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Guo J, You W, Lin K, Li Q, Guo X, Wang S, Bian Y, Ren W, Zhang R, Wang Y, Li B. An extraction-free method for rapid detection of CYP2C19 * 2/3/17 polymorphisms in one tube using melting curve analysis. Biotechnol J 2023; 18:e2300207. [PMID: 37551831 DOI: 10.1002/biot.202300207] [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: 05/08/2023] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023]
Abstract
Drug-metabolizing enzymes play an important role in the metabolism of drugs in vivo. Their activity is an important factor affecting the rate of drug metabolism, which directly determines the intensity and persistence of drug action. Patients taking medication can be divided into different metabolic types through detection of CYP2C19 drug-metabolizing enzyme gene polymorphisms, which can then be used for medication guidance for clopidogrel. Here, we describe a detection method based on real-time polymerase chain reaction (PCR). This method uses multicolor melting curve analysis to accurately identify different mutation sites and genotypes of CYP2C19 * 2, CYP2C19 * 3, and CYP2C19 * 17. The detection limit of plasmid samples was 1 copies μL-1 ; that of genomic samples was 0.1 ng μL-1 . The system can detect nine types of CYP2C19 * 2/3/17 at three sites in one tube, quickly achieving detection within 1 h. Combined with the sample release agent, sample extraction was completed in 5 s, achieving rapid diagnosis without extraction for timely diagnosis and treatment. Furthermore, the system is not limited to blood samples and can also be applied to oropharyngeal and saliva samples, increasing sampling diversity and convenience. When using clinical blood samples (n = 93), the detection system we established was able to quickly and accurately identify different genotypes, and the accuracy and effectiveness of the detection were confirmed by Sanger sequencing. Due to its accuracy, rapidity, simple operation, and low cost, detection technology based on real-time polymerase amplification combined with melting curve analysis is expected to become a powerful tool for detecting and guiding clopidogrel use in countries with limited resources.
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Affiliation(s)
- Jianguang Guo
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Weixin You
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Kangfeng Lin
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Qinghan Li
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Xiangju Guo
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Shuai Wang
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Ya Bian
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Wenjing Ren
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Rui Zhang
- Xiamen Cell Therapy Research Center, The First Affiliated Hospital of Xiamen, University, School of Medicine, Xiamen University, Xiamen, China
| | - Yanping Wang
- Emergency Department, HuBei ProvinciaI HospitaI Of TCM, Wuhan, China
| | - Boan Li
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling, Network and Engineering Research Center of Molecular Diagnostics of the Ministry, of Education, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
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Fereidouni M, Moossavi M, Kazemi T, Nouranihassankiade S, Asghari A. Association between polymorphisms of VKORC1 and CYP2C9 genes with warfarin maintenance dose in a group of warfarin users in Birjand city, Iran. J Cell Biochem 2018; 120:9588-9593. [PMID: 30525241 DOI: 10.1002/jcb.28235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/15/2018] [Indexed: 01/05/2023]
Abstract
Warfarin is the cardinal anticoagulant drug prescribed around the world. Due to stochastic bleeding in patients, it is essential to adjust the dose for every individual. The aim of the present study was to evaluate the frequency of CYP2C9 and VKORC1 gene polymorphisms and their association with warfarin maintenance dose in a sample of cardiovascular patients in Birjand, South-Khorasan province of Iran. Patients with a history of cardiovascular disorders who take warfarin daily were selected. CYP2C9 and VKORC1 gene polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism in all participants. A total of 114 patients (mean age: 52.7 ± 14.9 years, M/F ratio: 0.76) participated in this study. Regarding CYP2C9 gene polymorphisms, the most frequent genotype was 1*/1* (80.4% in females and 62.5% in males). The frequency of 1*/2* and 2*/2* variants was 13% and 6.5% in females and 25% and 12.5% in males, respectively. The frequency of VKORC1 gene (1639 G > A), was 31.5%, 39.5%, and 29% for GG, GA, and AA in males, respectively. Besides, the mentioned genotype frequencies for females were 50%, 40.5%, and 9.5%, respectively. Moreover, there was a statistically significant correlation between VKORC1 gene -1639 G > A variant and warfarin maintenance dose (P < 0.001) but not for CYP2C9 variants. The results of the current study confirmed that the mutant variants of CYP2C9 are not frequent and do not have any impact on warfarin dose. In the case of VKORC1, the mutant allele (A) showed a positive correlation with warfarin dose adjustment.
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Affiliation(s)
- Mohammad Fereidouni
- Cellular and Molecular Research Center, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Maryam Moossavi
- Student Research Committee, Birjand University of Medical Science, Birjand, Iran
| | - Touba Kazemi
- Cardiovascular Diseases Research Center, Professor of cardiology, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Arghavan Asghari
- Student Research Committee, Birjand University of Medical Science, Birjand, Iran.,Asthma, Allergy, and Immunology Research Center, Faculty of Medicine, Birjand University of Medical Science, Birjand, Iran
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Pei L, Tian X, Long Y, Nan W, Jia M, Qiao R, Zhang J. Establishment of a Han Chinese-specific pharmacogenetic-guided warfarin dosing algorithm. Medicine (Baltimore) 2018; 97:e12178. [PMID: 30200121 PMCID: PMC6133597 DOI: 10.1097/md.0000000000012178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Warfarin is the most common oral anticoagulant. Because of a narrow therapeutic range, interindividual differences in drug responses, and the risk of bleeding, there are many challenges in using warfarin. We need to predict the warfarin maintenance dose. However, ethnic-specific algorithms may be required, and some Chinese algorithms do not perform adequately. Therefore, we aimed to establish a Han Chinese appropriate algorithm.We recruited a study group consisting of 361 Han Chinese patients receiving warfarin treatment who had heart valve replacements. Genotyping of 38 single nucleotide polymorphisms (SNPs) in 13 candidate genes was carried out using the MassARRAY. In the derivation cohort, a multiple linear regression model was constructed to predict the warfarin dosage. We evaluated the accuracy of our algorithm in the validation cohort and compared it with the other 5 algorithms based on Han Chinese and other races.We established a Han Chinese-specific pharmacogenetic-guided warfarin dosing algorithm. Warfarin maintenance dosage (mg/day) = 1.787 - 0.023 × (Age) + 1.151 × (BSA [m]) + 0.917 × (VKORC1 AG) + 4.619 × (VKORC1 GG) + 0.595 × (CYP4F2 TT) + 0.707 × (CYP2C19 CC). It explained 58.3% of the variance in warfarin doses in Han Chinese patients and was superior to the other 5 algorithms. The ability of the 6 algorithms which estimate the required dose correctly was tested. Our model had a mean absolute error of 0.74 mg/day, the other 5 models have mean absolute error of 0.81 mg/day,1.05 mg/day, 1.24 mg/day, 1.18 mg/day, and 0.85 mg/day, respectively. Our model had a mean percentage error of 26.9%, the other 5 models have the mean percentage error of 27.7%, 27.2%, 52.3%, 45.7%, and 29.3%, respectively.Physicians can not adopt algorithm from other race directly to predict warfarin dose in patients with heart valve replacements, they should establish a new algorithm or adjust another algorithm to fit their patients. The algorithm established in this study has the potential to assist physicians in determining warfarin doses that are close to the appropriate doses.
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Affiliation(s)
- Lin Pei
- The Department of Laboratory Medicine, Peking University Third Hospital
| | - Xiaoyi Tian
- The Department of Clinical Laboratory Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Yan Long
- The Department of Laboratory Medicine, Peking University People's Hospital, Beijing, PR China
| | - Wenhui Nan
- The Department of Laboratory Medicine, Peking University People's Hospital, Beijing, PR China
| | - Mei Jia
- The Department of Laboratory Medicine, Peking University People's Hospital, Beijing, PR China
| | - Rui Qiao
- The Department of Laboratory Medicine, Peking University Third Hospital
| | - Jie Zhang
- The Department of Laboratory Medicine, Peking University Third Hospital
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Razavi FE, Zarban A, Hajipoor F, Naseri M. The allele frequency of CYP2C9 and VKORC1 in the Southern Khorasan population. Res Pharm Sci 2017. [PMID: 28626479 PMCID: PMC5465830 DOI: 10.4103/1735-5362.207202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The genetic factors are determinants in required dosage changes of warfarin among which are polymorphisms of CYP2C9 and VKORC1 genes. The present study aimed to determine the allele and genotype frequency of CYP2C9 and VKORC1 genes in Birjand population. This study was conducted on 120 individuals who referred to Imam Reza and Vali-Asr hospitals for PT/INR test. After extracting the genomic DNA, the considered sequences were amplified by PCR, and restriction fragment length polymorphism analysis was done by AvaII and KpnI enzymes to determine allele polymorphisms. Moreover, related sequences of VKORC1, after amplification, were sequenced for determining the genotype. Allelic and genotypic frequencies as well as Hardy-Weinberg equilibrium, observed heterozygosity, expected heterozygosity, and polymorphism information content were calculated by PowerMarker V 3.25 software. Amongst 120 individuals in this study with the mean age of 58.12 ± 12.7 years, 80.8%, 9.1%, and 10% exhibited the alleles of 1, 2, and 3 CYP2C9 gene, respectively. The genotype frequencies of 1/1, 1/2, 2/2, 3/1, 3/2, and 3/3 of this gene were found to be 64.1, 15.8, 0, 17.5, 2.5, and 0 %, respectively. In -1639 G>A region, VKORC1 had normal homozygote genotype (GG) and in 1173 C>T region, heterozygote (CT) with the frequency of 48.7% and 45.9% had the most prevalence. Compared with other populations, there is a considerable difference between the allele frequency of CYP2C9 and VKORC1 genetic variance. Since 35.8% of the selected populations carry an abnormal allele causing sensitivity to warfarin, the specialists at medical centers must be informed about the genotypes of patients before prescribing warfarin.
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Affiliation(s)
- Fariba Emadian Razavi
- Department of Prosthodontics, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, I.R. Iran
| | - Asghar Zarban
- Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, I.R. Iran
| | - Fatemeh Hajipoor
- Genomics Research Group, Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, I.R. Iran
| | - Mohsen Naseri
- Genomics Research Group, Cellular and Molecular Research Center, Paramedical Faculty, Birjand University of Medical Sciences, Birjand, I.R. Iran
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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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Kruszelnicka O, Świerszcz J, Bednarek J, Chyrchel B, Surdacki A, Nessler J. Asymmetric Dimethylarginine versus Proton Pump Inhibitors Usage in Patients with Stable Coronary Artery Disease: A Cross-Sectional Study. Int J Mol Sci 2016; 17:454. [PMID: 27092494 PMCID: PMC4848910 DOI: 10.3390/ijms17040454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/07/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022] Open
Abstract
A recent experimental study suggested that proton pump inhibitors (PPI), widely used to prevent gastroduodenal complications of dual antiplatelet therapy, may increase the accumulation of the endogenous nitric oxide synthesis antagonist asymmetric dimethylarginine (ADMA), an adverse outcome predictor. Our aim was to assess the effect of PPI usage on circulating ADMA in coronary artery disease (CAD). Plasma ADMA levels were compared according to PPI use for ≥1 month prior to admission in 128 previously described non-diabetic men with stable CAD who were free of heart failure or other coexistent diseases. Patients on PPI tended to be older and with insignificantly lower estimated glomerular filtration rate (GFR). PPI use was not associated with any effect on plasma ADMA (0.51 ± 0.11 (SD) vs. 0.50 ± 0.10 µmol/L for those with PPI (n = 53) and without PPI (n = 75), respectively; p = 0.7). Additionally, plasma ADMA did not differ between PPI users and non-users stratified by a history of current smoking, CAD severity or extent. The adjustment for patients’ age and GFR did not substantially change the results. Thus, PPI usage does not appear to affect circulating ADMA in non-diabetic men with stable CAD. Whether novel mechanisms of adverse PPI effects on the vasculature can be translated into clinical conditions, requires further studies.
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Affiliation(s)
- Olga Kruszelnicka
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College and John Paul II Hospital, 80 Prądnicka, 31-202 Cracow, Poland.
| | - Jolanta Świerszcz
- Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, 17 Kopernika, 31-501 Cracow, Poland.
| | - Jacek Bednarek
- Department of Electrocardiology, John Paul II Hospital, 80 Prądnicka, 31-202 Cracow, Poland.
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, 17 Kopernika, 31-501 Cracow, Poland.
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, 17 Kopernika, 31-501 Cracow, Poland.
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College and John Paul II Hospital, 80 Prądnicka, 31-202 Cracow, Poland.
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Sipeky C, Weber A, Melegh BI, Matyas P, Janicsek I, Szalai R, Szabo I, Varnai R, Tarlos G, Ganczer A, Melegh B. Interethnic variability of CYP4F2 (V433M) in admixed population of Roma and Hungarians. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2015; 40:280-283. [PMID: 26176903 DOI: 10.1016/j.etap.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/13/2015] [Accepted: 05/16/2015] [Indexed: 06/04/2023]
Abstract
AIMS Pharmacogenetic based dosing recommendations are provided in FDA-approved warfarin label for Caucasians. Evidence of notable difference in dosing algorithms of under-represented populations forced us to explore the genetic variability of CYP4F2 gene in Roma and Hungarian populations. PATIENTS AND METHODS 484 Roma, 493 Hungarian untreated subjects were genotyped for the CYP4F2*3 (rs2108622) variant by PCR-RFLP assay. RESULTS AND DISCUSSION We firstly report, that frequencies of the CYP4F2 rs2108622 GG, GA, AA genotypes and A allele in the Roma population were 46.5%, 42.6%, 10.9% and 32.2%; in Hungarians 50.1%, 42.2%, 7.7% and 22.8%, respectively. Bearing of two minor alleles of CYP4F2 missense variant (AA genotype) modestly explains inter-ethnic differences of studied populations (p<0.08). CYP4F2*3 (V433M) risk allele frequency of Roma (0.32) was in higher range, and of Hungarians (0.23) in lower range, as compared with other world populations. CONCLUSIONS Roma have an elevated chance for higher mean warfarin dose, besides a decreased risk of major bleeding events in long-term warfarin use.
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Affiliation(s)
- Csilla Sipeky
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary; Human Genetic and Pharmacogenetic Research Group, Janos Szentagothai Research Centre, Ifjusag 20, H-7624 Pecs, Hungary.
| | - Agnes Weber
- B.A.Z County Hospital and University Teaching Hospital, Szentpeteri Gate 72-76, H-3526 Miskolc, Hungary
| | - Bela I Melegh
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary
| | - Petra Matyas
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary
| | - Ingrid Janicsek
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary
| | - Renata Szalai
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary; Human Genetic and Pharmacogenetic Research Group, Janos Szentagothai Research Centre, Ifjusag 20, H-7624 Pecs, Hungary
| | - Istvan Szabo
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary
| | - Reka Varnai
- University of Pecs, Institute of Family Medicine, Akac str. 1, H-7632 Pecs, Hungary
| | - Greta Tarlos
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary
| | - Alma Ganczer
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary
| | - Bela Melegh
- University of Pecs, Clinical Centre, Department of Medical Genetics, Szigeti 12, H-7624 Pecs, Hungary; Human Genetic and Pharmacogenetic Research Group, Janos Szentagothai Research Centre, Ifjusag 20, H-7624 Pecs, Hungary
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Hu GX, Pan PP, Wang ZS, Yang LP, Dai DP, Wang SH, Zhu GH, Qiu XJ, Xu T, Luo J, Lian QQ, Ge RS, Cai JP. In vitro and in vivo characterization of 13 CYP2C9 allelic variants found in Chinese Han population. Drug Metab Dispos 2015; 43:561-9. [PMID: 25614704 DOI: 10.1124/dmd.114.061200] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our previous study detected totally 35 CYP2C9 allelic variants in 2127 Chinese subjects, of whom 21 novel alleles were reported for the first time in Chinese populations. The aim of the present study was to characterize the 13 CYP2C9 allelic variants both in vitro and in vivo. Different types of CYP2C9 variants were highly expressed in COS-7 cells, and 50 μM tolbutamide was added as the probing substrate to evaluate their metabolic abilities in vitro. Subsequently, the concentrations of tolbutamide and its metabolite in the plasma and urine within individuals with different types of genotypes were determined by HPLC to evaluate the catalytic activity of the 13 mutant CYP2C9 proteins in vivo. Our results showed that compared with *1/*1 wild-type subjects, subjects with *1/*40 genotype showed increased oral clearance (CL/F), whereas individuals with *1/*3, *1/*13, *3/*3, *3/*13, *1/*16, *1/*19, *1/*34, *1/*42, *1/*45, *1/*46, and *1/*48 genotype exhibited significantly decreased CL/F, and those with *1/*27, *1/*29, *1/*40, and *1/*41 genotype presented similar CL/F value. When expressed in COS-7 cells, the CYP2C9 variants showed similar pattern to the results in clinical study. The study suggests that, besides two typical defective alleles, *3 and *13, seven CYP2C9 allelic variants (*16, *19, *34, *42, *45, *46, and *48) cause defective effects on the enzymatic activities both in vitro and in vivo. In clinic, patients with these defective alleles should be paid close attention to.
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Affiliation(s)
- Guo-Xin Hu
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Pei-Pei Pan
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Zeng-Shou Wang
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Li-Ping Yang
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Da-Peng Dai
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Shuang-Hu Wang
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Guang-Hui Zhu
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Xiang-Jun Qiu
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Tao Xu
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Jun Luo
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Qing-Quan Lian
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Ren-Shan Ge
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
| | - Jian-Ping Cai
- Testing and Analysis Laboratory for Phase I Clinical Trials (G.-X.H., P.-P.P., S.-H.W., T.X., J.L.) and Second Affiliated Hospital and Yuying Children's Hospital (Z.-S.W., G.-H.Z., Q.-Q.L., R.-S.G.), Wenzhou Medical University, Wenzhou, P.R. China; Department of Pharmacy, Beijing Hospital, Ministry of Health, Beijing, P.R. China (L.-P.Y.); Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, P.R. China (D.-P.D., J.-P.C.); and Medical College of Henan University of Science and Technology, Luoyang, P.R. China (X.-J.Q.)
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Francis B, Lane S, Pirmohamed M, Jorgensen A. A review of a priori regression models for warfarin maintenance dose prediction. PLoS One 2014; 9:e114896. [PMID: 25501765 PMCID: PMC4264860 DOI: 10.1371/journal.pone.0114896] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 11/14/2014] [Indexed: 01/21/2023] Open
Abstract
A number of a priori warfarin dosing algorithms, derived using linear regression methods, have been proposed. Although these dosing algorithms may have been validated using patients derived from the same centre, rarely have they been validated using a patient cohort recruited from another centre. In order to undertake external validation, two cohorts were utilised. One cohort formed by patients from a prospective trial and the second formed by patients in the control arm of the EU-PACT trial. Of these, 641 patients were identified as having attained stable dosing and formed the dataset used for validation. Predicted maintenance doses from six criterion fulfilling regression models were then compared to individual patient stable warfarin dose. Predictive ability was assessed with reference to several statistics including the R-square and mean absolute error. The six regression models explained different amounts of variability in the stable maintenance warfarin dose requirements of the patients in the two validation cohorts; adjusted R-squared values ranged from 24.2% to 68.6%. An overview of the summary statistics demonstrated that no one dosing algorithm could be considered optimal. The larger validation cohort from the prospective trial produced more consistent statistics across the six dosing algorithms. The study found that all the regression models performed worse in the validation cohort when compared to the derivation cohort. Further, there was little difference between regression models that contained pharmacogenetic coefficients and algorithms containing just non-pharmacogenetic coefficients. The inconsistency of results between the validation cohorts suggests that unaccounted population specific factors cause variability in dosing algorithm performance. Better methods for dosing that take into account inter- and intra-individual variability, at the initiation and maintenance phases of warfarin treatment, are needed.
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Affiliation(s)
- Ben Francis
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Andrea Jorgensen
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
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