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Obayemi JE, Callans L, Nair N, Gao H, Gandla D, Loza BL, Gao S, Mohebnasab M, Trofe-Clark J, Jacobson P, Keating B. Assessing the Utility of a Genotype-Guided Tacrolimus Equation in African American Kidney Transplant Recipients: A Single Institution Retrospective Study. J Clin Pharmacol 2024; 64:944-952. [PMID: 38766706 DOI: 10.1002/jcph.2461] [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] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 05/22/2024]
Abstract
Tacrolimus metabolism is heavily influenced by the CYP3A5 genotype, which varies widely among African Americans (AA). We aimed to assess the performance of a published genotype-informed tacrolimus dosing model in an independent set of adult AA kidney transplant (KTx) recipients. CYP3A5 genotypes were obtained for all AA KTx recipients (n = 232) from 2010 to 2019 who met inclusion criteria at a single transplant center in Philadelphia, Pennsylvania, USA. Medical record data were used to calculate predicted tacrolimus clearance using the published AA KTx dosing equation and two modified iterations. Observed and model-predicted trough levels were compared at 3 days, 3 months, and 6 months post-transplant. The mean prediction error at day 3 post-transplant was 3.05 ng/mL, indicating that the model tended to overpredict the tacrolimus trough. This bias improved over time to 1.36 and 0.78 ng/mL at 3 and 6 months post-transplant, respectively. Mean absolute prediction error-a marker of model precision-improved with time to 2.33 ng/mL at 6 months. Limiting genotype data in the model decreased bias and improved precision. The bias and precision of the published model improved over time and were comparable to studies in previous cohorts. The overprediction observed by the published model may represent overfitting to the initial cohort, possibly limiting generalizability.
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Affiliation(s)
- Joy E Obayemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Callans
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhil Nair
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Hui Gao
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Divya Gandla
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Bao-Li Loza
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Gao
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maedeh Mohebnasab
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Trofe-Clark
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pamala Jacobson
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Brendan Keating
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, New York University, New York, NY, USA
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Pasari AS, Balwani MR, Gurjar P, Bawankule C, Bhawane A, Tolani P, Kashiv P, Dubey S, Katekhaye VM. CYP3A5 Polymorphism in Renal Transplantation: A Key to Personalized Immunosuppression. Transplant Proc 2023:S0041-1345(23)00104-5. [PMID: 36973144 DOI: 10.1016/j.transproceed.2023.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/20/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Tacrolimus is essential for the maintenance of immunosuppression after a kidney transplant. CYP3A5 is the gene that metabolizes tacrolimus, and polymorphism in this gene affects the metabolizing status. AIM To assess the genetic polymorphism status of patients undergoing kidney transplantation and determine its impact on graft function and complications in the post-transplant period. METHODS We retrospectively included the patients who had undergone a kidney transplant and had positive genetic polymorphism of the CYP3A5 gene. Based on loss of alleles, patients were categorized as non-expresser (loss of both alleles), intermediate expresser (loss of one allele), and expresser (no loss of allele) denoted by CYP3A5*3/*3, CYP3A5*1/*3, and CYP3A5*1/*1, respectively. Data were analyzed with descriptive statistics. RESULTS Of 25 patients, 60%, 32%, and 8% were non-expressers, intermediate-expressers, and expressers, respectively. The mean tacrolimus trough concentration to dose ratio after 6 months of the transplant was higher in non-expressers than intermediate-expressers and expressers (213 vs 85 and 46 ng/mL/mg/kg/d, respectively). The graft function was normal in all 3 groups except for graft rejection 1 patient in the expresser group. Compared with expressers, urinary tract infections (42.9% and 62.5%) and new-onset diabetes after transplantation (28.6% and 12.5%) were more frequent in non-expresser and intermediate expressers, respectively. The proportion of patients developing new-onset diabetes after transplantation was lower with the pre-transplant diagnosis of CYP3A5 polymorphism (16.7% vs 23.1%). CONCLUSION Genotype-based dosing of tacrolimus helps achieve the desired therapeutic concentrations that can help to optimize graft outcomes and reduce the tacrolimus-related adverse effects. Pre-transplant evaluation of CYP3A5 can be more helpful in planning treatment strategies for optimized outcomes after kidney transplantation.
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Warzyszyńska K, Zawistowski M, Karpeta E, Jałbrzykowska A, Kosieradzki M. CYP3A5 Expressor Genotype of the Transplanted Kidney Increases the Risk of Preterm Graft Loss and Acute Rejection. Nephron Clin Pract 2023; 147:441-450. [PMID: 36630936 DOI: 10.1159/000528109] [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: 04/06/2022] [Accepted: 10/25/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Tacrolimus is metabolized mainly in the liver by the CYP3A enzyme family, with a particularly well-documented role of CYP3A5. CYP3A5 is also expressed in the renal tissue and is present in the transplanted kidney. To date, the association between donor CYP3A5 polymorphisms and transplant outcome remains poorly understood. The aim of this study was to assess the effect of donor CYP3A5 expression on early and long-term transplant outcomes. METHODS A retrospective cohort study including 207 patients who received kidney grafts from 110 deceased donors was conducted at a single Central European Center. Tissue samples from all donors were studied for CYP3A5 single-nucleotide polymorphism (rs776746). Death-censored graft loss within 5-year follow-up, acute rejection occurrence, and kidney function, measured using serum creatinine and MDRD eGFR, were compared between groups of patients with allografts from rs776746 carriers (CYP3A5 expressors) and noncarriers (CYP3A5 nonexpressors). RESULTS Recipients who received kidneys from CYP3A5 expressors (n = 24) were at significantly higher risk of death-censored graft loss within 5-year follow-up (adjusted HR, 95% CI: 6.82, 2.01-23.12; p = 0.002) and acute rejection within the 1st posttransplant year (adjusted OR, 95% CI: 4.62, 1.67-12.77; p = 0.003) than those who did not (n = 183). The median time to loss of function was 1.93 [IQR; 0.77-3.19] years. CONCLUSIONS Donor CYP3A5 expressor status is associated with worse renal graft survival and a higher risk of acute rejection. Determination of donor CYP3A5 genotype is a potentially useful tool that may improve kidney transplant outcomes.
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Affiliation(s)
- Karola Warzyszyńska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Zawistowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
- Military Institute of Medicine, Warsaw, Poland
| | - Edyta Karpeta
- Department of Surgical and Transplantation Nursing and Extracorporeal Therapies, Medical University of Warsaw, Warsaw, Poland
| | | | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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Meng W, Zhang W, Yang S, Dou X, Liu Y, Li H, Liu J, Jin T, Li B. Analysis of pharmacogenomic very important pharmacogenomic variants: CYP3A5, ACE, PTGS2 and NAT2 genes in Chinese Bai population. Per Med 2022; 19:403-410. [PMID: 35801384 DOI: 10.2217/pme-2021-0157] [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]
Abstract
Aim: Our study aimed to screen the genotype frequencies of very important pharmacogenomic (VIP) mutations and identify their differences between Bai and other populations. Materials & methods: We selected 66 VIP variants from PharmGKB (www.pharmgkb.org/) for genotyping. χ2 test was used to identify differences in loci between these populations and Fst values of Bai and the other 26 populations were analyzed. Results: Our study showed that the frequencies of SNPs of CYP3A5, ACE, PTGS2 and NAT2 differed significantly from those of the other 26 populations. At the same time, we found that some VIP variants may affect the metabolism of drugs and the genetic relationship between the Bai population and East Asian populations was found to be the closest. Conclusion: By comparing the genotype frequencies of different populations, the loci with significant differences were identified and discussed, providing a theoretical basis for individualized drug use in the Bai ethnic population.
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Affiliation(s)
- Wenting Meng
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Wenjie Zhang
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Shuangyu Yang
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Xia Dou
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Yuanwei Liu
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Haiyue Li
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Jianfeng Liu
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Tianbo Jin
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Bin Li
- Key Laboratory of Resource Biology & Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, 229 TaiBai North Road, Xi'an, 710069, China.,Biomedicine Key Laboratory of Shaanxi Province, Northwest University, Xi'an, 710069, China
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Friebus-Kardash J, Nela E, Möhlendick B, Kribben A, Siffert W, Heinemann FM, Eisenberger U. Development of De Novo Donor-specific HLA Antibodies and AMR in Renal Transplant Patients Depends on CYP3A5 Genotype. Transplantation 2022; 106:1031-1042. [PMID: 34241984 PMCID: PMC9038248 DOI: 10.1097/tp.0000000000003871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The single-nucleotide polymorphism CYP3A5 rs776746 is related to a reduction in the metabolizing activity of the CYP3A5 enzyme. People carrying at least one copy of the wild-type allele, defined as CYP3A5 expressers, exhibit higher clearance and lower trough concentrations of tacrolimus than homozygous nonexpressers, and this difference may affect alloimmunization and allograft function. METHODS We retrospectively studied 400 kidney transplant recipients treated with a tacrolimus-based immunosuppression regimen to detect CYP3A5 genotype, de novo formation of HLA antibodies and donor-specific antibodies (DSAs), and clinical outcome up to 5 y after transplant. RESULTS We found that 69 (17%) of the 400 patients were CYP3A5 expressers. During the first 3 y after transplant, CYP3A5 expressers tended to have lower tacrolimus trough levels than nonexpressers, although their tacrolimus dosage was as much as 80% higher. De novo DSAs were found more frequently in CYP3A5 expressers than in nonexpressers (13/69 [19%] versus 33/331 [10%], P = 0.02). De novo DSA-free survival rates (P = 0.02) were significantly lower for expressers than for nonexpressers. CYP3A5 genotype had no effect on allograft failure, but CYP3A5 expressers exhibited a significantly higher frequency of antibody-mediated rejection. CYP3A5 expresser status was an independent risk factor for the development of de novo DSAs (relative risk, 2.34, P = 0.01). CONCLUSIONS Early detection of CYP3A5 expressers, enabling genotype-based dose adjustment of tacrolimus immediately after renal transplant, may be a useful strategy for reducing the risk of de novo DSA production and antibody-mediated rejection.
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Affiliation(s)
- Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ejona Nela
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Birte Möhlendick
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Winfried Siffert
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Falko Markus Heinemann
- Institute for Transfusion Medicine, Transplantation Diagnostics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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6
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Warzyszyńska K, Zawistowski M, Karpeta E, Jałbrzykowska A, Kosieradzki M. Renal Cyp3a5-Expressing Genotype Decreases Tacrolimus-to-Dose Ratio in Small Cohort of Renal Transplant Recipients—Preliminary Report. Transplant Proc 2022; 54:960-967. [DOI: 10.1016/j.transproceed.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
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7
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Lenain R, Maanaoui M, Hamroun A, Larrue R, Van Der Hauwaert C, Gibier JB, Gnemmi V, Gomis S, Labalette M, Broly F, Hennart B, Pottier N, Hazzan M, Cauffiez C, Glowacki F. Impact of Tacrolimus Daily Dose Limitation in Renal Transplant Recipients Expressing CYP3A5: A Retrospective Study. J Pers Med 2021; 11:jpm11101002. [PMID: 34683143 PMCID: PMC8539387 DOI: 10.3390/jpm11101002] [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: 07/28/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
The pharmacokinetic variability of tacrolimus can be partly explained by CYP3A5 activity. Our objective was to evaluate a tacrolimus sparing policy on renal graft outcome according to CYP3A5 6986A>G genetic polymorphism. This retrospective study included 1114 recipients with a median follow-up of 6.3 years. Genotyping of the 6986A>G allelic variant corresponding to CYP3A5*3 was systematically performed. One year after transplantation, tacrolimus blood trough concentration (C0) target range was 5–7 ng/mL. However, daily dose was capped to 0.10 mg/kg/day regardless of the CYP3A5 genotype. A total 208 CYP3A5*1/- patients were included. Despite a higher daily dose, CYP3A5*1/- recipients exhibited lower C0 during follow-up (p < 0.01). Multivariate analysis did not show any significant influence of CYP3A5*1/- genotype (HR = 0.70, 0.46–1.07, p = 0.10) on patient-graft survival. Glomerular Filtration Rate (GFR) decline was significantly lower for the CYP3A5*1/- group (p = 0.02). The CYP3A5*1/- genotype did not significantly impact the risk of biopsy-proven acute rejection (BPAR) (HR = 1.01, 0.68–1.49, p = 0.97) despite significantly lower C0. Based on our experience, a strategy of tacrolimus capping is associated with a better GFR evolution in CYP3A5*1/- recipients without any significant increase of BPAR incidence. Our study raised some issues about specific therapeutic tacrolimus C0 targets for CYP3A5*1/- patients and suggests to set up randomized control studies in this specific population.
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Affiliation(s)
- Rémi Lenain
- CHU Lille, Service de Néphrologie, F-59000 Lille, France; (R.L.); (M.M.); (A.H.); (S.G.); (M.H.); (F.G.)
| | - Mehdi Maanaoui
- CHU Lille, Service de Néphrologie, F-59000 Lille, France; (R.L.); (M.M.); (A.H.); (S.G.); (M.H.); (F.G.)
| | - Aghilès Hamroun
- CHU Lille, Service de Néphrologie, F-59000 Lille, France; (R.L.); (M.M.); (A.H.); (S.G.); (M.H.); (F.G.)
| | - Romain Larrue
- UMR9020-U1277—CANTHER—Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CNRS, Inserm, CHU Lille, F-59000 Lille, France; (R.L.); (C.V.D.H.); (N.P.)
- CHU Lille, Service de Toxicologie et Génopathies, F-59000 Lille, France; (F.B.); (B.H.)
| | - Cynthia Van Der Hauwaert
- UMR9020-U1277—CANTHER—Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CNRS, Inserm, CHU Lille, F-59000 Lille, France; (R.L.); (C.V.D.H.); (N.P.)
- CHU Lille, Département de la Recherche en Santé, F-59000 Lille, France
| | - Jean-Baptiste Gibier
- CHU Lille, Service d’Anatomo-Pathologie, F-59000 Lille, France; (J.-B.G.); (V.G.)
| | - Viviane Gnemmi
- CHU Lille, Service d’Anatomo-Pathologie, F-59000 Lille, France; (J.-B.G.); (V.G.)
| | - Sébastien Gomis
- CHU Lille, Service de Néphrologie, F-59000 Lille, France; (R.L.); (M.M.); (A.H.); (S.G.); (M.H.); (F.G.)
| | - Myriam Labalette
- CHU de Lille, Institut D’Immunologie-HLA, F-59000 Lille, France;
| | - Franck Broly
- CHU Lille, Service de Toxicologie et Génopathies, F-59000 Lille, France; (F.B.); (B.H.)
| | - Benjamin Hennart
- CHU Lille, Service de Toxicologie et Génopathies, F-59000 Lille, France; (F.B.); (B.H.)
| | - Nicolas Pottier
- UMR9020-U1277—CANTHER—Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CNRS, Inserm, CHU Lille, F-59000 Lille, France; (R.L.); (C.V.D.H.); (N.P.)
- CHU Lille, Service de Toxicologie et Génopathies, F-59000 Lille, France; (F.B.); (B.H.)
| | - Marc Hazzan
- CHU Lille, Service de Néphrologie, F-59000 Lille, France; (R.L.); (M.M.); (A.H.); (S.G.); (M.H.); (F.G.)
| | - Christelle Cauffiez
- UMR9020-U1277—CANTHER—Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CNRS, Inserm, CHU Lille, F-59000 Lille, France; (R.L.); (C.V.D.H.); (N.P.)
- Correspondence:
| | - François Glowacki
- CHU Lille, Service de Néphrologie, F-59000 Lille, France; (R.L.); (M.M.); (A.H.); (S.G.); (M.H.); (F.G.)
- UMR9020-U1277—CANTHER—Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CNRS, Inserm, CHU Lille, F-59000 Lille, France; (R.L.); (C.V.D.H.); (N.P.)
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8
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Saab AAER, El-hadidi ES, Hussein MM, Shararah MSAEB, Aly HH. Clinical utility of ABCB1 single nucleotide polymorphism on tacrolimus dose requirements in Egyptian liver transplant patients. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Background
Liver transplantation (LT) is the only effective radical cure for all types of end-stage liver diseases. Major advances have been made in the field of liver transplantation due to improvements in surgical techniques and organ conservation as well as optimization of intensive care and immunosuppressive management. We aimed to assess the influence of ABCB1 gene polymorphism of liver transplant recipients on blood level and dose requirements of oral tacrolimus, in an attempt to help in designing an individualized tacrolimus regimen for Egyptian liver transplant recipient. The study included 25 liver transplant recipients and their respective 25 donors. All subjects of this study were subjected to full medical history, clinical evaluation, laboratory investigations, and ABCB1 gene polymorphism evaluation by RT-PCR. Tacrolimus concentration was evaluated for all the recipients during the first 3 months post transplantation.
Results
The present study revealed that the presence of CC genotype was significantly correlated to the effect on tacrolimus C/D ratio and weight-adjusted tacrolimus dose during the first week of the first and 2nd months (Z = −2.108, P <0.05) but not the 3rd month post transplantation (p-value >0.05). Subjects carrying CC genotype required higher doses of tacrolimus to achieve the desired trough levels compared to subjects carrying CT and TT genotypes. The same effect was observed over the whole period of the study but the results were statistically non-significant (p-value>0.05). Recipients who received liver tissue from donors carrying CC genotype also required higher doses of tacrolimus and reached lower levels of blood tacrolimus trough levels.
Conclusion
The present study revealed that ABCB1 CC genotype of both recipients and donors of liver transplantation was significantly associated with increased required tacrolimus dose early after liver transplantation reaching statistically significant level in the first week of the first and second months.
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9
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Tziastoudi M, Pissas G, Raptis G, Cholevas C, Eleftheriadis T, Dounousi E, Stefanidis I, Theoharides TC. A Systematic Review and Meta-Analysis of Pharmacogenetic Studies in Patients with Chronic Kidney Disease. Int J Mol Sci 2021; 22:ijms22094480. [PMID: 33923087 PMCID: PMC8123337 DOI: 10.3390/ijms22094480] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is an important global public health problem due to its high prevalence and morbidity. Although the treatment of nephrology patients has changed considerably, ineffectiveness and side effects of medications represent a major issue. In an effort to elucidate the contribution of genetic variants located in several genes in the response to treatment of patients with CKD, we performed a systematic review and meta-analysis of all available pharmacogenetics studies. The association between genotype distribution and response to medication was examined using the dominant, recessive, and additive inheritance models. Subgroup analysis based on ethnicity was also performed. In total, 29 studies were included in the meta-analysis, which examined the association of 11 genes (16 polymorphisms) with the response to treatment regarding CKD. Among the 29 studies, 18 studies included patients with renal transplantation, 8 involved patients with nephrotic syndrome, and 3 studies included patients with lupus nephritis. The present meta-analysis provides strong evidence for the contribution of variants harbored in the ABCB1, IL-10, ITPA, MIF, and TNF genes that creates some genetic predisposition that reduces effectiveness or is associated with adverse events of medications used in CKD.
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Affiliation(s)
- Maria Tziastoudi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
- Correspondence: ; Tel.: +30-24-1350-1667; Fax: +30-24-1350-1015
| | - Georgios Pissas
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
| | | | - Christos Cholevas
- AHEPA Hospital, First Department of Ophthalmology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece;
| | - Theodoros Eleftheriadis
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Ioannis Stefanidis
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (G.P.); (T.E.); (I.S.)
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10
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Sallustio BC, Noll BD, Hu R, Barratt DT, Tuke J, Coller JK, Russ GR, Somogyi AA. Tacrolimus dose, blood concentrations and acute nephrotoxicity, but not CYP3A5/ABCB1 genetics, are associated with allograft tacrolimus concentrations in renal transplant recipients. Br J Clin Pharmacol 2021; 87:3901-3909. [PMID: 33646566 DOI: 10.1111/bcp.14806] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Long-term use of the immunosuppressant tacrolimus is limited by nephrotoxicity. Following renal transplantation, the risk of nephrotoxicity may be determined more by allograft than by blood tacrolimus concentrations, and thus may be affected by donor CYP3A5 and ABCB1 genetics. Little is known regarding factors that determine tacrolimus intrarenal exposure. METHODS This study investigated the relationship between trough blood (C0Blood ) and allograft (CGraft ) tacrolimus concentrations and tacrolimus dose, haematocrit, genetics, acute nephrotoxicity, rejection status, delayed graft function, and time post-transplant. C0Blood and CGraft were quantified in 132 renal transplant recipients together with recipient and donor CYP3A5 (rs776746) and ABCB1 3435 (rs1045642) genotypes. RESULTS C0Blood ranged from 2.6 to 52.3 ng/mL and CGraft from 33 to 828 pg/mg tissue. Adjusting for dose, recipients who were CYP3A5 expressors had lower C0Blood compared to nonexpressors, whilst delayed graft function was associated with higher C0Blood . Linear regression showed that the significant predictors of CGraft were C0Blood (point-wise P = 7 × 10-10 ), dose (P = .004) acute nephrotoxicity (P = .002) and an interaction between C0Blood and acute tacrolimus nephrotoxicity (P = .0002), with an adjusted r2 = 0.35 and no contribution from donor or recipient CYP3A5 or ABCB1 genotype. The association between CGraft and acute nephrotoxicity depended on one very high CGraft (828 pg/mg tissue). CONCLUSIONS Recipient and donor CYP3A5 and ABCB1 3435C>T genotypes are not determinants of allograft tacrolimus exposure in kidney transplant recipients. However, tacrolimus dose and C0Blood were significant predictors of CGraft , and the relationship between C0Blood and CGraft appeared to differ in the presence or absence of acute nephrotoxicity.
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Affiliation(s)
- Benedetta C Sallustio
- Department of Clinical Pharmacology, Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville South, SA, 5011, Australia.,Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Benjamin D Noll
- School of Pharmacy and Medical Sciences, University of South Australia, Australia, Adelaide, SA, 5000, Australia
| | - Rong Hu
- Department of Pharmacy, Guangzhou Women's and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Daniel T Barratt
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Jonathan Tuke
- ARC Centre for Excellence for Mathematical and Statistical Frontiers, School of Mathematical Sciences, Adelaide, SA, 5000, Australia.,School of Mathematical Sciences, Adelaide, SA, 5000, Australia
| | - Janet K Coller
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Graeme R Russ
- Central Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Andrew A Somogyi
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5000, Australia
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11
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Stefanović NZ, Veličković-Radovanović RM, Danković KS, Mitić BP, Paunović GJ, Cvetković MB, Cvetković TP. Combined Effect of Inter- and Intrapatient Variability in Tacrolimus Exposure on Graft Impairment Within a 3-Year Period Following Kidney Transplantation: A Single-Center Experience. Eur J Drug Metab Pharmacokinet 2020; 45:749-760. [PMID: 32886348 DOI: 10.1007/s13318-020-00644-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Tacrolimus is a cornerstone of the most immunosuppressive protocols after kidney transplantation, but its use is complicated by notable interpatient and intrapatient variability (IPV). The goal of this study was to evaluate whether or not tacrolimus IPV, or average dose-adjusted trough concentration (C0/D), during 6-12 months post-transplantation might have contributed to graft function decline in a 3-year period following kidney transplantation. After primary evaluation of individual effects of tacrolimus IPV and C0/D, the study aimed to estimate the combined effect of tacrolimus IPV and C0/D on composite endpoint (consisting of graft failure, chronic allograft dysfunction, chronic rejection, and doubling of serum creatinine concentration) in the period between 13 and 36 months after kidney transplantation. In addition, the goal was to analyze the impact of genetics on interpatient variability in tacrolimus exposure in the early and late post-transplantation periods. METHODS The study enrolled 104 Caucasian patients and included 2541 patient examinations up to 36 months after kidney transplantation. All patients were genotyped on CYP3A5 6986A>G and ABCB1 3435C>T gene polymorphism. Patients were divided into groups based on the tacrolimus IPV tertiles and the median value of average C0/D during 6-12 months post-transplantation. RESULTS The results showed a more pronounced decline in estimated glomerular filtration rate values within the high IPV tertile group (p = 0.018), as well as within the low C0/D group (p = 0.013) in a 3-year period after kidney transplantation. The carriers of CYP3A5*1/*3 genotype had lower C0/D compared to the CYP3A5*3/*3 carriers during the entire study period, while the results for ABCB1 were inconsistent when considering tacrolimus C0/D. Patients with high IPV/low C0/D had significantly reduced graft survival compared to the other tacrolimus IPV/C0/D combination groups (i.e., high IPV/high C0/D, low IPV/low C0/D, low IPV/high C0/D) with the hazard ratio of 3.14 in Cox analysis for reaching the composite endpoint. CONCLUSION The findings of this study suggest that combined assessment of tacrolimus IPV and tacrolimus C0/D may categorize patients towards risk of graft deterioration in the long-term post-transplantation period.
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Affiliation(s)
- Nikola Z Stefanović
- Department of Pharmacy, Faculty of Medicine, University of Nis, Dr Zorana Djindjica 81 Blvd., 18000, Nis, Serbia.
| | - Radmila M Veličković-Radovanović
- Department of Pharmacology With Toxicology, Faculty of Medicine, University of Nis, Dr Zorana Djindjica 81 Blvd., , 18000, Nis, Serbia
- Clinic of Nephrology, Clinical Center Nis, Dr Zorana Djindjica 48 Blvd., 18000, Nis, Serbia
| | - Katarina S Danković
- Faculty of Medicine, University of Nis, Dr Zorana Djindjica 81 Blvd., 18000, Nis, Serbia
| | - Branka P Mitić
- Clinic of Nephrology, Clinical Center Nis, Dr Zorana Djindjica 48 Blvd., 18000, Nis, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Nis, Dr Zorana Djindjica 81 Blvd., 18000, Nis, Serbia
| | - Goran J Paunović
- Clinic of Nephrology, Clinical Center Nis, Dr Zorana Djindjica 48 Blvd., 18000, Nis, Serbia
| | - Mina B Cvetković
- Clinic of Nephrology, Clinical Center Nis, Dr Zorana Djindjica 48 Blvd., 18000, Nis, Serbia
- Faculty of Medicine, University of Nis, Dr Zorana Djindjica 81 Blvd., 18000, Nis, Serbia
| | - Tatjana P Cvetković
- Clinic of Nephrology, Clinical Center Nis, Dr Zorana Djindjica 48 Blvd., 18000, Nis, Serbia
- Department of Biochemistry, Faculty of Medicine, University of Nis, Dr Zorana Djindjica 81 Blvd., 18000, Nis, Serbia
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12
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Cheung CY, Chan KM, Wong YT, Chak WL, Bekers O, van Hooff JP. Influence of CYP3A5 Genetic Polymorphism on Long-Term Renal Function in Chinese Kidney Transplant Recipients Using Limited Sampling Strategy and Abbreviated Area Under the Curve for Tacrolimus Monitoring. Prog Transplant 2020; 30:249-253. [PMID: 32552577 DOI: 10.1177/1526924820933823] [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: 11/16/2022]
Abstract
INTRODUCTION Although the association between CYP3A5 gene polymorphism and tacrolimus dosing requirements was well established, the impact on how CYP3A5 genotype affects the acute rejection and long-term renal function in patients who received kidney transplants and were treated with tacrolimus remained controversial. DESIGN Sixty-seven Chinese patients with kidney transplants receiving de novo tacrolimus-based immunosuppressive therapy with known CYP3A5 genotype were divided into 2 groups. Those with at least 1 CYP3A5*1 allele were CYP3A5 expressers while homozygotes for the mutant allele CYP3A5*3 were nonexpressers. Instead of trough level, our center used abbreviated area under the curve for tacrolimus monitoring. Primary outcome was the long-term renal function between both groups while secondary outcomes included the weight-adjusted daily tacrolimus dose, graft survival, incidence of biopsy-proven acute rejection (BPAR), opportunistic infection, and cancer. RESULTS Thirty-five (52.2%) patients were CYP3A5 expressers while 32 were nonexpressers. Mean daily tacrolimus dose in the CYP3A5 expressers and nonexpressers was 0.08 (0.03) and 0.05 (0.02) mg/kg, respectively (P < .01). Starting from 1-month posttransplant, the renal function was comparable between both groups, which persisted up to 10-year. Ten patients experienced BPAR rejection and there was no significant difference in the rejection-free survival between both groups (P = .87). There was also no significant difference in the death-censored graft survival between both groups (P = .86). Finally, the incidence of opportunistic infection and posttransplant cancer was similar between them. DISCUSSION There was no significant difference in renal function, graft survival, and acute rejection between CYP3A5 expressers and nonexpressers.
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Affiliation(s)
- Chi Yuen Cheung
- Renal Unit, Department of Medicine, 156451Queen Elizabeth Hospital, Hong Kong
| | - Koon Ming Chan
- Renal Unit, Department of Medicine, 156451Queen Elizabeth Hospital, Hong Kong
| | - Yuen Ting Wong
- Renal Unit, Department of Medicine, 156451Queen Elizabeth Hospital, Hong Kong
| | - Wai Leung Chak
- Renal Unit, Department of Medicine, 156451Queen Elizabeth Hospital, Hong Kong
| | - Otto Bekers
- Department of Clinical Chemistry, Central Diagnostic Laboratory, 199236Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Johannes P van Hooff
- Department of Internal Medicine, 199236Maastricht University Medical Centre, Maastricht, the Netherlands
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13
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Pallio G, Irrera N, Bitto A, Mannino F, Minutoli L, Rottura M, Pallio S, Altavilla D, Alibrandi A, Marciano MC, Righi M, Mannucci C, Arcoraci V, Squadrito F. Failure of Achieving Tacrolimus Target Blood Concentration Might Be Avoided by a Wide Genotyping of Transplanted Patients: Evidence from a Retrospective Study. J Pers Med 2020; 10:jpm10020047. [PMID: 32492825 PMCID: PMC7354451 DOI: 10.3390/jpm10020047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
Precise tacrolimus treatment in transplanted patients is achieved in the clinical setting by performing therapeutic drug monitoring (TDM) and consequently adjusting therapy. The aim of this study was to retrospectively analyze the variability in tacrolimus blood levels throughout 2 years of observation in 75 transplanted patients and to investigate if tacrolimus blood levels correlate with presence of genetic polymorphisms, thus modifying tacrolimus pharmacokinetics. CYP3A5*1 (G6986A), CYP3A4*1B (A392G), CYP3A4*22, ABCB1 (C3435T; C1236T; G2677A/T), SLCO1B1 (T521C), polymorphisms were analyzed. Based on the effect of their genotypes, patients were stratified into 5 groups: (1) reduced tacrolimus metabolism (RM), (2) increased metabolism (IM), (3) transporters polymorphisms (TM), (4) metabolism and transporter polymorphisms (AM) and (5) no mutations (Wild Type, WT). The percentage of the samples out of therapeutic range was significantly higher in the IM group than in the WT group (p = 0.001), as well as compared to the TM group (p = 0.004). Only IM pattern (p = 0.015) resulted as an independent predictor of number of tacrolimus blood levels out of therapeutic range. RM pattern (p = 0.006) was inversely related to the administered dose. Therefore, genotyping could become a standard practice before tacrolimus prescription thus decreasing side effects, increasing efficacy and reducing the economic burden for the national health system.
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Affiliation(s)
- Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
| | - Federica Mannino
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
| | - Letteria Minutoli
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
| | - Socrate Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
| | - Domenica Altavilla
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via C. Valeria, 98125 Messina, Italy; (D.A.); (M.R.); (C.M.)
| | - Angela Alibrandi
- Department of Economics Section of Statistical and Mathematical Sciences, University of Messina, Via dei Verdi, 98122 Messina, Italy;
| | - Maria Concetta Marciano
- Grande Ospedale Metropolitano: “Bianchi-Melacrino-Morelli”, Via Giuseppe Melacrino, 89124 Reggio Calabria, Italy;
| | - Maria Righi
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via C. Valeria, 98125 Messina, Italy; (D.A.); (M.R.); (C.M.)
| | - Carmen Mannucci
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via C. Valeria, 98125 Messina, Italy; (D.A.); (M.R.); (C.M.)
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
- Correspondence:
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (G.P.); (N.I.); (A.B.); (F.M.); (L.M.); (M.R.); (S.P.); (F.S.)
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14
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Zhang M, Tajima S, Shigematsu T, Fu R, Noguchi H, Kaku K, Tsuchimoto A, Okabe Y, Egashira N, Masuda S. Donor CYP3A5 Gene Polymorphism Alone Cannot Predict Tacrolimus Intrarenal Concentration in Renal Transplant Recipients. Int J Mol Sci 2020; 21:ijms21082976. [PMID: 32340188 PMCID: PMC7215698 DOI: 10.3390/ijms21082976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
CYP3A5 gene polymorphism in recipients plays an important role in tacrolimus blood pharmacokinetics after renal transplantation. Even though CYP3A5 protein is expressed in renal tubular cells, little is known about the influence on the tacrolimus intrarenal exposure and hence graft outcome. The aim of our study was to investigate how the tacrolimus intrarenal concentration (Ctissue) could be predicted based on donor CYP3A5 gene polymorphism in renal transplant recipients. A total of 52 Japanese renal transplant patients receiving tacrolimus were enrolled in this study. Seventy-four renal biopsy specimens were obtained at 3 months and 1 year after transplantation to determine the donor CYP3A5 polymorphism and measure the Ctissue by liquid chromatography-tandem mass spectrometry (LC-MS-MS). The tacrolimus Ctissue ranged from 52 to 399 pg/mg tissue (n = 74) and was weak but significantly correlated with tacrolimus trough concentration (C0) at 3 months after transplantation (Spearman, r = 0.3560, p = 0.0096). No significant relationship was observed between the donor CYP3A5 gene polymorphism and Ctissue or Ctissue/C0. These data showed that the tacrolimus systemic level has an impact on tacrolimus renal accumulation after renal transplantation. However, donor CYP3A5 gene polymorphism alone cannot be used to predict tacrolimus intrarenal exposure. This study may be valuable for exploring tacrolimus renal metabolism and toxicology mechanism in renal transplant recipients.
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Affiliation(s)
- Mengyu Zhang
- Department of Clinical Pharmacology and Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (M.Z.); (T.S.); (R.F.); (N.E.)
| | - Soichiro Tajima
- Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;
| | - Tomohiro Shigematsu
- Department of Clinical Pharmacology and Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (M.Z.); (T.S.); (R.F.); (N.E.)
- Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;
| | - Rao Fu
- Department of Clinical Pharmacology and Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (M.Z.); (T.S.); (R.F.); (N.E.)
| | - Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (H.N.); (K.K.); (Y.O.)
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (H.N.); (K.K.); (Y.O.)
| | - Akihiro Tsuchimoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (H.N.); (K.K.); (Y.O.)
| | - Nobuaki Egashira
- Department of Clinical Pharmacology and Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (M.Z.); (T.S.); (R.F.); (N.E.)
- Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;
| | - Satohiro Masuda
- Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;
- Department of Pharmacy, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, International University of Health and Welfare, 2600-1 Kita-kanemaru, Otawara 324-8501, Japan
- Correspondence: ; Tel.: +81-476-35-5600
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15
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Bentata Y. Tacrolimus: 20 years of use in adult kidney transplantation. What we should know about its nephrotoxicity. Artif Organs 2019; 44:140-152. [PMID: 31386765 DOI: 10.1111/aor.13551] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Abstract
Tacrolimus (or FK506), a calcineurin inhibitor (CNI) introduced in field of transplantation in the 1990s, is the cornerstone of most immunosuppressive regimens in solid organ transplantation. Its use has revolutionized the future of kidney transplantation (KT) and has been associated with better graft survival, a lower incidence of rejection, and improved drug tolerance with fewer side effects compared to cyclosporine. However, its monitoring remains complicated and underexposure increases the risk of rejection, whereas overexposure increases the risk of adverse effects, primarily nephrotoxicity, neurotoxicity, infections, malignancies, diabetes, and gastrointestinal complaints. Tacrolimus nephrotoxicity can be nonreversible and can lead to kidney graft loss, and its diagnosis is therefore best made with reference to the clinical context and after exclusion of other causes of graft dysfunction. Many factors contribute to its development including: systemic levels of tacrolimus; local renal exposure to tacrolimus; exposure to metabolites of tacrolimus; local susceptibility factors for CNI nephrotoxicity independent of systemic or local tacrolimus levels, such as the age of a kidney; local renal P-glycoprotein, local intestinal and hepatic cytochrome P450A3, and renin angiotensin system activation. The aim of this review is to describe the pharmacokinetics, pharmacodynamics, and mechanisms of acute and chronic tacrolimus nephrotoxicity in adult KT.
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Affiliation(s)
- Yassamine Bentata
- Nephrology and Kidney Transplantation Unit, University Hospital Mohammed VI, University Mohammed First, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed First, Oujda, Morocco
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16
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Yanik MV, Seifert ME, Locke JE, Hauptfeld-Dolejsek V, Crowley MR, Cutter GR, Mannon RB, Feig DI, Limdi NA. CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients. Pediatr Transplant 2019; 23:e13494. [PMID: 31124575 PMCID: PMC8009482 DOI: 10.1111/petr.13494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/30/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Optimal management of immunosuppression in kidney transplantation requires a delicate balance of efficacy and toxicity. Tacrolimus (TAC) dose requirements are significantly impacted by genetic variation in CYP3A5 polymorphisms, however the impact that genotype has on clinical outcomes in the pediatric kidney transplant population remains unclear. METHODS We evaluated a retrospective cohort of 98 pediatric kidney transplant recipients. The primary exposure was CYP3A5 genotype, which classified each recipient into the expresser (at least one CYP3A5*1 allele) or non-expresser group (only CYP3A5*3 alleles). The primary outcome was time to achieve a steady therapeutic TAC concentration. Secondary outcomes include incidence of early allograft rejection and calcineurin inhibitor (CNI) nephrotoxicity during the first year post-transplant. RESULTS The study cohort included 55 (56%) expressers and 43 (44%) non-expressers of the CYP3A5*1 allele. Expressers had a significantly longer time to achieve a steady therapeutic TAC concentration than non-expressers (log rank, P = 0.03). Expressers had a trend for higher incidence of early allograft rejection (29.1% vs 16.3%, log rank, P = 0.16). Early biopsy-proven CNI nephrotoxicity was seen in 60% of recipients, with no differences in the rate between expressers and non-expressers. CONCLUSIONS Pediatric kidney transplant recipients with the CYP3A5*1 allele (expressers) take a longer time to achieve therapeutic TAC levels than those with the CYP3A5*3 allele (non-expressers). However, we observed no significant differences in acute rejection or CNI nephrotoxicity based on CYP3A5 genotype. Thus CYP3A5 genotype was not observed to have an immediate impact on early transplant outcomes.
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Affiliation(s)
- Megan V. Yanik
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael E. Seifert
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jayme E. Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Vera Hauptfeld-Dolejsek
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael R. Crowley
- Heflin Center for Genomic Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary R. Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roslyn B. Mannon
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel I. Feig
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nita A. Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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17
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Cheung CY, Chan KM, Wong YT, Chak WL, Bekers O, van Hooff JP. Impact of CYP3A5 Genetic Polymorphism on Intrapatient Variability of Tacrolimus Exposure in Chinese Kidney Transplant Recipients. Transplant Proc 2019; 51:1754-1757. [DOI: 10.1016/j.transproceed.2019.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/05/2023]
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18
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The Effects of CYP3A5 Genetic Polymorphisms on Serum Tacrolimus Dose-Adjusted Concentrations and Long-Term Prognosis in Chinese Heart Transplantation Recipients. Eur J Drug Metab Pharmacokinet 2019; 44:771-776. [PMID: 31087280 DOI: 10.1007/s13318-019-00563-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Effective management of immunosuppressants is extemely important to improve prognosis of heart transplant recipients. We aim to investigate the effects of cytochrome P450 (CYP) 3A5 (rs776746) single nucleotide polymorphisms (SNPs) on serum tacrolimus concentrations/doses (C/Ds, ng/mL per mg/kg) and long-term prognosis in Chinese heart transplant recipients. METHODS We detected the CYP3A5 SNPs of 203 consecutive Chinese heart transplant recipients between August 2005 and July 2012, and 55 of them who received tacrolimus-based immunosuppressive therapy were enrolled in this study. The tacrolimus C/Ds at 1, 3, 6, 12, 24 and 36 months after transplantation were routinely calculated. X-ray-guided endomyocardial biopsies (EMBs) were performed at 1, 3 and 6 months after heart transplantion to evaluate acute rejection degrees. All participants were then followed up annually until May 2018. The designed primary endpoint was all-cause mortality. RESULTS In 55 heart transplant recipients (43 males and 12 females), CYP3A5 non-expressors (CYP3A5*3/*3, n = 40) had significantly higher tacrolimus C/Ds than expressors (CYP3A5*1/*3, n = 15) at all time points (P < 0.001). Chi-squared test showed no significant differences in EMB-proven acute rejections between the two groups within 6 months after heart transplantion. The median follow-up period was 94.7 months, and eight patients died. Kaplan-Meier analysis showed CYP3A5 expressors tend to have higher mortality than non-expressors (20% vs 12.5%, log-rank: P = 0.314). CONCLUSIONS CYP3A5 SNPs affect tacrolimus pharmacokinetics in Chinese heart transplant recipients, and non-expressors have higher tacrolimus C/Ds. In addition, expressors tend to have a worse long-term prognosis than non-expressors.
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Effect of tacrolimus dispositional genetics on acute rejection in the first 2 weeks and estimated glomerular filtration rate in the first 3 months following kidney transplantation. Pharmacogenet Genomics 2019; 29:9-17. [DOI: 10.1097/fpc.0000000000000360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Riva N, Dip M, Halac E, Cáceres Guido P, Woillard JB, Licciardone N, Chan D, Buendía J, Borgnia D, Bosaleh A, de Davila MT, Imventarza O, Schaiquevich P. Survival Time to Biopsy-Proven Acute Rejection and Tacrolimus Adverse Drug Reactions in Pediatric Liver Transplantation. Ther Drug Monit 2018; 40:401-410. [PMID: 29621122 DOI: 10.1097/ftd.0000000000000517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite advances in surgical procedures and the optimization of immunosuppressive therapies in pediatric liver transplantation, acute rejection (AR) and serious adverse drug reaction (ADR) to tacrolimus still contribute to morbidity and mortality. Identifying risk factors of safety and efficacy parameters may help in optimizing individual immunosuppressive therapies. This study aimed to identify peritransplant predictors of AR and factors related to the risk of ADR to tacrolimus in a large Latin American cohort of pediatric liver transplant patients. METHODS We performed a retrospective cohort study in a pediatric liver transplant population (n = 72). Peritransplant variables were collected retrospectively including demographic, clinical, laboratory parameters, genomic (CYP3A5 donor and recipients polymorphism), and tacrolimus trough concentrations (C0) over a 2-year follow-up period. Variability in tacrolimus C0 was calculated using percent coefficient of variation and tortuosity. ADR- and AR-free survival rates were calculated using the Kaplan-Meier method, and risk factors were identified by multivariate Cox regression models. RESULTS Cox-proportional hazard models identified that high tortuosity in tacrolimus C0 was associated with an 80% increased risk of AR [hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.01-3.22; P < 0.05], whereas steroid in maintenance doses decreased this risk (HR, 0.56; 95% CI, 0.31-0.99; P < 0.05). Forty-six patients experienced at least one ADR including hypomagnesemia, nephrotoxicity, hypertension, malignancies, and tremor as a first event. Multivariate analysis showed that C0 values 10 days before the event (HR, 1.25; 95% CI, 1.21-1.39; P < 0.0001) and CYP3A5 expresser recipients (HR, 2.05; 95% CI, 1.03-4.06; P < 0.05) were independent predictors of ADR. CONCLUSIONS Tacrolimus C0 values, its variability, and CYP3A5 polymorphisms were identified as risk factors of AR and tacrolimus ADR. This knowledge may help to control and reduce their incidence in pediatric liver transplant patients. Prospective studies are important to validate these results.
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Affiliation(s)
- Natalia Riva
- Unit of Clinical Pharmacokinetics, Hospital de Pediatría J.P. Garrahan
| | - Marcelo Dip
- Liver Transplant Service, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | - Esteban Halac
- Liver Transplant Service, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | | | - Jean B Woillard
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire à Limoges, Limoges, France
| | | | - Debora Chan
- Basic Science-Mathematics, Universidad Tecnológica Nacional
| | | | | | | | | | - Oscar Imventarza
- Liver Transplant Service, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatría J.P. Garrahan.,National Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina
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21
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Effect of CYP3A5 genotype on hospitalization cost for kidney transplantation. Int J Clin Pharm 2018; 41:88-95. [DOI: 10.1007/s11096-018-0750-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 11/08/2018] [Indexed: 12/23/2022]
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Yu M, Liu M, Zhang W, Ming Y. Pharmacokinetics, Pharmacodynamics and Pharmacogenetics of Tacrolimus in Kidney Transplantation. Curr Drug Metab 2018; 19:513-522. [PMID: 29380698 PMCID: PMC6182932 DOI: 10.2174/1389200219666180129151948] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/03/2017] [Accepted: 10/13/2017] [Indexed: 01/10/2023]
Abstract
Background: Tacrolimus (Tac, or FK506), a calcineurin inhibitor (CNI), is the first-line immu-nosuppressant which consists of the footstone as immunosuppressive regimens in kidney transplantation. However, the drug toxicity and the significant differences of pharmacokinetics (PK) and pharmacodynam-ics (PD) among individuals are hidden troubles for clinical application. Recently, emerging evidences of Tac pharmacogenetics (PG) regarding drug absorption, metabolism, disposition, excretion and response are discovered for better understanding of this drug. Method: We reviewed the published articles regarding the Tac PG and its effects on PK and PD in kidney transplantation. In addition, we summarized information on polygenic algorithms. Results: The polymorphism of genes encoding metabolic enzymes and transporters related to Tac were largely investigated, but the results were inconsistent. In addition to CYP3A4, CYP3A5 and P-gp (also known as ABCB1), single nucleotide polymorphisms (SNPs) might also affect the PK and PD parameters of Tac. Conclusion: The correlation between Tac PK, PD and PG is very complex. Although many factors need to be verified, it is envisaged that thorough understanding of PG may assist clinicians to predict the optimal starting dosage, help adjust the maintenance regimen, as well as identify high risk patients for adverse ef-fects or drug inefficacy
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Affiliation(s)
- Meng Yu
- Transplantation center, The 3rd Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Mouze Liu
- Institute of Clinical Pharmacology, Central South University; Hunan Key Laboratory of Pharmacogenetics, Changsha, 410078, Hunan, China
| | - Wei Zhang
- Institute of Clinical Pharmacology, Central South University; Hunan Key Laboratory of Pharmacogenetics, Changsha, 410078, Hunan, China
| | - Yingzi Ming
- Transplantation center, The 3rd Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
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Egeland EJ, Reisaeter AV, Robertsen I, Midtvedt K, Strøm EH, Holdaas H, Hartmann A, Åsberg A. High tacrolimus clearance - a risk factor for development of interstitial fibrosis and tubular atrophy in the transplanted kidney: a retrospective single-center cohort study. Transpl Int 2018; 32:257-269. [PMID: 30252957 DOI: 10.1111/tri.13356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/31/2018] [Accepted: 09/19/2018] [Indexed: 12/11/2022]
Abstract
Patients with high tacrolimus clearance are more likely to experience transient under-immunosuppression in case of a missed or delayed dose. We wanted to investigate the association between estimated tacrolimus clearance and development of graft interstitial fibrosis and tubular atrophy (IFTA) in kidney transplant recipients. Associations between estimated tacrolimus clearance [daily tacrolimus dose (mg)/trough concentration (μg/l)] and changes in IFTA biopsy scores from week 7 to 1-year post-transplantation were investigated. Data from 504 patients transplanted between 2009 and 2013 with paired protocol biopsies (7 weeks + 1-year post-transplant) were included. There were no differences in baseline biopsy scores (7 weeks) in patients with different estimated tacrolimus clearance. Increasing tacrolimus clearance was significantly associated with increased ci + ct score of ≥2 at 1 year, odds ratio of 1.67 (95% CI; 1.11-2.51). In patients without fibrosis (ci + ct ≤ 1) at 7 weeks (n = 233), increasing tacrolimus clearance was associated with development of de novo IFTA (i + t ≤ 1 and ci + ct ≥ 2) at 1 year, odds ratio of 2.01 (95% CI; 1.18-3.50) after adjusting for confounders. High tacrolimus clearance was significantly associated with development of IFTA the first year following renal transplantation.
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Affiliation(s)
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ida Robertsen
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Hallvard Holdaas
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Anders Hartmann
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Anders Åsberg
- School of Pharmacy, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Yang L, de Winter BCM, van Schaik RHN, Xie RX, Li Y, Andrews LM, Shuker N, Bahmany S, Koch B, van Gelder T, Hesselink DA. CYP3A5 and ABCB1 polymorphisms in living donors do not impact clinical outcome after kidney transplantation. Pharmacogenomics 2018; 19:895-903. [PMID: 29991328 DOI: 10.2217/pgs-2018-0066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: To investigate the association between donor CYP3A5 and ABCB1 polymorphisms and tacrolimus (Tac)-induced nephrotoxicity and renal function in kidney transplant recipients. Methods: The CYP3A5 6986A>G and ABCB1 3435C>T polymorphisms were determined in 237 recipients and donors. Results: There was no significant association between Tac-related nephrotoxicity and donor CYP3A5 and ABCB1 genotype. The donor ABCB1 3435C>T polymorphism was associated with estimated glomerular filtration rate on day 7 and month 1. The combined donor–recipient ABCB1 genotype (3435C>T polymorphism) was significantly related with estimated glomerular filtration rate on day 3 and 7 in univariate analysis. However, these differences were no longer statistically significant in multivariate analysis. Conclusion: A genetic analysis of ABCB1 and CYP3A5 of kidney transplant donors is not helpful to improve renal transplant outcomes.
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Affiliation(s)
- Lin Yang
- Department of Pharmacy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, PR China
| | - Brenda CM de Winter
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ron HN van Schaik
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rui-Xiang Xie
- Department of Pharmacy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, PR China
| | - Yi Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Louise M Andrews
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nauras Shuker
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Soma Bahmany
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Birgit Koch
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Nephrology & Transplantation, Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Division of Nephrology & Transplantation, Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Yang J, Claas FHJ, Eikmans M. Genome-wide association studies in kidney transplantation: Advantages and constraints. Transpl Immunol 2018; 49:1-4. [PMID: 29704558 DOI: 10.1016/j.trim.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 01/03/2023]
Abstract
Since the discovery of the human leukocyte antigen (HLA) system, the role of HLA molecules in the field of transplantation has been appreciated: better matching leads to better graft function. Since then, the association of other genetic polymorphisms with clinical outcome has been investigated in many studies. Genome-wide association studies (GWAS) represent a powerful tool to identify causal genetic variants, by simultaneously analyzing millions of single nucleotide polymorphisms scattered across the genome. GWAS in transplantation may indeed be useful to reveal novel markers that may potentially be involved in the mechanism of allograft rejection and graft failure. However, the relevance of GWAS for risk stratification or donor selection for an individual patient is limited as is already reflected by the fact that many parameters, significant in one study, cannot be confirmed in another one.
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Affiliation(s)
- Jianxin Yang
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H J Claas
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Eikmans
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
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Meng HY, Luo ZH, Hu B, Jin WL, Yan CK, Li ZB, Xue YY, Liu Y, Luo YE, Xu LQ, Yang H. SNPs affecting the clinical outcomes of regularly used immunosuppressants. Pharmacogenomics 2018. [PMID: 29517418 DOI: 10.2217/pgs-2017-0182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Recent studies have suggested that genomic diversity may play a key role in different clinical outcomes, and the importance of SNPs is becoming increasingly clear. In this article, we summarize the bioactivity of SNPs that may affect the sensitivity to or possibility of drug reactions that occur among the signaling pathways of regularly used immunosuppressants, such as glucocorticoids, azathioprine, tacrolimus, mycophenolate mofetil, cyclophosphamide and methotrexate. The development of bioinformatics, including machine learning models, has enabled prediction of the proper immunosuppressant dosage with minimal adverse drug reactions for patients after organ transplantation or for those with autoimmune diseases. This article provides a theoretical basis for the personalized use of immunosuppressants in the future.
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Affiliation(s)
- Huan-Yu Meng
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Zhao-Hui Luo
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Bo Hu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Wan-Lin Jin
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Cheng-Kai Yan
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Zhi-Bin Li
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Yuan-Yuan Xue
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Yu Liu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Yi-En Luo
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Li-Qun Xu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, PR China
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Chen L, Prasad GVR. CYP3A5 polymorphisms in renal transplant recipients: influence on tacrolimus treatment. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2018; 11:23-33. [PMID: 29563827 PMCID: PMC5846312 DOI: 10.2147/pgpm.s107710] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tacrolimus is a commonly used immunosuppressant after kidney transplantation. It has a narrow therapeutic range and demonstrates wide interindividual variability in pharmacokinetics, leading to potential underimmunosuppression or toxicity. Genetic polymorphism in CYP3A5 enzyme expression contributes to differences in tacrolimus bioavailability between individuals. Individuals carrying one or more copies of the wild-type allele *1 express CYP3A5, which increases tacrolimus clearance. CYP3A5 expressers require 1.5 to 2-fold higher tacrolimus doses compared to usual dosing to achieve therapeutic blood concentrations. Individuals with homozygous *3/*3 genotype are CYP3A5 nonexpressers. CYP3A5 nonexpression is the most frequent phenotype in most ethnic populations, except blacks. Differences between CYP3A5 genotypes in tacrolimus disposition have not translated into differences in clinical outcomes, such as acute rejection and graft survival. Therefore, although genotype-based dosing may improve achievement of therapeutic drug concentrations with empiric dosing, its role in clinical practice is unclear. CYP3A5 genotype may predict differences in absorption of extended-release and immediate-release oral formulations of tacrolimus. Two studies found that CYP3A5 expressers require higher doses of tacrolimus in the extended-release formulation compared to immediate release. CYP3A5 genotype plays a role in determining the impact of interacting drugs, such as fluconazole, on tacrolimus pharmacokinetics. Evidence conflicts regarding the impact of CYP3A5 genotype on risk of nephrotoxicity associated with tacrolimus. Further study is required.
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Affiliation(s)
- Lucy Chen
- Kidney Transplant Program, St Michael's Hospital, Toronto, ON, Canada
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Flamme-Obry F, Belaiche S, Hazzan M, Ramdan N, Noël C, Odou P, Décaudin B. [Clinical pharmacist and medication reconciliation in kidney transplantation]. Nephrol Ther 2018; 14:91-98. [PMID: 29477279 DOI: 10.1016/j.nephro.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Drug related problems (DRP) can lead to severe consequences in kidney recipients. The aim of the study was to assess the impact of the clinical pharmacist interventions on the incidence of DRP. METHOD The number of DRP were evaluated according to 3periods: Without intervention, with medication reconciliation at admission, and with medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge. RESULTS Patients concerned were mainly men, 55years old (median age), stage3 of CKD, transplanted for less than 3months or more than 1year, with cardiovascular risk factors and receiving an average of 9drugs/day. Among the DRP, 20% were avoidable and severe in most cases. In period1, 27.7% patients had at least 1DRP, in period2, 21.3% patients had at least 1DRP, and in period3, 17.4% of patients had at least 1DRP (P=0.03). One hundred and ten patients had medication reconciliation at admission with a mean of 0.6unintentional discrepancies per patient (omission in 81% of cases). The main drugs involved concerned the digestive-metabolic (24.5%), cardiovascular (23%), and nervous (23%) system. Sixty-eight interviews at discharge were realized and revealed self-medication habits. CONCLUSION Our study shows that medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge can help to reduce DRP in kidney recipients. Further studies are needed to confirm our results.
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Affiliation(s)
| | - Stéphanie Belaiche
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France.
| | - Marc Hazzan
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Nassima Ramdan
- EA 2694, santé publique : épidémiologie et qualité des soins, CHRU de Lille, University Lille, 59000 Lille, France
| | - Christian Noël
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Pascal Odou
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
| | - Bertrand Décaudin
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
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Asempa TE, Rebellato LM, Hudson S, Briley K, Maldonado AQ. Impact of CYP3A5 genomic variances on clinical outcomes among African American kidney transplant recipients. Clin Transplant 2017; 32. [PMID: 29161757 DOI: 10.1111/ctr.13162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 01/22/2023]
Abstract
Little is known about the impact of CYP3A5 polymorphisms on transplantation outcomes among African American (AA) kidney transplant recipients (KTRs). To assess this issue, clinical outcomes were compared between AA CYP3A5*1 expressers and nonexpressers. This retrospective cohort study analyzed AA KTRs. Biopsy-proven acute rejection (BPAR), delayed graft function (DGF), glomerular filtration rate (GFR), infections, and tacrolimus dosing requirements were examined in 106 immunologically high-risk AA kidney transplant patients over a 2-year follow-up period. In CYP3A5*1 expressers compared to nonexpressers, the incidence of BPAR was significantly higher in the first 6 months (13% vs 0%; P = .016) compared to 24 months (13% vs 7%; P = .521). Tacrolimus total daily dose at first therapeutic level was significantly higher in CYP3A5*1 expressers (12 mg/day) compared to nonexpressers (8 mg/day; P < .001). Compared to CYP3A5*1 nonexpressers, DGF incidence was significantly higher among CYP3A5*1 expressers (27.6% vs 6.7%; P = .006). By contrast, median GFR was significantly higher in CYP3A5*1 expressers compared to nonexpressers (54.5 mL/min vs 50.0 mL/min; P = .003) at 24 months. The findings from this retrospective study suggest that AAs with CYP3A5*1 expression require 50% more tacrolimus and have an increased incidence of DGF and acute rejection.
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Affiliation(s)
- Tomefa E Asempa
- Department of Pharmacy, Vidant Medical Center, Greenville, NC, USA
| | - Lorita M Rebellato
- Department of Pathology & Laboratory Medicine, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Suzanne Hudson
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | - Kimberly Briley
- Department of Pathology & Laboratory Medicine, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
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Marquet P, Albano L, Woillard JB, Rostaing L, Kamar N, Sakarovitch C, Gatault P, Buchler M, Charpentier B, Thervet E, Cassuto E. Comparative clinical trial of the variability factors of the exposure indices used for the drug monitoring of two tacrolimus formulations in kidney transplant recipients. Pharmacol Res 2017; 129:84-94. [PMID: 29229354 DOI: 10.1016/j.phrs.2017.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several studies found differences in tacrolimus whole blood trough levels (C0) or area-under-the curve (AUC) between the twice-daily (Tac-BID) and once-daily (Tac-OD) formulations given to kidney transplant recipients at equal doses. As C0 is widely used as a surrogate of the AUC for individual dose adjustment, this study investigated the correlation and proportionality between C0 and the 24h-AUC, depending on the formulation, time post-transplantation, pharmacogenetics traits and other individual characteristics. METHODS 45 adult kidney transplant recipients were randomized to receive either Tac OD or Tac BID. On days 8±1 (D8) and 90±3 (month 3, M3), blood samples were collected over 24h in both groups. Tacrolimus concentrations were determined using HPLC-MS/MS and common CYP3A5, CYP3A4 and ABCB1 genotypes characterized using allelic discrimination assays. Tacrolimus population pharmacokinetics was studied in the two patient groups using the Iterative Two Stage (ITS) technique, considering a one-compartment model with two gamma laws to describe the absorption phase. Bayesian estimation based on the C0, C1h and C3h concentrations was employed to estimate individual Tac AUC0-12h and AUC12-24h (for Tac BID), or AUC0-24h (for Tac OD). Multiple linear regression was used to evaluate the influence of Tac formulation, post-transplantation period, recipient gender, existing glucose metabolism disorders, and CYP3A5, CYP3A4 and ABCB1 genotypes on C0, AUC0-24h and the AUC-to-trough concentration ratios. RESULTS The Full Analysis Set comprised 22 patients on Tac OD and 20 on Tac BID. Tac exposure indices as well as their time evolution were similar in the two groups. Multi-linear modeling analysis showed that the Tac dose was higher with Tac-OD than Tac-BID, on D8 than at M3 and in CYP3A5 expressors (p<0.0001 for all). No such influence was found on C0 or C24h, while the AUC0-24h was significantly higher on D8 than at M3. The AUC0-24h/C0 ratio was not affected by the drug formulation and the polymorphisms studied, but it was significantly lower on D8 than at M3 (p=7.8×10-5). In contrast, both the post-transplantation period (p=1.53×10-4), and CYP3A5 expression (p=0.003) had a significant influence on the AUC0-24h/C24h ratio, explaining 19% and 12% of its variability, respectively. Consistently, for both Tac formulations, the AUC0-24h was better correlated with C24h than C0, and for Tac-BID the AUC0-12h was better correlated with C12h than C0. CONCLUSIONS This study confirms that the precisely timed 12h- or 24h-post-dose blood concentration (as opposed to the vaguely defined 'trough level') is a convenient surrogate of the 24h-AUC of tacrolimus for the two TAC formulations over the first 3 months post-transplantation. Still, for a given C24h value, AUC0-24h was higher on D8 and in CYP3A5 expressors. Bayesian estimation of AUC0-12h for TAC BID and AUC0-24h for TAC OD is feasible using only 3 time points within the first 3h, thus giving access to the actual overall exposure.
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Affiliation(s)
- Pierre Marquet
- Univ. Limoges, UMR_S 850, Limoges, France; INSERM, U850, Limoges, France; CHU Limoges, Service de pharmacologie, toxicologie et pharmacovigilance, Limoges, France; FHU SUPPORT, Limoges, France.
| | | | - Jean-Baptiste Woillard
- Univ. Limoges, UMR_S 850, Limoges, France; INSERM, U850, Limoges, France; CHU Limoges, Service de pharmacologie, toxicologie et pharmacovigilance, Limoges, France; FHU SUPPORT, Limoges, France
| | - Lionel Rostaing
- INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France; Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Charlotte Sakarovitch
- Department of Clinical research and Innovation, Nice University Hospital, Nice, France
| | - Philippe Gatault
- Department of Nephrology and Clinical Immunology, Bretonneau Hospital, CHRU de Tours, EA4245, Université François-Rabelais de Tours, Tours, France
| | - Matthias Buchler
- Department of Nephrology and Clinical Immunology, Bretonneau Hospital, CHRU de Tours, EA4245, Université François-Rabelais de Tours, Tours, France
| | - Bernard Charpentier
- Department of Nephrology, University Hospital of Bicêtre, Kremlin Bicêtre, IFNRT, UMR 1197 INSERM-Université Paris-Sud, Villejuif, France
| | - Eric Thervet
- Nephrology Department, Hopital Europeen Georges Pompidou, APHP, Paris, France; Université Paris Descartes, Paris France; Unite INSERM UMRS 1147, France
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31
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Gervasini G, García-Pino G, Vergara E, Mota-Zamorano S, García-Cerrada M, Luna E. CYP3A genotypes of donors but not those of the patients increase the risk of acute rejection in renal transplant recipients on calcineurin inhibitors: a pilot study. Eur J Clin Pharmacol 2017; 74:53-60. [DOI: 10.1007/s00228-017-2353-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/10/2017] [Indexed: 01/28/2023]
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Stapleton CP, Conlon PJ, Phelan PJ. Using omics to explore complications of kidney transplantation. Transpl Int 2017; 31:251-262. [PMID: 28892567 DOI: 10.1111/tri.13067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/26/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
Abstract
The importance of genetic and biochemical variation in renal transplant outcomes has been clear since the discovery of the HLA in the 1950s. Since that time, there have been huge advancements in both transplantation and omics. In recent years, there has seen an increased number of genome-, proteome- and transcriptome-wide studies in the field of transplantation moving away from the earlier candidate gene/protein approaches. These areas have the potential to lead to the development of personalized treatment depending on individual molecular risk profiles. Here, we discuss recent progress and the current literature surrounding omics and renal transplant complications.
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Affiliation(s)
- Caragh P Stapleton
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland.,Department of Medicine, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul J Phelan
- Department of Nephrology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
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Tortajada-Genaro LA, Puchades R, Maquieira Á. Primer design for SNP genotyping based on allele-specific amplification—Application to organ transplantation pharmacogenomics. J Pharm Biomed Anal 2017; 136:14-21. [DOI: 10.1016/j.jpba.2016.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 12/12/2022]
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Flahault A, Anglicheau D, Loriot MA, Thervet E, Pallet N. Clinical impact of the CYP3A5 6986A>G allelic variant on kidney transplantation outcomes. Pharmacogenomics 2016; 18:165-173. [PMID: 27977332 DOI: 10.2217/pgs-2016-0146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIM Meta-analyses and large cohort studies provide confusing results on the association of the CYP3A5 6986A>G allelic variant and adverse outcomes in kidney transplant recipients under tacrolimus-based immunosuppressive regimen. A residual effect of CYP3A5 recipient genotype is unexpected if kidney transplant recipients have similar exposure of tacrolimus. PATIENTS & METHODS We have undertaken a population-based, observational study, to investigate all the consecutive patients who received a kidney transplant at the Necker hospital between 2005 and 2015, who were treated with tacrolimus and for whom the CYP3A5 genotype was available. RESULTS & CONCLUSION We analyzed 577 patients followed for up to 5 years. We found a significant association of CYP3A5 genotypes with tacrolimus daily dose as well as with tacrolimus dose-adjusted concentrations. We however found no association of CYP3A5 genotypes with histology scores on biopsies, measured renal function, biopsy-proven acute rejection episodes and graft survival.
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Affiliation(s)
- Adrien Flahault
- College de France, Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis & Cardiovascular Functions, CIRB, INSERM U1050, Paris, France
| | - Dany Anglicheau
- Paris Descartes University, Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France.,Department of Nephrology & Kidney Transplantation, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie-Anne Loriot
- Paris Descartes University, Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France.,Clinical Chemistry Department, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eric Thervet
- Paris Descartes University, Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France.,Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Pallet
- Paris Descartes University, Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France.,Clinical Chemistry Department, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
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35
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Brooks E, Tett SE, Isbel NM, Staatz CE. Population Pharmacokinetic Modelling and Bayesian Estimation of Tacrolimus Exposure: Is this Clinically Useful for Dosage Prediction Yet? Clin Pharmacokinet 2016; 55:1295-1335. [DOI: 10.1007/s40262-016-0396-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Tang JT, Andrews LM, van Gelder T, Shi YY, van Schaik RHN, Wang LL, Hesselink DA. Pharmacogenetic aspects of the use of tacrolimus in renal transplantation: recent developments and ethnic considerations. Expert Opin Drug Metab Toxicol 2016; 12:555-65. [PMID: 27010623 DOI: 10.1517/17425255.2016.1170808] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Tacrolimus (Tac) is effective in preventing acute rejection but has considerable toxicity and inter-individual variability in pharmacokinetics and pharmacodynamics. Part of this is explained by polymorphisms in genes encoding Tac-metabolizing enzymes and transporters. A better understanding of Tac pharmacokinetics and pharmacodynamics may help to minimize different outcomes amongst transplant recipients by personalizing immunosuppression. AREAS COVERED The pharmacogenetic contribution of Tac metabolism will be examined, with a focus on recent discoveries, new developments and ethnic considerations. EXPERT OPINION The strongest and most consistent association in pharmacogenetics is between the CYP3A5 genotype and Tac dose requirement, with CYP3A5 expressers having a ~ 40-50% higher dose requirement compared to non-expressers. Two recent randomized-controlled clinical trials using CYP3A5 genotype, however, did not show a decrease in acute rejections nor reduced toxicity. CYP3A4*22, CYP3A4*26, and POR*28 are also associated with Tac dose requirements and may be included to provide the expected improvement of Tac therapy. Studies focusing on the intracellular drug concentrations and on calcineurin inhibitor-induced nephrotoxicity also seem promising. For all studies, however, the ethnic prevalence of genotypes should be taken into account, as this may significantly impact the effect of pre-emptive genotyping.
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Affiliation(s)
- J T Tang
- a Department of Laboratory Medicine , West China Hospital of Sichuan University , Chengdu , China.,b Department of Hospital Pharmacy , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - L M Andrews
- b Department of Hospital Pharmacy , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - T van Gelder
- b Department of Hospital Pharmacy , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.,c Department of Internal Medicine, Division of Nephrology and Renal Transplantation , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Y Y Shi
- d Department of Nephrology , West China Hospital of Sichuan University , Chengdu , China
| | - R H N van Schaik
- e Department of Clinical Chemistry , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - L L Wang
- a Department of Laboratory Medicine , West China Hospital of Sichuan University , Chengdu , China
| | - D A Hesselink
- c Department of Internal Medicine, Division of Nephrology and Renal Transplantation , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
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37
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Pharmacogenetic Biomarkers Predictive of the Pharmacokinetics and Pharmacodynamics of Immunosuppressive Drugs. Ther Drug Monit 2016; 38 Suppl 1:S57-69. [DOI: 10.1097/ftd.0000000000000255] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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38
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Vanhove T, Annaert P, Kuypers DRJ. Clinical determinants of calcineurin inhibitor disposition: a mechanistic review. Drug Metab Rev 2016; 48:88-112. [DOI: 10.3109/03602532.2016.1151037] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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39
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Yan L, Li Y, Tang JT, An YF, Wang LL, Shi YY. Donor ABCB1 3435 C>T genetic polymorphisms influence early renal function in kidney transplant recipients treated with tacrolimus. Pharmacogenomics 2016; 17:249-57. [PMID: 26784512 DOI: 10.2217/pgs.15.165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM Determine the effect of genetic variants of donors and recipients on early renal function and tacrolimus pharmacokinetics in kidney transplant recipients. PATIENTS & METHODS We measured CYP3A5 (6986A>G), ABCB1 (3435C>T, 2677G>T/A, 1236C>T) genetic polymorphisms in 120 renal transplant recipients and donors by high-resolution melting curve analysis. The renal function and tacrolimus trough concentrations were analyzed. RESULTS The genotype of CYP3A5 (6986A>G) in recipients showed strong influence on tacrolimus pharmacokinetics. The ABCB1 3435 CC genotype in donor was significantly associated with lower estimated glomerular filtration in recipients within 1 month (p < 0.05) and correlated with delayed creatinine recovery (p = 0.007). CONCLUSIONS ABCB1 3435 CC genotype in donor influences early renal function and creatinine recovery in tacrolimus-treated kidney transplant recipients.
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Affiliation(s)
- Lin Yan
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Li
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang-Tao Tang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yun-Fei An
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lan-Lan Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yun-Ying Shi
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
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40
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Burke MT, Isbel N, Barraclough KA, Jung JW, Wells JW, Staatz CE. Genetics and nonmelanoma skin cancer in kidney transplant recipients. Pharmacogenomics 2016; 16:161-72. [PMID: 25616102 DOI: 10.2217/pgs.14.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Kidney transplant recipients (KTRs) have a 65- to 250-fold greater risk than the general population of developing nonmelanoma skin cancer. Immunosuppressive drugs combined with traditional risk factors such as UV radiation exposure are the main modifiable risk factors for skin cancer development in transplant recipients. Genetic variation affecting immunosuppressive drug pharmacokinetics and pharmacodynamics has been associated with other transplant complications and may contribute to differences in skin cancer rates between KTRs. Genetic polymorphisms in genes encoding the prednisolone receptor, GST enzyme, MC1R, MTHFR enzyme and COX-2 enzyme have been shown to increase the risk of nonmelanoma skin cancer in KTRs. Genetic association studies may improve our understanding of how genetic variation affects skin cancer risk and potentially guide immunosuppressive treatment and skin cancer screening in at risk individuals.
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Affiliation(s)
- Michael T Burke
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
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41
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Effect of Genetic Polymorphism of CYP3A5 and CYP2C19 and Concomitant Use of Voriconazole on Blood Tacrolimus Concentration in Patients Receiving Hematopoietic Stem Cell Transplantation. Ther Drug Monit 2015; 37:581-8. [DOI: 10.1097/ftd.0000000000000182] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Stefanović NZ, Cvetković TP, Jevtović-Stoimenov TM, Ignjatović AM, Paunović GJ, Veličković RM. Investigation of CYP 3A5 and ABCB1 gene polymorphisms in the long-term following renal transplantation: Effects on tacrolimus exposure and kidney function. Exp Ther Med 2015; 10:1149-1156. [PMID: 26622455 DOI: 10.3892/etm.2015.2598] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 06/08/2015] [Indexed: 12/21/2022] Open
Abstract
The clinical use of tacrolimus (Tac) is complicated by the large inter-individual variability in its pharmacokinetics as well as by chronic adverse effects on renal function. The main goal of this study was to evaluate the potential influence of cytochrome P450 3A5 (CYP 3A5) and ATP-binding cassette transporter B1 (ABCB1) gene polymorphisms on Tac dose requirements and dose-adjusted concentrations in different long-term periods following renal transplantation. Another aim was to investigate whether these polymorphisms affect renal function in late post-transplant period. A total of 91 renal transplant recipients were enrolled for genotyping analysis, and 53 of these entered into a pharmacokinetic-pharmacogenetic study. Allele-specific polymerase chain reaction was used for CYP 3A5 and ABCB1 polymorphism determination. Pharmacokinetic data (dose, trough concentration and dose-adjusted concentration of Tac) and renal function parameters [creatinine (Cre) clearance and serum Cre level] were analyzed in relation to patient genotype at 6, 12 and 24 months after transplantation. Also, linear regression analysis was performed to evaluate the effect of CYP 3A5 and ABCB1 genotypes on Tac exposure and renal function up to 24 months post-transplant. Individuals carrying the CYP 3A5*1/*3 genotype had higher Tac dose requirements than CYP 3A5*3/*3 carriers at 6, 12 and 24 months after renal transplantation. The results revealed that ABCB1 polymorphism did not influence Tac dose requirements independently. Regression analysis showed that CYP 3A5 influenced the Tac dose-adjusted concentration as well as renal function up to 24 months post-transplant. These findings confirmed that CYP 3A5 polymorphism represents the most important determinant of Tac dose and exposure in the late period following renal transplantation. Furthermore, the obtained results indicate that the decline in renal function may be more pronounced in patients with CYP 3A5*1 in the long-term period after renal transplantation.
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Affiliation(s)
- Nikola Z Stefanović
- Department of Pharmacy, Faculty of Medicine, University of Nis, Nis 18000, Serbia
| | - Tatjana P Cvetković
- Institute of Biochemistry, Faculty of Medicine, University of Nis, Nis 18000, Serbia ; Clinic of Nephrology, Clinical Centre Nis, Nis 18000, Serbia
| | | | | | | | - Radmila M Veličković
- Department of Pharmacy, Faculty of Medicine, University of Nis, Nis 18000, Serbia ; Clinic of Nephrology, Clinical Centre Nis, Nis 18000, Serbia
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43
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Yang TH, Chen YK, Xue F, Han LZ, Shen CH, Zhou T, Luo Y, Zhang JJ, Xia Q. Influence ofCYP3A5genotypes on tacrolimus dose requirement: age and its pharmacological interaction withABCB1genetics in the Chinese paediatric liver transplantation. Int J Clin Pract 2015:53-62. [PMID: 26176181 DOI: 10.1111/ijcp.12667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- T.-H. Yang
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - Y.-K. Chen
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - F. Xue
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - L.-Z. Han
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - C.-H. Shen
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - T. Zhou
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - Y. Luo
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - J.-J. Zhang
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
| | - Q. Xia
- Department of Liver Surgery and Liver Transplantation; Ren Ji Hospital; School of Medicine Shanghai Jiao Tong University; Shanghai China
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44
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The donor ABCB1 (MDR-1) C3435T polymorphism is a determinant of the graft glomerular filtration rate among tacrolimus treated kidney transplanted patients. J Hum Genet 2015; 60:273-6. [DOI: 10.1038/jhg.2015.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 01/28/2023]
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45
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Personalized tacrolimus dose requirement by CYP3A5 but not ABCB1 or ACE genotyping in both recipient and donor after pediatric liver transplantation. PLoS One 2014; 9:e109464. [PMID: 25310192 PMCID: PMC4195667 DOI: 10.1371/journal.pone.0109464] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/10/2014] [Indexed: 12/20/2022] Open
Abstract
Tacrolimus (TAC) is the backbone of an immunosuppressive drug used in most solid organ transplant recipients. A single nucleotide polymorphism (SNP) at position 6986G>A in CYP3A5 has been notably involved in the pharmacokinetic variability of TAC. It is hypothesized that CYP3A5 genotyping in patients may provide a guideline for TAC therapeutic regimen. To further evaluate the impact of CYP3A5 variants in donors and recipients, ABCB1 and ACE SNPs in recipients on TAC disposition, clinical and laboratory data were retrospectively reviewed from 90 pediatric patients with liver transplantation and their corresponding donors after 1 year of transplantation. The recipients with CYP3A5 *1/*1 or *1/*3 required more time to achieve TAC therapeutic range during the induction phase, and needed more upward dose during the late induction and the maintained phases, with lower C/D ratio, compared with those with CYP3A5 *3/*3. And donor CYP3A5 genotypes were found to impact on TAC trough concentrations after liver transplantation. No association between ABCB1 or ACE genotypes and TAC disposition post-transplantation was found. These results strongly suggest that CYP3A5 genotyping both in recipient and donor, not ABCB1 or ACE is necessary for establishing a personalized TAC dosage regimen in pediatric liver transplant patients.
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46
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Saracino A, Muscaridola N, Cifarelli RA, Stallone G, Grandaliano G, Santarsia G. Multidrug-resistance 1 gene single-nucleotide polymorphisms do not influence long-term graft survival after kidney transplantation. Transplant Proc 2014; 46:2214-9. [PMID: 25242754 DOI: 10.1016/j.transproceed.2014.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The single-nucleotide polymorphisms (SNPs) of the Multidrug resistance 1 (MDR1) gene have been associated with changes in the pharmacokinetics of cyclosporine (CsA) and tacrolimus (FK506). Our aim was investigate the influence of MDR1 SNPs on long-term graft survival in a population of kidney transplant recipients. METHODS We retrospectively analyzed 154 patients; they were genotyped for the SNPs C1236T, G2677T/A, and C3435T and evaluated for the influence of those 3 SNPs on CsA or FK506 pharmacokinetics and on long-term graft survival. RESULTS Thirty-one patients were wild-type for C1236T, G2677T/A, and C3435T polymorphisms (group A), 76 patients had ≥1 heterozygous mutations (group B), and 47 patients had ≥1 homozygous mutations (group C). CsA-receiving patients in group C needed a significantly higher oral dose than patients in groups B and A (P=.02). No differences in FK506 trough level nor in oral dose taken were observed in FK506-receiving patients. Kaplan-Meier analysis did not show survival differences in the 3 groups, and Cox proportional hazards model confirmed that the MDR1 SNPs did not represent a risk for graft loss. CONCLUSIONS Pretransplantation determination of MDR1 SNPs may be helpful to optimize the starting dose of CsA but can not predict long-term graft survival.
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Affiliation(s)
- A Saracino
- Basilicata Referral Center for Transplantation Hospital of Matera, Matera, Italy.
| | - N Muscaridola
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - R A Cifarelli
- X-Life Metapontum Agrobios, Hospital of Matera, Matera, Italy
| | - G Stallone
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Grandaliano
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Santarsia
- Basilicata Referral Center for Transplantation Hospital of Matera, Matera, Italy
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47
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Rojas L, Neumann I, Herrero MJ, Bosó V, Reig J, Poveda JL, Megías J, Bea S, Aliño SF. Effect of CYP3A5*3 on kidney transplant recipients treated with tacrolimus: a systematic review and meta-analysis of observational studies. THE PHARMACOGENOMICS JOURNAL 2014; 15:38-48. [PMID: 25201288 DOI: 10.1038/tpj.2014.38] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/26/2014] [Accepted: 06/04/2014] [Indexed: 12/21/2022]
Abstract
The highly variable pharmacokinetics of tacrolimus can hamper the optimal management of kidney transplant patients. This variability has been attributed to the genetic polymorphism of CYP3A5 6986A>G, but the evidence is not clear. We conducted a meta-analysis of studies evaluating the effect of CYP3A5 polymorphism on kidney transplant recipients with tacrolimus plasma concentration divided by daily dose per body weight (C/D) and clinical outcomes. We searched in MEDLINE and EMBASE. We found evidence suggesting a significantly lower C/D among CYP3A5*1 allele carriers compared with carriers of the CYP3A5*3/*3 genotype at weeks 1 and 2, and months 1, 3, 6 and 12. We demonstrated that the expresser genotype might have higher risk of acute rejection and chronic nephrotoxicity. In conclusion, CYP3A5 6986A>G polymorphism can affect tacrolimus pharmacokinetics and the incidence of acute rejection and chronic nephrotoxicity on kidney transplant recipients. Patients at high risk of developing tacrolimus-related complications could be detected even before their kidney transplant.
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Affiliation(s)
- L Rojas
- 1] Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile [2] Pharmacogenetic Unit, Drug Clinical Area, Hospital Universitari i Politècnic, La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - I Neumann
- 1] Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile [2] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - M José Herrero
- Pharmacogenetic Unit, Drug Clinical Area, Hospital Universitari i Politècnic, La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - V Bosó
- Pharmacogenetic Unit, Drug Clinical Area, Hospital Universitari i Politècnic, La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - J Reig
- Pharmacogenetic Unit, Drug Clinical Area, Hospital Universitari i Politècnic, La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - J Luis Poveda
- Pharmacogenetic Unit, Drug Clinical Area, Hospital Universitari i Politècnic, La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - J Megías
- Pharmacogenetic Unit, Drug Clinical Area, Hospital Universitari i Politècnic, La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - S Bea
- Nephrology Department, Kidney transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - S F Aliño
- 1] Pharmacogenetic Unit, Drug Clinical Area, Hospital Universitari i Politècnic, La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain [2] Clinical Pharmacology Unit, Drug Clinical Area, Hospital Universitari i Politècnic La Fe, Valencia, Spain [3] Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain
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48
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The impact of APOL1, CAV1, and ABCB1 gene variants on outcomes in kidney transplantation: donor and recipient effects. Pediatr Nephrol 2014; 29:1485-92. [PMID: 23748364 PMCID: PMC3809028 DOI: 10.1007/s00467-013-2531-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022]
Abstract
Dramatic improvements have been seen in short-term kidney allograft survival over recent decades with introduction of more potent immunosuppressant medications and regimens. Unfortunately, improvements in long-term graft survival have lagged behind. The genomics revolution is providing new insights regarding the potential impact of kidney donor genotypes on long-term graft survival. Variation in the donor apolipoprotein L1 (APOL1), caveolin 1 (CAV1), and multi-drug resistance 1 encoding P-glycoprotein genes (ABCB1) are all associated with graft survival after kidney transplantation. Although the precise mechanisms whereby these donor gene variants confer risk for graft loss have yet to be determined, these findings provide novel opportunities for modifying interactive environmental factors and optimizing kidney allocation with the ultimate goal of improving long-term graft survival rates.
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Maluf DG, Dumur CI, Suh JL, Lee JK, Cathro EP, King AL, Gallon L, Brayman KL, Mas VR. Evaluation of molecular profiles in calcineurin inhibitor toxicity post-kidney transplant: input to chronic allograft dysfunction. Am J Transplant 2014; 14:1152-1163. [PMID: 24698514 PMCID: PMC4377109 DOI: 10.1111/ajt.12696] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 01/21/2014] [Accepted: 01/28/2014] [Indexed: 02/05/2023]
Abstract
The molecular basis of calcineurin inhibitor toxicity (CNIT) in kidney transplantation (KT) and its contribution to chronic allograft dysfunction (CAD) with interstitial fibrosis (IF) and tubular atrophy (TA) were evaluated by: (1) identifying specific CNIT molecular pathways that associate with allograft injury (cross-sectional study) and (2) assessing the contribution of the identified CNIT signature in the progression to CAD with IF/TA (longitudinal study). Kidney biopsies from well-selected transplant recipients with histological diagnosis of CNIT (n = 14), acute rejection (n = 13) and CAD with IF/TA (n = 10) were evaluated. Normal allografts (n = 18) were used as controls. To test CNIT contribution to CAD progression, an independent set of biopsies (n = 122) from 61 KT patients collected at 3 and ~12 months post-KT (range = 9-18) were evaluated. Patients were classified based on 2-year post-KT graft function and histological findings as progressors (n = 30) or nonprogressors to CAD (n = 31). Molecular signatures characterizing CNIT samples were identified. Patients classified as progressors showed an overlap of 7% and 22% with the CNIT signature at 3 and at ~12 months post-KT, respectively, while the overlap was <1% and 1% in nonprogressor patients, showing CNIT at the molecular level as a nonimmunological factor involved in the progression to CAD.
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Affiliation(s)
- DG Maluf
- University of Virginia, Department of Surgery PO Box 800679, Charlottesville, VA 22908-0679
| | - CI Dumur
- University of Virginia, Department of Pathology PO Box 800904, VA 22908-0214
| | - JL Suh
- University of Virginia, Department of Surgery PO Box 800679, Charlottesville, VA 22908-0679
| | - JK Lee
- University of Virginia, Division of Biostatistics PO Box 800717, VA 22298-0717
| | - EP Cathro
- University of Virginia, Department of Pathology PO Box 800904, VA 22908-0214
| | - AL King
- Virginia Commonwealth University, Division of Nephrology PO Box 980662, VA 23298-0662
| | - L Gallon
- Northwestern University, Division of Nephrology, Department of Internal Medicine, Comprehensive Transplant Center Chicago, IL 60611
| | - KL Brayman
- University of Virginia, Department of Surgery PO Box 800679, Charlottesville, VA 22908-0679
| | - VR Mas
- University of Virginia, Department of Surgery PO Box 800679, Charlottesville, VA 22908-0679
- Corresponding author: Valeria Mas, Ph.D. Associate Professor Research Surgery Co-Director Transplant Research Director Translational Genomics Transplant Laboratory Transplant Division, Department of Surgery University of Virginia PO Box 800679 Charlottesville, VA 22908-0679
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