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Mifsud Buhagiar L, Casha M, Grech A, Serracino Inglott A, LaFerla G. The interplay between pharmacogenetics, concomitant drugs and blood levels of amitriptyline and its main metabolites. Per Med 2022; 19:113-123. [PMID: 35118877 DOI: 10.2217/pme-2021-0022] [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
Background: The research considers the impact of genotype-inferred variability on blood levels of amitriptyline and its main metabolites, as may be moderated by phenocopying. Patients & methods: CYP2D6 and CYP2C19 genotypes, and serum concentrations of amitriptyline, nortriptyline and hydroxymetabolites, were determined in 33 outpatients. Co-medications were reviewed to identify CYP inhibition risk. Results: CYP2C19 metabolizer status explained interpatient variation in nortriptyline to amitriptyline concentration ratios. The hydroxymetabolite to parent ratios increased with higher CYP2D6 activity scores and lower CYP2D6 inhibition risk. In patients at high CYP2D6 inhibition risk, the amitriptyline + nortriptyline concentration was, on average, 52% above the higher end of expected ranges. Conclusion: Practical construal of pharmacogenetics and drug interactions tantamount to aberrant metabolism can facilitate patient-tailored use of the established drug.
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Affiliation(s)
- Luana Mifsud Buhagiar
- Department of Pharmacy, Faculty of Medicine & Surgery, University of Malta, Msida, MSD 2080, Malta.,Medicines Authority, Malta Life Sciences Park, San Ġwann, SĠN 3000, Malta
| | - Marilyn Casha
- Department of Surgery, Faculty of Medicine & Surgery, University of Malta, Msida, MSD 2080, Malta
| | - Anton Grech
- Department of Psychiatry, Faculty of Medicine & Surgery, University of Malta, Msida, MSD 2080, Malta
| | - Anthony Serracino Inglott
- Department of Pharmacy, Faculty of Medicine & Surgery, University of Malta, Msida, MSD 2080, Malta.,Medicines Authority, Malta Life Sciences Park, San Ġwann, SĠN 3000, Malta
| | - Godfrey LaFerla
- Department of Surgery, Faculty of Medicine & Surgery, University of Malta, Msida, MSD 2080, Malta
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2
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Bhave G, Chen JC, Singer A, Sharma A, Robinson JT. Distributed sensor and actuator networks for closed-loop bioelectronic medicine. MATERIALS TODAY (KIDLINGTON, ENGLAND) 2021; 46:125-135. [PMID: 34366697 PMCID: PMC8336425 DOI: 10.1016/j.mattod.2020.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Designing implantable bioelectronic systems that continuously monitor physiological functions and simultaneously provide personalized therapeutic solutions for patients remains a persistent challenge across many applications ranging from neural systems to bioelectronic organs. Closed-loop systems typically consist of three functional blocks, namely, sensors, signal processors and actuators. An effective system, that can provide the necessary therapeutics, tailored to individual physiological factors requires a distributed network of sensors and actuators. While significant progress has been made, closed-loop systems still face many challenges before they can truly be considered as long-term solutions for many diseases. In this review, we consider three important criteria where materials play a critical role to enable implantable closed-loop systems: Specificity, Biocompatibility and Connectivity. We look at the progress made in each of these fields with respect to a specific application and outline the challenges in creating bioelectronic technologies for the future.
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Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel) 2021; 14:ph14060514. [PMID: 34071813 PMCID: PMC8230242 DOI: 10.3390/ph14060514] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023] Open
Abstract
Both inflammation and smoking can influence a drug’s pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients’ drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior—both clinically relevant in psychiatry—that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.
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Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs—Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel) 2021. [DOI: 10.3390/ph14060514
expr 938544256 + 801362328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Both inflammation and smoking can influence a drug’s pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients’ drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior—both clinically relevant in psychiatry—that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.
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5
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Moschny N, Hefner G, Grohmann R, Eckermann G, Maier HB, Seifert J, Heck J, Francis F, Bleich S, Toto S, Meissner C. Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel) 2021; 14:514. [PMID: 34071813 PMCID: PMC8230242 DOI: 10.3390/ph14060514&set/a 947965394+957477086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Both inflammation and smoking can influence a drug's pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients' drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior-both clinically relevant in psychiatry-that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.
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Affiliation(s)
- Nicole Moschny
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
- Correspondence: ; Tel.: +49-511-532-3656
| | - Gudrun Hefner
- Department of Psychiatry and Psychotherapy, Vitos Clinic for Forensic Psychiatry, Kloster-Eberbach-Str. 4, 65346 Eltville, Germany;
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaum-Str. 7, 80336 Munich, Germany;
| | - Gabriel Eckermann
- Department of Forensic Psychiatry and Psychotherapy, Hospital Kaufbeuren, Kemnater-Str. 16, 87600 Kaufbeuren, Germany;
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;
| | - Flverly Francis
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Catharina Meissner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
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Influence of serum inflammatory cytokines on cytochrome P450 drug metabolising activity during breast cancer chemotherapy: a patient feasibility study. Sci Rep 2021; 11:5648. [PMID: 33707475 PMCID: PMC7952716 DOI: 10.1038/s41598-021-85048-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
Individual response to chemotherapy in patients with breast cancer is variable. Obesity and exercise are associated with better and worse outcomes, respectively, and it is known that both impact the systemic cytokine milieu. Cytochrome P450 (CYP) enzymes are responsible for the metabolism of many chemotherapy agents, and CYP enzyme activity has been shown to be modified by inflammatory cytokines in vitro and in vivo. Cytokine-associated changes in CYP metabolism may alter chemotherapy exposure, potentially affecting treatment response and patient survival. Therefore, better understanding of these biological relationships is required. This exploratory single arm open label trial investigated changes in in vivo CYP activity in twelve women treated for stage II or III breast cancer, and demonstrated for the first time the feasibility and safety of utilising the Inje phenotyping cocktail to measure CYP activity in cancer patients receiving chemotherapy. Relative CYP activity varied between participants, particularly for CYP2C9 and CYP2D6, and changes in serum concentrations of the inflammatory cytokine monocyte chemoattractant protein 1 inversely correlated to CYP3A4 activity during chemotherapy. Future use of phenotyping cocktails in a clinical oncology setting may help guide drug dosing and improve chemotherapy outcomes. Clinical Trial Registration: Trial was retrospectively registered to the Australia New Zealand Clinical Trial Registry (ANZCTR). ACTRN12620000832976, 21 Aug 2020, https://www.anzctr.org.au/ACTRN12620000832976.aspx.
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7
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Déri MT, Kiss ÁF, Tóth K, Paulik J, Sárváry E, Kóbori L, Monostory K. End-stage renal disease reduces the expression of drug-metabolizing cytochrome P450s. Pharmacol Rep 2020; 72:1695-1705. [PMID: 32638224 PMCID: PMC7704481 DOI: 10.1007/s43440-020-00127-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND End-stage renal disease is an irreversible status of kidney dysfunction that reduces both renal and non-renal drug clearance. Accumulation of uremic toxins seems to modify the activities of drug-metabolizing cytochrome P450 (CYP) enzymes. The aim of the present work was to refine gene expression analysis for efficient and accurate quantification of CYP mRNAs in patients' leukocytes. METHODS We compared six liquid-liquid extraction reagents for RNA isolation and five reverse transcriptase kits for RNA-to-cDNA conversion, and developed quantitative polymerase chain reaction methods for duplex measurements of CYP target genes and the reference gene. The expression of CYP1A2, CYP2C9, CYP2C19 and CYP3A4 in patients with end-stage kidney disease (N = 105) and in organ donors with healthy kidney function (N = 110) was compared. RESULTS Regarding the RNA yield and purity, TRIzol, Trizolate and TRI reagents were equal; however, TRI reagent was the most advantageous in terms of financial cost. Reverse transcription using Maxima First Strand cDNA Synthesis kit appeared to be the most efficient with the widest range for quantification of the target transcript. The refined method with the detection of various CYPs and the reference gene in duplex PCR efficiently quantified even the low-level CYP expression. In leukocytes of patients with end-stage renal disease, all four CYPs were expressed at significantly lower level than in organ donors with normal kidney function (p < 0.0001). CONCLUSIONS Reduced CYP expression was a direct evidence of transcriptional down-regulation of CYP genes in patients with impaired kidney function.
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Affiliation(s)
- Máté Tamás Déri
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary
| | - Ádám Ferenc Kiss
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary
| | - Katalin Tóth
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary
| | - József Paulik
- Nucleotest Bio Ltd., Tündérliget 3/2, 1038, Budapest, Hungary
| | - Enikő Sárváry
- Department of Transplantation and Surgery, Semmelweis University, Baross 23, 1082, Budapest, Hungary
| | - László Kóbori
- Department of Transplantation and Surgery, Semmelweis University, Baross 23, 1082, Budapest, Hungary
| | - Katalin Monostory
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary.
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Drevin G, Picard N, Jousset N, Briet M, Abbara C. Pitfalls and challenges associated with phenoconversion in forensic toxcicology. Forensic Sci Int Genet 2020; 51:102433. [PMID: 33278816 DOI: 10.1016/j.fsigen.2020.102433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE In recent years, several publications have demonstrated the interest and the usefulness of pharmacogenetics in forensic toxicology. However, this approach remains namely focused on DNA-based phenotype, which may potentially lead to misinterpretation. Other determinants such as co-medication or physiological parameters may also impact the phenotype. This article aims to highlight the importance of considering such determinants in forensic toxicology, through the original case of a heroin-related fatality. METHOD Ethanol concentration determination and toxicological screening were performed using gas chromatography with flame ionization detection, liquid chromatography with diode array detection and gas chromatography with mass spectrometry detection. CYP2C19 and CYP2D6 genotypes were determined by Taqman® real-time PCR analyses. RESULTS Femoral blood analyses revealed the presence of ethanol, morphine, codeine, venlafaxine (VEN), O-desmethylvenlafaxine (ODV) and N-desmethylvenlafaxine (NDV), paroxetine, and risperidone. 6-acetylmorphine was also identified in urine. VEN, paroxetine and risperidone were quantified at supra-therapeutic or toxic blood concentrations. NDV was not quantified. The metabolic ratio of VEN (ODV to VEN) was exceptionally low (about 0.7). Pharmacogenetics testing showed that the patient was heterozygous for the CYP2C19*2 loss-of-function allele, which predict an intermediate metabolism for CYP2C19. None of the deficient CYP2D6 alleles investigated were identified. Those results suggest an extensive CYP2D6-metabolism phenotype. CONCLUSION A discrepancy was seen between the results of the genomic evaluation and the observed metabolic ratio of VEN. This tends to exclude a genetic origin and lead us to formulate other hypotheses, such as phenoconversion that may have been induced by drug interaction involving patients' regular medications. Phenoconversion is as a complex phenomenon that leads to genotype-phenotype mismatch without any genetic abnormality particularly described for cytochromes P450 2D6 and 2C19. Although transient, phenoconversion can have a significant impact on the analysis and interpretation of genotype-focused clinical outcomes correlation and in forensic toxicology conclusions.
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Affiliation(s)
- G Drevin
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France; Université d'Angers, Angers, France.
| | - N Picard
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU Limoges, Limoges, France
| | - N Jousset
- Université d'Angers, Angers, France; Institut de Médecine légale, CHU Angers, Angers, France
| | - M Briet
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France; Université d'Angers, Angers, France; Laboratoire MitoVasc, UMR INSERM 1083 CNRS 6015, Angers, France
| | - C Abbara
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
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Jaumaux F, P. Gómez de Cadiñanos L, Gabant P. In the Age of Synthetic Biology, Will Antimicrobial Peptides be the Next Generation of Antibiotics? Antibiotics (Basel) 2020; 9:antibiotics9080484. [PMID: 32781540 PMCID: PMC7460114 DOI: 10.3390/antibiotics9080484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 12/17/2022] Open
Abstract
Antibiotics have changed human health and revolutionised medical practice since the Second World War. Today, the use of antibiotics is increasingly limited by the rise of antimicrobial-resistant strains. Additionally, broad-spectrum antibiotic activity is not adapted to maintaining a balanced microbiome essential for human health. Targeted antimicrobials could overcome these two drawbacks. Although the rational design of targeted antimicrobial molecules presents a formidable challenge, in nature, targeted genetically encoded killing molecules are used by microbes in their natural ecosystems. The use of a synthetic biology approach allows the harnessing of these natural functions. In this commentary article we illustrate the potential of applying synthetic biology towards bacteriocins to design a new generation of antimicrobials.
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Vieira PA, Shin CB, Arroyo-Currás N, Ortega G, Li W, Keller AA, Plaxco KW, Kippin TE. Ultra-High-Precision, in-vivo Pharmacokinetic Measurements Highlight the Need for and a Route Toward More Highly Personalized Medicine. Front Mol Biosci 2019; 6:69. [PMID: 31475156 PMCID: PMC6707041 DOI: 10.3389/fmolb.2019.00069] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/25/2019] [Indexed: 12/24/2022] Open
Abstract
Clinical drug dosing would, ideally, be informed by high-precision, patient-specific data on drug metabolism. The direct determination of patient-specific drug pharmacokinetics ("peaks and troughs"), however, currently relies on cumbersome, laboratory-based approaches that require hours to days to return pharmacokinetic estimates based on only one or two plasma drug measurements. In response clinicians often base dosing on age, body mass, pharmacogenetic markers, or other indirect estimators of pharmacokinetics despite the relatively low accuracy of these approaches. Here, in contrast, we explore the use of indwelling electrochemical aptamer-based (E-AB) sensors as a means of measuring pharmacokinetics rapidly and with high precision using a rat animal model. Specifically, measuring the disposition kinetics of the drug tobramycin in Sprague-Dawley rats we demonstrate the seconds resolved, real-time measurement of plasma drug levels accompanied by measurement validation via HPLC-MS on ex vivo samples. The resultant data illustrate the significant pharmacokinetic variability of this drug even when dosing is adjusted using body weight or body surface area, two widely used pharmacokinetic predictors for this important class of antibiotics, highlighting the need for improved methods of determining its pharmacokinetics.
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Affiliation(s)
- Philip A. Vieira
- Department of Psychology, California State University, Dominguez Hills, Carson, CA, United States
- Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Christina B. Shin
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Netzahualcóyotl Arroyo-Currás
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gabriel Ortega
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Weiwei Li
- Bren School of Environmental Science & Management, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Arturo A. Keller
- Bren School of Environmental Science & Management, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Kevin W. Plaxco
- Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, United States
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, CA, United States
- Interdepartmental Program in Biomolecular Science and Engineering, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Tod E. Kippin
- Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, United States
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
- Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, CA, United States
- Department of Molecular Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, CA, United States
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Park Y, Kim H, Choi JY, Yun S, Min BJ, Seo ME, Im HJ, Kang HJ, Kim JH. Star Allele-Based Haplotyping versus Gene-Wise Variant Burden Scoring for Predicting 6-Mercaptopurine Intolerance in Pediatric Acute Lymphoblastic Leukemia Patients. Front Pharmacol 2019; 10:654. [PMID: 31244663 PMCID: PMC6580331 DOI: 10.3389/fphar.2019.00654] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/20/2019] [Indexed: 12/21/2022] Open
Abstract
Nudix Hydrolase 15 (NUDT15) and Thiopurine S-Methyltransferase (TPMT) are strong genetic determinants of thiopurine toxicity in pediatric acute lymphoblastic leukemia (ALL) patients. Since patients with NUDT15 or TPMT deficiency suffer severe adverse drug reactions, star (*) allele-based haplotypes have been used to predict an optimal 6-mercaptopurine (6-MP) dosing. However, star allele haplotyping suffers from insufficient, inconsistent, and even conflicting designations with uncertain and/or unknown functional alleles. Gene-wise variant burden (GVB) scoring enables us to utilize next-generation sequencing (NGS) data to predict 6-MP intolerance in children with ALL. Whole exome sequencing was performed for 244 pediatric ALL patients under 6-MP treatments. We assigned star alleles with PharmGKB haplotype set translational table. GVB for NUDT15 and TPMT was computed by aggregating in silico deleteriousness scores of multiple coding variants for each gene. Poor last-cycle dose intensity percent (DIP < 25%) was considered as 6-MP intolerance, resulting therapeutic failure of ALL. DIPs showed significant differences ( p < 0.05) among NUDT15 poor (PM, n = 1), intermediate (IM, n = 48), and normal (NM, n = 195) metabolizers. TPMT exhibited no PM and only seven IMs. GVB showed significant differences among the different haplotype groups of both NUDT15 and TPMT ( p < 0.05). Kruskal–Wallis test for DIP values showed statistical significances for the seven different GVB score bins of NUDT15. GVBNUDT15 outperformed the star allele-based haplotypes in predicting patients with reduced last-cycle DIPs at all DIP threshold levels (i.e., 5%, 10%, 15%, and 25%). In NUDT15-and-TPMT combined interaction analyses, GVBNUDT15,TPMT outperformed star alleles [area under the receiver operating curve (AUROC) = 0.677 vs. 0.645] in specificity (0.813 vs. 0.796), sensitivity (0.526 vs. 0.474), and positive (0.192 vs. 0.164) and negative (0.953 vs. 0.947) predictive values. Overall, GVB correctly classified five more patients (i.e., one into below and four into above 25% DIP groups) than did star allele haplotypes. GVB analysis demonstrated that 6-MP intolerance in pediatric ALL can be reliably predicted by aggregating NGS-based common, rare, and novel variants together without hampering the predictive power of the conventional haplotype analysis.
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Affiliation(s)
- Yoomi Park
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyery Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.,Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Sunmin Yun
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung-Joo Min
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung-Eui Seo
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.,Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Ju Han Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea.,Center for Precision Medicine, Seoul National University Hospital, Seoul, South Korea
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Qian T, Zhu S, Hoshida Y. Use of big data in drug development for precision medicine: an update. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019; 4:189-200. [PMID: 31286058 PMCID: PMC6613936 DOI: 10.1080/23808993.2019.1617632] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/08/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Big-data-driven drug development resources and methodologies have been evolving with ever-expanding data from large-scale biological experiments, clinical trials, and medical records from participants in data collection initiatives. The enrichment of biological- and clinical-context-specific large-scale data has enabled computational inference more relevant to real-world biomedical research, particularly identification of therapeutic targets and drugs for specific diseases and clinical scenarios. AREAS COVERED Here we overview recent progresses made in the fields: new big-data-driven approach to therapeutic target discovery, candidate drug prioritization, inference of clinical toxicity, and machine-learning methods in drug discovery. EXPERT OPINION In the near future, much larger volumes and complex datasets for precision medicine will be generated, e.g., individual and longitudinal multi-omic, and direct-to-consumer datasets. Closer collaborations between experts with different backgrounds would also be required to better translate analytic results into prognosis and treatment in the clinical practice. Meanwhile, cloud computing with protected patient privacy would become more routine analytic practice to fill the gaps within data integration along with the advent of big-data. To conclude, integration of multitudes of data generated for each individual along with techniques tailored for big-data analytics may eventually enable us to achieve precision medicine.
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Affiliation(s)
- Tongqi Qian
- Department of Genetics and Genomic Sciences and Icahn
Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Shijia Zhu
- Liver Tumor Translational Research Program, Simmons
Comprehensive Cancer Center, Division of Digestive and Liver Diseases, Department of
Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
75390, USA
| | - Yujin Hoshida
- Liver Tumor Translational Research Program, Simmons
Comprehensive Cancer Center, Division of Digestive and Liver Diseases, Department of
Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
75390, USA
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Monostory K, Nagy A, Tóth K, Bűdi T, Kiss Á, Déri M, Csukly G. Relevance of CYP2C9 Function in Valproate Therapy. Curr Neuropharmacol 2019; 17:99-106. [PMID: 29119932 PMCID: PMC6341495 DOI: 10.2174/1570159x15666171109143654] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/09/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Genetic polymorphisms of drug metabolizing enzymes can substantially modify the pharmacokinetics of a drug and eventually its efficacy or toxicity; however, inferring a patient's drug metabolizing capacity merely from his or her genotype can lead to false prediction. Non-genetic host factors (age, sex, disease states) and environmental factors (nutrition, comedication) can transiently alter the enzyme expression and activities resulting in genotypephenotype mismatch. Although valproic acid is a well-tolerated anticonvulsant, pediatric patients are particularly vulnerable to valproate injury that can be partly attributed to the age-related differences in metabolic pathways. METHODS CYP2C9 mediated oxidation of valproate, which is the minor metabolic pathway in adults, appears to become the principal route in children. Genetic and non-genetic variations in CYP2C9 activity can result in significant inter- and intra-individual differences in valproate pharmacokinetics and valproate induced adverse reactions. RESULTS The loss-of-function alleles, CYP2C9*2 or CYP2C9*3, display significant reduction in valproate metabolism in children; furthermore, low CYP2C9 expression in patients with CYP2C9*1/*1 genotype also leads to a decrease in valproate metabolizing capacity. Due to phenoconversion, the homozygous wild genotype, expected to be translated to CYP2C9 enzyme with normal activity, is transiently switched into poor (or extensive) metabolizer phenotype. CONCLUSION Novel strategy for valproate therapy adjusted to CYP2C9-status (CYP2C9 genotype and CYP2C9 expression) is strongly recommended in childhood. The early knowledge of pediatric patients' CYP2C9-status facilitates the optimization of valproate dosing which contributes to the avoidance of misdosing induced adverse reactions, such as abnormal blood levels of ammonia and alkaline phosphatase, and improves the safety of children's anticonvulsant therapy.
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Affiliation(s)
- Katalin Monostory
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Andrea Nagy
- Heim Pal Children's Hospital, Budapest, Hungary
| | - Katalin Tóth
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Tamás Bűdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ádám Kiss
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Máté Déri
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Chang LC, Colonna TE. Recent updates and challenges on the regulation of precision medicine: The United States in perspective. Regul Toxicol Pharmacol 2018; 96:41-47. [PMID: 29715491 DOI: 10.1016/j.yrtph.2018.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/08/2018] [Accepted: 04/27/2018] [Indexed: 11/18/2022]
Abstract
The rapid progress in "omics", such as genomics, metabolomics, microbiomics, has paved the path for precision medicine and revolutionized the development of drugs and devices promising to meet unmet medical needs. The aim of the present study was to investigate the current regulatory framework established by the United States Food and Drug Administration (USFDA) and to identify challenges and concerns through study of related literatures in the PubMed database. We found that efforts were made to facilitate the implementation of precision medicine through organizational reform, publication of guidance documents, and continuous post-market surveillance. The challenges identified included the critical, fundamental structural requirements of databases, essential regulatory considerations for market approval, and the appropriate clinical use such as whole genomic sequencing tests especially for a newborn or even fetus. These issues are worth further research to devise an integral approach involving scientific, ethical, legal, and social considerations.
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Affiliation(s)
- Lin-Chau Chang
- School of Pharmacy, College of Medicine, National Taiwan University, 33 Linsen S. Rd., Zhongzheng Dist., Taipei City 10050, Taiwan.
| | - Thomas E Colonna
- Regulatory Science and Food Safety Regulation Programs, Johns Hopkins University, Montgomery County Campus, 9601 Medical Center Drive, Rockville, MD 20850, United States
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Toward a world of theranostic medication: Programming biological sentinel systems for therapeutic intervention. Adv Drug Deliv Rev 2016; 105:66-76. [PMID: 27189230 DOI: 10.1016/j.addr.2016.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/02/2016] [Accepted: 05/05/2016] [Indexed: 12/21/2022]
Abstract
Theranostic systems support diagnostic and therapeutic functions in a single integrated entity and enable precise spatiotemporal control of the generation of therapeutic molecules according to the individual patient's disease state, thereby maximizing the therapeutic outcome and minimizing side effects. These systems can also incorporate reporter systems equipped with a disease-sensing module that can be used to estimate the efficacy of treatment in vivo. Among these reporter systems, biological sentinel systems, such as viruses, bacteria, and mammalian cells, have great potential for use in the development of novel theranostic systems because of their ability to sense a variety of disease markers and secrete various therapeutic molecules. Furthermore, recent advances in biotechnology and synthetic biology have made it possible to treat these biological systems as true programmable entities capable of conducting complex operations, to accurately identify each individual patient's disease state. In this review, we introduce the basic design principles of these rapidly expanding classes of biological sentinel system-based theranostic agents, with a focus on recent advances, and we also discuss potential enabling technologies that can further improve these systems and provide more sophisticated therapeutic interventions in the near future. In addition, we consider the possibility of synergistic use of theranostic agents that use different modalities and discuss the prospects for next-generation theranostic agents.
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16
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Zaid AN, Al Ramahi R, Cortesi R, Mousa A, Jaradat N, Ghazal N, Bustami R. Investigation of the Bioequivalence of Rosuvastatin 20 mg Tablets after a Single Oral Administration in Mediterranean Arabs Using a Validated LC-MS/MS Method. Sci Pharm 2016; 84:536-546. [PMID: 28117319 PMCID: PMC5064244 DOI: 10.3390/scipharm84030536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/04/2016] [Indexed: 12/29/2022] Open
Abstract
There is a wide inter-individual response to statin therapy including rosuvastatin calcium (RC), and it has been hypothesized that genetic differences may contribute to these variations. In fact, several studies have shown that pharmacokinetic (PK) parameters for RC are affected by race. The aim of this study is to demonstrate the interchangeability between two generic RC 20 mg film-coated tablets under fasting conditions among Mediterranean Arabs and to compare the pharmacokinetic results with Asian and Caucasian subjects from other studies. A single oral RC 20 mg dose, randomized, open-label, two-way crossover design study was conducted in 30 healthy Mediterranean Arab volunteers. Blood samples were collected prior to dosing and over a 72-h period. Concentrations in plasma were quantified using a validated liquid chromatography tandem mass spectrometry method. Twenty-six volunteers completed the study. Statistical comparison of the main PK parameters showed no significant difference between the generic and branded products. The point estimates (ratios of geometric mean %) were 107.73 (96.57-120.17), 103.61 (94.03-114.16), and 104.23 (94.84-114.54) for peak plasma concentration (Cmax), Area Under the Curve (AUC)0→last, and AUC0→∞, respectively. The 90% confidence intervals were within the pre-defined limits of 80%-125% as specified by the Food and Drug Administration and European Medicines Agency for bioequivalence studies. Both formulations were well-tolerated and no serious adverse events were reported. The PK results (AUC0→last and Cmax) were close to those of the Caucasian subjects. This study showed that the test and reference products met the regulatory criteria for bioequivalence following a 20 mg oral dose of RC under fasting conditions. Both formulations also showed comparable safety results. The PK results of the test and reference in the study subjects fall within the acceptable interval of 80%-125% and they were very close to the results among Caucasians. These PK results may be useful in order to determine the suitable RC dose among Arab Mediterranean patients.
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Affiliation(s)
- Abdel Naser Zaid
- Department of Pharmacy, Faculty of Medicine & health Sciences, An-Najah National University, 44859 Nablus, P.O. Box 7, Palestine.
| | - Rowa Al Ramahi
- Department of Pharmacy, Faculty of Medicine & health Sciences, An-Najah National University, 44859 Nablus, P.O. Box 7, Palestine.
| | - Rita Cortesi
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy.
| | - Ayman Mousa
- R&D department Avalon Pharma (Middle East Pharmaceutical Industries Co. Ltd), 11372 Riyadh, Kingdom of Saudi Arabia.
| | - Nidal Jaradat
- Department of Pharmacy, Faculty of Medicine & health Sciences, An-Najah National University, 44859 Nablus, P.O. Box 7, Palestine.
| | - Nadia Ghazal
- Naratech Pharma Consultancy, 11814 Amman, Jordan.
| | - Rana Bustami
- Pharmaceutical Research Unit, Complex No 19, Yajouz St 19, 11910 Amman, Jordan.
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17
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Cytochrome allelic variants and clopidogrel metabolism in cardiovascular diseases therapy. Mol Biol Rep 2016; 43:473-84. [DOI: 10.1007/s11033-016-3983-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/04/2016] [Indexed: 01/18/2023]
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18
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Shimazawa R, Ikeda M. Overcoming regulatory challenges in the development of companion diagnostics for monitoring and safety. Per Med 2016; 13:155-167. [DOI: 10.2217/pme.15.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Concurrent development and co-approval of a companion diagnostic (CDx) with a corresponding drug is ideal, but often unfeasible. Because of limited exposure to a drug in clinical trials, crucial information on safety is sometimes revealed only after approval. Therefore, a CDx for monitoring/safety is often developed after approval of a corresponding drug. However, regulatory guidance is insufficient if contemporaneous development is not possible, thereby leaving plenty of opportunities for improvement with respect to pharmacovigilance and retrospective validation of the CDx. Furthermore, global harmonization of guidance on how to incorporate new scientific information from retrospective analyses of biomarkers should lead to the establishment of more evidence for the development of CDx for approved drugs.
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Affiliation(s)
- Rumiko Shimazawa
- Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
- Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Masayuki Ikeda
- Department of Medical Informatics, Kagawa University Hospital, Miki-cho Ikenobe, Kagawa 761-0793, Japan
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Piguet V, D’Incau S, Besson M, Desmeules J, Cedraschi C. Prescribing Generic Medication in Chronic Musculoskeletal Pain Patients: An Issue of Representations, Trust, and Experience in a Swiss Cohort. PLoS One 2015; 10:e0134661. [PMID: 26237036 PMCID: PMC4523195 DOI: 10.1371/journal.pone.0134661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 07/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Parallel to an ever stronger advocacy for the use of generics, various sources of information report concerns regarding substitution. The literature indicates that information regarding substitution is not univocal. The aim of this qualitative study was to explore patients’ representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Methods Qualitative methods were selected because the aim was to access the range of patients' representations and to consider their conceptions. Standardized face-to-face semi-structured interviews were used, and transcripts were submitted to content analysis. Results Patients’ representations suggest that they might be confident in taking a generic medication: when he/she has an understanding of generics as resulting from a development process that has become part of the public domain; the generic medication is prescribed by the physician; each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Discussion Economic arguments are not sufficient to justify substitution, and may even raise issues calling upon cognitive dissonance. Even in non-life-threatening diseases, negative cues require attention and need be de-emphasized - in particular lower price as an indication of lower quality, and generic status as contradictory with advocating individualization of medication.
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Affiliation(s)
- Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Stéphanie D’Incau
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Christine Cedraschi
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of General Medical Rehabilitation, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Kaufmann M, Keppens M, Blair ED. A perspective analysis: companion diagnostics: an evolving paradigm in 21st century healthcare. Per Med 2015; 12:389-402. [PMID: 29771658 DOI: 10.2217/pme.15.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Medical history has not wandered far from its original aspirations of being personalized. Diagnostic capability has evolved from the metaphysical to the anatomical to the cellular and ultimately to the molecular level. Now that diseases can be subclassified into categories that indicate the course of disease and in some cases its likely response to treatment, there is a responsibility to act on that information. As more predictive biomarkers become clinically validated and as more targeted therapies become available, single marker companion diagnostics for specific drugs will be replaced by multiplex and multiparameter diagnostics that may be applicable across disease entities preserving sample, time, money and enabling rapid molecular taxonomy. We call this an ensemble relationship model between diagnostics and medicines.
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Affiliation(s)
- Martina Kaufmann
- Martina Kaufmann Strategic Consulting, Dorfmatt 22, 79379 Müllheim, Germany
| | - Mieke Keppens
- Quest-ion, Sint Vitusstraat 2 G, 1411PT Naarden-Vesting, The Netherlands
| | - Edward D Blair
- Integrated Medicines Ltd, Topfield House, Ermine Street, Caxton, Cambridge, CB23 3PQ, UK
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21
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Kojima R, Aubel D, Fussenegger M. Novel theranostic agents for next-generation personalized medicine: small molecules, nanoparticles, and engineered mammalian cells. Curr Opin Chem Biol 2015; 28:29-38. [PMID: 26056952 DOI: 10.1016/j.cbpa.2015.05.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/03/2015] [Accepted: 05/15/2015] [Indexed: 12/20/2022]
Abstract
Modern medicine is currently undergoing a paradigm shift from conventional disease treatments based on the diagnosis of a generalized disease state to a more personalized, customized treatment model based on molecular-level diagnosis. This uses novel biosensors that can precisely extract disease-related information from complex biological systems. Moreover, with the recent progress in chemical biology, materials science, and synthetic biology, it has become possible to simultaneously conduct diagnosis and targeted therapy (theranostics/theragnosis) by directly connecting the readout of a biosensor to a therapeutic output. These advances pave the way for more advanced and better personalized treatment for intractable diseases with fewer side effects. In this review, we describe recent advances in the development of cutting-edge theranostic agents that contain both diagnostic and therapeutic functions in a single integrated system. By comparing the advantages and disadvantages of each modality, we discuss the future challenges and prospects of developing ideal theranostic agents for the next generation of personalized medicine.
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Affiliation(s)
- Ryosuke Kojima
- ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Dominique Aubel
- IUTA Département Génie Biologique, Université Claude Bernard Lyon 1, Boulevard du 11 Novembre 1918, F-69622 Villeurbanne Cedex, France
| | - Martin Fussenegger
- ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland; Faculty of Life Science, University of Basel, Mattenstrasse 26, CH-4058 Basel, Switzerland.
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Shah RR, Smith RL. Inflammation-induced phenoconversion of polymorphic drug metabolizing enzymes: hypothesis with implications for personalized medicine. Drug Metab Dispos 2014; 43:400-10. [PMID: 25519488 DOI: 10.1124/dmd.114.061093] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Phenoconversion transiently converts genotypic extensive metabolizers (EMs) into phenotypic poor metabolizers (PMs) of drugs, potentially with corresponding changes in clinical response. This phenomenon, typically resulting from coadministration of medications that inhibit certain drug metabolizing enzymes (DMEs), is especially well documented for enzymes of the cytochrome P450 family. Nonclinical evidence gathered over the last two decades also strongly implicates elevated levels of some proinflammatory cytokines, released during inflammation, in down-regulation of drug metabolism, especially by certain DMEs of the P450 family, thereby potentially causing transient phenoconversion. Clinically, phenoconversion of NAT2, CYP2C19, and CYP2D6 has been documented in inflammatory conditions associated with elevated cytokines, such as human immunodeficiency virus infection, cancer, and liver disease. The potential of other inflammatory conditions to cause phenoconversion has not been studied but experimental and anecdotal clinical evidence supports infection-induced down-regulation of CYP1A2, CYP3A4, and CYP2C9 as well. Collectively, the evidence supports a hypothesis that certain inflammatory conditions associated with elevated proinflammatory cytokines may cause phenoconversion of certain DMEs. Since inflammatory conditions associated with elevated levels of proinflammatory cytokines are highly prevalent, phenoconversion of genotypic EM patients into transient phenotypic PMs may be more frequent than appreciated. Since drug pharmacokinetics, and therefore the clinical response, is influenced by DME phenotype rather than genotype per se, phenoconversion (whatever its cause) can have a significant impact on the analysis and interpretation of genotype-focused clinical outcome association studies. There is a risk that focusing on genotype alone may miss important associations between clinical outcomes and DME phenotypes, thus compromising future prospects of personalized medicine.
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Affiliation(s)
- Rashmi R Shah
- Rashmi Shah Consultancy Ltd., 8 Birchdale, Gerrards Cross, Buckinghamshire, United Kingdom (R.R.S.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College, South Kensington campus, London, United Kingdom (R.L.S.)
| | - Robert L Smith
- Rashmi Shah Consultancy Ltd., 8 Birchdale, Gerrards Cross, Buckinghamshire, United Kingdom (R.R.S.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College, South Kensington campus, London, United Kingdom (R.L.S.)
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Brauch H, Schwab M. Prediction of tamoxifen outcome by genetic variation of CYP2D6 in post-menopausal women with early breast cancer. Br J Clin Pharmacol 2014; 77:695-703. [PMID: 24033728 DOI: 10.1111/bcp.12229] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/11/2013] [Indexed: 12/14/2022] Open
Abstract
The question of whether genetic polymorphisms of CYP2D6 can affect treatment outcome in patients with early post-menopausal oestrogen receptor (ER)-positive breast cancer has been a matter of debate over the past few years. In this article we revisit the hypothesis of CYP2D6 being a potential tamoxifen outcome predictor and provide detailed insight into the ongoing controversy that prevented the CYP2D6 marker from being accepted by the scientific and clinical community. We summarize the available pharmacokinetic, pharmacodynamic and pharmacogenetic evidence and resolve the controversy based on the recognized methodological and statistical issues. The cumulative evidence suggests that genotyping for CYP2D6 is clinically relevant in post-menopausal women. This is important, because the clarification of this issue has the potential to resolve a clinical management question that is relevant to hundreds of thousands of women diagnosed with ER-positive breast cancer each year, who should not be denied effective endocrine therapy.
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Affiliation(s)
- Hiltrud Brauch
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany; University Tuebingen, Tuebingen
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24
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Ehmann F, Caneva L, Papaluca M. European Medicines Agency initiatives and perspectives on pharmacogenomics. Br J Clin Pharmacol 2014; 77:612-7. [PMID: 24433361 DOI: 10.1111/bcp.12319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 12/19/2013] [Indexed: 02/02/2023] Open
Abstract
Pharmacogenomics, the study of variations of DNA and RNA characteristics as related to drug response, has become an integral part of drug development and pharmacovigilance, as reflected by the incorporation of pharmacogenomic data in EU product information. In this short review article, we describe recent European Medicines Agency initiatives intended to support further the implementation of pharmacogenomics in drug development and surveillance so that patients and the public can benefit from advances in genomic science and technology.
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Affiliation(s)
- Falk Ehmann
- European Medicines Agency, 7 Westferry Circus, London, E14 4HB, UK
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Abstract
The challenge of personalized medicine is to move away from the traditional 'one-size-fits-all' pharmacology to genotype-based individualized therapies. As an individual's response to drugs is under the control of genes, personal genetic profiles could help clinicians to predict individual drug response and prescribe the right drug and dose, thereby optimising efficacy and avoiding risk of adverse effects. Currently, the concrete application of pharmacogenetics into clinical practice is limited to a few drugs, and the genetic prediction of drug response is far from clear for many of thve principal complex disorders. This is even more evident in the field of osteoporosis and metabolic bone disorders, for which few pharmacogenetic studies have been conducted, and no conclusive results are available. In this chapter, we review recent research on pharmacogenetics of osteoporosis, evaluate criticisms, and offer possible suggestions for improvements in this field and for possible future applications into clinical practice.
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Affiliation(s)
- Francesca Marini
- Metabolic Bone Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
| | - Maria Luisa Brandi
- Metabolic Bone Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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Tutton R. Pharmacogenomic biomarkers in drug labels: what do they tell us? Pharmacogenomics 2014; 15:297-304. [PMID: 24533709 DOI: 10.2217/pgs.13.198] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM This article investigates the number of drugs on the market with pharmacogenomics (PGx) biomarker data in their labels using two public sources - the US FDA and the PharmGKB. METHODS The article analyzes the FDA Table of Pharmacogenomic Biomarkers in Drug Labels to show the number of drugs with PGx biomarker information in their labels. Scrutinizing the language of labels, it also engages with whether this information is intended to direct clinicians to take particular actions or not, and whether biomarker information is included on grounds of drug efficacy or to improve safety. The FDA table is compared to the PharmGKB Drug Labels with PGx info database to highlight how they differ in the number of drugs that they include. CONCLUSION Analysis of the FDA and the PharmGKB data show that approximately 12% of drugs licensed in the period 1998-2012 had PGx biomarker information included in their labels at the time of their approval. Of that number, labels direct clinicians to utilize PGx testing prior to prescribing treatments in only 14 cases. This clearly falls short of expectations many had in the 1990s about the transformative impact of PGx. In most cases, the inclusion of this information currently has limited or no direct clinical utility.
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Affiliation(s)
- Richard Tutton
- Centre for Science Studies, Department of Sociology, Lancaster University, Lancaster, UK.
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27
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Song M, Lee HW, Kang D. The potential application of personalized preventive research. Jpn J Clin Oncol 2014; 44:1017-24. [PMID: 25249379 DOI: 10.1093/jjco/hyu135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
With increases in life expectancy, the focus has shifted to living a healthier, longer life. By concentrating on preventing diseases before occurrence, researchers aim to diminish the increasing gap in medical costs and health inequalities prevalent across many nations. Although we have entered an era of post-genomics, we are still in infancy in terms of personalized preventive research. Personalized preventive research has and will continue to improve with advancements in the use of biomarkers and risk assessment. More evidence based on well-designed epidemiologic studies is required to provide comprehensive preventive medical care based on genetic and non-genetic profile data. The realization of personalized preventive research requires building of evidence through appropriate methodology, verification of results through translational studies as well as development and application of prediction models.
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Affiliation(s)
- Minkyo Song
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul
| | - Hwi-Won Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Burnett HF, Tanoshima R, Chandranipapongse W, Madadi P, Ito S, Ungar WJ. Testing for thiopurine methyltransferase status for safe and effective thiopurine administration: a systematic review of clinical guidance documents. THE PHARMACOGENOMICS JOURNAL 2014; 14:493-502. [DOI: 10.1038/tpj.2014.47] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/10/2014] [Accepted: 07/14/2014] [Indexed: 01/04/2023]
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Adelung MR, Fitzsimons VM. Pharmacogenomics: the path to individualised patient care. ACTA ACUST UNITED AC 2014; 23:738-9. [PMID: 25072336 DOI: 10.12968/bjon.2014.23.13.738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark R Adelung
- Nursing Clinical Instructor School of Nursing, Ocean County College PhD Candidate, Kean University Union, New Jersey, USA
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Response to CYP2D6 substrate antidepressants is predicted by a CYP2D6 composite phenotype based on genotype and comedications with CYP2D6 inhibitors. J Neural Transm (Vienna) 2014; 122:35-42. [DOI: 10.1007/s00702-014-1273-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
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Gryn SE, Kim RB. Personalized medicine: importance of clinical interpretative skills for real-world patient care. Per Med 2014; 11:395-408. [PMID: 29783478 DOI: 10.2217/pme.14.16] [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
Sequencing of the human genome led to great hopes and expectations for a 'genomics revolution' where disease diagnosis as well as therapies would be based on an individual's genetic makeup. Although significant progress has been made, a number of challenging hurdles must be overcome prior to the broader adoption and implementation of pharmacogenomics and personalized medicine as a part of standard patient care. One aspect of pharmacogenomics-based personalized medicine that has not garnered as much attention, a key focus of this perspective, is the importance of interpreting pharmacogenomic test results in a patient-specific clinical context, and expert physicians and other allied health care providers with the requisite expertise in clinical pharmacology and genomics who are able to provide such services.
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Affiliation(s)
- Steven E Gryn
- Division of Clinical Pharmacology, Department of Medicine, Western University, London Health Sciences Centre-UH; 339 Windermere Road; London, ON. N6A 5A5; Canada
| | - Richard B Kim
- Division of Clinical Pharmacology, Department of Medicine, Western University, London Health Sciences Centre-UH; 339 Windermere Road; London, ON. N6A 5A5; Canada
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Personalised medicine, disease prevention, and the inverse care law: more harm than benefit? Eur J Epidemiol 2014; 29:383-90. [PMID: 24729105 DOI: 10.1007/s10654-014-9898-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 04/02/2014] [Indexed: 01/11/2023]
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Awada Z, Zgheib NK. Pharmacogenovigilance: a pharmacogenomics pharmacovigilance program. Pharmacogenomics 2014; 15:845-56. [DOI: 10.2217/pgs.14.44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In this report, we review the importance of pharmacovigilance in detecting postmarketing adverse drug events and the potential for developing pharmacogenovigilance programs by integrating pharmacogenomics with pharmacovigilance. We propose to start developing such a program in primary healthcare systems that use basic features of electronic medical records and have access to large numbers of patients commonly prescribed drugs. Such programs, if carefully designed, may grow over time and hopefully enhance the collection and interpretation of useful data for the clinical applications of pharmacogenomics testing.
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Affiliation(s)
- Zeinab Awada
- Biomedical Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nathalie Khoueiry Zgheib
- Department of Pharmacology & Toxicology, Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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Drögemöller BI, Wright GEB, Warnich L. Considerations for rare variants in drug metabolism genes and the clinical implications. Expert Opin Drug Metab Toxicol 2014; 10:873-84. [PMID: 24673405 DOI: 10.1517/17425255.2014.903239] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Large-scale whole genome and exome resequencing studies have revealed that humans have a high level of deleterious rare variation, which has important implications for the design of future pharmacogenetics studies. AREAS COVERED Current pharmacogenetic guidelines focus on the implementation of common variation into dosing guidelines. However, it is becoming apparent that rare variation may also play an important role in differential drug response. Current sequencing technologies offer the opportunity to examine rare variation, but there are many challenges associated with such analyses. Nonetheless, if a comprehensive picture of the role that genetic variants play in treatment outcomes is to be obtained, it will be necessary to include the entire spectrum of variation, including rare variants, into pharmacogenetic research. EXPERT OPINION In order to implement pharmacogenetics in the clinic, patients should be genotyped for clinically actionable pharmacogenetic variants and patients responding unfavourably to treatment after pharmacogenetics-based dosing should be identified and resequenced to identify additional functionally relevant variants, including rare variants. All derived information should be added to a central database to allow for the updating of existing dosing guidelines. By routinely implementing such strategies, pharmacogenetics-based treatment guidelines will continue to improve.
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Caoili SEC. Beyond new chemical entities: advancing drug development based on functional versatility of antibodies. Hum Vaccin Immunother 2014; 10:1639-44. [PMID: 24632567 PMCID: PMC4185958 DOI: 10.4161/hv.28192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Antibody-type agents (i.e., antibodies and derivatives thereof) may be produced as clinically valuable antidotes, which conceivably could be developed in tandem with prospective new pharmaceutical products so as to render the risks of clinical trials more acceptable from a regulatory standpoint. Yet, this is but a relatively narrow view of the full potential utility associated with antibody-type agents, the significance of which is appreciated upon reconsidering key aspects of early modern biomedical research (notably major contributions thereto by Nobel Laureate Paul Ehrlich) in light of much more recent advances (e.g., application of immunity-oriented approaches to diseases in general, epitope-specific targeting, abzyme-mediated catalysis, antibody-mediated sustained-release buffering of unbound-ligand concentrations, and enhanced thermal and metabolic stability of deuterated chemical species via the kinetic isotope effect), as conditioned by health-related concerns (e.g., current and anticipated epidemiologic transitions vis-a-vis environmental changes) especially with regard to sustainable development (e.g., emphasizing more efficient resource utilization toward increased global resilience based on greater independence from high-maintenance technological infrastructure). The broader view that thus emerges highlights the urgent need to rebalance the health-research agenda, which presently reflect an overemphasis on small-molecule candidate-drug discovery, in order to advance health based on a comprehensive fundamental synthesis of immunity and pharmacology.
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Affiliation(s)
- Salvador Eugenio C Caoili
- Department of Biochemistry and Molecular Biology; College of Medicine; University of the Philippines Manila; Manila, Philippines
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Abstract
The number and use of pharmacogenetic tests to assess a patient's likelihood of response or risk of an adverse event is expanding across medical specialties and becoming more prevalent. During this period of development and translation, different approaches are being investigated to optimize delivery of pharmacogenetic services. In this paper, we review pre-emptive and point-of-care delivery approaches currently implemented or being investigated and discuss the advantages and disadvantages of each approach. The continued growth in knowledge about the genetic basis of drug response combined with development of new and less expensive testing technologies and electronic medical records will impact future delivery systems. Regardless of delivery approach, the currently limited knowledge of health professionals about genetics generally or PGx specifically will remain a major obstacle to utilization.
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Affiliation(s)
- Susanne B. Haga
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708, Tel: 919.684.0325, Fax: 919.613.6448
| | - Jivan Moaddeb
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708, Tel: 919.684.0325, Fax: 919.613.6448
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Haga SB. Delivering pharmacogenetic testing to the masses: an achievable goal? Pharmacogenomics 2014; 15:1-4. [DOI: 10.2217/pgs.13.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences & Policy & Sanford School of Public Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708, USA
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Haga SB, LaPointe NMA. The potential impact of pharmacogenetic testing on medication adherence. THE PHARMACOGENOMICS JOURNAL 2013; 13:481-3. [PMID: 23999596 PMCID: PMC3969027 DOI: 10.1038/tpj.2013.33] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/06/2013] [Accepted: 07/22/2013] [Indexed: 01/22/2023]
Abstract
Poor medication adherence is a well-known problem, particularly in patients with chronic conditions, and is associated with significant morbidity, mortality and health-care costs. Multi-faceted and personalized interventions have shown the greatest success. Pharmacogenetic (PGx) testing may serve as another tool to boost patients' confidence in the safety and efficacy of prescribed medications. Here, we consider the potential impact (positively or negatively) of PGx testing on medication-taking behavior.
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Affiliation(s)
- Susanne B. Haga
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708, Tel: 919.684.0325, Fax: 919.613.6448,
| | - Nancy M. Allen LaPointe
- Associate Professor of Medicine, Duke University, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27710, Phone: 919-668-8529,
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Shimazawa R, Ikeda M. Are there any differences in the regulations of personalized medicine among the USA, EU and Japan? Br J Clin Pharmacol 2013; 75:1365-7. [PMID: 22978372 PMCID: PMC3635607 DOI: 10.1111/j.1365-2125.2012.04462.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 08/29/2012] [Indexed: 01/02/2023] Open
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Godman B, Finlayson AE, Cheema PK, Zebedin-Brandl E, Gutiérrez-Ibarluzea I, Jones J, Malmström RE, Asola E, Baumgärtel C, Bennie M, Bishop I, Bucsics A, Campbell S, Diogene E, Ferrario A, Fürst J, Garuoliene K, Gomes M, Harris K, Haycox A, Herholz H, Hviding K, Jan S, Kalaba M, Kvalheim C, Laius O, Lööv SA, Malinowska K, Martin A, McCullagh L, Nilsson F, Paterson K, Schwabe U, Selke G, Sermet C, Simoens S, Tomek D, Vlahovic-Palcevski V, Voncina L, Wladysiuk M, van Woerkom M, Wong-Rieger D, Zara C, Ali R, Gustafsson LL. Personalizing health care: feasibility and future implications. BMC Med 2013; 11:179. [PMID: 23941275 PMCID: PMC3750765 DOI: 10.1186/1741-7015-11-179] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/09/2013] [Indexed: 01/11/2023] Open
Abstract
Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer's perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Alexander E Finlayson
- King’s Centre for Global Health, Global Health Offices, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Parneet K Cheema
- Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Eva Zebedin-Brandl
- Hauptverband der Österreichischen Sozialversicherungsträger, 21 Kundmanngasse, AT-1031, Wien, Austria
- Institute of Pharmacology and Toxicology, Department for Biomedical Sciences, University of Vienna, Vienna, Austria
| | - Inaki Gutiérrez-Ibarluzea
- Osteba Basque Office for HTA, Ministry of Health of the Basque Country, Donostia-San Sebastian 1, 01010, Vitoria-Gasteiz, Basque Country, Spain
| | - Jan Jones
- NHS Tayside, Kings Cross, Dundee DD3 8EA, UK
| | - Rickard E Malmström
- Department of Medicine, Clinical Pharmacology Unit, Karolinska Institutet, Karolinska University Hospital Solna, SE-17176, Stockholm, Sweden
| | - Elina Asola
- Pharmaceutical Pricing Board, Ministry of Social Affairs and Health, PO Box 33, FI-00023 Government, Helsinki, Finland
| | | | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Public Health & Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh EH12 9EB, UK
| | - Iain Bishop
- Public Health & Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh EH12 9EB, UK
| | - Anna Bucsics
- Hauptverband der Österreichischen Sozialversicherungsträger, 21 Kundmanngasse, AT-1031, Wien, Austria
| | - Stephen Campbell
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK
| | - Eduardo Diogene
- Unitat de Coordinació i Estratègia del Medicament, Direcció Adjunta d'Afers Assistencials, Catalan Institute of Health, Barcelona, Spain
| | - Alessandra Ferrario
- London School of Economics and Political Science, LSE Health, Houghton Street, London WC2A 2AE, UK
| | - Jurij Fürst
- Health Insurance Institute, Miklosiceva 24, SI-1507, Ljubljana, Slovenia
| | - Kristina Garuoliene
- Medicines Reimbursement Department, National Health Insurance Fund, Europas a. 1, Vilnius, Lithuania
| | - Miguel Gomes
- INFARMED, Parque da Saúde de Lisboa, Avenida do Brasil 53, 1749-004, Lisbon, Portugal
| | - Katharine Harris
- King’s Centre for Global Health, Global Health Offices, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Alan Haycox
- Liverpool Health Economics Centre, University of Liverpool, Chatham Street, Liverpool L69 7ZH, UK
| | - Harald Herholz
- Kassenärztliche Vereinigung Hessen, 15 Georg Voigt Strasse, DE-60325, Frankfurt am Main, Germany
| | - Krystyna Hviding
- Norwegian Medicines Agency, Sven Oftedals vei 8, 0950, Oslo, Norway
| | - Saira Jan
- Clinical Programs, Pharmacy Management, Horizon Blue Cross Blue Shield of New Jersey, Newark, USA
| | - Marija Kalaba
- Republic Institute for Health Insurance, Jovana Marinovica 2, 11000, Belgrade, Serbia
| | | | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia
| | - Sven-Ake Lööv
- Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden
| | - Kamila Malinowska
- HTA Consulting, Starowiślna Street, 17/3, 31-038, Cracow, Poland
- Public Health School, The Medical Centre of Postgraduate Education, Kleczewska Street, 61/63, 01-813, Warsaw, Poland
| | - Andrew Martin
- NHS Greater Manchester Commissioning Support Unit, Salford, Manchester, UK
| | - Laura McCullagh
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin 8, Ireland
| | - Fredrik Nilsson
- Dental and Pharmaceuticals Benefits Agency (TLV), PO Box 22520 Flemingatan 7, SE-104, Stockholm, Sweden
| | | | - Ulrich Schwabe
- University of Heidelberg, Institute of Pharmacology, D-69120, Heidelberg, Germany
| | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIDO), Rosenthaler Straße 31, 10178, Berlin, Germany
| | | | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium
| | - Dominik Tomek
- Faculty of Pharmacy, Comenius University and Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Vera Vlahovic-Palcevski
- Unit for Clinical Pharmacology, University Hospital Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
| | - Luka Voncina
- Ministry of Health, Republic of Croatia, Ksaver 200a, Zagreb, Croatia
| | | | - Menno van Woerkom
- Dutch Institute for Rational Use of Medicines, 3527 GV, Utrecht, Netherlands
| | - Durhane Wong-Rieger
- Institute for Optimizing Health Outcomes, 151 Bloor Street West, Suite 600, Toronto, ON M5S 1S4, Canada
| | - Corrine Zara
- Barcelona Health Region, Catalan Health Service, Esteve Terrades 30, 08023, Barcelona, Spain
| | - Raghib Ali
- INDOX Cancer Research Network, Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
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Kennedy JL, Voudouris NC. Incorporating psychiatric pharmacogenetics into family practice. Pharmacogenomics 2013; 14:1121-4. [DOI: 10.2217/pgs.13.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- James L Kennedy
- Psychiatric Neurogenetics Section, Centre for Addiction & Mental Health, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
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43
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Mills R, Haga SB. Clinical delivery of pharmacogenetic testing services: a proposed partnership between genetic counselors and pharmacists. Pharmacogenomics 2013; 14:957-68. [PMID: 23746189 PMCID: PMC3731754 DOI: 10.2217/pgs.13.76] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
One of the basic questions in the early uses of pharmacogenetic (PGx) testing revolves around the clinical delivery of testing. Because multiple health professionals may play a role in the delivery of PGx testing, various clinical delivery models have begun to be studied. We propose that a partnership between genetic counselors and pharmacists can assist clinicians in the delivery of comprehensive PGx services. Based on their expert knowledge of pharmacokinetics and pharmacodynamics, pharmacists can facilitate the appropriate application of PGx test results to adjust medication use as warranted and act as a liaison to the healthcare team recommending changes in medication based on test results and patient input. Genetic counselors are well-trained in genetics as well as risk communication and counseling methodology, but have limited knowledge of pharmaceuticals. The complementary knowledge and skill set supports the partnership between genetic counselors and pharmacists to provide effective PGx testing services.
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Affiliation(s)
- Rachel Mills
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708
| | - Susanne B. Haga
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708
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44
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Steinke D, Ashcroft D. Personalized medicine: Implications for research and policy. J Health Serv Res Policy 2013. [DOI: 10.1177/1355819613476276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Douglas Steinke
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester School of Pharmacy and Pharmaceutical Sciences, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester School of Pharmacy and Pharmaceutical Sciences, Manchester, UK
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