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Hirata TDC, Dagli-Hernandez C, Genvigir FDV, Lauschke VM, Zhou Y, Hirata MH, Hirata RDC. Cardiovascular Pharmacogenomics: An Update on Clinical Studies of Antithrombotic Drugs in Brazilian Patients. Mol Diagn Ther 2021; 25:735-755. [PMID: 34357562 DOI: 10.1007/s40291-021-00549-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Anticoagulant and antiplatelet drugs effectively prevent thrombotic events in patients with cardiovascular diseases, ischemic stroke, peripheral vascular diseases, and other thromboembolic diseases. However, genetic and non-genetic factors affect the response to antithrombotic therapy and can increase the risk of adverse events. This narrative review discusses pharmacogenomic studies on antithrombotic drugs commonly prescribed in Brazil. Multiple Brazilian studies assessed the impact of pharmacokinetic (PK) and pharmacodynamic (PD) gene variants on warfarin response. The reduced function alleles CYP2C9*2 and CYP2C9*3, and VKORC1 rs9923231 (c.-1639G>A) are associated with increased sensitivity to warfarin and a low dose requirement to prevent bleeding episodes, whereas CYP4F2 rs2108622 (p.Val433Met) carriers have higher dose requirements (warfarin resistance). These deleterious variants and non-genetic factors (age, gender, body weight, co-administered drugs, food interactions, and others) account for up to 63% of the warfarin dose variability. Few pharmacogenomics studies have explored antiplatelet drugs in Brazilian cohorts, finding associations between CYP2C19*2, PON1 rs662 and ABCC3 rs757421 genotypes and platelet responsiveness or clopidogrel PK in subjects with coronary artery disease (CAD) or acute coronary syndrome (ACS), whereas ITGB3 contributes to aspirin PK but not platelet responsiveness in diabetic patients. Brazilian guidelines on anticoagulants and antiplatelets recommend the use of a platelet aggregation test or genotyping only in selected cases of ACS subjects without ST-segment elevation taking clopidogrel, and also suggest CYP2C9 and VKORC1 genotyping before starting warfarin therapy to assess the risk of bleeding episodes or warfarin resistance.
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Affiliation(s)
- Thiago Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Carolina Dagli-Hernandez
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Fabiana Dalla Vecchia Genvigir
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Volker Martin Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Solna, Sweden.,Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, 70376, Germany
| | - Yitian Zhou
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Solna, Sweden
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil.
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Rodrigues-Soares F, Suarez-Kurtz G. Pharmacogenomics research and clinical implementation in Brazil. Basic Clin Pharmacol Toxicol 2019; 124:538-549. [PMID: 30589990 DOI: 10.1111/bcpt.13196] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/17/2018] [Indexed: 12/23/2022]
Abstract
We searched PubMed entries and the Lattes database of Brazilian Pharmacogenetics Network investigators, for pharmacogenetic/genomic (PGx) studies in the Brazilian population, focusing on the drugs and genes included in the Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. Warfarin was the most extensively studied drug in a PGx context: a genomewide association study targeting warfarin stable dose identified significant signals in VKORC1 and CYP2C9, several PGx dosing algorithms were developed based on these and other genes, and the implications of population admixture on extrapolation of dosing recommendations in the CPIC guidelines were examined. A study in renal transplanted patients disclosed association of CYP3A5*6 and CYP3A5*7 with tacrolimus dosing, which led to addition of these variants to CYP3A5*3 in the CPIC tacrolimus guideline. Studies verified predisposition of HIV-positive carriers of UGT1A1*28 to severe atazanavir-induced hyperbilirubinaemia, intolerance to 5-fluorouracyl in gastrointestinal cancer patients with deleterious DPYD variants, failure of HCV-infected carriers of IFNL3 rs12979860 to obtain a sustained viral response to PEG-IFN-α, and hypersensitivity reactions to abacavir in HIV-positive carriers of HLA-B*57:01. No prospective analyses of drug therapy outcomes or cost-effectiveness assessments of PGx-guided therapy were found. In conclusion, the limited adoption of PGx-informed drug prescription in Brazil reflects combination of recognized barriers to PGx implementation worldwide plus factors specific to the Brazilian population. The latter include rarity/absence of genetic variants on which international PGx guidelines are based (eg HLA-B*15.02 for phenytoin and carbamazepine) and the caveat of extrapolating to the admixed Brazilian population, guidelines based on categorical variables, such as continental ancestry (eg warfarin guidelines), "race" or ethnicity.
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Maagdenberg H, Bierings MB, van Ommen CH, van der Meer FJ, Appel IM, Tamminga RY, Cessie SL, Swen JJ, der Straaten TV, Boer AD, Maitland-van der Zee AH. Effects of age and genetic variations in VKORC1, CYP2C9 and CYP3A4 on the phenprocoumon dose in pediatric patients. Pharmacogenomics 2018; 19:1195-1202. [PMID: 30207196 DOI: 10.2217/pgs-2018-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIM To study the effects of clinical and genetic factors on the phenprocoumon dose requirement in pediatric patients and to develop a dosing algorithm. METHODS Pediatric patients who used phenprocoumon were invited to participate in a retrospective follow-up study. Clinical information and genotypes of genetic variations in CYP2C9, VKORC1, CYP4F2, CYP2C18 and CYP3A4 were collected and tested with linear regression for association with phenprocoumon dose requirement. RESULTS Of the 41 patients included in the analysis, age, VKORC1, CYP2C9*2/*3 and CYP3A4*1B were statistically significantly associated with dose requirement, and together explained 80.4% of the variability in phenprocoumon dose requirement. CONCLUSION Our study reveals that age and genetic variations explain a significant part of the variability in phenprocoumon dose requirement in pediatric patients.
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Affiliation(s)
- Hedy Maagdenberg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Marc B Bierings
- Department of Pediatric Stem Cell Transplantation, Princess Maxima Center for pediatric oncology/Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Heleen van Ommen
- Department of Pediatric Oncology/Hematology, Erasmus MC/Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Felix Jm van der Meer
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Inge M Appel
- Department of Pediatric Oncology/Hematology, Erasmus MC/Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rienk Yj Tamminga
- Department of Pediatric Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia le Cessie
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tahar van der Straaten
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Mizera L, Geisler T, Mörike K, Gawaz M, Steeg M. Problems in anticoagulation of a patient with antibiotic treatment for endocarditis: interaction of rifampicin and vitamin K antagonists. BMJ Case Rep 2018; 2018:bcr-2016-215155. [PMID: 29440136 DOI: 10.1136/bcr-2016-215155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The cytochrome P450 is a superfamily of isoenzymes that are responsible for the metabolism of many drugs. Significant changes in pharmacokinetics and drug interactions may be due to induction of hepatic cytochrome P450 enzymes. Rifampicin is a common inducer of CYP3A4. We report a case of a 57-year-old woman who was suspected for endocarditis and therefore treated with rifampicin. Due to previous mechanical aortic valve replacement, she also received phenprocoumon for anticoagulation. Although continuing anticoagulant therapy, antibiotic coadministration led to normal international normalised ratio (INR) level. Fifteen days after the treatment with rifampicin ended, INR returned to therapeutic level.
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Affiliation(s)
- Lars Mizera
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Tobias Geisler
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Klaus Mörike
- Department fur Experimentelle und Klinische Pharmakologie und Toxikologie, Eberhard Karls Universitat Tubingen, Tübingen, Germany
| | - Meinrad Gawaz
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Martin Steeg
- Klinik für Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tuebingen, Germany
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Flores-Gutiérrez S, Rodríguez-Larralde Á, Vívenes de Lugo M, Castro de Guerra D. Distribution of polymorphisms in the CYP2C9 gene and CYP2C19/CYP2C9 haplotypes among Venezuelan populations. Ann Hum Biol 2016; 44:191-198. [PMID: 27230833 DOI: 10.1080/03014460.2016.1192218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Polymorphisms with decreased enzyme activity of their gene products have been reported in region CYP2C with population variations in haplotype structure. AIM To estimate the allelic and genotypic frequencies of variants CYP2C9*2 and CYP2C9*3 and of CYP2C9/CYP2C19 haplotypes in Venezuelan populations. SUBJECTS AND METHODS Six hundred and thirty-four individuals from nine admixed populations (AP) and the Warao indigenous group were studied. Allelic frequencies, linkage disequilibrium and genetic distances for haplotypes were calculated and compared within Venezuela and with data available in the literature. RESULTS Heterogeneity in the distribution of CYP2C9 alleles and CYP2C9/CYP2C19 haplotypes among the AP and the Warao was observed. The joint frequency of haplotypes, with at least one non-functional variant, shows values in AP between 21-41%, while in Warao it reaches 5%. The haplotype that includes the Asian and rare Latin America CYP2C19*3 allele was detected in most AP and in Warao. Pairwise Fst values showed that the Warao was an outlier compared with the AP, while these are closer to European-derived populations. No significant correlation was found between haplotype frequencies and admixture. CONCLUSIONS These results support the need to understand the distribution of genomic biomarkers related to the metabolism of drugs, for planning national public health strategies.
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Affiliation(s)
- Sara Flores-Gutiérrez
- a Laboratorio de Genética Humana, Centro de Medicina Experimental , Instituto Venezolano de Investigaciones Científicas , Caracas , Venezuela
| | - Álvaro Rodríguez-Larralde
- a Laboratorio de Genética Humana, Centro de Medicina Experimental , Instituto Venezolano de Investigaciones Científicas , Caracas , Venezuela
| | | | - Dinorah Castro de Guerra
- a Laboratorio de Genética Humana, Centro de Medicina Experimental , Instituto Venezolano de Investigaciones Científicas , Caracas , Venezuela
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Abstract
Phenprocoumon is an anticoagulant used for thromboembolic disorder prophylaxis metabolized mainly by CYP3A4. However, polymorphisms in this gene did not explain the observed variability. PPARA (peroxisome proliferator-activated receptor-α) is a nuclear receptor that, among others, influences CYP3A4 gene expression. The aim of this study was to determine whether PPARA gene polymorphisms and the CYP3A4*22 allele are associated with phenprocoumon dose variability. A total of 198 patients on a stable dose of phenprocoumon were included in the study. Genotyping was performed by allele discrimination using standardized TaqMan assays. Differences between the average phenprocoumon dose and genotypes/haplotypes were assessed by analysis of variance and multiple linear regression analyses. Patients with the PPARA rs4253728A allele needed higher phenprocoumon doses. However, the effect size (3%) of this association was small. The CYP3A4*22 allele was not associated with the dose of phenprocoumon. As this is the first report of an association between PPARA gene polymorphisms and phenprocoumon dose, future studies are warranted to confirm these results.
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Suarez-Kurtz G, Botton MR. Pharmacogenetics of coumarin anticoagulants in Brazilians. Expert Opin Drug Metab Toxicol 2014; 11:67-79. [PMID: 25345887 DOI: 10.1517/17425255.2015.976201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Coumarin vitamin K antagonists are the mainstay of anticoagulant therapy in atrial fibrillation, prosthetic heart valves and thromboembolic conditions. Concerns with these drugs include large inter-individual variability in dose requirements, narrow therapeutic index and need to monitor prothrombin time repeatedly. AREAS COVERED Pharmacogenetic studies and dosing algorithms for warfarin and phenprocoumon. EXPERT OPINION Gene candidate studies in Brazilian patients verified consistently the association of warfarin and pheprocoumon stable dose requirements with CYP2C9 and VKORC1 polymorphisms, and minor or no influence of other pharmacogenes (e.g., CYP4F2 and F7). The predictive power of warfarin and phenprocoumon dosing algorithms developed for Brazilians compares favorably with those reported for other populations. A warfarin dosing algorithm derived for an admixed cohort performed equally well in self-reported White and Black patients, in marked contrast with the considerably poorer performance of other warfarin algorithms in patients of African descent compared to those of European ancestry. This discrepancy is ascribed to the extensive European/African admixture among Brazilians. Prospective studies of clinical utility of coumarin dosing algorithms, in the context of the Brazilian Public Health System, would represent an important counterpart to recently published trials in European and North American cohorts with predominant or exclusive European ancestry.
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Affiliation(s)
- Guilherme Suarez-Kurtz
- Instituto Nacional de Câncer, Pharmacology Division , Rua André Cavalcanti 37, Rio de Janeiro, CEP 20231-050, RJ , Brazil +5521 3207 6502 ;
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Hubacek JA, Pelclova D, Seidl Z, Vaneckova M, Klempir J, Ruzicka E, Ridzon P, Urban P, Fenclova Z, Petrik V, Diblik P, Kuthan P, Miovsky M, Janikova B, Adamkova V, Zakharov S. Rare Alleles within theCYP2E1(MEOS System) Could be Associated with Better Short-Term Health Outcome after Acute Methanol Poisoning. Basic Clin Pharmacol Toxicol 2014; 116:168-72. [DOI: 10.1111/bcpt.12310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/05/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Jaroslav A. Hubacek
- Centre for Experimental Medicine; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine of 1st Faculty of Medicine; Toxicological Information Centre; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Zdenek Seidl
- Department of Radiology; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Manuela Vaneckova
- Department of Radiology; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Jiri Klempir
- Department of Neurology and Centre of Clinical Neuroscience; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical Neuroscience; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Petr Ridzon
- Department of Occupational Medicine; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Zdenka Fenclova
- Department of Occupational Medicine; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Vit Petrik
- Department of Occupational Medicine; 1st Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology; General University Hospital in Prague; Prague Czech Republic
| | - Pavel Kuthan
- Department of Ophthalmology; General University Hospital in Prague; Prague Czech Republic
| | - Michal Miovsky
- Department of Addictology; First Faculty of Medicine; Charles University in Prague and General University Hospital; Prague Czech Republic
| | - Barbara Janikova
- Department of Addictology; First Faculty of Medicine; Charles University in Prague and General University Hospital; Prague Czech Republic
| | - Vera Adamkova
- Centre for Experimental Medicine; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine of 1st Faculty of Medicine; Toxicological Information Centre; Charles University and General University Hospital in Prague; Prague Czech Republic
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