1
|
Nkoy FL, Stone BL, Zhang Y, Luo G. A Roadmap for Using Causal Inference and Machine Learning to Personalize Asthma Medication Selection. JMIR Med Inform 2024; 12:e56572. [PMID: 38630536 PMCID: PMC11063904 DOI: 10.2196/56572] [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: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
Inhaled corticosteroid (ICS) is a mainstay treatment for controlling asthma and preventing exacerbations in patients with persistent asthma. Many types of ICS drugs are used, either alone or in combination with other controller medications. Despite the widespread use of ICSs, asthma control remains suboptimal in many people with asthma. Suboptimal control leads to recurrent exacerbations, causes frequent ER visits and inpatient stays, and is due to multiple factors. One such factor is the inappropriate ICS choice for the patient. While many interventions targeting other factors exist, less attention is given to inappropriate ICS choice. Asthma is a heterogeneous disease with variable underlying inflammations and biomarkers. Up to 50% of people with asthma exhibit some degree of resistance or insensitivity to certain ICSs due to genetic variations in ICS metabolizing enzymes, leading to variable responses to ICSs. Yet, ICS choice, especially in the primary care setting, is often not tailored to the patient's characteristics. Instead, ICS choice is largely by trial and error and often dictated by insurance reimbursement, organizational prescribing policies, or cost, leading to a one-size-fits-all approach with many patients not achieving optimal control. There is a pressing need for a decision support tool that can predict an effective ICS at the point of care and guide providers to select the ICS that will most likely and quickly ease patient symptoms and improve asthma control. To date, no such tool exists. Predicting which patient will respond well to which ICS is the first step toward developing such a tool. However, no study has predicted ICS response, forming a gap. While the biologic heterogeneity of asthma is vast, few, if any, biomarkers and genotypes can be used to systematically profile all patients with asthma and predict ICS response. As endotyping or genotyping all patients is infeasible, readily available electronic health record data collected during clinical care offer a low-cost, reliable, and more holistic way to profile all patients. In this paper, we point out the need for developing a decision support tool to guide ICS selection and the gap in fulfilling the need. Then we outline an approach to close this gap via creating a machine learning model and applying causal inference to predict a patient's ICS response in the next year based on the patient's characteristics. The model uses electronic health record data to characterize all patients and extract patterns that could mirror endotype or genotype. This paper supplies a roadmap for future research, with the eventual goal of shifting asthma care from one-size-fits-all to personalized care, improve outcomes, and save health care resources.
Collapse
Affiliation(s)
- Flory L Nkoy
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Bryan L Stone
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Division of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| |
Collapse
|
2
|
Li Y, Chang Y, Yan Y, Ma X, Zhou W, Zhang H, Guo J, Wei J, Jin T. Very important pharmacogenetic variants landscape and potential clinical relevance in the Zhuang population from Yunnan province. Sci Rep 2024; 14:7495. [PMID: 38553524 PMCID: PMC10980727 DOI: 10.1038/s41598-024-58092-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
The gradual evolution of pharmacogenomics has shed light on the genetic basis for inter-individual drug response variations across diverse populations. This study aimed to identify pharmacogenomic variants that differ in Zhuang population compared with other populations and investigate their potential clinical relevance in gene-drug and genotypic-phenotypic associations. A total of 48 variants from 24 genes were genotyped in 200 Zhuang subjects using the Agena MassARRAY platform. The allele frequencies and genotype distribution data of 26 populations were obtained from the 1000 Genomes Project, followed by a comparison and statistical analysis. After Bonferroni correction, significant differences in genotype frequencies were observed of CYP3A5 (rs776746), ACE (rs4291), KCNH2 (rs1805123), and CYP2D6 (rs1065852) between the Zhuang population and the other 26 populations. It was also found that the Chinese Dai in Xishuangbanna, China, Han Chinese in Beijing, China, and Southern Han Chinese, China showed least deviation from the Zhuang population. The Esan in Nigeria, Gambian in Western Division, The Gambia, and Yoruba in Ibadan, Nigeria exhibited the largest differences. This was also proved by structural analysis, Fst analysis and phylogenetic tree. Furthermore, these differential variants may be associated with the pharmacological efficacy and toxicity of Captopril, Amlodipine, Lisinopril, metoclopramide, and alpha-hydroxymetoprolol in the Zhuang population. Our study has filled the gap of pharmacogenomic information in the Zhuang population and has provided a theoretical framework for the secure administration of drugs in the Zhuang population.
Collapse
Affiliation(s)
- Yujie Li
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Yanting Chang
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Yan Yan
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Xiaoya Ma
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Wenqian Zhou
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Huan Zhang
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Jinping Guo
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Jie Wei
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China
- College of Life Science, Northwest University, Xi'an, 710127, China
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Tianbo Jin
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, #229 North TaiBai Road, Xi'an, 710069, Shaanxi, China.
- College of Life Science, Northwest University, Xi'an, 710127, China.
- Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, Shaanxi, China.
| |
Collapse
|
3
|
Wang Z, Hou J, Zheng H, Wang D, Tian W, Zhang D, Yan J. Genetic and phenotypic frequency distribution of ACE, ADRB1, AGTR1, CYP2C9*3, CYP2D6*10, CYP3A5*3, NPPA and factors associated with hypertension in Chinese Han hypertensive patients. Medicine (Baltimore) 2023; 102:e33206. [PMID: 36897672 PMCID: PMC9997823 DOI: 10.1097/md.0000000000033206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
We analyzed the polymorphisms of 7 antihypertensive drugs-related genes and the factors associated with hypertension in hypertensive patients of Han ethnicity in Qingyang, China. A total of 354 hypertensive patients of Han ethnicity were enrolled from Qingyang, China. The ACE (I/D), ADRB1 (1165G > C), AGTR1 (1166A > C), CYP2C9*3, CYP2D6*10, CYP3A5*3 and NPPA (T2238C) polymorphisms were assessed. Clinical data of patients was also obtained. The influencing factors of hypertension were evaluated. The genotype frequencies of ACE, ADRB1, AGTR1, CYP2C9, CYP3A5 and NPPA loci were in Hardy-Weinberg equilibrium, with mutation frequencies of 39.27%, 74.29%, 6.21%, 4.80%, 72.46% and 0.71%, respectively. CYP2D6 locus was not in Hardy-Weinberg equilibrium. There was no statistical difference in allele frequencies between different genders (P > .05). There was significant difference in the frequencies of ACE (I/D) and NPPA (T2238C) loci among different regions of China (P < .05). Gender, ACE (I/D) and ADRB1 (1165G > C) gene polymorphism, smoking, homocysteine and HDL levels were associated hypertension. The mutation frequencies of ADRB1 (1165G > C) and CYP3A5*3 were high in hypertensive patients of Han ethnicity in Qingyang, suggesting these patients may be more sensitive to beta-blockers and calcium ion antagonists. Meanwhile, hypertension was associated with gender, ACE (I/D) and ADRB1 (1165G > C) gene polymorphisms, smoking, homocysteine and HDL levels.
Collapse
Affiliation(s)
- Zhenyun Wang
- Department of Urinary Surgery, The People’s Hospital of Qingyang City, Qingyang, China
| | - Juanjuan Hou
- Department of Clinical Laboratory Medicine, The People’s Hospital of Qingyang City, Qingyang, China
| | - Hongjun Zheng
- Department of Clinical Laboratory Medicine, The People’s Hospital of Qingyang City, Qingyang, China
| | - Dan Wang
- Department of Neurosurgery, The People’s Hospital of Qingyang City, Qingyang, China
| | - Weihua Tian
- Department of Clinical Laboratory Medicine, The Hospital of TCM of Gansu Province, Lanzhou, China
| | - Dan Zhang
- Department of Cardiology, The People’s Hospital of Qingyang City, Qingyang, China
| | - Jiamin Yan
- Department of Clinical Laboratory Medicine, The People’s Hospital of Qingyang City, Qingyang, China
| |
Collapse
|
4
|
Lee FY, Islahudin F, Abdul Gafor AH, Wong HS, Bavanandan S, Mohd Saffian S, Md Redzuan A, Makmor-Bakry M. Adverse Drug Reactions of Antihypertensives and CYP3A5*3 Polymorphism Among Chronic Kidney Disease Patients. Front Pharmacol 2022; 13:848804. [PMID: 35359836 PMCID: PMC8963814 DOI: 10.3389/fphar.2022.848804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022] Open
Abstract
Chronic kidney disease (CKD) patients may be more susceptible to adverse drug reactions (ADRs), given their complex medication regimen and altered physiological state driven by a decline in kidney function. This study aimed to describe the relationship between CYP3A5*3 polymorphism and the ADR of antihypertensive drugs in CKD patients. This retrospective, multi-center, observational cohort study was performed among adult CKD patients with a follow-up period of up to 3 years. ADRs were detected through medical records. CYP3A5*3 genotyping was performed using the direct sequencing method. From the 200 patients recruited in this study, 33 (16.5%) were found to have ADRs related to antihypertensive drugs, with 40 ADRs reported. The most frequent ADR recorded was hyperkalemia (n = 8, 20.0%), followed by bradycardia, hypotension, and dizziness, with 6 cases (15.0%) each. The most common suspected agents were angiotensin II receptor blockers (n = 11, 27.5%), followed by angiotensin-converting enzyme inhibitors (n = 9, 22.5%). The CYP3A5*3 polymorphism was not found to be associated with antihypertensive-related ADR across the genetic models tested, despite adjustment for other possible factors through multiple logistic regression (p > 0.05). After adjusting for possible confounding factors, the factors associated with antihypertensive-related ADR were anemia (adjusted odds ratio [aOR] 5.438, 95% confidence interval [CI]: 2.002, 14.288) and poor medication adherence (aOR 3.512, 95% CI: 1.470, 8.388). In conclusion, the CYP3A5*3 polymorphism was not found to be associated with ADRs related to antihypertensives in CKD patients, which requires further verification by larger studies.
Collapse
Affiliation(s)
- Fei Yee Lee
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Clinical Research Centre, Hospital Selayang, Ministry of Health Malaysia, Batu Caves, Malaysia
| | - Farida Islahudin
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- *Correspondence: Farida Islahudin,
| | - Abdul Halim Abdul Gafor
- Nephrology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hin-Seng Wong
- Clinical Research Centre, Hospital Selayang, Ministry of Health Malaysia, Batu Caves, Malaysia
- Nephrology Department, Hospital Selayang, Ministry of Health Malaysia, Selangor, Malaysia
| | - Sunita Bavanandan
- Nephrology Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Shamin Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adyani Md Redzuan
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|