From the bench to the clinic and back again: translational biomarker discovery using in silico mining of pharmacogenomic data

Pharmacogenomic biomarkers for personalized medicine

Pharmacogenomics examines how the benefits and adverse effects of a drug vary among patients in a target population by analyzing genomic profiles of individual patients. Personalized medicine prescribes specific therapeutics that best suit an individual patient. Much current research focuses on developing genomic biomarkers to identify patients, to identify which patients would benefit from a treatment, have an adverse response, or no response at all, prior to treatment according to relevant differences in risk factors, disease types and/or responses to therapy. This review describes the use of the two personalized medicine biomarkers, prognostic and predictive, to classify patients into subgroups for treatment recommendation.

An approach to identifying preclinical biomarkers of susceptibility to drug-induced toxicity

Aim: Drug-induced toxicity that leads to termination of candidate drugs or postmarketing removal of approved drugs can potentially be explained by the existence of susceptible subpopulations. If the susceptible subpopulations are identified in advance, the drug’s benefits could be maximized by optimal treatment decisions. This article presents a statistical model and an approach for identifying pharmacogenomic biomarkers of susceptibility to drug-induced toxicity for detecting the susceptible subpopulations. Materials & methods: Biomarkers are categorized into three disjoint sets: biomarkers of both susceptibility and exposure (A); biomarkers of susceptibility only (B); and biomarkers of exposure only (C). Set B contains the most useful biomarkers to identify susceptible subpopulations prior to drug exposure; these markers demonstrate no change in response before and after drug exposure. We present a sample size analysis to illustrate the issues and challenges facing identifying biomarker set B. Results: The required sample size increases as the proportion of the susceptible subpopulation decreases. The examples demonstrated that at least 75 subjects per group are needed for a population with a 5% susceptible subpopulation and more than 1000 are often necessary. Conclusion: This study demonstrates that the biomarkers identified by common methods are a mixture of biomarkers of exposure and susceptibility (A and C), it further demonstrates that the proposed approach could be used to identify biomarkers of susceptibility (B), where a large sample size may be required for adequate power and low false-positive rate.

Original submitted 14 October 2010; Revision submitted 8 December 2010.

Genomic and metabolomic advances in the identification of disease and adverse event biomarkers

Incomplete knowledge of tissue pathogenesis is hampering the identification of biomarkers for the appropriate therapeutic targets to prevent or inhibit disease processes, and the prediction and diagnosis of injury due to disease and adverse events of drug therapy. The revolution in genomics and metabolomics, combined with advanced bioinformatics and computational methods for mining such large, complex data sets, are beginning to provide critical insights into tissue injury. Such results will move us closer to the promise of personalized medicine.

From pharmacogenomics to translational biomarkers

There is a need for new biomarkers to enable faster detection of adverse events due to drugs and disease processes. One would prefer biomarkers that are useful in multiple species (i.e., translational or bridging biomarkers) so that it would be possible to directly link responses between species and follow such injury in both preclinical and clinical settings. This chapter will explore some of the issues surrounding the use of pharmacogenomics to identify and qualify such biomarkers, and examples will be provided.