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Mahajna M, Abu Fanne R, Berkovitch M, Tannous E, Vinker S, Green I, Matok I. Effect of CYP2C19 Pharmacogenetic Testing on Predicting Citalopram and Escitalopram Tolerability and Efficacy: A Retrospective, Longitudinal Cohort Study. Biomedicines 2023; 11:3245. [PMID: 38137466 PMCID: PMC10740827 DOI: 10.3390/biomedicines11123245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Background-Various antidepressant agents are metabolized by the CYP2C19 enzyme, including Citalopram and Escitalopram. Variation in CYP2C19 expression might give rise to different plasma concentrations of the active metabolites, potentially affecting both drugs' efficacy and tolerability. Aim-The aim of this study was to evaluate differences in the Escitalopram and Citalopram efficacy and tolerability between different CYP2C19 genotype-based metabolizing categories in outpatients suffering from major depressive disorder (MDD). Methods-In a retrospective, longitudinal cohort study of electronic medical-record data, 283 patients with MDD who were prescribed Escitalopram or Citalopram with the available CYP2C19-genotyping test were enrolled. The primary efficacy end point was adverse drug reactions recorded in the medical files. A proportional-odds, multilevel-regression model for longitudinal ordinal data was used to estimate the relation between the CYP2C19 genotype and adverse drug reactions, adjusting for potential confounding variables and other explanatory variables. Latent-class analysis (LCA) was utilized to detect the presence of clinically significant subgroups and their relation to an individual's metabolizing status for CYP2D6/CYP2C19. Results-With poor CYP2C19 metabolizers as a reference, for each unit difference in the activity score of the CYP2C19 phenotype, the odds ratio for drug intolerability was lowered by 0.73 (95% credible intervals: 0.56-0.89), adjusting for significant covariates. In addition, applying LCA, we identified two qualitatively different subgroups: the first group (61.85%) exhibited multiple side effects, low compliance, and frequent treatment changes, whereas the second group (38.15%) demonstrated fewer side effects, good adherence, and fewer treatment changes. The CYP2C19 phenotype was substantially associated with the group membership. Conclusions-We found a positive association between the CYP2C19 activity scores, as inferred from the genotype, and both the efficacy of and tolerability to both Es/Citalopram. LCA enabled valuable insights into the underlying structure of the population; the CYP2C19 phenotype has a predictive value that discriminates between low-adherence, low-drug-tolerance, and low-response patients and high-adherence, high-drug-tolerance, and high-response patients. Personalized medicine based on CYP2C19 genotyping could evolve as a promising new avenue towards mitigating Escitalopram and Citalopram therapy and the associated side effects and enhancing treatment success.
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Affiliation(s)
- Mahmood Mahajna
- Department of Clinical Pharmacy, The Hebrew University, Jerusalem 9112002, Israel
- Hillel Yaffe Medical Center, Hadera 3810000, Israel;
| | - Rami Abu Fanne
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 3200003, Israel
- Leumit Health Care Services, Tel Aviv 6812509, Israel; (S.V.); (I.G.)
| | - Matitiahu Berkovitch
- Department of Clinical Pharmacology and Toxicology, Shamir Medical Center Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Elias Tannous
- Hillel Yaffe Medical Center, Hadera 3810000, Israel;
- Department of Medical Sciences, Faculty of Medicine, Ben-Gurion University of the Negev, Beersheva 8410501, Israel
| | - Shlomo Vinker
- Leumit Health Care Services, Tel Aviv 6812509, Israel; (S.V.); (I.G.)
| | - Ilan Green
- Leumit Health Care Services, Tel Aviv 6812509, Israel; (S.V.); (I.G.)
| | - Ilan Matok
- Department of Clinical Pharmacy, The Hebrew University, Jerusalem 9112002, Israel
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Stingl JC, Radermacher J, Wozniak J, Viviani R. Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes. Pharmaceutics 2022; 14:pharmaceutics14122833. [PMID: 36559326 PMCID: PMC9781550 DOI: 10.3390/pharmaceutics14122833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Pharmacogenetic variability in drug metabolism leads to patient vulnerability to side effects and to therapeutic failure. Our purpose was to introduce a systematic statistical methodology to estimate quantitative dose adjustments based on pharmacokinetic differences in pharmacogenetic subgroups, addressing the concerns of sparse data, incomplete information on phenotypic groups, and heterogeneity of study design. Data on psychotropic drugs metabolized by the cytochrome P450 enzyme CYP2C19 were used as a case study. CYP2C19 activity scores were estimated, while statistically assessing the influence of methodological differences between studies, and used to estimate dose adjustments in genotypic groups. Modeling effects of activity scores in each substance as a population led to prudential predictions of adjustments when few data were available ('shrinkage'). The best results were obtained with the regularized horseshoe, an innovative Bayesian approach to estimate coefficients viewed as a sample from two populations. This approach was compared to modeling the population of substance as normally distributed, to a more traditional "fixed effects" approach, and to dose adjustments based on weighted means, as in current practice. Modeling strategies were able to assess the influence of study parameters and deliver adjustment levels when necessary, extrapolated to all phenotype groups, as well as their level of uncertainty. In addition, the horseshoe reacted sensitively to small study sizes, and provided conservative estimates of required adjustments.
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Affiliation(s)
- Julia Carolin Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH, 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-241-8089131
| | - Jason Radermacher
- Institute of Clinical Pharmacology, University Hospital of RWTH, 52074 Aachen, Germany
| | - Justyna Wozniak
- Institute of Clinical Pharmacology, University Hospital of RWTH, 52074 Aachen, Germany
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
- Psychiatry and Psychotherapy Clinic, University of Ulm, 89075 Ulm, Germany
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Bernini de Brito R, Ghedini PC. CYP2C19 polymorphisms and outcomes of Escitalopram treatment in Brazilians with major depression. Heliyon 2020; 6:e04015. [PMID: 32509985 PMCID: PMC7264488 DOI: 10.1016/j.heliyon.2020.e04015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/14/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022] Open
Abstract
Escitalopram (ESC), a selective serotonin reuptake inhibitor indicated for the treatment of depression and anxiety disorders, is primarily metabolized by cytochrome P450 (CYP) 2C19, which is a highly polymorphic enzyme known to cause inter-individual differences in pharmacokinetics. We hypothesized that CYP2C19 polymorphisms are associated with major depressive disorder (MDD) remission in patients treated with ESC in the long term. Thirty-one patients with MDD receiving chronic treatment with ESC monotherapy or combination therapy with other antidepressants (mirtazapine and bupropion), in naturalistic conditions, were included in the study. For comparison of genotype and phenotype frequencies, a group of 126 healthy subjects was also included. The CYP2C19∗2, CYP2C19∗3, and CYP2C19∗17 polymorphisms were analyzed by RFLP-PCR genotyping. The CYP2C19 genotypes and phenotypes were similar in patient and healthy subject groups. Four phenotypes were found in the healthy subject group: ultra-rapid (UM; 28%), extensive (EM; 52%), intermediate (IM; 17%), and poor metabolizers (PM; 3%). The patient group showed the UM (22.5%), EM (55%), and IM (22.5%) phenotypes. The UM patients had significantly higher ESC doses than both EM and IM patients (20.7 ± 4.5, 15.7 ± 3.8, and 14.0 ± 3.3 mg/day, respectively; p = 0.0041). Furthermore, all patients using ESC in combination with mirtazapine or bupropion antidepressants (ESC plus mirtazapine or bupropion) were UM metabolizers, suggesting that the ∗17 ultra-rapid allele seems to be the factor responsible for lower response to ESC, even at higher doses. The CYP2C19 UM phenotype is associated with higher ESC doses and antidepressant combinations for symptom remission in MDD patients.
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Affiliation(s)
- Rodrigo Bernini de Brito
- Department of Pharmacology, Laboratory of Biochemistry and Molecular Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil.,Brain Institute, Bueno Medical Center, Goiânia, GO, Brazil
| | - Paulo César Ghedini
- Department of Pharmacology, Laboratory of Biochemistry and Molecular Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
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Radhakrishnan A, Kuppusamy G, Ponnusankar S, Shanmukhan NK. Pharmacogenomic phase transition from personalized medicine to patient-centric customized delivery. THE PHARMACOGENOMICS JOURNAL 2019; 20:1-18. [PMID: 31819163 DOI: 10.1038/s41397-019-0135-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
Abstract
Personalized medicine has been a booming area in clinical research for the past decade, in which the detailed information about the patient genotype and clinical conditions were collected and considered to optimize the therapy to prevent adverse reactions. However, the utility of commercially available personalized medicine has not yet been maximized due to the lack of a structured protocol for implementation. In this narrative review, we explain the role of pharmacogenetics in personalized medicine, next-generation personalized medicine, i.e., patient-centric personalized medicine, in which the patient's comfort is considered along with pharmacogenomics to be a primary factor. We extensively discuss the classifications, strategies, tools, and drug delivery systems that can support the implementation of patient-centric personalized medicine from an industrial perspective.
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Affiliation(s)
- Arun Radhakrishnan
- Department of Pharmaceutics, JSS College of Pharmacy (JSS Academy of Higher Education & Research), Ooty, India.
| | - Gowthamarajan Kuppusamy
- Department of Pharmaceutics, JSS College of Pharmacy (JSS Academy of Higher Education & Research), Ooty, India.
| | - Sivasankaran Ponnusankar
- Department of Pharmacy Practice, JSS College of Pharmacy (JSS Academy of Higher Education & Research), Ooty, India
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Association between serotonin 2A receptor (HTR2A), serotonin transporter (SLC6A4) and brain-derived neurotrophic factor (BDNF) gene polymorphisms and citalopram/sertraline induced sexual dysfunction in MDD patients. THE PHARMACOGENOMICS JOURNAL 2019; 20:443-450. [DOI: 10.1038/s41397-019-0127-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 02/08/2023]
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6
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Kanders SH, Pisanu C, Bandstein M, Jonsson J, Castelao E, Pistis G, Gholam-Rezaee M, Eap CB, Preisig M, Schiöth HB, Mwinyi J. A pharmacogenetic risk score for the evaluation of major depression severity under treatment with antidepressants. Drug Dev Res 2019; 81:102-113. [PMID: 31617956 PMCID: PMC7028038 DOI: 10.1002/ddr.21609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/28/2022]
Abstract
The severity of symptoms as well as efficacy of antidepressants in major depressive disorder (MDD) is modified by single nucleotide polymorphisms (SNPs) in different genes, which may contribute in an additive or synergistic fashion. We aimed to investigate depression severity in participants with MDD under treatment with antidepressants in relation to the combinatory effect of selected genetic variants combined using a genetic risk score (GRS). The sample included 150 MDD patients on regular AD therapy from the population‐based Swiss PsyCoLaus cohort. We investigated 44 SNPs previously associated with antidepressant response by ranking them with regard to their association to the Center for Epidemiologic Studies Short Depression Scale (CES‐D) score using random forest. The three top scoring SNPs (rs12248560, rs878567, rs17710780) were subsequently combined into an unweighted GRS, which was included in linear and logistic regression models using the CES‐D score, occurrence of a major depressive episode (MDE) during follow‐up and regular antidepressant treatment during the 6 months preceding follow‐up assessment as outcomes. The GRS was associated with MDE occurrence (p = .02) and ln CES‐D score (p = .001). The HTR1A rs878567 variant was associated with ln CES‐D after adjustment for demographic and clinical variables [p = .02, lower scores for minor allele (G) carriers]. Additionally, rs12248560 (CYP2C19) CC homozygotes showed a six‐fold higher likelihood of regular AD therapy at follow‐up compared to minor allele homozygotes [TT; ultrarapid metabolizers (p = .03)]. Our study suggests that the cumulative consideration of pharmacogenetic risk variants more reliably reflects the impact of the genetic background on depression severity than individual SNPs.
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Affiliation(s)
- Sofia H Kanders
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Claudia Pisanu
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Jörgen Jonsson
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Enrique Castelao
- Department of Psychiatry, University of Lausanne, Lausanne, Switzerland
| | - Giorgio Pistis
- Department of Psychiatry, University of Lausanne, Lausanne, Switzerland
| | | | - Chin B Eap
- Department of Psychiatry, University of Lausanne, Lausanne, Switzerland.,Department of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, University of Lausanne, Lausanne, Switzerland
| | - Helgi B Schiöth
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jessica Mwinyi
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Jay K, Mitra A, Harding T, Matthes D, Van Ness B. Identification of a de novo FOXP1 mutation and incidental discovery of inherited genetic variants contributing to a case of autism spectrum disorder and epilepsy. Mol Genet Genomic Med 2019; 7:e00751. [PMID: 31111659 PMCID: PMC6625142 DOI: 10.1002/mgg3.751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background Autism spectrum disorder is commonly co‐diagnosed intellectual disability, language disorder, anxiety, and epilepsy, however, symptom management is difficult due to the complex genetic nature of ASD. Methods We present a next‐generation sequencing‐based case study with both de novo and inherited genetic variants and highlight the impact of structural variants on post‐translational regulation of protein expression. Since management of symptoms has classically been through pharmaceutical therapies, a pharmacogenomics screen was also utilized to determine possible drug/gene interactions. Results A de novo variant was identified within the FOXP1 3′ untranslated regulatory region using exome sequencing. Additionally, inherited variants that likely contribute to the current and potential future traits were identified within the COMT, SLC6A4, CYP2C19, and CYP2D6 genes. Conclusion This study aims to elucidate how a collection of variant genotypes could potentially impact neural development resulting in a unique phenotype including ASD and epilepsy. Each gene's contribution to neural development is assessed, and the interplay of these genotypes is discussed. The results highlight the utility of exome sequencing in conjunction with pharmacogenomics screening when evaluating possible causes of and therapeutic treatments for ASD‐related symptoms.
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Affiliation(s)
- Kristy Jay
- College of Biological Sciences, Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota
| | - Amit Mitra
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - Taylor Harding
- College of Biological Sciences, Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota
| | - David Matthes
- College of Biological Sciences, Department of Biology, Teaching, and Learning, University of Minnesota-Twin Cities, Minneapolis, Minnesota
| | - Brian Van Ness
- College of Biological Sciences, Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota
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Effects of Cytochrome P450 2C19 Genetic Polymorphisms on Responses to Escitalopram and Levels of Brain-Derived Neurotrophic Factor in Patients With Panic Disorder. J Clin Psychopharmacol 2019; 39:117-123. [PMID: 30742590 DOI: 10.1097/jcp.0000000000001014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND The purpose of this study was to examine the relationships between ytochrome P450 family 2 subfamily C member 19 (CYP2C19) polymorphisms, brain-derived neurotrophic factor (BDNF) plasma levels, and treatment responses to escitalopram in Chinese patients with panic disorder (PD). METHODS/PROCEDURES Ninety patients with PD were administered the Panic Disorder Severity Scale-Chinese Version (PDSS-CV) and Hamilton Anxiety Scale (HAMA-14) from baseline to 8 weeks. Escitalopram treatment (10 mg/d) was administered for 8 consecutive weeks. Three CYP2C19 metabolizers, including extensive metabolizers, intermediate metabolizers, and poor metabolizers (PMs), and 5 CYP2C19 genotypes were detected by polymerase chain reaction-genotyping microarray analysis. Baseline plasma BDNF levels were tested using human BDNF enzyme-linked immunosorbent assay kits. FINDINGS/RESULTS Our findings showed no significant differences in demographic data, baseline PDSS-CV scores, or HAMA-14 scores between the 3 CYP2C19 metabolizer groups (P's > 0.05). Repeated-measures analysis showed a significant reduction in PDSS-CV (F = 221.49, df = 3, P < 0.001) and HAMA-14 (F = 260.47, df = 3, P < 0.001) scores over 8 weeks in PD patients. In addition, patients with PMs had a greater reduction in HAMA-14 scores (F = 2.14, P = 0.049) than did those with extensive metabolizers and intermediate metabolizers. Moreover, our findings showed that patients with *2/*2 genotypes had a greater reduction in PDSS-CV scores than did those with other genotypes (F = 2.14, df = 12, P = 0.015). IMPLICATIONS/CONCLUSIONS Our study provides preliminary evidence of the effects of CYP2C19 PMs on treatment responses to escitalopram in Chinese PD patients, but no significant correlation between treatment responses and BDNF levels was found.
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Demirbugen Oz M, Uckun Z, Yuce-Artun N, Baskak B, Ozdemir H, Kizil Ozel T, Devrimci Ozguven H, Suzen HS. The relationship between the serotonin 2A receptor gene -1438A/G and 102T/C polymorphisms and citalopram/sertraline-induced nausea in major depressed patients. Hum Psychopharmacol 2018; 33:e2673. [PMID: 30221791 DOI: 10.1002/hup.2673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of the present study was to determine the relationship between the polymorphisms of -1438A/G and 102T/C in the 5-HT2A receptor (HTR2A) gene and nausea/vomiting as a side effect induced by sertraline (SERT) or citalopram (CIT) in patients with major depressive disorder. METHODS A total of 128 patients were enrolled, 63 patients received CIT, whereas 65 patients were treated with SERT. Nausea/vomiting were assessed with the UKU Side-effects Rating Scale at baseline and at the end of the second and fourth weeks. Polymerase chain reaction-restriction fragment length polymorphism technique was employed to determine genetic differences. RESULTS We have found that, in the patients treated with CIT, there was a nominally significant difference in the genotypic distribution associated with -1438A/G polymorphism between patients with and without nausea (X2 = 6.15, p = 0.041). Moreover, logistic regression analysis revealed a significant association between nausea/vomiting as a side effect and -1438A/G polymorphism. That is, patients with the G allele were at a higher risk for developing nausea/vomiting (p = 0.044, odds ratio = 2.213). The 102T/C polymorphism in the HTR2A gene had no significant effect on the nausea/vomiting as a side effect among participants treated with either CIT or SERT. CONCLUSION The present study suggests the association of the HTR2A gene -1438A/G polymorphism with nausea/vomiting as a side effect related to CIT treatment.
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Affiliation(s)
- Merve Demirbugen Oz
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara University, Ankara, Turkey
| | - Zuhal Uckun
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Mersin University, Mersin, Turkey
| | - Nazan Yuce-Artun
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara University, Ankara, Turkey
| | - Bora Baskak
- School of Medicine, Psychiatry Department, Ankara University, Ankara, Turkey
| | - Hatice Ozdemir
- School of Medicine, Psychiatry Department, Kırıkkale University, Kırıkkale, Turkey
| | - Tugba Kizil Ozel
- School of Medicine, Psychiatry Department, Ankara University, Ankara, Turkey
| | | | - H Sinan Suzen
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara University, Ankara, Turkey
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Kiss ÁF, Vaskó D, Déri MT, Tóth K, Monostory K. Combination of CYP2C19 genotype with non-genetic factors evoking phenoconversion improves phenotype prediction. Pharmacol Rep 2017; 70:525-532. [PMID: 29665549 DOI: 10.1016/j.pharep.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND CYP2C19 is an important drug-metabolizing enzyme, responsible for metabolism of approximately 10% of the drugs on the market. Large inter-individual differences exist in metabolic activities, which are primarily attributed to genetic polymorphism of CYP2C19 gene. Conflicting results have been published about the role of CYP2C19 polymorphisms in metabolism of CYP2C19 substrates and clinical outcomes; thus, we aimed to investigate CYP2C19 genotype-phenotype associations, and we sought to elicit potential causes of discrepancies in the genotype-based prediction by incorporating the liver donors' demographic data, drug administration events and pathological conditions. METHODS (S)-Mephenytoin was used to assess CYP2C19 activities in human liver microsomes derived from 114 Hungarian organ donors. CYP2C19 genotype was determined by SNP genotyping for CYP2C19*2, CYP2C19*3, CYP2C19*4 and CYP2C19*17 variants, and CYP2C19 mRNA levels were measured by qPCR method. Clinical data of the donors were considered in the genotype-based phenotype prediction. RESULTS CYP2C19 phenotype of 40% of the donors was well-predicted from the genotype data, whereas the phenotype of 13% was underestimated displaying higher activity, and of 47% was overestimated displaying lower activity than predicted from CYP2C19 genotype. Among the donors with overestimated phenotype, one was treated with CYP2C19 substrate/inhibitor, 9 were on amoxicillin-clavulanic acid therapy, 7 were chronic alcohol consumers and 9 had disease with inflammatory processes. CONCLUSIONS CYP2C19 genotype only partially determines the CYP2C19 phenotypic appearance; co-medication, diseases with inflammatory processes and aspecific factors, such as chronic alcohol consumption and amoxicillin-clavulanic acid therapy (or any drug therapy resulting in liver injury) seem to be potential phenotype-modifying factors.
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Affiliation(s)
- Ádám Ferenc Kiss
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Dorottya Vaskó
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Máté Tamás Déri
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Katalin Tóth
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Katalin Monostory
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary.
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Correlation between cytochrome P450 2C19 genetic polymorphism and treatment response to escitalopram in panic disorder. Pharmacogenet Genomics 2017; 27:279-284. [DOI: 10.1097/fpc.0000000000000290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Influence of CYP2B6 and CYP2C19 polymorphisms on sertraline metabolism in major depression patients. Int J Clin Pharm 2016; 38:388-94. [PMID: 26830411 DOI: 10.1007/s11096-016-0259-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Genetic polymorphisms in CYP2B6 and CYP2C19 may cause variability in the metabolism of sertraline, a widely used antidepressant in major depressive disorder treatment. OBJECTIVE This study investigates the impact of CYP2B6*4 (785A > G), CYP2B6*9 (516G > T), CYP2B6*6 (516G > T + 685G > A) CYP2C19*2 (685G > A), CYP2C19*17 (-3402C > T) polymorphisms on plasma concentrations of sertraline and N-desmethyl sertraline in major depression patients treated with sertraline [n = 50]. SETTING Participants were patients who admitted to an adult psychiatry outpatient unit at a university hospital. These were DSM-IV major depression diagnosed patients with a stable sertraline medication regimen [for at least one month]. METHODS CYP2B6*4 (rs 2279343; 785A > G), CYP2B6*9 (516G > T; rs 3745274), CYP2B6*6 (516G > T + 685G > A) CYP2C19*2 (rs 4244285; 685G > A), CYP2C19*17 (rs 11188072; -3402C > T), polymorphisms were analyzed by polymerase chain reaction and restriction fragment length polymorphism. Plasma concentrations were measured by high-performance liquid chromatography in patients treated with SERT. MAIN OUTCOME MEASURE The distribution of CYP2B6*4, *6, *9 and CYP2C19*2, *17 among patient group and the association between genotype and sertraline metabolism. RESULTS Sertraline, N-desmethyl sertraline, N-desmethyl sertraline/sertraline and dose-adjusted plasma concentrations were statistically compared between individuals with wild-type and variant alleles both for CYP2B6 and CYP2C19 enzymes. The mean N-desmethyl sertraline/sertraline value, was significantly lower in all subgroups with *6 and *9 variant alleles (p < 0.05). Sertraline/C values were significantly higher (p < 0.05) and N-desmethyl sertraline/C values were lower in all subgroups with *6 and *9 variant alleles compared to wild-type subgroup. CONCLUSION CYP2B6*6 and *9 variant alleles had a significant decreasing effect on sertraline metabolism in major depression patients which might result as variations in sertraline therapy.
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