1
|
Ma B, Yang K, Li X, Su N, Yu T, Zou Y, Xu X, Wang F, Cheng J, Yan Z, Chen T, Zhang L. Factors Influencing Plasma Concentrations of Valproic Acid in Pediatric Patients With Epilepsy and the Clinical Significance of CYP2C9 Genotypes in Personalized Valproic Acid Therapy. Ther Drug Monit 2024; 46:503-511. [PMID: 38287884 DOI: 10.1097/ftd.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND The aim of this study was to investigate the factors affecting plasma valproic acid (VPA) concentration in pediatric patients with epilepsy and the clinical significance of CYP2C9 gene polymorphisms in personalized dosing using therapeutic drug monitoring and pharmacogenetic testing. METHODS The medical records of children with epilepsy who underwent therapeutic drug monitoring at our institution between July 2022 and July 2023 and met the inclusion criteria were reviewed. Statistical analysis was performed to determine whether age, sex, blood ammonia, liver function, kidney function, and other characteristics affected the concentration-to-dose ratio of VPA (CDRV) in these patients. To investigate the effect of CYP2C9 polymorphisms on CDRV, DNA samples were collected from patients and the CYP2C9 genotypes were identified using real-time quantitative PCR. RESULTS The mean age of 208 pediatric patients with epilepsy was 5.50 ± 3.50 years. Among these patients, 182 had the CYP2C9 *1/*1 genotype, with a mean CDRV (mcg.kg/mL.mg) of 2.64 ± 1.46, 24 had the CYP2C9 *1/*3 genotype, with a mean CDRV of 3.28 ± 1.74, and 2 had the CYP2C9 *3/*3 genotype, with a mean CDRV of 6.46 ± 3.33. There were statistical differences among these 3 genotypes ( P < 0.05). The CDRV in these patients were significantly influenced by age, aspartate aminotransferase, total bilirubin, direct bilirubin, globulin, albumin/globulin ratio, prealbumin, creatinine, and CYP2C9 polymorphisms. In addition, multivariate linear regression analysis identified total bilirubin, direct bilirubin, and CYP2C9 polymorphisms as independent risk factors for high CDRV. CONCLUSIONS Liver problems and mutations in the CYP2C9 gene increase VPA levels. This underscores the importance of considering these factors when prescribing VPA to children with epilepsy, thereby enhancing the safety and efficacy of the therapy.
Collapse
Affiliation(s)
- Bingsuo Ma
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
- School of Pharmacy, Dali University, Yunnan, Dali, China; and
| | - Kun Yang
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
- School of Pharmacy, Dali University, Yunnan, Dali, China; and
| | - Xinping Li
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
| | - Ning Su
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
- School of Pharmacy, Dali University, Yunnan, Dali, China; and
| | - Ting Yu
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
- School of Pharmacy, Dali University, Yunnan, Dali, China; and
| | - Yan Zou
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
- School of Pharmacy, Dali University, Yunnan, Dali, China; and
| | - Xingmeng Xu
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
| | - Fei Wang
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
| | - Jingdong Cheng
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
| | - Zijun Yan
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
- School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Yunnan, Kunming, China
| | - Tong Chen
- School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Yunnan, Kunming, China
| | - Liangming Zhang
- Department of Pharmacy, Panzhihua Central Hospital, Sichuan, Panzhihua, China
| |
Collapse
|
2
|
Bouhniz OE, Kenani A. Potential role of genetic polymorphisms in neoadjuvant chemotherapy response in breast cancer. J Chemother 2024:1-15. [PMID: 38511398 DOI: 10.1080/1120009x.2024.2330241] [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: 10/27/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chemoresistance leads to treatment failure, which can arise through different mechanisms including patients' characteristics. Searching for genetic profiles as a predictor for drug response and toxicity has been extensively studied in pharmacogenomics, thus contributing to personalized medicine and providing alternative treatments. Numerous studies have demonstrated significant evidence of association between genetic polymorphisms and response to neoadjuvant chemotherapy (NAC) in breast cancer. In this review, we explored the potential impact of genetic polymorphisms in NAC primary resistance through selecting a specific clinical profile. The genetic variability within pharmacokinetics, pharmacodynamics, DNA synthesis and repair, and oncogenic signaling pathways genes could be predictive or prognostic markers for NAC resistance. The clinical implication of these results can help provide individualized treatment plans in the early stages of breast cancer treatment. Further studies are needed to determine the genetic hosts of primary chemoresistance mechanisms in order to further emphasize the implementation of genotypic approaches in personalized medicine.
Collapse
Affiliation(s)
- Om Elez Bouhniz
- Research Laboratory "Environment, Inflammation, Signaling and Pathologies" (LR18ES40), Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Abderraouf Kenani
- Research Laboratory "Environment, Inflammation, Signaling and Pathologies" (LR18ES40), Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| |
Collapse
|