERM CESP, Team ≪MOODS≫, Service Hospitalo-Universitaire de Psychiatrie, Universite Paris Saclay, Le Kremlin Bicetre, France.,Service Hospitalo-Universitaire de Psychiatrie, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - S Crettol
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M L Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J de Leon
- Eastern State Hospital, University of Kentucky Mental Health Research Center, Lexington, KY, USA
| | - C Greiner
- Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
| | - O Howes
- King's College London and MRC London Institute of Medical Sciences (LMS)-Imperial College, London, UK
| | - E Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - R Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - J H Meyer
- Campbell Family Mental Health Research Institute, CAMH and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - R Moessner
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - H Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,GGZ Drenthe Mental Health Services Drenthe, Assen, The Netherlands.,Department of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - D J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - M Reis
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Clinical Chemistry and Pharmacology, Skåne University Hospital, Lund, Sweden
| | - P Riederer
- Center of Mental Health, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, University of Southern Denmark Odense, Odense, Denmark
| | - H G Ruhe
- Department of Psychiatry, Radboudumc, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - O Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - E Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - B Stegman
- Institut für Pharmazie der Universität Regensburg, Regensburg, Germany
| | - W Steimer
- Institute for Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Munich, Germany
| | - J Stingl
- Institute for Clinical Pharmacology, University Hospital of RWTH Aachen, Germany
| | - S Suzen
- Department of Toxicology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - H Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - S Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - F Vandenberghe
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Vay M, Meyer MJ, Blank A, Skopp G, Rose P, Tzvetkov MV, Mikus G. Oral Yohimbine as a New Probe Drug to Predict CYP2D6 Activity: Results of a Fixed-Sequence Phase I Trial. Clin Pharmacokinet 2021; 59:927-939. [PMID: 32060866 PMCID: PMC7329762 DOI: 10.1007/s40262-020-00862-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Yohimbine pharmacokinetics were determined after oral administration of a single oral dose of yohimbine 5 mg and a microdose of yohimbine 50 µg in relation to different cytochrome P450 (CYP) 2D6 genotypes. The CYP2D6 inhibitor paroxetine was used to investigate the influence on yohimbine pharmacokinetics. Microdosed midazolam was applied to evaluate a possible impact of yohimbine on CYP3A activity and the possibility of combining microdosed yohimbine and midazolam to simultaneously determine CYP2D6 and CYP3A activity. Methods In a fixed-sequence clinical trial, 16 healthy volunteers with a known CYP2D6 genotype [extensive (10), intermediate (2) and poor (4) metaboliser] received an oral dose of yohimbine 50 µg, yohimbine 5 mg at baseline and during paroxetine as a CYP2D6 inhibitor. Midazolam (30 µg) was co-administered to determine CYP3A activity at each occasion. Plasma concentrations of yohimbine, its main metabolite 11-OH-yohimbine, midazolam and paroxetine were quantified using validated liquid chromatography-tandem mass spectrometry assays. Results Pharmacokinetics of yohimbine were highly variable and a CYP2D6 genotype dependent clearance was observed. After yohimbine 5 mg, the clearance ranged from 25.3 to 15,864 mL/min and after yohimbine 50 µg, the clearance ranged from 39.6 to 38,822 mL/min. A more than fivefold reduction in clearance was caused by paroxetine in CYP2D6 extensive metabolisers, while the clearance in poor metabolisers was not affected. Yohimbine did not alter CYP3A activity as measured by microdosed midazolam. Conclusions The pharmacokinetics of yohimbine were highly correlated with CYP2D6, which was further supported by the clearance inhibition caused by the CYP2D6 inhibitor paroxetine. With these data, yohimbine is proposed to be a suitable probe drug to predict CYP2D6 activity. In addition, the microdose can be used in combination with microdosed midazolam to simultaneously evaluate CYP2D6 and CYP3A activity without any interaction between the probe drugs and because the microdoses exert no pharmacological effects. Clinical Trial Registration EudraCT2017-001801-34. Electronic supplementary material The online version of this article (10.1007/s40262-020-00862-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuela Vay
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Marleen Julia Meyer
- Institute of Clinical Pharmacology, University Medical Center Göttingen, Göttingen, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | | | - Peter Rose
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | | | - Gerd Mikus
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Zastrozhin MS, Skryabin VY, Petukhov AE, Pankratenko EP, Grishina EA, Ryzhikova KA, Torrado MV, Shipitsyn VV, Bryun EA, Sychev DA. Impact of CYP2D6 Polymorphism on Equilibrium Concentration of Fluoxetine in Patients Diagnosed With Major Depressive Disorder and Comorbid Alcohol Use Disorders. J Psychiatr Pract 2021; 27:372-379. [PMID: 34529603 DOI: 10.1097/pra.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Fluoxetine is used in the treatment of patients with recurrent depressive disorder. Some of these patients do not achieve an adequate response to a treatment regimen containing fluoxetine, and many of these patients experience dose-dependent adverse drug reactions. The cytochrome P450 enzyme CYP2D6 is involved in the biotransformation of fluoxetine, the activity of which is quite dependent on the polymorphism of the gene encoding this enzyme. OBJECTIVE The objective of the study was to investigate the influence of the 1846G>A polymorphism of the CYP2D6 gene on the concentration/dose indicator of fluoxetine in patients diagnosed with major depressive disorder and comorbid alcohol use disorder. METHODS Our study included 101 patients with major depressive disorder and alcohol use disorder (average age: 41.3±14.5 y) who were treated with fluoxetine at an average dose of 26.1±8.7 mg/d. Treatment efficacy was assessed using validated psychometric scales, and the safety/tolerability of the therapy was assessed using the Udvalg for Kliniske Undersogelser Side-Effect Rating Scale. Genotyping was done using a real-time polymerase chain reaction. Therapeutic drug monitoring was performed using high-performance liquid chromatography-mass spectrometry. RESULTS CYP2D6 genotyping by polymorphic marker 1846G>A (rs3892097) in the 101 patients found that there were 81 patients (80.2%) with the GG genotype ("wild-type," normal metabolism), 20 (19.8%) with the GA genotype (intermediate metabolism), and no subjects with the AA genotype (poor metabolism). Statistically significant results in treatment efficacy as evaluated by Hamilton Rating Scale for Depression scores at the end of the treatment course were found: GG 9.0 [confidence interval (CI): 6.0; 12.0] and GA 12.0 (CI: 9.5; 14.0), P=0.005. Statistically significant results were also obtained for the safety profile as measured by scores on the Udvalg for Kliniske Undersogelser Side-Effect Rating Scale: GG 3.0 (CI 2.0; 4.0) and GA 5.0 (CI: 4.0; 5.0), P<0.001. Finally, a statistically significant difference was found in concentration/dose indicators of fluoxetine in patients with the different genotypes: GG 4.831 (CI: 3.654; 6.204) and GA 7.011 (CI: 5.431; 8.252), P<0.001. CONCLUSION The effect of the genetic polymorphism of the CYP2D6 gene on the efficacy and safety profiles of fluoxetine was demonstrated in a group of 101 patients with major depressive disorder and alcohol use disorder.
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Deodhar M, Turgeon J, Michaud V. Contribution of CYP2D6 Functional Activity to Oxycodone Efficacy in Pain Management: Genetic Polymorphisms, Phenoconversion, and Tissue-Selective Metabolism. Pharmaceutics 2021; 13:1466. [PMID: 34575542 PMCID: PMC8468517 DOI: 10.3390/pharmaceutics13091466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 02/01/2023] Open
Abstract
Oxycodone is a widely used opioid for the management of chronic pain. Analgesic effects observed following the administration of oxycodone are mediated mostly by agonistic effects on the μ-opioid receptor. Wide inter-subject variability observed in oxycodone efficacy could be explained by polymorphisms in the gene coding for the μ-opioid receptor (OPRM1). In humans, oxycodone is converted into several metabolites, particularly into oxymorphone, an active metabolite with potent μ-opioid receptor agonist activity. The CYP2D6 enzyme is principally responsible for the conversion of oxycodone to oxymorphone. The CYP2D6 gene is highly polymorphic with encoded protein activities, ranging from non-functioning to high-functioning enzymes. Several pharmacogenetic studies have shown the importance of CYP2D6-mediated conversion of oxycodone to oxymorphone for analgesic efficacy. Pharmacogenetic testing could optimize oxycodone therapy and help achieve adequate pain control, avoiding harmful side effects. However, the most recent Clinical Pharmacogenetics Implementation Consortium guidelines fell short of recommending pharmacogenomic testing for oxycodone treatment. In this review, we (1) analyze pharmacogenomic and drug-interaction studies to delineate the association between CYP2D6 activity and oxycodone efficacy, (2) review evidence from CYP3A4 drug-interaction studies to untangle the nature of oxycodone metabolism and its efficacy, (3) report on the current knowledge linking the efficacy of oxycodone to OPRM1 variants, and (4) discuss the potential role of CYP2D6 brain expression on the local formation of oxymorphone. In conclusion, we opine that pharmacogenetic testing, especially for CYP2D6 with considerations of phenoconversion due to concomitant drug administration, should be appraised to improve oxycodone efficacy.
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Affiliation(s)
- Malavika Deodhar
- Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, Orlando, FL 32827, USA; (M.D.); (J.T.)
| | - Jacques Turgeon
- Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, Orlando, FL 32827, USA; (M.D.); (J.T.)
- Faculty of Pharmacy, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Veronique Michaud
- Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, Orlando, FL 32827, USA; (M.D.); (J.T.)
- Faculty of Pharmacy, Université de Montréal, Montréal, QC H3T 1J4, Canada
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Alrashdi S, Paudyal V, Elnaem MH, Cheema E. Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00859-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yong C, Devine SM, Abel AC, Tomlins SD, Muthiah D, Gao X, Callaghan R, Steinmetz MO, Prota AE, Capuano B, Scammells PJ. 1,3-Benzodioxole-Modified Noscapine Analogues: Synthesis, Antiproliferative Activity, and Tubulin-Bound Structure. ChemMedChem 2021; 16:2882-2894. [PMID: 34159741 DOI: 10.1002/cmdc.202100363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Since the revelation of noscapine's weak anti-mitotic activity, extensive research has been conducted over the past two decades, with the goal of discovering noscapine derivatives with improved potency. To date, noscapine has been explored at the 1, 7, 6', and 9'-positions, though the 1,3-benzodioxole motif in the noscapine scaffold that remains unexplored. The present investigation describes the design, synthesis and pharmacological evaluation of noscapine analogues consisting of modifications to the 1,3-benzodioxole moiety. This includes expansion of the dioxolane ring and inclusion of metabolically robust deuterium and fluorine atoms. Favourable structural modifications were subsequently incorporated into multi-functionalised noscapine derivatives that also possessed modifications previously shown to promote anti-proliferative activity in the 1-, 6'- and 9'-positions. Our research efforts afforded the deuterated noscapine derivative 14 e and the dioxino-containing analogue 20 as potent cytotoxic agents with EC50 values of 1.50 and 0.73 μM, respectively, against breast cancer (MCF-7) cells. Compound 20 also exhibited EC50 values of <2 μM against melanoma, non-small cell lung carcinoma, and cancers of the brain, kidney and breast in an NCI screen. Furthermore, compounds 14 e and 20 inhibit tubulin polymerisation and are not vulnerable to the overexpression of resistance conferring P-gp efflux pumps in drug-resistant breast cancer cells (NCIADR/RES ). We also conducted X-ray crystallography studies that yielded the high-resolution structure of 14 e bound to tubulin. Our structural analysis revealed the key interactions between this noscapinoid and tubulin and will assist with the future design of noscapine derivatives with improved properties.
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Affiliation(s)
- Cassandra Yong
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Shane M Devine
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Anne-Catherine Abel
- Laboratory of Biomolecular Research, Division of Biology and Chemistry, Paul Scherrer Institut, 5232, Villigen PSI, Switzerland
| | - Stefan D Tomlins
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Divya Muthiah
- Research School of Biology, Australian National University, Canberra, ACT, 2061, Australia
| | - Xuexin Gao
- Research School of Biology, Australian National University, Canberra, ACT, 2061, Australia
| | - Richard Callaghan
- Research School of Biology, Australian National University, Canberra, ACT, 2061, Australia
| | - Michel O Steinmetz
- Laboratory of Biomolecular Research, Division of Biology and Chemistry, Paul Scherrer Institut, 5232, Villigen PSI, Switzerland.,Biozentrum, University of Basel, 4056, Basel, Switzerland
| | - Andrea E Prota
- Laboratory of Biomolecular Research, Division of Biology and Chemistry, Paul Scherrer Institut, 5232, Villigen PSI, Switzerland
| | - Ben Capuano
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Peter J Scammells
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
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A Narrative Review on Perioperative Pain Management Strategies in Enhanced Recovery Pathways-The Past, Present and Future. J Clin Med 2021; 10:jcm10122568. [PMID: 34200695 PMCID: PMC8229260 DOI: 10.3390/jcm10122568] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022] Open
Abstract
Effective pain management is a key component in the continuum of perioperative care to ensure optimal outcomes for surgical patients. The overutilization of opioids in the past few decades for postoperative pain control has been a major contributor to the current opioid epidemic. Multimodal analgesia (MMA) and enhanced recovery after surgery (ERAS) pathways have been repeatedly shown to significantly improve postoperative outcomes such as pain, function and satisfaction. The current review aims to examine the history of perioperative MMA strategies in ERAS and provide an update with recent evidence. Furthermore, this review details recent advancements in personalized pain medicine. We speculate that the next important step for improving perioperative pain management could be through incorporating these personalized metrics, such as clinical pharmacogenomic testing and patient-reported outcome measurements, into ERAS program.
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Zastrozhin M, Skryabin V, Smirnov V, Zastrozhina A, Grishina E, Ryzhikova K, Bure I, Golovinskii P, Koporov S, Bryun E, Sychev D. Effect of Genetic Polymorphism of the CYP2D6 Gene on the Efficacy and Safety of Fluvoxamine in Major Depressive Disorder. Am J Ther 2021; 29:e26-e33. [PMID: 34117140 DOI: 10.1097/mjt.0000000000001388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have shown that cytochrome P450 2D6 (CYP2D6) is involved in the metabolism of fluvoxamine, the activity of which is highly dependent, inter alia, on the polymorphism of the gene encoding it. The objective of our study was to investigate the effect of 1846G>A polymorphism of the CYP2D6 gene on the efficacy and safety of fluvoxamine, using findings on CYP2D6 enzymatic activity and on CYP2D6 expression level in patients with depressive disorders comorbid with alcohol use disorder. STUDY QUESTION Efficacy and safety of fluvoxamine depend on the polymorphism of CYP2D6 gene in patients with major depressive disorder. STUDY DESIGN Our study enrolled 96 male patients with depressive disorders comorbid with alcohol use disorder. Patients were examined on days 1, 9, and 16 of fluvoxamine therapy. MEASURES AND OUTCOMES Treatment efficacy was evaluated using the validated psychometric scales. Therapy safety was assessed using the UKU Side-Effect Rating Scale. For genotyping and estimation of the microRNA (miRNA) plasma levels, we performed the real-time polymerase chain reaction. The activity of CYP2D6 was evaluated using the HPLC-MS/MS method by the content of the endogenous substrate of given isoenzyme and its metabolite in urine (6-hydroxy-1,2,3,4-tetrahydro-β-carboline/pinoline ratio). RESULTS Our study revealed the statistically significant results for the treatment efficacy evaluation [the Hamilton Depression Rating Scale scores at the end of the treatment course: (GG) 2.0 (1.0-4.0) and (GA) 5.0 (4.0-7.0), P < 0.001]. Analysis of the results of the pharmacotranscriptomic part of the study did not show the statistically significant difference in the hsa-miR-370-3p plasma levels in patients with different genotypes: (GG) 26.9 (15.0-32.2), (GA) 31.8 (22.7-33.7), P = 0.247. In addition, we evaluated the relationship between the CYP2D6 enzymatic activity (as evaluated by 6-hydroxy-1,2,3,4-tetrahydro-β-carboline/pinoline ratio measurement) and the hsa-miR-370-3p plasma concentration: rs = -0.243, P = 0.017. CONCLUSIONS The effect of genetic polymorphism of the CYP2D6 gene on the efficacy and safety profiles of fluvoxamine was demonstrated in a group of 96 patients with depressive disorders comorbid with alcohol use disorder.
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Affiliation(s)
- Michael Zastrozhin
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia; and NRC Institute of Immunology FMBA of Russia, Moscow, Russia
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Batistaki C, Chrona E, Kostroglou A, Kostopanagiotou G, Gazouli M. CYP2D6 Basic Genotyping of Patients with Chronic Pain Receiving Tramadol or Codeine. A Study in a Greek Cohort. PAIN MEDICINE 2021; 21:3199-3204. [PMID: 32443139 DOI: 10.1093/pm/pnaa122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine. DESIGN Prospective cohort study. SETTING General hospital, pain management unit. SUBJECTS Patients with chronic pain, treated with codeine or tramadol. METHODS Patients' pain was assessed at baseline (numeric rating scale [NRS]; 0-10). Prescription of codeine or tramadol was selected randomly. The assessment of patients' response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of >50% or an NRS <4 was considered a positive response. Patients' blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]). RESULTS Seventy-six consecutive patients were studied (20 males, 56 females), aged 21-85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]). CONCLUSIONS Genotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.
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Affiliation(s)
- Chrysanthi Batistaki
- 2nd Department of Anaesthesiology, Faculty of Medicine, National, Kapodistrian University of Athens, Pain Management Unit, "Attikon" Hospital, Athens, Greece
| | - Eleni Chrona
- Department of Anaesthesiology, General Hospital of Nikea, "Ag. Panteleimon," Piraeus, Greece
| | - Andreas Kostroglou
- 2nd Department of Anaesthesiology, Faculty of Medicine, National, Kapodistrian University of Athens, Pain Management Unit, "Attikon" Hospital, Athens, Greece
| | - Georgia Kostopanagiotou
- 2nd Department of Anaesthesiology, Faculty of Medicine, National, Kapodistrian University of Athens, Pain Management Unit, "Attikon" Hospital, Athens, Greece
| | - Maria Gazouli
- Laboratory of Biology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Physiologically Based Pharmacokinetic Modelling to Describe the Pharmacokinetics of Risperidone and 9-Hydroxyrisperidone According to Cytochrome P450 2D6 Phenotypes. Clin Pharmacokinet 2021; 59:51-65. [PMID: 31359271 DOI: 10.1007/s40262-019-00793-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The genetic polymorphism of cytochrome P450 (CYP) 2D6 is characterized by an excessive impact on positive and adverse drug reactions to antipsychotics, such as risperidone. Consequently, the pharmacokinetics of the drug and metabolite can be substantially altered and exhibit a high variability between the different phenotypes. The goal of this study was to develop a physiologically based pharmacokinetic (PBPK) model considering the CYP2D6 genetic polymorphism for risperidone and 9-hydroxyrisperidone (9-OH-RIS) taking CYP3A4 into account. Additionally, risperidone dose adjustments, which would compensate for genetically caused differences in the plasma concentrations of the active moiety (sum of risperidone and 9-OH-RIS) were calculated. METHODS Based on available knowledge about risperidone, 9-OH-RIS, and relevant physiological changes according to different CYP2D6 phenotypes, several PBPK models were built. In addition, an initial model was further evaluated based on the plasma concentrations of risperidone and 9-OH-RIS from a single-dose study including 71 genotyped healthy volunteers treated with 1 mg of oral risperidone. RESULTS PBPK models were able to accurately describe risperidone exposure after single-dose administration, especially in the concentration range ≥ 1 µg/L, illustrated by a minimal bias and a good precision. About 90.3% of all weighted residuals versus observed plasma concentrations ≥ 1 µg/L were in the ± 30% range. The risperidone/9-OH-RIS ratio increased progressively according to reduced CYP2D6 activity, resulting in a mean ratio of 4.96 for poor metabolizers. Simulations demonstrate that dose adjustment of the drug by - 25% for poor metabolizers and by - 10% for intermediate metabolizers results in a similar exposure to that of extensive metabolizers. Conversely, the risperidone/9-OH-RIS ratio can be used to determine the phenotype of individuals. CONCLUSION PBPK modelling can provide a valuable tool to predict the pharmacokinetics of risperidone and 9-OH-RIS in healthy volunteers, according to the different CYP2D6 phenotypes taking CYP3A4 into account. These models are able to ultimately support decision-making regarding dose-optimization strategies, especially for subjects showing lower CYP2D6 activity.
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Abouelela ME, Assaf HK, Abdelhamid RA, Elkhyat ES, Sayed AM, Oszako T, Belbahri L, El Zowalaty AE, Abdelkader MSA. Identification of Potential SARS-CoV-2 Main Protease and Spike Protein Inhibitors from the Genus Aloe: An In Silico Study for Drug Development. Molecules 2021; 26:1767. [PMID: 33801151 PMCID: PMC8004122 DOI: 10.3390/molecules26061767] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/22/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease is a global rapidly spreading virus showing very high rates of complications and mortality. Till now, there is no effective specific treatment for the disease. Aloe is a rich source of isolated phytoconstituents that have an enormous range of biological activities. Since there are no available experimental techniques to examine these compounds for antiviral activity against SARS-CoV-2, we employed an in silico approach involving molecular docking, dynamics simulation, and binding free energy calculation using SARS-CoV-2 essential proteins as main protease and spike protein to identify lead compounds from Aloe that may help in novel drug discovery. Results retrieved from docking and molecular dynamics simulation suggested a number of promising inhibitors from Aloe. Root mean square deviation (RMSD) and root mean square fluctuation (RMSF) calculations indicated that compounds 132, 134, and 159 were the best scoring compounds against main protease, while compounds 115, 120, and 131 were the best scoring ones against spike glycoprotein. Compounds 120 and 131 were able to achieve significant stability and binding free energies during molecular dynamics simulation. In addition, the highest scoring compounds were investigated for their pharmacokinetic properties and drug-likeness. The Aloe compounds are promising active phytoconstituents for drug development for SARS-CoV-2.
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Affiliation(s)
- Mohamed E. Abouelela
- Department of Pharmacognosy, Faculty of Pharmacy, Al-Azhar University, Assiut-Branch, Assiut 71524, Egypt; (M.E.A.); (H.K.A.); (R.A.A.); (E.S.E.)
| | - Hamdy K. Assaf
- Department of Pharmacognosy, Faculty of Pharmacy, Al-Azhar University, Assiut-Branch, Assiut 71524, Egypt; (M.E.A.); (H.K.A.); (R.A.A.); (E.S.E.)
| | - Reda A. Abdelhamid
- Department of Pharmacognosy, Faculty of Pharmacy, Al-Azhar University, Assiut-Branch, Assiut 71524, Egypt; (M.E.A.); (H.K.A.); (R.A.A.); (E.S.E.)
| | - Ehab S. Elkhyat
- Department of Pharmacognosy, Faculty of Pharmacy, Al-Azhar University, Assiut-Branch, Assiut 71524, Egypt; (M.E.A.); (H.K.A.); (R.A.A.); (E.S.E.)
| | - Ahmed M. Sayed
- Department of Pharmacognosy, Faculty of Pharmacy, Nahda University, Beni-Suef 62513, Egypt;
| | - Tomasz Oszako
- Department of Forest Protection, Forest Research Institute, 05-090 Sekocin Stary, Poland;
| | - Lassaad Belbahri
- Laboratory of Soil Biology, University of Neuchatel, 2000 Neuchatel, Switzerland
| | - Ahmed E. El Zowalaty
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
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Zastrozhin MS, Skryabin VY, Smirnov VY, Zastrozhina AK, Kaverina EV, Klepikov DA, Grishina EA, Ryzhikova KA, Bure IV, Bryun EA, Sychev DA. Impact of the Omics-Based Biomarkers on the Mirtazapine's Steady-State Concentration, Efficacy and Safety in Patients with Affective Disorders Comorbid with Alcohol Use Disorder. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:31-42. [PMID: 34092821 PMCID: PMC8146558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Mirtazapine is commonly administered to patients with recurrent depressive disorder. Some of these patients do not show adequate response to the therapy with mirtazapine, whereas many of them experience dose-dependent adverse drug reactions. Previous research revealed that CYP2D6 is involved in the metabolism of mirtazapine, the activity of which is highly dependent on the polymorphism of the gene encoding it. OBJECTIVE The objective of this study was to investigate the effect of polymorphisms of the CYP3A4, CYP2C9, CYP3A5, ABCB1, CYP2C19, SCL6A4, and 5-HTR2A genes on the concentration/dose indicator of mirtazapine and on the CYP3A expression level obtained by measuring the miR-27b plasma concentration levels in patients suffering from a recurrent depressive disorder. MATERIAL AND METHODS Our study included 108 patients with recurrent depressive disorder (average age - 35.2 ± 15.1 years). The treatment regimen included mirtazapine in an average daily dose of 45.0 [30.0; 60.0] mg per week. Therapy efficacy was assessed using the international psychometric scales. Therapy safety was assessed using the UKU Side-Effect Rating Scale. For genotyping and estimation of the microRNA (miRNA) plasma levels, we performed the real-time polymerase chain reaction. The activity of CYP3A was evaluated using the HPLC-MS/MS method by the content of the endogenous substrate of the given isoenzyme and its metabolite in urine (6b-HC/cortisol). Therapeutic drug monitoring has been performed using HPLC-MS/MS. RESULTS Our study didn't reveal any statistically significant results in terms of the treatment efficacy and safety of the therapy. We also didn't reveal a statistical significance for the concentration/dose indicator of mirtazapine in patients with different genotypes. Analysis of the results of the pharmacotranscriptomic part of the study didn't demonstrate the statistically significant difference in the miR-27b plasma levels in patients with different genotypes. At the same time, correlation analysis didn't reveal a statistically significant relationship between the mirtazapine efficacy profile evaluated by changes in HAMD scale scores and the miR-27b plasma concentration: rs = -0.2, p = 0.46. Also, we didn't reveal the correlation between the miRNA concentration and safety profile: rs = 0.029, p = 0.93. In addition, we didn't reveal the relationship between the CYP3A enzymatic activity and the miR-27b plasma concentration: rs = -0,188, p = 0.85. However, the difference in the CYP3A enzymatic activity in carriers of AG and GG genotypes of the 6986A > G polymorphism of CYP3A5 gene has been revealed: (AG) 4.75 [1.28; 7.34] vs (GG) 8.83 [4.73; 13.62], p-value = 0.023. CONCLUSION Thus, the effect of genetic polymorphism of the CYP3A4, CYP2C9, CYP2C9, CYP3A5, ABCB1, CYP2C19, CYP2C19, CYP2C19, SCL6A4, 5-HTR2A gene on the efficacy and safety profiles of mirtazapine was not demonstrated in a group of 108 patients with depressive disorder and alcohol use disorder.
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Affiliation(s)
- M S Zastrozhin
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - VYu Skryabin
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - VYu Smirnov
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - A K Zastrozhina
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - E V Kaverina
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - D A Klepikov
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - E A Grishina
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - K A Ryzhikova
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - I V Bure
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - E A Bryun
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
| | - D A Sychev
- MS Zastrozhin, M.D., PhD, Head of Laboratory of Genetics and Fundamental Studies, Associate Professor of the Addiction Psychiatry Department; VYu Skryabin, M.D., Head of Clinical Department, Teaching Assistant of the Addiction Psychiatry Department; EA Bryun, M.D., PhD, Professor, President, Head of Addiction Psychiatry Department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. VV Smirnov, PhD, Associate Professor of Pharmaceutical Toxicology Department; Head of Laboratory of Pharmacokinetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation. AK Zastrozhina, Assistant of the Department; EA Grishina, PhD, Head Of Biomolecular Researchers Department of the Research Center; KA Ryzhikova, Research Fellow of the Biomolecular Researchers Department of the Research center; IV Bure, PhD, Research Fellow of the Biomolecular Researchers Department of the Research Center; DA Sychev, Corresponding Member of the Academy of Sciences of Russia, M.D., PhD, Professor, Rector, Head of Clinical Pharmacology and Therapy Department. Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia. EV Kaverina, M.D., PhD, Associate Professor of the Department of Public Health, Healthcare and Hygiene, Peoples Friendship University of Russia, Moscow, Russian Federation. DA Klepikov, M.D., Assistant Professor of Clinical Pharmacology, Kazakh National Medical University, Almaty, Kazakhstan
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