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Bishop JR. Pharmacists as facilitators of pharmacogenomic guidance for antidepressant drug selection and dosing. Clin Transl Sci 2021; 14:1206-1209. [PMID: 34058073 PMCID: PMC8301590 DOI: 10.1111/cts.13057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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2
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Mohan P, Gupta YK, Prakash J. Application of pharmacogenomics in psychiatric practice: The road ahead. Ind Psychiatry J 2021; 30:4-5. [PMID: 34483516 PMCID: PMC8395549 DOI: 10.4103/ipj.ipj_119_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Prafull Mohan
- Department of Pharmacology, AFMC, Pune, Maharashtra, India
| | - Y K Gupta
- President, AIIMS, Bhopal, Madhya Pradesh, India.,President, AIIMS, Jammu and Kashmir, India.,Department of Pharmacology, AIIMS, New Delhi, India
| | - Jyoti Prakash
- Department of Psychiatry, AFMC, Pune, Maharashtra, India
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3
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Sabater A, Ciudad CJ, Cendros M, Dobrokhotov D, Sabater-Tobella J. g-Nomic: a new pharmacogenetics interpretation software. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:75-85. [PMID: 31239753 PMCID: PMC6554524 DOI: 10.2147/pgpm.s203585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/27/2019] [Indexed: 11/23/2022]
Abstract
We present g-Nomic, a pharmacogenetics interpretation software that analyzes globally a prescribed medication taking into account the personal background genetics, drug–drug interactions, lifestyle, nutritional supplements, inhibitors, inducers, and other risks to analyze primary or secondary metabolism pathways. G-Nomic provides a set of recommendations describing the suitability of a given combination of drugs for each patient according to their genes and polymedication. G-Nomic is updated monthly including data from the new drugs to be included, their known interactions, and the relevant pharmacokinetic biomarkers. For the interactions, the list is curated manually, only keeping those with clinical relevance. For each drug, their FDA and EMA drug labels are accessed, to check for relevant enzymes and transport proteins that influence its pharmacokinetics, and for their ability to induce or inhibit other enzymes, particularly the CYP-450 system. When this information is not available, a PubMed search is made to look for these characteristics. In addition, a distinction is made between drugs and prodrugs. A query on the g-Nomic software begins with entering the medication by either their common or commercial name. Non-pharmacological substances can be also added or selected under “lifestyle habits”. The lifestyle list is dynamic, showing only the substances known to interact with the drugs that are currently selected, and includes herb compounds, such as St. John’s wort, as well as proper lifestyle substances such as grapefruit or cigarette smoking. The software provides a list of the genes classified as primary biomarkers as candidates for genetic testing, and a list of the interactions that have been detected. If genetic information is available then, or is made available at a later point, these results can also be entered and the software returns pharmacogenetics recommendations regarding specific genotypes. g-Nomic takes all the above-mentioned parameters in an easy and user-friendly tool making prescription safer.
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Affiliation(s)
- Ana Sabater
- Department of Information Technology, EUGENOMIC, Barcelona 08012, Spain
| | - Carlos J Ciudad
- Department of Biochemistry and Physiology, University of Barcelona, Barcelona 08028, Spain
| | - Marc Cendros
- Department of Information Technology, EUGENOMIC, Barcelona 08012, Spain
| | - Denis Dobrokhotov
- Department of Information Technology, EUGENOMIC, Barcelona 08012, Spain
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4
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Rasool M, Malik A, Naseer MI, Manan A, Ansari SA, Begum I, Qazi MH, Pushparaj PN, Abuzenadah AM, Al-Qahtani MH, Kamal MA, Natesan Pushparaj P, Gan SH. The role of epigenetics in personalized medicine: challenges and opportunities. BMC Med Genomics 2015; 8 Suppl 1:S5. [PMID: 25951941 PMCID: PMC4315318 DOI: 10.1186/1755-8794-8-s1-s5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Epigenetic alterations are considered to be very influential in both the normal and disease states of an organism. These alterations include methylation, acetylation, phosphorylation, and ubiquitylation of DNA and histone proteins (nucleosomes) as well as chromatin remodeling. Many diseases, such as cancers and neurodegenerative disorders, are often associated with epigenetic alterations. DNA methylation is one important modification that leads to disease. Standard therapies are given to patients; however, few patients respond to these drugs, because of various molecular alterations in their cells, which may be partially due to genetic heterogeneity and epigenetic alterations. To realize the promise of personalized medicine, both genetic and epigenetic diagnostic testing will be required. This review will discuss the advances that have been made as well as the challenges for the future.
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Affiliation(s)
- Mahmood Rasool
- Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
- KACST Technology Innovation Center in Personalized Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Arif Malik
- Institute of Molecular Biology and Biotechnology, (IMBB), the University of Lahore, Lahore, Pakistan
| | - Muhammad Imran Naseer
- Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdul Manan
- Institute of Molecular Biology and Biotechnology, (IMBB), the University of Lahore, Lahore, Pakistan
| | - Shakeel Ahmed Ansari
- Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Irshad Begum
- Institute of Molecular Biology and Biotechnology, (IMBB), the University of Lahore, Lahore, Pakistan
| | - Mahmood Husain Qazi
- Center for Research in Molecular Medicine (CRiMM), The University of Lahore, Pakistan
| | - Peter Natesan Pushparaj
- Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel M Abuzenadah
- Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
- KACST Technology Innovation Center in Personalized Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | | | - Mohammad Amjad Kamal
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter Natesan Pushparaj
- Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Siew Hua Gan
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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5
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Innovative Diagnostic Technologies and Their Significance for Personalized Medicine. Mol Diagn Ther 2012; 14:141-7. [DOI: 10.1007/bf03256366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Abstract
Tamoxifen is an effective antiestrogen used in the treatment of hormone receptor-positive breast cancer. Bioconversion of tamoxifen to endoxifen, its most abundant active metabolite, is primarily dependent on the activity of cytochrome P450 2D6 (CYP2D6), which is highly polymorphic. Over 20 published studies have reported on the potential association between CYP2D6 polymorphism and tamoxifen treatment outcome, with highly inconsistent results. The purpose of this review is to explore differences among 17 independent studies to identify factors that may have contributed to the discrepant findings. This report discusses six putative factors that are grouped into two categories: (a) clinical management criteria: hormone receptor classification, menopausal status, and tamoxifen combination therapy; (b) pharmacologic criteria: genotyping comprehensiveness, CYP2D6 inhibitor coadministration, and tamoxifen adherence. Comparison of these factors between the positive and negative studies suggests that tamoxifen combination therapy, genotyping comprehensiveness, and CYP2D6 inhibitor coadministration may account for some of the contradictory results. Future association studies on the link between CYP2D6 genotype and tamoxifen treatment efficacy should account for combination therapy and CYP2D6 inhibition, and interrogate as many CYP2D6 alleles as possible.
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Affiliation(s)
- Daniel L Hertz
- UNC Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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7
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Brunicardi FC, Gibbs RA, Wheeler DA, Nemunaitis J, Fisher W, Goss J, Chen C. Overview of the development of personalized genomic medicine and surgery. World J Surg 2011; 35:1693-9. [PMID: 21424870 PMCID: PMC3281749 DOI: 10.1007/s00268-011-1056-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Personalized genomic medicine and surgery (PGMS) represents a new approach to health care that customizes patients' medical treatment according to their own genetic information. This new approach is the result of increased knowledge of the human genome and ways this information can be applied by physicians in the medical and surgical management of their patients. A patient's genotype can yield important information concerning disease susceptibility and the effectiveness of medications, therefore guiding specific, targeted imaging and treatment therapies. This review summarizes major achievements of human genomic studies and applications of genomics in health care. Five years ago we developed a model for the development of PGMS in which genomic profile guides choice of therapy. In this article we discussed our progress, including an updating of the model, and a future vision of PGMS.
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Affiliation(s)
- F Charles Brunicardi
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1709 Dryden Street, Suite 1500, Houston, TX 77030, USA.
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8
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Wong EHF, Fox JC, Ng MYM, Lee CM. Toward personalized medicine in the neuropsychiatric field. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 101:329-49. [PMID: 22050858 DOI: 10.1016/b978-0-12-387718-5.00013-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There are great expectations for the personalized medicine approach to address the therapeutic needs of patients in the twenty-first century. Advances in human genome science and molecular innovations in neuroscience have encouraged the pharmaceutical industry to focus beyond broad spectrum population therapeutics--the driving force behind the "blockbuster" product concept--to personalized medicine. For central nervous system (CNS) therapeutics, repeated failures in converting scientific discoveries to clinical trial successes and regulatory approvals have precipitated a drug pipeline crisis and eroded confidence in the industry. This chapter describes how innovations in genomics and translational medicine can impact the future of neuropsychiatry and deconvolute the complexity of psychiatric diseases from symptoms biology. A targeted and consistent investment is needed to restore confidence in translating science into clinical success.
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Affiliation(s)
- Erik H F Wong
- AstraZeneca Pharmaceuticals, External Science, CNS-Pain Innovative Medicine Unit, Wilmington, Delaware, USA
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9
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Ginsburg GS, Willard HF. Genomic and personalized medicine: foundations and applications. Transl Res 2009; 154:277-87. [PMID: 19931193 DOI: 10.1016/j.trsl.2009.09.005] [Citation(s) in RCA: 294] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 11/15/2022]
Abstract
The last decade has witnessed a steady embrace of genomic and personalized medicine by senior government officials, industry leadership, health care providers, and the public. Genomic medicine, which is the use of information from genomes and their derivatives (RNA, proteins, and metabolites) to guide medical decision making-is a key component of personalized medicine, which is a rapidly advancing field of health care that is informed by each person's unique clinical, genetic, genomic, and environmental information. As medicine begins to embrace genomic tools that enable more precise prediction and treatment disease, which include "whole genome" interrogation of sequence variation, transcription, proteins, and metabolites, the fundamentals of genomic and personalized medicine will require the development, standardization, and integration of several important tools into health systems and clinical workflows. These tools include health risk assessment, family health history, and clinical decision support for complex risk and predictive information. Together with genomic information, these tools will enable a paradigm shift to a comprehensive approach that will identify individual risks and guide clinical management and decision making, all of which form the basis for a more informed and effective approach to patient care. DNA-based risk assessment for common complex disease, molecular signatures for cancer diagnosis and prognosis, and genome-guided therapy and dose selection are just among the few important examples for which genome information has already enabled personalized health care along the continuum from health to disease. In addition, information from individual genomes, which is a fast-moving area of technological development, is spawning a social and information revolution among consumers that will undoubtedly affect health care decision making. Although these and other scientific findings are making their way from the genome to the clinic, the full application of genomic and personalized medicine in health care will require dramatic changes in regulatory and reimbursement policies as well as legislative protections for privacy for system-wide adoption. Thus, there are challenges from both a scientific and a policy perspective to personalized health care; however, they will be confronted and solved with the certainty that the science behind genomic medicine is sound and the practice of medicine that it informs is evidence based.
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Affiliation(s)
- Geoffrey S Ginsburg
- Duke Institute for Genome Sciences & Policy, Duke University, Durham, NC 27708, USA.
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11
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Abstract
Epilepsy is the most common serious chronic neurological disorder. Treatment consists mainly of antiepileptic drugs (AEDs), with more than 15 different molecules available. However, AED treatment is often problematic because of unpredictability of drug response, adverse drug reactions and optimal dosing in individual patients. Moreover, up to one in three patients with epilepsy are refractory to currently available AEDs. Pharmacogenetic studies explore the contribution of genetic variants to interindividual differences in drug response. An increasing number of pharmacogenetic association studies in epilepsy are being reported. Nevertheless, at present only one association is firmly established, namely that of the HLA-B*1502 allele with severe cutaneous adverse drug reactions on carbamazepine therapy in the Han Chinese population. It is likely that large collaborations looking at multiple genes encoding entire drug pathways, or even the entire human genome, together with new pharmacogenetic strategies will result in the discovery of other genetic variants involved in AED response. Although several challenges remain, it is hoped that, ultimately, these findings will lead to the development of predictive tests, resulting in a more efficacious and safer AED treatment, and to the development of new AEDs with novel mechanisms of action, particularly aimed at patients with drug-refractory epilepsy.
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Affiliation(s)
- Chantal Depondt
- Université Libre de Bruxelles, Service de Neurologie, Hôpital Erasme, 808 Route de Lennik, 1070 Bruxelles, Belgium.
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12
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Merrick BA. The plasma proteome, adductome and idiosyncratic toxicity in toxicoproteomics research. BRIEFINGS IN FUNCTIONAL GENOMICS AND PROTEOMICS 2008; 7:35-49. [PMID: 18270218 DOI: 10.1093/bfgp/eln004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Toxicoproteomics uses the discovery potential of proteomics in toxicology research by applying global protein measurement technologies to biofluids and tissues after host exposure to injurious agents. Toxicoproteomic studies thus far have focused on protein profiling of major organs and biofluids such as liver and blood in preclinical species exposed to model toxicants. The slow pace of discovery for new biomarkers, toxicity signatures and mechanistic insights is partially due to the limited proteome coverage derived from analysis of native organs, tissues and body fluids by traditional proteomic platforms. Improved toxicoproteomic analysis would result by combining higher data density LC-MS/MS platforms with stable isotope labelled peptides and parallel use of complementary platforms. Study designs that remove abundant proteins from biofluids, enrich subcellular structures and include cell specific isolation from heterogeneous tissues would greatly increase differential expression capabilities. By leveraging resources from immunology, cell biology and nutrition research communities, toxicoproteomics could make particular contributions in three inter-related areas to advance mechanistic insights and biomarker development: the plasma proteome and circulating microparticles, the adductome and idiosyncratic toxicity.
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Affiliation(s)
- B Alex Merrick
- National Center for Toxicogenomics, National Institute of Environmental Health Sciences, PO Box 12233, Research Triangle Park, NC 27709, USA.
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Kaput J, Perlina A, Hatipoglu B, Bartholomew A, Nikolsky Y. Nutrigenomics: concepts and applications to pharmacogenomics and clinical medicine. Pharmacogenomics 2007; 8:369-90. [PMID: 17391074 DOI: 10.2217/14622416.8.4.369] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The maintenance of health and the prevention and treatment of chronic diseases are influenced by naturally occurring chemicals in foods. In addition to supplying the substrates for producing energy, a large number of dietary chemicals are bioactive--that is, they alter the regulation of biological processes and, either directly or indirectly, the expression of genetic information. Nutrients and bioactives may produce different physiological phenotypes among individuals because of genetic variability and not only alter health, but also disease initiation, progression and severity. The study and application of gene-nutrient interactions is called nutritional genomics or nutrigenomics. Nutrigenomic concepts, research strategies and clinical implementation are similar to and overlap those of pharmacogenomics, and both are fundamental to the treatment of disease and maintenance of optimal health.
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Affiliation(s)
- Jim Kaput
- Department of Surgery, University of Illinois Chicago, 909 South Wolcott Street MC 958, Chicago, IL 60612, USA.
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14
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Gurwitz D, Motulsky AG. ‘Drug reactions, enzymes, and biochemical genetics’: 50 years later. Pharmacogenomics 2007; 8:1479-84. [DOI: 10.2217/14622416.8.11.1479] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- David Gurwitz
- Tel-Aviv University, Department of Human Genetics and Molecular Medicine, Faculty of Medicine, Tel-Aviv, Israel
| | - Arno G Motulsky
- University of Washington, Departments of Medicine (Medical Genetics) and Genome Sciences, Seattle, Washington, USA
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15
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Arvanitidis K, Ragia G, Iordanidou M, Kyriaki S, Xanthi A, Tavridou A, Manolopoulos VG. Genetic polymorphisms of drug-metabolizing enzymes CYP2D6, CYP2C9, CYP2C19 and CYP3A5 in the Greek population. Fundam Clin Pharmacol 2007; 21:419-26. [PMID: 17635181 DOI: 10.1111/j.1472-8206.2007.00510.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of the present study was to determine the prevalence of the most common allelic variants of the polymorphic cytochrome P450 (CYP) enzymes CYP2D6, CYP2C9, CYP2C19 and CYP3A5 and to predict the genotype frequency for each polymorphism in the Greek population. DNA isolated from peripheral blood samples derived from 283 non-related Greek ethnic subjects was used to determine the frequency of CYP2D6*3, CYP2D6*4, CYP2C9*2, CYP2C9*3 and CYP3A5*3 allelic variants by the polymerase chain reaction (PCR)-restriction fragment length polymorphism method, CYP2C19*2 and CYP2C19*3 with allelic specific amplification (PCR-ASA), and CYP2D6*2 (gene duplications) by long PCR analysis. The allelic frequencies (out of a total of 566 alleles) for CYP2D6*3 and CYP2D6*4, were 2.3% and 17.8%, respectively, while gene duplications (CYP2D6*2) were found in 7.4% of the subjects tested. For CYP2C9*2 and CYP2C9*3 polymorphisms the allelic frequencies were 12.9% and 8.13% respectively. For CYP2C19, the *2 polymorphism was present at an allelic frequency of 13.1%, while no subjects were found carrying the CYP2C19*3 allele. Finally, the CYP3A5*3 allele was abundantly present in the Greek population with an allelic frequency of 94.4%. Overall our results show that the frequencies of the common defective allelic variants of CYP2C9, CYP2C19 and CYP3A5 in Greek subjects are similar to those reported for several other Caucasian populations. Finally, a high prevalence of CYP2D6 gene duplication among Greeks was found, a finding that strengthens the idea that a South/North gradient exists in the occurrence of CYP2D6 ultrarapid metabolizers in European populations.
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Affiliation(s)
- Kostas Arvanitidis
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
Despite advancements in genetics, chemistry, and protein engineering, recent years have seen fewer approvals of new drugs, increases in development costs, and high-profile drug withdrawals. This article focuses on technologic methods for improving drug development efficiency. These technologies include high-content cell screening, expression profiling, mass spectroscopy, mouse models of disease, and a post-launch screening program that enables investigations of adverse drug effects. Implementation of these new technologies promises to improve performance in drug development and safety.
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Affiliation(s)
- C Thomas Caskey
- Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
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Martínez C, Blanco G, García-Martín E, Agúndez JAG. [Clinical pharmacogenomics for CYP2C8 and CYP2C9: general concepts and application to the use of NSAIDs]. FARMACIA HOSPITALARIA 2007; 30:240-8. [PMID: 17022718 DOI: 10.1016/s1130-6343(06)73982-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To study the major mutations in genes CYP2C8 and CYP2C9, their frequency in populations of diverse ethnical descent, their analysis methods, and the major drugs with affected metabolism, with a special emphasis on NSAIDs. METHOD Repeated searches of Pubmed (January 1966-January 2006) and Scholar Google were performed. All searches were restricted to studies in humans, and papers not written in Spanish or English were excluded. RESULTS Ten allelic variants of CYP2C8 and 24 of CYP2C have been reported. Not all of them exert a relevant effect on drug metabolism. In Caucasians 22% of CYP2C8 genes and 31% of CYP2C9 genes have mutations. In Asians fewer than 1% and nearly 3% are mutated, respectively. Major identification methods include endonuclease digestion, PCR, pyrosequencing, and microarrays. Not all NSAIDs are exclusive substrates for CYP2C8/9. The usefulness of allelic variant analysis varies with each individual drug. The risk for digestive hemorrhage associated with the CYP2C9 genotype is particularly relevant when using aceclofenac, celecoxib, diclofenac, ibuprofen, indomethacin, lornoxicam, piroxicam, or naproxen. CONCLUSIONS Although CYP2C8/9 activity plays an essential role in the metabolism of and clinical response to many NSAIDs, the use of pharmacogenomic techniques is not equally useful for all these drugs.
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Affiliation(s)
- C Martínez
- Departamento de Farmacología, Facultad de Medicina, Universidad de Extremadura, Servicio de Cirugía General, Hospital Universitario Infanta Cristina, Badajoz
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18
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Abstract
Observations over the later half of the last century have suggested that genetic factors may be the prime determinant of drug response, at least for some drugs. Retrospectively gathered data have provided further support to the notion that genotype-based prescribing will improve the overall efficacy rates and minimize adverse drug reactions (ADRs), making personalized medicine a reality. During the last 16 years, 38 drugs have been withdrawn from major markets due to safety concerns. Inevitably, a question arises as to whether it might be possible to 'rescue' some of these drugs by promoting genotype-based prescribing. However, ironically pharmacogenetics has not perceptibly improved the risk/benefit of a large number of genetically susceptible drugs that are already in wide clinical use and are associated with serious ADRs. Drug-induced hepatotoxicity and QT interval prolongation (with or without torsade de pointes) account for 24 (63%) of these 38 drug withdrawals. In terms of the number of drugs implicated, both these toxicities are on the increase. Many others have had to be withdrawn due to their inappropriate use. This paper discusses the criteria that a drug would need to fulfill, and summarizes the likely regulatory requirements, before its pharmacogenetic rescue can be considered to be realistic. One drug that fulfils these criteria is perhexiline (withdrawn worldwide in 1988) and is discussed in some detail. For the majority of these 38 drugs there are, at present, no candidates for genetic traits to which the toxicity that led to their withdrawal may be linked. For a few other drugs where a potential candidate for a genetic trait might explain the toxicity of concern, the majority of patients who experienced the index toxicity had easily managed nongenetic risk factors. It may be possible to rescue these drugs simply by careful attention to their dose, interaction potential and prescribing patterns, but without the need for any pharmacogenetic test. In addition, the pharmacogenetic rescue of drugs might not be as effective as anticipated as hardly any pharmacogenetic test is known to have the required test efficiency to promote individualized therapy. Multiple pathways of drug elimination, contribution to toxicity by metabolites as well as the parent drug, gene-gene interactions, multiple mechanisms of toxicity and inadequate characterization of phenotype account for this lack of highly predictive tests. The clinical use of tests that lack the required efficiency carries the risks of over- or under-dosing some patients, denying the drug to others and decreasing physician vigilance of patients. Above all, at present, prescribing physicians lack an adequate understanding of pharmacogenetics and its limitations. It is also questionable whether their prescribing will comply with the requirements for pretreatment pharmacogenetic tests to make pharmacogenetic rescue a realistic goal.
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Jain KK. A critical review of the Royal Society's report on personalized medicine. Drug Discov Today 2006; 11:573-5. [PMID: 16793525 DOI: 10.1016/j.drudis.2006.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 02/20/2006] [Accepted: 05/11/2006] [Indexed: 11/17/2022]
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Ginsburg GS, Angrist M. The future may be closer than you think: a response from the Personalized Medicine Coalition to the Royal Society's report on personalized medicine. Per Med 2006; 3:119-123. [DOI: 10.2217/17410541.3.2.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A recent report from the British Royal Society on the prospects for personalized medicine provides a sobering assessment of the field and its prospects. The report contends that pharmacogenetics has little clinical relevance at the moment and will only progress with the completion of large, cumbersome clinical trials. The report goes on to note that the regulatory infrastructure, medical education initiatives and public deliberation necessary to make personalized medicine a reality are essentially nonexistent, at least so far. In our view, personalized medicine is much more than a hypothetical protocol designed to correlate genotypes with prescriptions. We argue that the development of personalized medicine is a broader phenomenon that is already being practiced in one form or another in many contexts. Both academic medicine and the pharmaceutical industry have a huge stake in bringing pharmacogenetic-based personalized medicine to fruition; we expect both entities to act as drivers of what will be a long-term, iterative process.
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Affiliation(s)
- Geoffrey S Ginsburg
- Duke University, Duke Institute for Genome Sciences & Policy, Durham, North Carolina, USA
- Personalized Medicine Coalition, 1401 H Street, NW Suite 650, Washington DC 20005, USA
| | - Misha Angrist
- Duke University, Duke Institute for Genome Sciences & Policy, Durham, North Carolina, USA
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