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Gao H, Yang N, Yang L, Wang H, Zhang G, Ma X, Deng N. Advances and Perspectives in methods for identifying high platelet reactivity. Heliyon 2023; 9:e22214. [PMID: 38107326 PMCID: PMC10724541 DOI: 10.1016/j.heliyon.2023.e22214] [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: 05/08/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Antiplatelet therapy is the foundational treatment for the prevention and treatment of coronary and cerebrovascular ischemic events in patients with coronary heart disease, ischemic stroke, and transient ischemic attack (TIA). However, with more and more studies reporting an increased risk of thrombosis in some patients due to poor response to therapeutic agents, the selection of appropriate P2Y12 inhibitors has become a major challenge that needs to be addressed urgently. Currently, commonly used oral P2Y12 inhibitors include clopidogrel, ticagrelor, and prasugrel. Assessing patients' risk factors before the development of treatment regimens by effectively predicting the risk of high platelet reactivity with specific P2Y12 inhibitors in advance to avert the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) is the key point to the problem. Up to now, methods available for predicting platelet reactivity include genetic testing, platelet function testing, and risk scores. This review provides a summarization of the existent available identification methods and analyzes the advantages and drawbacks of different methods in specific clinical settings, intending to guide the rational clinical application of P2Y12 receptor inhibitors.
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Affiliation(s)
- Hua Gao
- Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
- School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
| | - Nan Yang
- School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
| | - Libo Yang
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Hui Wang
- Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Guoshan Zhang
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xueping Ma
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Ning Deng
- Office of Drug Clinical Trial Organization, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
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Giantini A, Timan IS, Dharma R, Sukmawan R, Setiabudy R, Alwi I, Harahap AR, Listiyaningsih E, Partakusuma LG, Tansir AR, Sahar W, Hidayat R. The role of clopidogrel resistance-related genetic and epigenetic factors in major adverse cardiovascular events among patients with acute coronary syndrome after percutaneous coronary intervention. Front Cardiovasc Med 2023; 9:1027892. [PMID: 36843628 PMCID: PMC9944402 DOI: 10.3389/fcvm.2022.1027892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023] Open
Abstract
Despite patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel therapy, some patients still experience major adverse cardiovascular events (MACEs). Clopidogrel resistance, which may be regulated by genetic and epigenetic factors, may play a role in MACEs. This study aimed to determine the association between genetic (CYP2C19 and P2Y12 polymorphisms) and epigenetic (DNA methylation of CYP2C19 and P2Y12 and miRNA-26a expression) factors and their effects on MACEs among post-PCI patients. Post-PCI patients who received a standard dosage of clopidogrel at Harapan Kita Hospital between September 2018 and June 2020 were included in this study. MACEs were observed in patients within 1 year after PCI. Platelet aggregation was assessed using light transmission aggregometry (LTA). DNA methylation of CYP2C19 and P2Y12 was assessed using the bisulfite conversion method. CYP2C19 and P2Y12 polymorphisms and miRNA-26a expression were evaluated using quantitative real-time polymerase chain reaction (qRT-PCR). Among a total of 201 subjects, 49.8% were clopidogrel-resistant, and 14.9% experienced MACEs within 1 year after PCI (death was 7.5%). Hypomethylation of CYP2C19 (p = 0.037) and miRNA-26a upregulation (p = 0.020) were associated with clopidogrel resistance. CYP2C19*2/*3 polymorphisms (p = 0.047) were associated with MACEs in 1 year. This study demonstrated that hypomethylation of CYP2C19 and miRNA-26a upregulation increased the risk of clopidogrel resistance in post-PCI patients, but there was no correlation between clopidogrel resistance and MACEs. However, CYP2C19*2/*3 polymorphisms were the factors that predicted MACEs within 1 year.
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Affiliation(s)
- Astuti Giantini
- Clinical Pathology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Central Jakarta, Indonesia,Universitas Indonesia Hospital, Universitas Indonesia, Depok, Indonesia,*Correspondence: Astuti Giantini ✉
| | - Ina S. Timan
- Clinical Pathology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Central Jakarta, Indonesia
| | - Rahajuningsih Dharma
- Clinical Pathology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Central Jakarta, Indonesia
| | - Renan Sukmawan
- Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Rianto Setiabudy
- Pharmacology and Therapeutics Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Central Jakarta, Indonesia
| | - Idrus Alwi
- Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Central Jakarta, Indonesia
| | - Alida R. Harahap
- Clinical Pathology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Central Jakarta, Indonesia
| | | | | | - Arif R. Tansir
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Windy Sahar
- Universitas Indonesia Hospital, Universitas Indonesia, Depok, Indonesia
| | - Rakhmad Hidayat
- Universitas Indonesia Hospital, Universitas Indonesia, Depok, Indonesia,Neurology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Central Jakarta, Indonesia
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The efficacy of clopidogrel in preventing recurrent cardiovascular events among Arab population carrying different CYP2C19 mutations: systematic review and meta-analysis. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00313-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The prevalence and the role of CYP2C19 gene mutations concerning recurrent Cardiovascular Events (CVEs) among patients treated with clopidogrel is still controversial especially among Arab people. Therefore, this review aimed to determine the frequency of CYP2C19 polymorphic alleles among the Arab population and to investigate the efficacy of clopidogrel as an antiplatelet drug among those carrying different variants of this gene.
Methodology
Two authors independently searched in PubMed, Google Scholar, and EMBASE databases at any year for studies related to the role of CYP2C19 gene on the prognosis of patients with CVEs treated with clopidogrel. The review included Arab people who were genotyped to determine the frequency of CYP2C19 genotypes and alleles (the qualitative part). Concerning the quantitative part (meta-analysis), only patients who previously had CVEs and using clopidogrel as secondary prophylaxis had been included. The Newcastle Ottawa Scale for non-randomizes Studies was utilized to consider the risk of bias among included studies. We analyzed the data using odds ratio at 95% confidence interval and the quality of evidence of each outcome measure was judged using GRADE approach.
Results
The current study revealed that 4% of Arabs reported in the included studies are homozygous, and 25% are heterozygous for the CYP2C19*2 allele. While 3% and 18.5% of them are homozygous and heterozygous of CYP2C19*17 alleles, respectively. A significant increased risk of recurrent CVEs by about threefold was associated with CYP2C19*2 or CYP2C19*3 allele carriers (OR = 3.32, CI = 1.94–5.67, and OR = 3.53, CI = 1.17–10.63, respectively). However, no significant increased risk among carriers of CYP2C19*17 mutation (OR = 0.80, (CI = 0.44–1.44) was documented.
Conclusion
The present study revealed that Arabs carrying CYP2C19*2 and CYP2C19*3 alleles could be at increased risk of decreasing the antiplatelet efficacy of clopidogrel and an alternative drug should be prescribed for those patients to avoid recurrent CVEs. However, few available studies were included in the quantitative part of the analysis and further studies with large sample size are recommended to confirm our results.
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Alkattan A, Alkhalifah A, Alsalameen E, Alghanim F, Radwan N. Polymorphisms of genes related to phase II metabolism and resistance to clopidogrel. Pharmacogenomics 2021; 23:61-79. [PMID: 34866404 DOI: 10.2217/pgs-2021-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Clopidogrel is an antiplatelet drug commonly used to prevent coagulation. This review aimed to investigate the effect of polymorphisms of G6PD, GCLC, GCLM, GSS, GST, GSR, HK and GLRX genes on clopidogrel during phase II metabolism through exploring previous studies. The results revealed that low glutathione plasma levels caused by several alleles related to these genes could affect the bioactivation process of the clopidogrel prodrug, making it unable to inhibit platelet aggregation perfectly and thus leading to severe consequences in patients with a high risk of blood coagulation. However, the study recommends platelet reactivity tests to predict clopidogrel efficacy rather than studying gene mutations, as most of these mutations are rare and other nongenetic factors could affect the drug's efficacy.
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Affiliation(s)
- Abdullah Alkattan
- Planning and Research Department, General Directorate of School Health, Ministry of Health, Riyadh 11176, Saudi Arabia
| | - Ahmed Alkhalifah
- Department of Sales, Fresenius Kabi, Alhaya Medical Company, Riyadh, Saudi Arabia
| | - Eman Alsalameen
- Department of Pharmacy, King Khalid University Hospital, Medical City King Saud University, Riyadh, Saudi Arabia
| | - Fatimah Alghanim
- Department of General Medicine, Faculty of Medicine, Imam Abdulrahman bin Faisal University
| | - Nashwa Radwan
- Department of Public Health & Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.,Department of Research, Assisting Deputyship for Primary Health Care, Ministry of Heath, Riyadh, Saudi Arabia
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