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Abdel‐latif R, Badji R, Mohammed S, Al‐Muftah W, Mbarek H, Darwish D, Assaf D, Al‐Badriyeh D, Elewa H, Afifi N, Masoodi NA, Omar AS, Al Suwaidi J, Bujassoum S, Al Hail M, Ismail SI, Althani A. QPGx-CARES: Qatar pharmacogenetics clinical applications and research enhancement strategies. Clin Transl Sci 2024; 17:e13800. [PMID: 38818903 PMCID: PMC11140449 DOI: 10.1111/cts.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 06/01/2024] Open
Abstract
Pharmacogenetic (PGx)-informed medication prescription is a cutting-edge genomic application in contemporary medicine, offering the potential to overcome the conventional "trial-and-error" approach in drug prescription. The ability to use an individual's genetic profile to predict drug responses allows for personalized drug and dosage selection, thereby enhancing the safety and efficacy of treatments. However, despite significant scientific and clinical advancements in PGx, its integration into routine healthcare practices remains limited. To address this gap, the Qatar Genome Program (QGP) has embarked on an ambitious initiative known as QPGx-CARES (Qatar Pharmacogenetics Clinical Applications and Research Enhancement Strategies), which aims to set a roadmap for optimizing PGx research and clinical implementation on a national scale. The goal of QPGx-CARES initiative is to integrate PGx testing into clinical settings with the aim of improving patient health outcomes. In 2022, QGP initiated several implementation projects in various clinical settings. These projects aimed to evaluate the clinical utility of PGx testing, gather valuable insights into the effective dissemination of PGx data to healthcare professionals and patients, and identify the gaps and the challenges for wider adoption. QPGx-CARES strategy aimed to integrate evidence-based PGx findings into clinical practice, focusing on implementing PGx testing for cardiovascular medications, supported by robust scientific evidence. The current initiative sets a precedent for the nationwide implementation of precision medicine across diverse clinical domains.
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Affiliation(s)
- Rania Abdel‐latif
- Qatar Genome Program, Qatar Precision Health InstituteQatar FoundationDohaQatar
| | - Radja Badji
- Qatar Genome Program, Qatar Precision Health InstituteQatar FoundationDohaQatar
| | | | - Wadha Al‐Muftah
- Qatar Genome Program, Qatar Precision Health InstituteQatar FoundationDohaQatar
| | - Hamdi Mbarek
- Qatar Genome Program, Qatar Precision Health InstituteQatar FoundationDohaQatar
| | - Dima Darwish
- Qatar Genome Program, Qatar Precision Health InstituteQatar FoundationDohaQatar
| | - Duha Assaf
- Qatar Genome Program, Qatar Precision Health InstituteQatar FoundationDohaQatar
| | | | - Hazem Elewa
- College of Pharmacy, QU HealthQatar UniversityDohaQatar
| | - Nahla Afifi
- Qatar Biobank for Medical ResearchQatar Foundation for Education, Science, and CommunityDohaQatar
| | | | - Amr Salah Omar
- Cardiology and Cardiovascular SurgeryDepartment Hamad Medical CorporationDohaQatar
| | - Jassim Al Suwaidi
- Cardiology and Cardiovascular SurgeryDepartment Hamad Medical CorporationDohaQatar
| | - Salha Bujassoum
- Medical Oncology, National Center for Cancer Care and ResearchDepartment Hamad Medical CorporationDohaQatar
| | - Moza Al Hail
- Pharmacy DepartmentHamad Medical CorporationDohaQatar
| | - Said I. Ismail
- Qatar Genome Program, Qatar Precision Health InstituteQatar FoundationDohaQatar
| | - Asma Althani
- Biomedical Research CenterQatar UniversityDohaQatar
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HU CY, WANG YL, FAN ZX, SUN XP, WANG S, LIU Z. Effect of cytochrome P450 2C19 (CYP2C19) gene polymorphism and clopidogrel reactivity on long term prognosis of patients with coronary heart disease after PCI. J Geriatr Cardiol 2024; 21:90-103. [PMID: 38440340 PMCID: PMC10908579 DOI: 10.26599/1671-5411.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Objective To investigate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity and its association with long-term clinical outcome in patients with coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI). Methods In total, 675 patients were enrolled. Based on the platelet inhibition rate, patients were categorized into two groups: clopidogrel low responsiveness (CLR) and normal clopidogrel responsiveness (NCR). The CLR group was divided into ticagrelor and clopidogrel group based on the antiplatelet drugs used in the follow-up treatment. Patients were classified into three groups (normal metabolizer, intermediate metabolizer, and poor metabolizer) based on the CYP2C19 genotype. We aimed to evaluate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity. The cumulative rates of 12-month all-cause deaths, major adverse cardiovascular events (MACCEs), and bleeding events were calculated. Results CLR was observed in 44.4% of the overall population. Significant differences were observed in the platelet inhibition rate of clopidogrel among the three metabolic genotypes (P < 0.05). At the 12-month follow-up, 13 patients (1.9%) died and 96 patients (14.2%) experienced MACCEs. Patients with CLR (9.6% vs. 11.7% vs. 22.1%, P < 0.05) or poor metabolizer (10.7% vs. 16.4% vs. 22.6%, P = 0.026) experienced a higher rate of MACCEs. A MACCEs risk score between zero and two was calculated. The highest incidence of MACCEs significantly increased with the 2-positive results, and the area under the curve (AUC) was 0.712 (95% CI: 0.650-0.774, P < 0.05). There was no significant difference between the group with a score of one and the occurrence of MACCEs (P > 0.05). Conclusions Low response to clopidogrel in CHD patients is correlated with CYP2C19 gene polymorphism. CYP2C19 genotyping combined with platelet reactivity is an independent predictor of 12-months MACCEs in patients with clopidogrel treatment after PCI, which is better than either test alone.
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Affiliation(s)
- Cheng-Yan HU
- Department of Geriatrics, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Yan-Ling WANG
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zhen-Xing FAN
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xi-Peng SUN
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Shuai WANG
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
- Emergency Department of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhi LIU
- Emergency Department of Xuanwu Hospital, Capital Medical University, Beijing, China
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Soh BWT, Cusack R, Waters M, O'Connor C, Arnous S, Kiernan T. Post-percutaneous coronary intervention CYP2C19 genotyping in an Irish population: The potential role in identifying clopidogrel therapy-related bleeding risks. Br J Clin Pharmacol 2023; 89:2413-2422. [PMID: 36890711 DOI: 10.1111/bcp.15709] [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: 01/09/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
AIMS Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains the standard of care. CYP2C19 genetic polymorphisms cause variable clopidogrel bioactivation. Increased function (CYP2C19*17) allele carriers (rapid metabolizers [RM] or ultrarapid metabolizers [UM]) are clopidogrel hyper-responders, hence are more susceptible to clopidogrel-related bleeding. Since current guidelines recommend against routine genotyping following PCI, data on the clinical utility of CYP2C19*17 genotype guided strategy are sparce. Our study provides real-world data on the 12-month follow-up of CYP2C19 genotyping in patients post-PCI. METHODS This is a cohort study within an Irish population receiving 12-month DAPT following PCI. It identifies the prevalence of CYP2C19 polymorphisms within an Irish population and describes the ischaemic and bleeding outcomes after 12 months of DAPT. RESULTS A total of 129 patients were included with the following CYP2C19 polymorphism prevalence: 30.2% hyper-responders (26.4% RM [1*/17*], 3.9% UM [17*/17*]) and 28.7% poor-responders (22.5% IM [1*/2*], 3.9% IM [2*/17*], 2.3% PM [2*/2*]). A total of 53 and 76 patients received clopidogrel and ticagrelor, respectively. At 12 months, total bleeding incidence within the clopidogrel group was positively correlated with CYP2C19 activity: IM/PM (0.0%), NM (15.0%) and RM/UM (25.0%). The positive relationship showed a moderate association that was statistically significant: rτ = 0.28, P = 0.035. CONCLUSIONS The prevalence of CYP2C19 polymorphisms in Ireland is 58.9% (30.2% CYP2C19*17, 28.7% CYP2C19*2) with an approximately one in three chance of being a clopidogrel hyper-responder. Positive correlation between bleeding and increasing CYP2C19 activity within the clopidogrel group (n = 53) suggests possible clinical utility of a genotype-guided strategy identifying high bleeding risk with clopidogrel in CYP2C19*17 carriers, but further studies are required.
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Affiliation(s)
| | - Ronan Cusack
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Max Waters
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Cormac O'Connor
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Samer Arnous
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Thomas Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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Ni Y, Chen X, Ling C, Zhu Z, Yue Y, Wang J, He A, Liu R. Electrochemical peptide nucleic acid functionalized α-Fe 2O 3/Fe 3O 4 nanosheets for detection of CYP2C19*2 gene. Mikrochim Acta 2023; 190:189. [PMID: 37083854 DOI: 10.1007/s00604-023-05781-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
The CYP2C19*2 gene carriers and non-carriers are closely related to the dosage of clopidogrel. To correctly guide the use of clopidogrel and promote individualized therapy, an ultra-sensitive electrochemical biosensor was developed for the detection of CYP2C19*2 gene. The heterogeneous α-Fe2O3/Fe3O4 nanosheets were prepared via the hydrothermal-calcination process, and the preparation parameters were optimized. The average diameter and thickness of the nanosheets were approximately 150 nm and 53 nm, respectively; and the saturation magnetization was 80.2 emu/g. The α-Fe2O3/Fe3O4@Au nanosheets were prepared by sodium borohydride reduction method, and self-assembled to the electrode surface with magnetic field. Ultra-sensitive detection of CYP2C19*2 gene was realized through the recognition ability of strong single base mismatching of peptide nucleic acid and signal amplification effect of magnetic α-Fe2O3/Fe3O4@Au nanosheets. Under optimal detection conditions, the current had a good linear correlation with the negative logarithm of CYP2C19*2 gene concentration in the range 1 pM-1 nM, and the detection limit was 0.64 pM (S/N = 3). Meanwhile, the electrochemical signals of target DNA and incomplete complementary DNA were detected. The constructed biosensor exhibited good selectivity, reproducibility, and stability, providing a promising strategy for the detection of other gene mutations by electrochemical biosensors.
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Affiliation(s)
- Yun Ni
- School of Pharmacy, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Xiu Chen
- The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Zhenjiang, 212300, People's Republic of China
| | - Chen Ling
- School of Pharmacy, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Ziye Zhu
- School of Pharmacy, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Yao Yue
- School of Pharmacy, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Jie Wang
- School of Pharmacy, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Aolin He
- Affiliated Kunshan Hospital, Jiangsu University, Suzhou, 215300, People's Republic of China.
| | - Ruijiang Liu
- School of Pharmacy, Jiangsu University, Zhenjiang, 212013, People's Republic of China.
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Li L, Li Y, Yin T, Chen J, Shi F. A Cohort Study of the Effects of Integrated Medical and Nursing Rounds Combined with AIDET Communication Mode on Recovery and Quality of Life in Patients Undergoing Percutaneous Coronary Intervention. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9489203. [PMID: 36060670 PMCID: PMC9433234 DOI: 10.1155/2022/9489203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the influence of the communication mode of "Acknowledge, Introduce, Duration, Explanation, and Thanks (AIDET)" on the postoperative recovery and quality of life of patients undergoing percutaneous coronary intervention. Methods Sixty patients with percutaneous coronary intervention in our hospital from April 2019 to April 2021 were selected. The patients were randomly divided into a control group (n = 30) and research group (n = 30). The control group received integrated medical and nursing rounds, and the research group received integrated medical and nursing rounds combined with AIDET communication mode. The scores of nursing satisfaction, cardiac function, self-nursing ability, short-term prognosis, and quality of life were compared between the two groups. Results In the comparison of nursing satisfaction between the two groups, the satisfaction of the research group was low in 1 case, moderate in 6 cases, and high in 27 cases, with a satisfaction rate of 96.67%. In the control group, there were 7 cases with low satisfaction, 10 cases with moderate satisfaction, and 13 cases with high satisfaction, with a satisfaction rate of 76.67%. The nursing satisfaction of the research group was higher than that of the control group, and the difference was statistically significant, and the difference was statistically significant (P < 0.05). After intervention, the cardiac function of the two groups was improved. The LVEF and LVESVI of the research group were higher than those of the control group, while the WMSI of the research group was lower than that of the control group (P < 0.05). In the comparison of self-nursing ability, the self-nursing maintenance, self-nursing management, self-nursing confidence, and total score of self-nursing in the research group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The incidence rates of acute myocardial infarction (AMI), revascularization, arrhythmia, heart failure, cardiogenic shock, and cardiac death in the research group were obviously lower than those in the control group, and the difference was statistically significant (P < 0.05). After intervention, the scores of quality of life of the two groups decreased, and the scores of physiological function, psychological function, social function, and health self-cognition in the research group were lower than those in the control group (P < 0.05). Conclusion Medical and nursing integrated ward rounds combined with AIDET communication mode can effectively improve the prognosis of patients undergoing percutaneous coronary intervention to promote the establishment of a harmonious nurse-patient relationship. The patients' self-care ability is able to be effectively enhanced.
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Affiliation(s)
- Lan Li
- Department of Cardiovascular Medicine II, The Fourth Hospital of Changsha City, No. 70 Lushan South Road, Yuelu District, Changsha City, Hunan Province, China 410006
| | - Yongheng Li
- Nursing Department, The Fourth Hospital of Changsha City, No. 70 Lushan South Road, Yuelu District, Changsha City, Hunan Province, China 410006
| | - Tao Yin
- Nursing Department, The Fourth Hospital of Changsha City, No. 70 Lushan South Road, Yuelu District, Changsha City, Hunan Province, China 410006
| | - Jinglin Chen
- Respiratory Medicine Ward II, The Fourth Hospital of Changsha City, No. 70 Lushan South Road, Yuelu District, Changsha City, Hunan Province, China 410006
| | - Fengjiao Shi
- Department of Cardiovascular Medicine II, The Fourth Hospital of Changsha City, No. 70 Lushan South Road, Yuelu District, Changsha City, Hunan Province, China 410006
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