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de Jong LM, Boussallami S, Sánchez-López E, Giera M, Tushuizen ME, Hoekstra M, Hawinkels LJAC, Rissmann R, Swen JJ, Manson ML. The impact of CYP2C19 genotype on phenoconversion by concomitant medication. Front Pharmacol 2023; 14:1201906. [PMID: 37361233 PMCID: PMC10285291 DOI: 10.3389/fphar.2023.1201906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction: Pharmacogenetics-informed drug prescribing is increasingly applied in clinical practice. Typically, drug metabolizing phenotypes are determined based on genetic test results, whereupon dosage or drugs are adjusted. Drug-drug-interactions (DDIs) caused by concomitant medication can however cause mismatches between predicted and observed phenotypes (phenoconversion). Here we investigated the impact of CYP2C19 genotype on the outcome of CYP2C19-dependent DDIs in human liver microsomes. Methods: Liver samples from 40 patients were included, and genotyped for CYP2C19*2, *3 and *17 variants. S-mephenytoin metabolism in microsomal fractions was used as proxy for CYP2C19 activity, and concordance between genotype-predicted and observed CYP2C19 phenotype was examined. Individual microsomes were subsequently co-exposed to fluvoxamine, voriconazole, omeprazole or pantoprazole to simulate DDIs. Results: Maximal CYP2C19 activity (Vmax) in genotype-predicted intermediate metabolizers (IMs; *1/*2 or *2/*17), rapid metabolizers (RMs; *1/*17) and ultrarapid metabolizers (UMs; *17/*17) was not different from Vmax of predicted normal metabolizers (NMs; *1/*1). Conversely, CYP2C19*2/*2 genotyped-donors exhibited Vmax rates ∼9% of NMs, confirming the genotype-predicted poor metabolizer (PM) phenotype. Categorizing CYP2C19 activity, we found a 40% concordance between genetically-predicted CYP2C19 phenotypes and measured phenotypes, indicating substantial phenoconversion. Eight patients (20%) exhibited CYP2C19 IM/PM phenotypes that were not predicted by their CYP2C19 genotype, of which six could be linked to the presence of diabetes or liver disease. In subsequent DDI experiments, CYP2C19 activity was inhibited by omeprazole (-37% ± 8%), voriconazole (-59% ± 4%) and fluvoxamine (-85% ± 2%), but not by pantoprazole (-2 ± 4%). The strength of CYP2C19 inhibitors remained unaffected by CYP2C19 genotype, as similar percental declines in CYP2C19 activity and comparable metabolism-dependent inhibitory constants (Kinact/KI) of omeprazole were observed between CYP2C19 genotypes. However, the consequences of CYP2C19 inhibitor-mediated phenoconversion were different between CYP2C19 genotypes. In example, voriconazole converted 50% of *1/*1 donors to a IM/PM phenotype, but only 14% of *1/*17 donors. Fluvoxamine converted all donors to phenotypic IMs/PMs, but *1/*17 (14%) were less likely to become PMs than *1/*1 (50%) or *1/*2 and *2/*17 (57%). Conclusion: This study suggests that the differential outcome of CYP2C19-mediated DDIs between genotypes are primarily dictated by basal CYP2C19 activity, that may in part be predicted by CYP2C19 genotype but likely also depends on disease-related factors.
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Affiliation(s)
- Laura M. de Jong
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Soukayna Boussallami
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Elena Sánchez-López
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Maarten E. Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Menno Hoekstra
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Lukas J. A. C. Hawinkels
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden, Netherlands
- Department of Dermatology, Leiden University Medical Center, Leiden, Netherlands
| | - Jesse J. Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Martijn L. Manson
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden, Netherlands
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Borro M, Salerno G, Gentile G, Simmaco M. Opinion paper on the systematic application of integrated bioinformatic tools to actuate routine precision medicine in poly-treated patients. Clin Chem Lab Med 2023; 61:662-665. [PMID: 36656995 DOI: 10.1515/cclm-2022-1293] [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: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
Precision Medicine is a reality in selected medical areas, as oncology, or in excellent healthcare structures, but it is still far to reach million patients who could benefit from this medical concept. Here, we sought to highlight how the time is ripe to achieve horizontal delivery to a significant larger audience of patients, represented by the poly-treated patients. Combination therapies are frequent (especially in the elderly, to treat comorbidities) and are related to decreased drug safety and efficacy, disease's exacerbation, additional treatments, hospitalization. But the recent development and validation of bioinformatic tools, aimed to automatic evaluation and optimization of poly-therapies, according to the unique individual characteristics (including genotype), is ready to change the daily approach to pharmacological prescription.
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Affiliation(s)
- Marina Borro
- Clinical Biochemistry Laboratory, Sant'Andrea Hospital of Rome, Rome, Italy.,Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Gerardo Salerno
- Clinical Biochemistry Laboratory, Sant'Andrea Hospital of Rome, Rome, Italy.,Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giovanna Gentile
- Clinical Biochemistry Laboratory, Sant'Andrea Hospital of Rome, Rome, Italy.,Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Simmaco
- Clinical Biochemistry Laboratory, Sant'Andrea Hospital of Rome, Rome, Italy.,Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Allelic and Genotype Frequencies of CYP2B6 ∗2 (64C > T) and CYP2B6 ∗3 (777C > A) in Three Dominant Ethnicities of the Iranian Population. Genet Res (Camb) 2023; 2023:8283470. [PMID: 36817260 PMCID: PMC9934979 DOI: 10.1155/2023/8283470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Background Cytochrome P450 complex plays a key role in drug metabolism. CYP2B6 has an essential part in Cytochrome P450 complex metabolism. This study aims to determine the allelic distribution of CYP2B6∗2 and CYP2B6∗3 in three main Iranian ethnicities: Fars, Turk, and Kurd. Methods The study was conducted on 174 unrelated healthy volunteers from three main Iranian ethnicities. After DNA extraction from peripheral blood samples, genotyping of CYP2B6∗2 and ∗3 was performed using tetra ARMS and ARMS PCR, respectively. Results The average age of 174 cases was 40.69 ± 11.87 (mean ± SD) and 39.06 ± 11.63 (mean ± SD) for males and females. In the CYP2B6∗2 variant, the genotyping frequency of wild type (C/C), heterozygous (C/T), and homozygous mutant (T/T) was 8.7%, 86%, and 5.2%, respectively. The CYP2B6∗2 (c.64C > T) allele frequency was 48.2% (95% CI: (37.8-58.6)). In the CYP2B6∗3 variant, the frequency of wild type (C/C), heterozygous (C/T), and homozygous mutant (T/T) was 75.3%, 11%, and 13.6%, respectively. The CYP2B6∗3 (c.777C > A) allelic frequency was 19.1% (95% CI: (17.5-20.7)). Conclusion Allelic distribution in three main Iranian ethnicities, i.e., Turk, Kurd, and Fars, is remarkably higher than that in other populations, even that in Southern Iran. High frequencies of CYP2B6∗2 and ∗3 in the Iranian population highly affect drug responsiveness. Understanding such variability could help to increase drug efficacy and reduce its toxicity.
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Cytochromes P450 and P-Glycoprotein Phenotypic Assessment to Optimize Psychotropic Pharmacotherapy: A Retrospective Analysis of Four Years of Practice in Psychiatry. J Pers Med 2022; 12:jpm12111869. [PMID: 36579580 PMCID: PMC9693601 DOI: 10.3390/jpm12111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Altered cytochromes P450 enzymes (CYP) and P-glycoprotein transporter (P-gp) activity may explain variabilities in drug response. In this study, we analyzed four years of phenotypic assessments of CYP/P-gp activities to optimize pharmacotherapy in psychiatry. A low-dose probe cocktail was administered to evaluate CYP1A2, 2B6, 2D6, 2C9, 2C19, 3A4, and P-gp activities using the probe/metabolite concentration ratio in blood or the AUC. A therapeutic adjustment was suggested depending on the phenotyping results. From January 2017 to June 2021, we performed 32 phenotypings, 10 for adverse drug reaction, 6 for non-response, and 16 for both reasons. Depending on the CYP/P-gp evaluated, only 23% to 56% of patients had normal activity. Activity was decreased in up to 57% and increased in up to 60% of cases, depending on the CYP/P-gp evaluated. In 11/32 cases (34%), the therapeutic problem was attributable to the patient's metabolic profile. In 10/32 cases (31%), phenotyping excluded the metabolic profile as the cause of the therapeutic problem. For all ten individuals for which we had follow-up information, phenotyping allowed us to clearly state or clearly exclude the metabolic profile as a possible cause of therapeutic failure. Among them, seven showed a clinical improvement after dosage adaptation, or drug or pharmacological class switching. Our study confirmed the interest of CYP and P-gp phenotyping for therapeutic optimization in psychiatry.
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Torres-Loureiro S, Scudeler MM, Andrade PXC, Sampaio-Coelho J, Nobre IH, Céspedes-Garro C, Tarazona-Santos E, Llerena A, Rodrigues-Soares F. Pharmacogenetics research in Brazil: a systematic review. Pharmacogenomics 2022; 23:263-275. [DOI: 10.2217/pgs-2021-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Pharmacogenomics (PGx) is a rising scientific area in many countries, such as Brazil. Objectives: To identify biomarkers, therapeutic areas, probe drugs and regions/ethnicities most studied in the country in order to guide future studies. Materials & methods: Systematic review of 1060 studies (from 1968 to 2020) comprising 80 genes, six probe drugs and 3,819,233 individuals. Results: MTHFR and HLA-A/B were the most studied genes and metoprolol and dextromethorphan the most studied probe drugs. Oncology was the most studied therapeutic area considering PGx biomarkers. The country’s regions and ethnic groups were studied unevenly, with south/southeast and White people over-represented in respect to their demographic relevance, in detriment of the center-west/northeast/north and Black/mixed individuals. Conclusion: Many of the gaps and possible paths to be covered to reach even PGx data are pointed out by this review.
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Affiliation(s)
- Sabrina Torres-Loureiro
- Departamento de Patologia, Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, 38025-350, Brazil
| | - Mariana M Scudeler
- Departamento de Patologia, Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, 38025-350, Brazil
| | - Poliana XC Andrade
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 31270-910, Brazil
| | - Julia Sampaio-Coelho
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 31270-910, Brazil
- Residência Médica de Pediatria do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Igor H Nobre
- Departamento de Patologia, Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, 38025-350, Brazil
| | - Carolina Céspedes-Garro
- Genetics Section, School of Biology, University of Costa Rica, San Pedro, San José 11501, Costa Rica
| | - Eduardo Tarazona-Santos
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 31270-910, Brazil
- RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
- Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| | - Adrián Llerena
- RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
- Instituto de Investigación Biosanitaria de Extremadura, Universidad de Extremadura, SES, Badajoz, Extremadura, Spain
| | - Fernanda Rodrigues-Soares
- Departamento de Patologia, Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, 38025-350, Brazil
- RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
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Pita-Oliveira M, Rodrigues-Soares F. Influence of GSTM1, GSTT1, and GSTP1 genetic polymorphisms on disorders in transplant patients: a systematic review. Drug Metab Pers Ther 2021; 37:123-131. [PMID: 34856092 DOI: 10.1515/dmpt-2021-0165] [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: 07/17/2021] [Accepted: 11/03/2021] [Indexed: 11/15/2022]
Abstract
The glutathione-S-transferase (GST) enzymes are phase II isoenzymes responsible for protection against free radicals and xenobiotics. Since these proteins are described as polymorphic, polymorphisms in genes that encode them may alter enzymatic function and contribute to oxidative stress. In this context, such polymorphisms were already associated with several diseases and multiple therapeutic outcomes. A systematic review was performed to evaluate studies regarding the association between polymorphisms in three genes encoding enzymes of the GST family - GSTM1, GSTT1, and GSTP1 - and disorders in transplant patients. A total of 125 articles on which inclusion and exclusion criteria were applied were identified at PubMed database. Thirty-two studies met the target criteria and were included in the review. The mechanisms by which GST genotypes influence the development of disorders in transplant patients differ by disorder: they may participate in it by decreasing metabolism of drugs administered to patients undergoing transplantation, then exposing them to greater toxicity; by decreasing the repair ability against oxidative stress; or by encoding proteins that may be recognized as foreign, setting of an alloimmune reaction. Although some results are better established - such as GSTM1 null genotype's role in the development of toxicity events in transplant patients - others require further evidences, as GST influence on the development of pulmonary decline and posttransplant diabetes mellitus (PTDM). The importance of investigating these associations lies in a personalized medicine, in which the high-risk genotype patient has its treatment individualized and its care for prophylaxis and surveillance increased, potentially reducing this population's morbimortality.
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Affiliation(s)
- Murilo Pita-Oliveira
- Departamento de Patologia, Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Fernanda Rodrigues-Soares
- Departamento de Patologia, Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Ing Lorenzini K, Desmeules J, Rollason V, Bertin S, Besson M, Daali Y, Samer CF. CYP450 Genotype-Phenotype Concordance Using the Geneva Micrococktail in a Clinical Setting. Front Pharmacol 2021; 12:730637. [PMID: 34512355 PMCID: PMC8427306 DOI: 10.3389/fphar.2021.730637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Pharmacokinetic variability is a major source of differences in drug response and can be due to genetic variants and/or drug-drug interactions. Cytochromes P450 are among the most studied enzymes from a pharmacokinetic point of view. Their activity can be measured by phenotyping, and/or predicted by genotyping. Depending on the presence of drugs and/or diseases that can affect their in vivo activity, both approaches can be complementary. In 2014, the Geneva cocktail using dried blood spots was validated in healthy volunteers for CYP450 phenotyping. Since its clinical implementation, it has been used in approximately 500 patients in various clinical situations. Our study aims to report the concordance between CYP450 genotype and phenotype in real-life patients. The prospectively collected data from patients who were genotyped and/or phenotyped between January 2014 and December 2020 were reviewed. A total of 537 patients were genotyped and/or phenotyped for CYP450 during this period, and 241 underwent simultaneous genotyping and phenotyping allowing for genotype/phenotype concordance assessment. Genotyping correctly predicted poor metabolizer phenotypes for most CYPs isoenzymes studied, whereas agreement was more variable for intermediate, normal, and ultrarapid metabolizers. Discrepancies between the phenotype predicted on the basis of genotyping and the measured phenotype were not always explained by concurrent medication (phenotypic switch). Therefore genotyping and phenotyping tests are complementary approaches when aiming to individualize drug therapy. In the 537 patients, the majority of clinical situations were observed with analgesic/anesthetic drugs (n = 187), followed by antidepressants (n = 153), antineoplastics (n = 97), and immunosuppressants (n = 93). Inefficacy (or low drug levels) and adverse drug reaction (or high drug levels) were the main reasons for testing. Genotype and/or phenotype results explained or at least contributed to the clinical event in 44% of cases.
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Affiliation(s)
- Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Bertin
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Caroline F Samer
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Frequency of Important CYP450 Enzyme Gene Polymorphisms in the Iranian Population in Comparison with Other Major Populations: A Comprehensive Review of the Human Data. J Pers Med 2021; 11:jpm11080804. [PMID: 34442448 PMCID: PMC8401584 DOI: 10.3390/jpm11080804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 01/08/2023] Open
Abstract
Genetic polymorphisms in cytochrome P450 genes can cause alteration in metabolic activity of clinically important medicines. Thus, single nucleotide variants (SNVs) and copy number variations (CNVs) in CYP genes are leading factors of drug pharmacokinetics and toxicity and form pharmacogenetics biomarkers for drug dosing, efficacy, and safety. The distribution of cytochrome P450 alleles differs significantly between populations with important implications for personalized drug therapy and healthcare programs. To provide a meta-analysis of CYP allele polymorphisms with clinical importance, we brought together whole-genome and exome sequencing data from 800 unrelated individuals of Iranian population (100 subjects from 8 major ethnics of Iran) and 63,269 unrelated individuals of five major human populations (EUR, AMR, AFR, EAS and SAS). By integrating these datasets with population-specific linkage information, we evolved the frequencies of 140 CYP haplotypes related to 9 important CYP450 isoenzymes (CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4 and CYP3A5) giving a large resource for major genetic determinants of drug metabolism. Furthermore, we evaluated the more frequent Iranian alleles and compared the dataset with the Caucasian race. Finally, the similarity of the Iranian population SNVs with other populations was investigated.
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Meta-analysis of probability estimates of worldwide variation of CYP2D6 and CYP2C19. Transl Psychiatry 2021; 11:141. [PMID: 33627619 PMCID: PMC7904867 DOI: 10.1038/s41398-020-01129-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 01/31/2023] Open
Abstract
Extensive migration has led to the necessity of knowledge regarding the treatment of migrants with different ethnical backgrounds. This is especially relevant for pharmacological treatment, because of the significant variation between migrant groups in their capacity to metabolize drugs. For psychiatric medications, CYP2D6 and CYP2C19 enzymes are clinically relevant. The aim of this meta-analysis was to analyze studies reporting clinically useful information regarding CYP2D6 and CYP2C19 genotype frequencies, across populations and ethnic groups worldwide. To that end, we conducted a comprehensive meta-analysis using Embase, PubMed, Web of Science, and PsycINFO (>336,000 subjects, 318 reports). A non-normal metabolizer (non-NM) probability estimate was introduced as the equivalent of the sum-prevalence of predicted poor, intermediate, and ultrarapid metabolizer CYP2D6 and CYP2C19 phenotypes. The probability of having a CYP2D6 non-NM predicted phenotype was highest in Algeria (61%) and lowest in Gambia (2.7%) while the probability for CYP2C19 was highest in India (80%) and lowest in countries in the Americas, particularly Mexico (32%). The mean total probability estimates of having a non-NM predicted phenotype worldwide were 36.4% and 61.9% for CYP2D6 and CYP2C19, respectively. We provide detailed tables and world maps summarizing clinically relevant data regarding the prevalence of CYP2D6 and CYP2C19 predicted phenotypes and demonstrating large inter-ethnic differences. Based on the documented probability estimates, pre-emptive pharmacogenetic testing is encouraged for every patient who will undergo therapy with a drug(s) that is metabolized by CYP2D6 and/or CYP2C19 pathways and should be considered in case of treatment resistance or serious side effects.
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Hasanah YIF, Harahap Y, Purwanto DJ. Phenotyping Study of Cyclophosphamide 4-Hydroxylation in Malay Cancer Patients. Drug Des Devel Ther 2021; 15:305-313. [PMID: 33536743 PMCID: PMC7849187 DOI: 10.2147/dddt.s279128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cyclophosphamide (CP) is an anticancer alkylating group (nitrogen mustard) and a prodrug that will be metabolized to form its active metabolite, 4-hydroxycyclophosphamide (4-OHCP). The various enzymes involved in its bioactivation can cause a wide range of CP expression and activity among patients and ultimately affect the metabolism, efficacy and toxicity of this drug. The effectiveness of CP therapy can be determined by 4-OHCP level in dried blood spot (DBS). Aim The purpose of this study was to conduct the phenotyping of CP 4-hydroxylation rate in Malay cancer patients. Methodology Phenotyping study of CP 4-hydroxylation rate to 40 subjects of Malay cancer patients was done based on the value of its bioactivity ratio (4-OHCP to CP levels). Results The result shown the cyclophosphamide 4-hydroxylation rate of 80% (n=32) subjects as ultrarapid metabolizer (UM) and 20% (n=8) as poor metabolizer (PM). Conclusion Phenotyping study of CP 4-hydroxylation in Malay cancer patients can be conducted by quantifying CP bioactivity ratio (4-OHCP to CP level) in dried blood spot. In majority of Malay cancer patients, cyclophosphamide would be bioactivated through 4-hydroxylation in hepar rapidly as indicated by the high value of the bioactivity ratio or the increased CP clearance and 4-OHCP level.
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Affiliation(s)
| | - Yahdiana Harahap
- Bioavailability and Bioequivalence Laboratory, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia.,Indonesia Defense University, Bogor 16810, West Java, Indonesia
| | - Denni Joko Purwanto
- Functional Medical Staff of Surgical Oncology, Dharmais Cancer Hospital, Jakarta, Indonesia
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11
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P Sarmiento A, Dorado P, Borbón A, de Andrés F, LLerena A. High prevalence of CYP2D6 ultrarapid metabolizers in a mestizo Colombian population in relation to Hispanic mestizo populations. Pharmacogenomics 2020; 21:1227-1236. [PMID: 33124522 DOI: 10.2217/pgs-2020-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Interethnic differences in CYP2D6 allele frequency have been demonstrated across Latin-American countries. Only one previous study describing CYP2D6 genotypes in Colombian population has been performed. Thus, this study aimed to evaluate the CYP2D6 genetic variability in a mestizo Colombian population, as well as the similarities and differences concerning other Hispanic mestizo (HM) populations. Methodology: Two hundred and twelve unrelated healthy Colombian subjects were studied, in which different CYP2D6 polymorphisms were analyzed by extra long-PCR and real-time PCR. Results & discussion: A high percentage of ultrarapid metabolizers (18.4%) was found, representing the highest frequency calculated within the HM populations studied. However, the percentage of poor metabolizers (4.7%) was similar to those previously reported in HM populations.
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Affiliation(s)
- Alba P Sarmiento
- Pontificia Universidad Javeriana, Bogotá, Colombia.,RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
| | - Pedro Dorado
- INUBE Instituto Universitario de Investigación Biosanitaria de Extremadura, Universidad de Extremadura, Badajoz, Spain.,RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
| | - Angélica Borbón
- Instituto Nacional de Salud, Bogotá, Colombia.,RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
| | - Fernando de Andrés
- INUBE Instituto Universitario de Investigación Biosanitaria de Extremadura, Universidad de Extremadura, Badajoz, Spain.,RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
| | - Adrián LLerena
- INUBE Instituto Universitario de Investigación Biosanitaria de Extremadura, Universidad de Extremadura, Badajoz, Spain.,RIBEF Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Badajoz, Extremadura, Spain
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de Andrés F, Altamirano-Tinoco C, Ramírez-Roa R, Montes-Mondragón CF, Dorado P, Peñas-Lledó EM, LLerena A. Relationships between CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 metabolic phenotypes and genotypes in a Nicaraguan Mestizo population. THE PHARMACOGENOMICS JOURNAL 2020; 21:140-151. [PMID: 33024249 DOI: 10.1038/s41397-020-00190-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/17/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022]
Abstract
Interethnic variability in the drug-metabolizing capacity of CYP450 enzymes may lead to discrepancies in the relationship between genotypes and phenotypes worldwide. The present study was aimed to analyze for the first time whether there is a relationship between clinically relevant CYP450 genetic polymorphisms and their drug oxidation capacity (metabolic phenotype) in a population of healthy Nicaraguan volunteers. Two hundred and twelve participants were genotyped for CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4, and their actual metabolic phenotype (evaluated by the Metabolic Ratio, MR) was analyzed by using the CEIBA cocktail approach. The results showed the wide interindividual variability in all the studied enzymes and a significant difference (p < 0.004) in the activity of CYP1A2 between male and female subjects. The number of CYP2C19 (p < 0.0001) and CYP2D6 (p < 0.0001) active alleles were shown inversely correlated with their corresponding MR, although there were marked genotype-phenotype discrepancies. There was an actual enzyme capacity overlapping (MR) between genotypically Poor (gPMs) and Extensive Metabolizers (gEMs) of 3.14% subjects for CYP2D6 and 0.94% for CYP2C9. Similarly, there was an overlapping for metabolic phenotypes of 11.48% of genotypically ultrarapid metabolizers (gUMs) for CYP2C19 and 2.09% for CYP2D6 and gEMs. Therefore, the current approach for metabolic phenotype prediction based just on genotype does not predict properly for all individuals within this Nicaraguan Mestizo population, thus representing a potential barrier for the clinical implementation of personalized medicine in this region. However, it is necessary to improve the prediction of phenotype from genotype in order to improve the pharmacogenetic implementation in populations with specific ethnic backgrounds.
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Affiliation(s)
- Fernando de Andrés
- INUBE Extremadura Biosanitary University Research Institute, CICAB Clinical Research Centre, Badajoz University Hospital; University of Extremadura, Badajoz, Spain.,RIBEF Ibero American Network of Pharmacogenetics and Pharmacogenomics, León, Nicaragua
| | - Catalina Altamirano-Tinoco
- RIBEF Ibero American Network of Pharmacogenetics and Pharmacogenomics, León, Nicaragua.,UNAN Universidad Nacional Autónoma de Nicaragua, Facultad de Ciencias Médicas, León, Nicaragua
| | - Ronald Ramírez-Roa
- RIBEF Ibero American Network of Pharmacogenetics and Pharmacogenomics, León, Nicaragua. .,UNAN Universidad Nacional Autónoma de Nicaragua, Facultad de Ciencias Médicas, León, Nicaragua.
| | | | - Pedro Dorado
- INUBE Extremadura Biosanitary University Research Institute, CICAB Clinical Research Centre, Badajoz University Hospital; University of Extremadura, Badajoz, Spain.,RIBEF Ibero American Network of Pharmacogenetics and Pharmacogenomics, León, Nicaragua.,Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Eva M Peñas-Lledó
- INUBE Extremadura Biosanitary University Research Institute, CICAB Clinical Research Centre, Badajoz University Hospital; University of Extremadura, Badajoz, Spain.,RIBEF Ibero American Network of Pharmacogenetics and Pharmacogenomics, León, Nicaragua.,Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Adrián LLerena
- INUBE Extremadura Biosanitary University Research Institute, CICAB Clinical Research Centre, Badajoz University Hospital; University of Extremadura, Badajoz, Spain. .,RIBEF Ibero American Network of Pharmacogenetics and Pharmacogenomics, León, Nicaragua. .,Faculty of Medicine, University of Extremadura, Badajoz, Spain. .,CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.
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13
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Peñas-LLedó E, Terán E, Sosa-Macías M, Galaviz-Hernández C, Gil JP, Nair S, Diwakar S, Hernández I, Lara-Riegos J, Ramírez-Roa R, Verde I, Tarazona-Santos E, Molina-Guarneros J, Moya G, Rägo L, LLerena A. Challenges and Opportunities for Clinical Pharmacogenetic Research Studies in Resource-limited Settings: Conclusions From the Council for International Organizations of Medical Sciences-Ibero-American Network of Pharmacogenetics and Pharmacogenomics Meeting. Clin Ther 2020; 42:1595-1610.e5. [PMID: 32782137 DOI: 10.1016/j.clinthera.2020.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The symposium Health and Medicines in Indigenous Populations of America was organized by the Council for International Organizations of Medical Sciences (CIOMS) Working Group on Clinical Research in Resource-Limited Settings (RLSs) and the Ibero-American Network of Pharmacogenetics and Pharmacogenomics (RIBEF). It was aimed to share and evaluate investigators' experiences on challenges and opportunities on clinical research and pharmacogenetics. METHODS A total of 33 members from 22 countries participated in 2 sessions: RIBEF studies on population pharmacogenetics about the relationship between ancestry with relevant drug-related genetic polymorphisms and the relationship between genotype and phenotype in Native Americans (session 1) and case examples of clinical studies in RLSs from Asia (cancer), America (diabetes and women health), and Africa (malaria) in which the participants were asked to answer in free text their experiences on challenges and opportunities to solve the problems (session 2). Later, a discourse analysis grouping common themes by affinity was conducted. FINDINGS The main result of session 1 was that the pharmacogenetics-related ancestry of the population should be considered when designing clinical studies in RLSs. In session 2, 21 challenges and 20 opportunities were identified. The social aspects represent the largest proportion of the challenges (43%) and opportunities (55%), and some of them seem to be common. IMPLICATIONS The main discussion points were gathered in the Declaration of Mérida/T'Hó and announced on the Parliament of Extremadura during the CIOMS-RIBEF meeting in 4 of the major Latin American autochthonous languages (Náhualth, Mayan, Miskito, and Kichwa). The declaration highlighted the following: (1) the relevance of population pharmacogenetics, (2) the sociocultural contexts (interaction with traditional medicine), and (3) the education needs of research teams for clinical research in vulnerable and autochthonous populations.
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Affiliation(s)
- Eva Peñas-LLedó
- INUBE Extremadura Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain; University of Conscientiousness Project, Campus PHI, Acebo, Extremadura, Spain
| | | | - Marta Sosa-Macías
- Instituto Politécnico Nacional, CIIDIR Unidad Durango, Durango, Mexico
| | | | | | | | | | | | | | | | | | - Eduardo Tarazona-Santos
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Graciela Moya
- Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Lembit Rägo
- CIOMS Council for International Organizations of Medical Sciences, Geneva, Switzerland
| | - Adrián LLerena
- INUBE Extremadura Biosanitary University Research Institute, University of Extremadura, Badajoz, Spain; University of Conscientiousness Project, Campus PHI, Acebo, Extremadura, Spain.
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14
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Neyshaburinezhad N, Rouini M, Shirzad N, Esteghamati A, Nakhjavani M, Namazi S, Ardakani YH. Evaluating the effect of type 2 diabetes mellitus on CYP450 enzymes and P-gp activities, before and after glycemic control: A protocol for a case-control pharmacokinetic study. MethodsX 2020; 7:100853. [PMID: 32337164 PMCID: PMC7176986 DOI: 10.1016/j.mex.2020.100853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/29/2020] [Indexed: 12/18/2022] Open
Abstract
Cytochrome P450s (CYP450) family is one of the most critical factors in the metabolism process. Hence, the present study aims to characterize the activity of CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5, and P-glycoprotein (P-gp) pump in patients with type 2 diabetes (T2DM). This characterization was performed before and after good glycemic control versus non-diabetic subjects following the administration of a substrate probe drug cocktail. This single-center clinical study proposes the characterization of T2DM impacts on major CYP450 drug-metabolizing enzyme and P-glycoprotein (P-gp) activities. The main propose of the present study is evaluating any alternation in major CYP450 enzymes and P-gp activities in patients with T2DM, before (A1C>7%) and after (A1C≤7%) good glycemic control along with comparing the activities versus non-diabetic subjects. The phenotypes will be assessed following the oral administration of a drug cocktail containing caffeine (CYP1A2), bupropion (CYP2B6), flurbiprofen (CYP2C9), omeprazole (CYP2C19), dextromethorphan (CYP2D6), midazolam (CYP3A4/5), and fexofenadine (P-gp) as probe substrates. Furthermore, the influence of variables such as glycemia, genetic polymorphisms, and inflammation on the metabolism process will be evaluated. The first patient has entered the study in Dec 2018.
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Affiliation(s)
- Navid Neyshaburinezhad
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Rouini
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Shirzad
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soha Namazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Yalda H. Ardakani
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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15
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Rodrigues-Soares F, Peñas-Lledó EM, Tarazona-Santos E, Sosa-Macías M, Terán E, López-López M, Rodeiro I, Moya GE, Calzadilla LR, Ramírez-Roa R, Grazina M, Estévez-Carrizo FE, Barrantes R, LLerena A. Genomic Ancestry, CYP2D6, CYP2C9, and CYP2C19 Among Latin Americans. Clin Pharmacol Ther 2019; 107:257-268. [PMID: 31376146 DOI: 10.1002/cpt.1598] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
We present the distribution of CYP2D6, CYP2C9, and CYP2C19 variants and predicted phenotypes in 33 native and admixed populations from Ibero-America (n > 6,000) in the context of genetic ancestry (n = 3,387). Continental ancestries are the major determinants of frequencies of the increased-activity allele CYP2C19*17 and CYP2C19 gUMs (negatively associated with Native American ancestry), decreased-activity alleles CYP2D6*41 and CYP2C9*2 (positively associated with European ancestry), and decreased-activity alleles CYP2D6*17 and CYP2D6*29 (positively associated with African ancestry). For the rare alleles, CYP2C9*2 and CYPC19*17, European admixture accounts for their presence in Native American populations, but rare alleles CYP2D6*5 (null-activity), CYP2D6-multiplication alleles (increased activity), and CYP2C9*3 (decreased-activity) were present in the pre-Columbian Americas. The study of a broad spectrum of Native American populations from different ethno-linguistic groups show how autochthonous diversity shaped the distribution of pharmaco-alleles and give insights on the prevalence of clinically relevant phenotypes associated with drugs, such as paroxetine, tamoxifen, warfarin, and clopidogrel.
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Affiliation(s)
- Fernanda Rodrigues-Soares
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Departamento de Genética, Ecologia e Evolução, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Departamento de Patologia, Genética e Evolução, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Eva M Peñas-Lledó
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Instituto de Investigación Biosanitaria de Extremadura, Universidad de Extremadura, SES, Badajoz, Extremadura, Spain
| | - Eduardo Tarazona-Santos
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Departamento de Genética, Ecologia e Evolução, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Estudos Avançados Transdisciplinares, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Martha Sosa-Macías
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Instituto Politécnico Nacional, Durango, Mexico
| | - Enrique Terán
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Marisol López-López
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Universidad Autónoma Metropolitana, Ciudad de México, Mexico
| | - Idania Rodeiro
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Instituto de Ciencias del Mar, La Habana, Cuba
| | - Graciela E Moya
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Universidad Católica de Argentina, Buenos Aires, Argentina
| | - Luis R Calzadilla
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Centro Comunitario de Salud Mental, La Habana Vieja, La Habana, Cuba
| | - Ronald Ramírez-Roa
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Universidad Nacional Autónoma de Nicaragua, León, Nicaragua
| | - Manuela Grazina
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Faculdade de Medicina & Centro de Neurociências e Biologia Celular, University of Coimbra, Coimbra, Portugal
| | - Francisco E Estévez-Carrizo
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Universidad de Montevideo, Montevideo, Uruguay
| | - Ramiro Barrantes
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Universidad de Costa Rica, San José, Costa Rica
| | - Adrián LLerena
- RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics, Badajoz, Extremadura, Spain.,Instituto de Investigación Biosanitaria de Extremadura, Universidad de Extremadura, SES, Badajoz, Extremadura, Spain
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16
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Abstract
The cytochromes P450 comprise a family of enzymes that are responsible for around three-quarters of all drug metabolism reactions that occur in human populations. Many isoforms of cytochrome P450 exist but most reactions are undertaken by CYP2C9, CYP2C19, CYP2D6 and CYP3A4. This brief review focusses on the first three isozymes which exhibit polymorphism of phenotype.If there is a wide variation in drug metabolising capacity within the population, this may precipitate clinical consequences and influence the drug treatment of patients. Such problems range from a lack of efficacy to unanticipated toxicity. In order to minimise untoward events and "personalise" a patient's treatment, efforts have been made to discover an individual's drug metabolism status. This requires knowledge of the subject's phenotype at the time of clinical treatment. Since such testing is difficult, time-consuming and costly, the simpler approach of genotyping has been advocated.However, the correlation between genotype and phenotype is not good, with values of up to 50% misprediction being reported. Genotype-assisted forecasts cannot therefore be used with confidence to replace actual phenotype measurements. Obfuscating factors discussed include gene splicing, single nucleotide polymorphisms, epigenetics and microRNA, transcription regulation and multiple gene copies.
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17
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Supervised Classification of CYP2D6 Genotype and Metabolizer Phenotype With Postmortem Tramadol-Exposed Finns. Am J Forensic Med Pathol 2019; 40:8-18. [DOI: 10.1097/paf.0000000000000447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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A pathway-driven predictive model of tramadol pharmacogenetics. Eur J Hum Genet 2019; 27:1143-1156. [PMID: 30824817 DOI: 10.1038/s41431-019-0369-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/12/2019] [Accepted: 02/16/2019] [Indexed: 12/14/2022] Open
Abstract
Predicting metabolizer phenotype (MP) is typically performed using data from a single gene. Cytochrome p450 family 2 subfamily D polypeptide 6 (CYP2D6) is considered the primary gene for predicting MP in reference to approximately 30% of marketed drugs and endogenous toxins. CYP2D6 predictions have proven clinically effective but also have well-documented inaccuracies due to relatively high genotype-phenotype discordance in certain populations. Herein, a pathway-driven predictive model employs genetic data from uridine diphosphate glucuronosyltransferase, family 1, polypeptide B7 (UGT2B7), adenosine triphosphate (ATP)-binding cassette, subfamily B, number 1 (ABCB1), opioid receptor mu 1 (OPRM1), and catechol-O-methyltransferase (COMT) to predict the tramadol to primary metabolite ratio (T:M1) and the resulting toxicologically inferred MP (t-MP). These data were then combined with CYP2D6 data to evaluate performance of a fully combinatorial model relative to CYP2D6 alone. These data identify UGT2B7 as a potentially significant explanatory marker for T:M1 variability in a population of tramadol-exposed individuals of Finnish ancestry. Supervised machine learning and feature selection were used to demonstrate that a set of 16 loci from 5 genes can predict t-MP with over 90% accuracy, depending on t-MP category and algorithm, which was significantly greater than predictions made by CYP2D6 alone.
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19
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Sivadas A, Scaria V. Population-scale genomics-Enabling precision public health. ADVANCES IN GENETICS 2018; 103:119-161. [PMID: 30904093 DOI: 10.1016/bs.adgen.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The current excitement for affordable genomics technologies and national precision medicine initiatives marks a turning point in worldwide healthcare practices. The last decade of global population sequencing efforts has defined the enormous extent of genetic variation in the human population resulting in insights into differential disease burden and response to therapy within and between populations. Population-scale pharmacogenomics helps to provide insights into the choice of optimal therapies and an opportunity to estimate, predict and minimize adverse events. Such an approach can potentially empower countries to formulate national selection and dosing policies for therapeutic agents thereby promoting public health with precision. We review the breadth and depth of worldwide population-scale sequencing efforts and its implications for the implementation of clinical pharmacogenetics toward making precision medicine a reality.
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Affiliation(s)
- Ambily Sivadas
- GN Ramachandran Knowledge Center for Genome Informatics, CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), New Delhi, India
| | - Vinod Scaria
- GN Ramachandran Knowledge Center for Genome Informatics, CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), New Delhi, India.
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20
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Soares-Souza G, Borda V, Kehdy F, Tarazona-Santos E. Admixture, Genetics and Complex Diseases in Latin Americans and US Hispanics. CURRENT GENETIC MEDICINE REPORTS 2018. [DOI: 10.1007/s40142-018-0151-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Naranjo MEG, Rodrigues-Soares F, Peñas-Lledó EM, Tarazona-Santos E, Fariñas H, Rodeiro I, Terán E, Grazina M, Moya GE, López-López M, Sarmiento AP, Calzadilla LR, Ramírez-Roa R, Ortiz-López R, Estévez-Carrizo FE, Sosa-Macías M, Barrantes R, LLerena A. Interethnic Variability in CYP2D6, CYP2C9, and CYP2C19 Genes and Predicted Drug Metabolism Phenotypes Among 6060 Ibero- and Native Americans: RIBEF-CEIBA Consortium Report on Population Pharmacogenomics. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2018; 22:575-588. [PMID: 30183544 DOI: 10.1089/omi.2018.0114] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pharmacogenetic variation in Latin Americans is understudied, which sets a barrier for the goal of global precision medicine. The RIBEF-CEIBA Network Consortium was established to characterize interindividual and between population variations in CYP2D6, CYP2C9, and CYP2C19 drug metabolizing enzyme genotypes, which were subsequently utilized to catalog their "predicted drug metabolism phenotypes" across Native American and Ibero American populations. Importantly, we report in this study, a total of 6060 healthy individuals from Ibero-America who were classified according to their self-reported ancestry: 1395 Native Americans, 2571 Admixed Latin Americans, 96 Afro-Latin Americans, 287 white Latin Americans (from Cuba), 1537 Iberians, and 174 Argentinean Ashkenazi Jews. Moreover, Native Americans were grouped into North-, Central-, and South Amerindians (from Mexico, Costa Rica, and Peru, respectively). All subjects were studied for the most common and functional CYP2D6, CYP2C9, and CYP2C19 allelic variants, and grouped as genotype-predicted poor or ultrarapid metabolizer phenotypes (gPMs and gUMs, respectively). Native Americans showed differences from each ethnic group in at least two alleles of CYP2D6, CYP2C9, and CYP2C19. Native Americans had higher frequencies of wild-type alleles for all genes, and lower frequency of CYP2D6*41, CYP2C9*2, and CYP2C19*17 (p < 0.05). Native Americans also showed less CYP2C19 gUMs than the rest of the population sample. In addition, differences within Native Americans (mostly North vs. South) were also found. The interethnic differences described supports the need for population-specific personalized and precision medicine programs for Native Americans. To the best of our knowledge, this is the largest study carried out in Native Americans and other Ibero-American populations analyzing CYP2D6, CYP2C9, and CYP2C19 genetic polymorphisms. Population pharmacogenomics is a nascent field of global health and warrants further research and education.
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Affiliation(s)
- María-Eugenia G Naranjo
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
| | - Fernanda Rodrigues-Soares
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,3 Universidade Federal de Minas Gerais , Belo Horizonte, Brazil .,4 Faculdade Uninassau , Manaus, Brazil
| | - Eva M Peñas-Lledó
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
| | - Eduardo Tarazona-Santos
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,3 Universidade Federal de Minas Gerais , Belo Horizonte, Brazil .,5 PRISMA , Lima, Peru
| | - Humberto Fariñas
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
| | - Idania Rodeiro
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,6 Instituto de Ciencias del Mar , La Habana, Cuba
| | - Enrique Terán
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,7 Universidad San Francisco de Quito , Quito, Ecuador
| | - Manuela Grazina
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,8 UC, CNC-Center for Neuroscience and Cell Biology, FMUC-Faculty of Medicine, University of Coimbra , Coimbra, Portugal
| | - Graciela E Moya
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,9 Universidad Católica de Argentina , Buenos Aires, Argentina
| | - Marisol López-López
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,10 Universidad Autónoma Metropolitana , Ciudad de México, Mexico
| | - Alba P Sarmiento
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,11 Pontifica Universidad Javeriana , Bogotá, Colombia
| | - Luis R Calzadilla
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,12 Centro Comunitario de SaludMental de la Habana Vieja, La Habana, Cuba
| | - Ronald Ramírez-Roa
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,13 Universidad Nacional Autónoma de Nicaragua , León, Nicaragua
| | - Rocío Ortiz-López
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,14 Tecnológico de Monterrey , Monterrey, Mexico
| | - Francisco E Estévez-Carrizo
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,15 Universidad de Montevideo , Montevideo, Uruguay
| | - Martha Sosa-Macías
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,16 Instituto Politécnico Nacional , Durango, Mexico
| | - Ramiro Barrantes
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,17 Universidad de Costa Rica , San José, Costa Rica
| | - Adrián LLerena
- 1 RIBEF Ibero-American Network of Pharmacogenetics and Pharmacogenomics , Badajoz, Spain .,2 Universidad de Extremadura , Badajoz, Spain
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22
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Adadey SM, Awandare G, Amedofu GK, Wonkam A. Public Health Burden of Hearing Impairment and the Promise of Genomics and Environmental Research: A Case Study in Ghana, Africa. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2018; 21:638-646. [PMID: 29140768 DOI: 10.1089/omi.2017.0145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hearing impairment (HI) is one of the most disabling conditions of major global health burden that contributes adversely to the social and economic development of a country, if not managed properly. A proper assessment of the nationwide burden and etiology of HI is instrumental in the prevention, treatment, and management of the condition. This article sought to perform an expert review of HI in Ghana to determine the present knowledge of its burden and possible causes of the condition. A literature search was conducted in PubMed using the following keywords: "hearing loss" OR "hearing impairment" OR "deafness" AND "Ghana." The literature was scanned until July 20, 2017, with specific inclusion of targeted landmark and background articles on HI. From the search, 18 of out 5869 articles were selected and considered for the review. The results of the search indicated that there were no extensive studies to determine the national burden of HI in Ghana. However, the few studies assessed suggested that the disease is either acquired or inherited. The burden of acquired HI was higher in adults than children, women than men, and people working in a noisy environment. Regarding the genetic cause, specific founder mutations in GJB2 gene (R143W, L79P, V178A, R184Q, A197S, I203K, and L214P) was the only identified genetic cause of HI in Ghana, but the other HI genes were not investigated. There has been some modest effort to study HI in Ghana, but comprehensive studies on the genetic and environmental etiologies (using the "multi-OMICS" approaches), classification, and burden of HI on Ghana are needed.
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Affiliation(s)
- Samuel Mawuli Adadey
- 1 West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana , Accra, Ghana
| | - Gordon Awandare
- 1 West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana , Accra, Ghana
| | | | - Ambroise Wonkam
- 3 Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town, South Africa
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McGraw J, Gerhardt A, Morris TC. Opportunities and obstacles in genotypic prediction of cytochrome P450 phenotypes. Expert Opin Drug Metab Toxicol 2018; 14:659-661. [PMID: 29863909 DOI: 10.1080/17425255.2018.1484451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Joseph McGraw
- a Department of Pharmaceutical and Administrative Sciences , Concordia University Wisconsin , Mequon , WI , USA
| | | | - Tommy C Morris
- c Xavier University of Louisiana, Division of Basic Pharmaceutical Sciences , New Orleans , LA , USA
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24
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Koopmans AB, Vinkers DJ, Poulina IT, Gelan PJA, van Schaik RHN, Hoek HW, van Harten PN. No Effect of Dose Adjustment to the CYP2D6 Genotype in Patients With Severe Mental Illness. Front Psychiatry 2018; 9:349. [PMID: 30131727 PMCID: PMC6090167 DOI: 10.3389/fpsyt.2018.00349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background: The CYP2D6 enzyme is involved in the metabolism of numerous psychopharmacological drugs. Guidelines recommend how to adjust the dose of medication based on the CYP2D6 genotype. Aims: To evaluate the effect of dose adjustment to the CYP2D6 genotype and phenotype, in patients with severe mental illness (SMI) already receiving psychopharmacological treatment. Methods: A total of 269 psychiatric patients (on the island Curaçao) receiving antipsychotic treatment were genotyped for CYP2D6. Of these, 45 patients were included for dose adjustment according to the clinical guideline of the Royal Dutch Association for the Advancement of Pharmacy, i.e., 17 CYP2D6 poor metabolizers, 26 intermediate metabolizers, and 2 ultrarapid metabolizers. These 45 patients were matched for age, gender, and type of medication with a control group of 41 patients who were CYP2D6 extensive metabolizers (i.e., with a normal CYP2D6 function). At baseline and at 4 months after dose adjustment, subjective experience, psychopathology, extrapyramidal side-effects, quality of life, and global functioning were assessed in these two groups. Results: At baseline, there were no differences between the groups regarding the prescribed dosage of antipsychotics, the number of side-effects, psychiatric symptoms, global functioning, or quality of life. After dose adjustment, no significant improvement in these parameters was reported. Conclusion: In psychiatric patients with SMI already receiving antipsychotic treatment, dose adjustment to the CYP2D6 genotype or phenotype according to the guidelines showed no beneficial effect. This suggests that dose adjustment guidelines are currently not applicable for patients already using antipsychotics. ClinicalTrials.gov: Cost-effectiveness of CYP2D6 and CYP2C19 Genotyping in Psychiatric Patients in Curacao; Identifier: NCT02713672; https://clinicaltrials.gov/ct2/show/NCT02713672?term=CYP2D6&rank=5.
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Affiliation(s)
- Anne B Koopmans
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - David J Vinkers
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Igmar T Poulina
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hans W Hoek
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Peter N van Harten
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Innova, Psychiatric Centre GGz Centraal, Amersfoort, Netherlands
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de Andrés F, Sosa-Macías M, Ramos BPL, Naranjo MEG, LLerena A. CYP450 Genotype/Phenotype Concordance in Mexican Amerindian Indigenous Populations–Where to from Here for Global Precision Medicine? ACTA ACUST UNITED AC 2017; 21:509-519. [DOI: 10.1089/omi.2017.0101] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Fernando de Andrés
- CICAB Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
- Department of Analytical Chemistry and Food Technology, Faculty of Pharmacy, University of Castilla-La Mancha, Albacete, Spain
| | | | | | - María-Eugenia G. Naranjo
- CICAB Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
| | - Adrián LLerena
- CICAB Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
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Adedeji WA, Igbinoba SI, Fakeye TO, Oladosu IA, Fehintola FA, Ma Q, Morse GD. Evaluation of CYP2D6 phenotype in the Yoruba Nigerian population. Expert Rev Clin Pharmacol 2017; 10:1145-1152. [PMID: 28786716 DOI: 10.1080/17512433.2017.1362979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a lack of information on CYP2D6, a major metabolizing enzyme, in Africa ethnic nationalities. The objective was to determine CYP2D6 phenotype in Yoruba Nigerians using dextromethorphan (DEX). METHOD A total of 89 healthy volunteers received 30 mg of DEX orally followed by blood and urine sample collection at 3-hour and over 8 h post-dose, respectively. DEX and dextrorphan (DOR) concentrations were determined using High Performance Liquid Chromatography (HPLC). The metabolic ratio (MR, DEX/DOR) were plotted for the phenotype determination. RESULTS The log MR that separated poor (PMs) from normal metabolizers (NMs) was 0.28 and 0.75 for urine and plasma, respectively. Two subjects (2.3%) identified as PMs had a mean MR of 17 and 3.2 in plasma and urine, significantly higher than that of NMs (p < .0001). A positive correlation between urine and plasma MR was noted. CONCLUSION The prevalence of PMs in the Yoruba Nigerians was similar to that reported among blacks.
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Affiliation(s)
- Waheed Adeola Adedeji
- a Department of Clinical Pharmacology , University College Hospital , Ibadan , Nigeria
| | - Sharon Iyobor Igbinoba
- b Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Titilayo O Fakeye
- c Department of Clinical Pharmacy & Pharmacy Administration , University of Ibadan , Ibadan , Nigeria
| | | | - Fatai Adewale Fehintola
- a Department of Clinical Pharmacology , University College Hospital , Ibadan , Nigeria.,e Department of Pharmacology and Therapeutics , University of Ibadan , Ibadan , Nigeria
| | - Qing Ma
- f Translational Pharmacology Research Core , School of Pharmacy and Pharmaceutical Sciences, New York Center of Excellence in Bioinformatics and Life Sciences , Buffalo , NY , USA
| | - Gene D Morse
- f Translational Pharmacology Research Core , School of Pharmacy and Pharmaceutical Sciences, New York Center of Excellence in Bioinformatics and Life Sciences , Buffalo , NY , USA.,g Center for Integrated Global Biomedical Sciences , University at Buffalo , Buffalo , NY , USA
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Adehin A, Bolaji OO, Maggo S, Kennedy MA. Relationship between metabolic phenotypes and genotypes of CYP1A2 and CYP2A6 in the Nigerian population. Drug Metab Pers Ther 2017; 32:39-47. [PMID: 28231062 DOI: 10.1515/dmpt-2016-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND CYP1A2 and CYP2A6 are polymorphic drug-metabolising enzymes that are also implicated in the activation of procarcinogens in humans. Some of their alleles and haplotypes, often varied in prevalence across populations, are thought to influence activity despite the known contribution of environmental factors. This study assessed the potential influence of some genetic variants of CYP1A2 and CYP2A6 on metabolic phenotypes in Nigerians. METHODS Genomic DNA was extracted from blood samples of 100 healthy, unrelated subjects for whom CYP1A2 and CYP2A6 phenotypes had previously been determined, alongside an additional 80 other individuals for whom phenotype data were unavailable. The samples were screened for CYP1A2 (*1C,*1D,*1E,*1F, *3,*4,*6,*7) and CYP2A6 (*9,*11,*17) alleles using the Sequenom MassARRAY platform for some alleles and direct Sanger sequencing for others. The genetic data acquired were subsequently analysed for haplotypes and assessed for concordance with phenotypes. RESULTS All five CYP1A2 haplotypes (CYP1A2*1F, 1J, 1N, 1L, 1W) identified in the Nigerian population were not significantly predictive of metabolic phenotypes. Heterozygous CYP1A2*1J carriers and homozygous CYP1A2*1W carriers showed statistically insignificant decrease in CYP1A2 activity. The CYP2A6*9/*17 genotype was, however, significantly associated with the CYP2A6-poor metabolic phenotype, whereas CYP2A6*9 or CYP2A6*17 alone did not show any such association. CYP2A6*11 was not detected in the population. CONCLUSIONS Our findings suggest that CYP1A2 alleles or haplotypes were not predictive of metabolic phenotypes in the Nigerian population. Carriers of CYP2A6*9/*17 genotype are likely to be poor metabolisers of CYP2A6 substrates and may experience adverse reactions or poor efficacy while using drugs metabolised mainly by CYP2A6.
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Sosa-Macías M, Teran E, Waters W, Fors MM, Altamirano C, Jung-Cook H, Galaviz-Hernández C, López-López M, Remírez D, Moya GE, Hernández F, Fariñas H, Ramírez R, Céspedes-Garro C, Tarazona-Santos E, LLerena A. Pharmacogenetics and ethnicity: relevance for clinical implementation, clinical trials, pharmacovigilance and drug regulation in Latin America. Pharmacogenomics 2016; 17:1741-1747. [PMID: 27790935 DOI: 10.2217/pgs-2016-0153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Congress of Pharmacogenetics and Personalized Medicine. Ethnicity, clinical implementation and regulatory environment (MESTIFAR 2016 Quito) Quito, Ecuador, 19-21 May 2016. The Ibero-American Network of Pharmacogenetics and Pharmacogenomics (RIBEF) was created in 2006 with the main aim of promoting personalized medicine and collaborative pharmacogenetics research in Spanish- and Portuguese-speaking countries in America and the Iberian Peninsula. The final goal of this initiative was the inclusion of Latin American populations that may benefit from the implementation of personalized medicine in drug therapy. Several initiatives have been promoted including the MESTIFAR project, which aimed to analyze the ethnicity, genotype and/or metabolic phenotype in Ibero-American populations. To date, 6060 healthy volunteers have been analyzed; among them, 2571 were admixed, 1824 were Caucasians, 1395 were Native Americans, 174 were Jews and 96 were Afro-descendants. Due to the large genetic variability within Latin Americans, ethnicity may be a relevant factor for the clinical implementation of personalized medicine. Moreover, the present status of clinical implementation and the future perspectives of pharmacogenetics, pharmacovigilance and clinical trials for drug regulation in Latin America compared with the EMA-Pharmacogenomics Working Party and the US FDA initiatives were analyzed.
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Affiliation(s)
- Martha Sosa-Macías
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Instituto Politéctico Nacional-CIIDIR, Unidad Durango, Academia de Genómica, Durango, Mexico
| | - Enrique Teran
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - William Waters
- Comité de Ética en Seres Humanos, Universidad San Francisco de Quito, Quito, Ecuador
| | - Martha M Fors
- Facultad de Medicina, Universidad de las Américas, Quito, Ecuador
| | - Catalina Altamirano
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Universidad Nacional Autónoma de Nicaragua, León, Facultad de Medicina, Nicaragua
| | - Helgi Jung-Cook
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Facultad de Química, Universidad Nacional Autónoma de México, México
| | - Carlos Galaviz-Hernández
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Instituto Politéctico Nacional-CIIDIR, Unidad Durango, Academia de Genómica, Durango, Mexico
| | - Marisol López-López
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana, Xochimilco, México
| | - Diadelis Remírez
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Centro para el Control Estatal de Medicamentos, La Habana, Cuba
| | - Graciela E Moya
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Francisco Hernández
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Facultad de Ciencias Médicas, Universidad Estatal de Guayaquil, Guayaquil, Ecuador
| | - Humberto Fariñas
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,CICAB Clinical Research Centre, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - Ronald Ramírez
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Universidad Nacional Autónoma de Nicaragua, León, Facultad de Medicina, Nicaragua
| | - Carolina Céspedes-Garro
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Genetics Section, Universidad de Costa Rica, San José, Costa Rica
| | - Eduardo Tarazona-Santos
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,Universidade Federal de Minas Gerais, Instituto de Ciencias Biológicas, Departamento de Biologia Geral, Belo Horizonte, Brazil
| | - Adrián LLerena
- RIBEF, Ibero-American Network of Pharmacogenetics & Pharmacogenomics, Mérida, Badajoz, Spain.,CICAB Clinical Research Centre, Extremadura University Hospital & Medical School, Badajoz, Spain
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