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Feldman K, Kearns GL, Pearce RE, Abdel-Rahman SM, Leeder JS, Friesen A, Staggs VS, Gaedigk A, Weigel J, Shakhnovich V. Utility of the 13 C-pantoprazole breath test as a CYP2C19 phenotyping probe for children. Clin Transl Sci 2022; 15:1155-1166. [PMID: 35099109 PMCID: PMC9099127 DOI: 10.1111/cts.13232] [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: 09/30/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/29/2022] Open
Abstract
The 13 C-pantoprazole breath test (PAN-BT) is a safe, non-invasive, in-vivo CYP2C19 phenotyping probe for adults. Our objective was to evaluate PAN-BT performance in children, with a focus on discriminating individuals who, according to guidelines from the Clinical Pharmacology Implementation Consortium (CPIC), would benefit from starting dose escalation vs. reduction for proton pump inhibitors (PPIs). Children (n=65; 6-17 years) genotyped for CYP2C19 variants *2, *3, *4, and *17 received a single oral dose of 13 C-pantoprazole. Plasma concentrations of pantoprazole and its metabolites, and changes in exhaled 13 CO2 (termed delta-over-baseline or DOB), were measured 10 times over 8 hours using HPLC-UV and spectrophotometry, respectively. Pharmacokinetic parameters of interest were generated and DOB features derived using feature engineering for the first 180 minutes post-administration. DOB features, age, sex, and obesity status were used to run bootstrap analysis at each timepoint (Ti) independently. For each iteration, stratified samples were drawn based on genotype prevalence in the original cohort. A random forest was trained, and predictive performance of PAN-BT evaluated. Strong discriminating ability for CYP2C19 intermediate vs. normal/rapid metabolizer phenotype was noted at DOBT30min (mean sensitivity: 0.522, specificity: 0.784), with consistent model outperformance over a random or a stratified classifier approach at each time-point (p<0.001). With additional refinement and investigation, the test could become a useful and convenient dosing tool in clinic to help identify children who would benefit most from PPI dose escalation vs. dose reduction, in accordance with CPIC guidelines.
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Affiliation(s)
- Keith Feldman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - Gregory L Kearns
- Texas Christian University and UNTHSC School of Medicine, Fort Worth, TX, USA
| | - Robin E Pearce
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - Susan M Abdel-Rahman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - J Steven Leeder
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - Alec Friesen
- Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Vincent S Staggs
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - Andrea Gaedigk
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jaylene Weigel
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Valentina Shakhnovich
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
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Klieber M, Oberacher H, Hofstaetter S, Beer B, Neururer M, Amann A, Alber H, Modak A. CYP2C19 Phenoconversion by Routinely Prescribed Proton Pump Inhibitors Omeprazole and Esomeprazole: Clinical Implications for Personalized Medicine. J Pharmacol Exp Ther 2015; 354:426-30. [PMID: 26159874 DOI: 10.1124/jpet.115.225680] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/08/2015] [Indexed: 12/23/2022] Open
Abstract
The phenotype pantoprazole-(13)C breath test (Ptz-BT) was used to evaluate the extent of phenoconversion of CYP2C19 enzyme activity caused by commonly prescribed proton pump inhibitors (PPI) omeprazole and esomprazole. The Ptz-BT was administered to 26 healthy volunteers and 8 stable cardiovascular patients twice at baseline and after 28 days of PPI therapy to evaluate reproducibility of the Ptz-BT and changes in CYP2C19 enzyme activity (phenoconversion) after PPI therapy. The average intrapatient interday variability in CYP2C19 phenotype (n = 31) determined by Ptz-BT was considerably low (coefficient of variation, 17%). Phenotype conversion resulted in 25 of 26 (96%) nonpoor metabolizer (non-PM) volunteers/patients as measured by the Ptz-BT at baseline and after PPI therapy. The incidence of PM status by phenotype following administration of omeprazole/esomeprazole (known inhibitors of CYP2C19) was 10-fold higher than those who are genetically PMs in the general population, which could have critical clinical implications for personalizing medications primarily metabolized by CYP2C19, such as clopidogrel, PPI, cyclophosphamide, thalidomide, citalopram, clonazepam, diazepam, phenytoin, etc. The Ptz-BT can rapidly (30 minutes) evaluate CYP2C19 phenotype and, more importantly, can identify patients with phenoconversion in CYP2C19 enzyme activity caused by nongenetic factors such as concomitant drugs.
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Affiliation(s)
- Martin Klieber
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Herbert Oberacher
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Silvia Hofstaetter
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Beate Beer
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Martin Neururer
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Anton Amann
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Hannes Alber
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Anil Modak
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
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Amann A, Mochalski P, Ruzsanyi V, Broza YY, Haick H. Assessment of the exhalation kinetics of volatile cancer biomarkers based on their physicochemical properties. J Breath Res 2014; 8:016003. [PMID: 24566039 DOI: 10.1088/1752-7155/8/1/016003] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The current review provides an assessment of the exhalation kinetics of volatile organic compounds (VOCs) that have been linked with cancer. Towards this end, we evaluate various physicochemical properties, such as 'breath:air' and 'blood:fat' partition coefficients, of 112 VOCs that have been suggested over the past decade as potential markers of cancer. With these data, we show that the cancer VOC concentrations in the blood and in the fat span over 12 and 8 orders of magnitude, respectively, in order to provide a specific counterpart concentration in the exhaled breath (e.g., 1 ppb). This finding suggests that these 112 different compounds have different storage compartments in the body and that their exhalation kinetics depends on one or a combination of the following factors: (i) the VOC concentrations in different parts of the body; (ii) the VOC synthesis and metabolism rates; (iii) the partition coefficients between tissue(s), blood and air; and (iv) the VOCs' diffusion constants. Based on this analysis, we discuss how this knowledge allows modeling and simulating the behavior of a specific VOC under different sampling protocols (with and without exertion of effort). We end this review by a brief discussion on the potential role of these scenarios in screening and therapeutic monitoring of cancer.
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Affiliation(s)
- Anton Amann
- Breath Research Institute, Leopold-Franzens University of Innsbruck, 6850 Dornbirn, Austria. Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, 6020 Innsbruck, Austria
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