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Wang Z, Huang J, Xie D, He D, Lu A, Liang C. Toward Overcoming Treatment Failure in Rheumatoid Arthritis. Front Immunol 2022; 12:755844. [PMID: 35003068 PMCID: PMC8732378 DOI: 10.3389/fimmu.2021.755844] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disorder characterized by inflammation and bone erosion. The exact mechanism of RA is still unknown, but various immune cytokines, signaling pathways and effector cells are involved. Disease-modifying antirheumatic drugs (DMARDs) are commonly used in RA treatment and classified into different categories. Nevertheless, RA treatment is based on a "trial-and-error" approach, and a substantial proportion of patients show failed therapy for each DMARD. Over the past decades, great efforts have been made to overcome treatment failure, including identification of biomarkers, exploration of the reasons for loss of efficacy, development of sequential or combinational DMARDs strategies and approval of new DMARDs. Here, we summarize these efforts, which would provide valuable insights for accurate RA clinical medication. While gratifying, researchers realize that these efforts are still far from enough to recommend specific DMARDs for individual patients. Precision medicine is an emerging medical model that proposes a highly individualized and tailored approach for disease management. In this review, we also discuss the potential of precision medicine for overcoming RA treatment failure, with the introduction of various cutting-edge technologies and big data.
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Affiliation(s)
- Zhuqian Wang
- Department of Biology, School of Life Sciences, Southern University of Science and Technology, Shenzhen, China.,Institute of Integrated Bioinfomedicine and Translational Science (IBTS), School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China.,Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Jie Huang
- Department of Biology, School of Life Sciences, Southern University of Science and Technology, Shenzhen, China
| | - Duoli Xie
- Institute of Integrated Bioinfomedicine and Translational Science (IBTS), School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China.,Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Dongyi He
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Aiping Lu
- Institute of Integrated Bioinfomedicine and Translational Science (IBTS), School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China.,Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China
| | - Chao Liang
- Department of Biology, School of Life Sciences, Southern University of Science and Technology, Shenzhen, China.,Institute of Integrated Bioinfomedicine and Translational Science (IBTS), School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China.,Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
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Makarem YS, Hareedy MS, Hassanien M, Ahmed EA, Hetta HF, Mohamed AA. Frequency and impact of DHODH, ABCG2 and CYP2C19 SNPs on the therapeutic efficacy, tolerability and toxicity of leflunomide. Pharmacogenomics 2021; 22:1201-1209. [PMID: 34747629 DOI: 10.2217/pgs-2020-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Leflunomide is one of the commonly used drugs in treatment of rheumatoid arthritis (RA), which on administration is converted into its active metabolite teriflunomide. Aim: Our aim is to evaluate the frequencies of dihydrooroate dehydrogenase (DHODH) (rs3213422), ABCG2 (rs2231142) and CYP2C19 (rs4244285) allele distribution among patients receiving leflunomide for RA and their possible impact on leflunomide performance in disease control. Patients & methods: Patients (>18 years) who fulfilled the 2010 ACR classification criteria for RA receiving leflunomide (20 mg/day) were included in the study. Disease activity score 28 was used to assess patients disease activity. Blood samples were collected for full blood count and blood chemistry. Genomic DNA was extracted from peripheral blood. The selection of SNPs was based on the criteria of minor allele frequency among Caucasians. Results: A significant association between the therapeutic outcome of leflunomide and DHODH genotyping was observed but not with CYP2C19 and ABCG2. Importantly, there is a significant association between DHODH (rs3213422) CC genotype and the number of patients with controlled disease. Conclusion: We strongly suggest that polymorphisms in the DHODH are the major factor affecting leflunomide pharmacogenetics and therapeutic efficacy.
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Affiliation(s)
- Yasmine S Makarem
- Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammad Salem Hareedy
- Department of Pharmacology & Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Manal Hassanien
- Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa A Ahmed
- Department of Pharmacology & Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0595, USA
| | - Alaa Aa Mohamed
- Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Rheumatology, The Betsi Cadwaladr University Health Board, Wales, UK
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3
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Wiese MD, Hopkins AM, King C, Wechalekar MD, Lee A, Spargo L, Metcalf R, McWilliams L, Hill C, Cleland LG, Proudman SM. Precision Medicine With Leflunomide: Consideration of the DHODH Haplotype and Plasma Teriflunomide Concentration and Modification of Outcomes in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 73:983-989. [PMID: 32339392 DOI: 10.1002/acr.24236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Leflunomide is a commonly used disease-modifying drug in the treatment of rheumatoid arthritis (RA). Its effects are mediated via inhibition of dihydroorotate dehydrogenase (DHODH) by its active metabolite teriflunomide, and the pharmacokinetics of teriflunomide are highly variable. Our objective was to examine the association between the DHODH haplotype and plasma teriflunomide concentration with response to leflunomide in patients with RA where leflunomide was added to an existing disease-modifying drug regimen after failure to achieve an adequate response with conventional triple therapy. METHODS Patients with RA who were taking, or were about to initiate, leflunomide were included. Participant characteristics, including the DHODH haplotype, were determined. Up to 5 plasma samples were collected after leflunomide was initiated for assays of total and free teriflunomide concentration. Disease activity was determined via the 28-joint Disease Activity Score (DAS28). The association between DAS28 scores and patient covariates was determined by linear mixed-effects modeling. RESULTS A total of 67 patients were included in the study. The DAS28 score after initiation of leflunomide was associated with the baseline DAS28 score (β = 0.70, P < 0.001) and was higher in those who carried the DHODH haplotype 2 (β = 0.56. P = 0.01) and did not carry the shared epitope (β = 0.56, P = 0.013). As total and free plasma teriflunomide concentration increased, the DAS28 score was significantly lower (P < 0.001 and P = 0.001, respectively). When considering threshold concentrations, teriflunomide concentrations >16 mg/liter were associated with a DAS28 score that was 0.33 lower, and when free teriflunomide concentration was >35 µg/liter, the DAS28 score was 0.32 lower. CONCLUSION Teriflunomide concentration and carriage of the DHODH haplotype 2 are associated with response to leflunomide in patients with RA, and a total plasma teriflunomide concentration of at least 16 mg/liter is needed to maximize the likelihood of response.
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Affiliation(s)
- Michael D Wiese
- University of South Australia, Adelaide, South Australia, Australia
| | - Ashley M Hopkins
- Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Catherine King
- University of South Australia, Adelaide, South Australia, Australia
| | - Mihir D Wechalekar
- Flinders University of South Australia and Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Anita Lee
- Royal Adelaide Hospital and The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia
| | | | - Robert Metcalf
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Leah McWilliams
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine Hill
- Royal Adelaide Hospital and The University of Adelaide, Adelaide, and The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | | | - Susanna M Proudman
- Royal Adelaide Hospital and The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia
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Zhang J, Terán G, Popa M, Madapura H, Ladds MJGW, Lianoudaki D, Grünler J, Arsenian-Henriksson M, McCormack E, Rottenberg ME, Catrina SB, Laín S, Darekar S. DHODH inhibition modulates glucose metabolism and circulating GDF15, and improves metabolic balance. iScience 2021; 24:102494. [PMID: 34113829 PMCID: PMC8169992 DOI: 10.1016/j.isci.2021.102494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022] Open
Abstract
Dihydroorotate dehydrogenase (DHODH) is essential for the de novo synthesis of pyrimidine ribonucleotides, and as such, its inhibitors have been long used to treat autoimmune diseases and are in clinical trials for cancer and viral infections. Interestingly, DHODH is located in the inner mitochondrial membrane and contributes to provide ubiquinol to the respiratory chain. Thus, DHODH provides the link between nucleotide metabolism and mitochondrial function. Here we show that pharmacological inhibition of DHODH reduces mitochondrial respiration, promotes glycolysis, and enhances GLUT4 translocation to the cytoplasmic membrane and that by activating tumor suppressor p53, increases the expression of GDF15, a cytokine that reduces appetite and prolongs lifespan. In addition, similar to the antidiabetic drug metformin, we observed that in db/db mice, DHODH inhibitors elevate levels of circulating GDF15 and reduce food intake. Further analysis using this model for obesity-induced diabetes revealed that DHODH inhibitors delay pancreatic β cell death and improve metabolic balance.
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Affiliation(s)
- Juan Zhang
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Graciela Terán
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Mihaela Popa
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science, Hematology Section, University of Bergen, 5021 Bergen, Norway
| | - Harsha Madapura
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
- SciLifeLab, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Tomtebodavägen 23, SE-171 21 Stockholm, Sweden
| | | | - Danai Lianoudaki
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
- SciLifeLab, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Tomtebodavägen 23, SE-171 21 Stockholm, Sweden
| | - Jacob Grünler
- Department of Endocrinology and Diabetes, Karolinska University Hospital, 17176 Stockholm, Sweden
- Center for Diabetes, Academic Specialist Centrum, 11365 Stockholm, Sweden
| | - Marie Arsenian-Henriksson
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Emmet McCormack
- Centre for Cancer Biomarkers, CCBIO, Department of Clinical Science, Hematology Section, University of Bergen, 5021 Bergen, Norway
- Department of Medicine, Haematology Section, Haukeland University Hospital, Bergen, Norway
| | - Martin Enrique Rottenberg
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Endocrinology and Diabetes, Karolinska University Hospital, 17176 Stockholm, Sweden
- Center for Diabetes, Academic Specialist Centrum, 11365 Stockholm, Sweden
| | - Sonia Laín
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
- SciLifeLab, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Tomtebodavägen 23, SE-171 21 Stockholm, Sweden
| | - Suhas Darekar
- Department of Microbiology, Tumor and Cell Biology (MTC), Biomedicum, Karolinska Institutet, SE-171 65 Stockholm, Sweden
- SciLifeLab, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Tomtebodavägen 23, SE-171 21 Stockholm, Sweden
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5
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Monitoring of Peripheral Blood Leukocytes and Plasma Samples: A Pilot Study to Examine Treatment Response to Leflunomide in Rheumatoid Arthritis. Pharmaceuticals (Basel) 2021; 14:ph14020106. [PMID: 33573015 PMCID: PMC7910893 DOI: 10.3390/ph14020106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Rheumatoid arthritis (RA) is a painful inflammatory disease of the joints which affects a considerable proportion of the world population, mostly women. If not adequately treated, RA patients can become permanently disabled. Importantly, not all the patients respond to the available anti-rheumatic therapies, which also present diverse side effects. In this context, monitoring of treatment response is pivotal to avoid unnecessary side effects and costs towards an ineffective therapy. Herein, we performed a pilot study to investigate the potential use of flow cytometry and attenuated total reflection–Fourier transform infrared (ATR-FTIR) spectroscopy as measures to identify responders and non-responders to leflunomide, a disease-modifying drug used in the treatment of RA patients. The evaluation of peripheral blood CD62L+ polymorphonuclear cell numbers and ATR-FTIR vibrational modes in plasma were able to discriminate responders to leflunomide (LFN) three-months after therapy has started. Overall, the results indicate that both flow cytometry and ATR-FTIR can potentially be employed as additional measures to monitor early treatment response to LFN in RA patients.
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6
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Qian Y, Liang X, Kong P, Cheng Y, Cui H, Yan T, Wang J, Zhang L, Liu Y, Guo S, Cheng X, Cui Y. Elevated DHODH expression promotes cell proliferation via stabilizing β-catenin in esophageal squamous cell carcinoma. Cell Death Dis 2020; 11:862. [PMID: 33060568 PMCID: PMC7566478 DOI: 10.1038/s41419-020-03044-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
As a key enzyme in de novo pyrimidine biosynthesis, the expression level of dihydroorotate dehydrogenase (DHODH) has been reported to be elevated in various types of malignant tumors and its tumor-promoting effect was considered to relate to its pyrimidine synthesis function. Here, we revealed one intriguing potential mechanism that DHODH modulated β-catenin signaling in esophageal squamous cell carcinoma (ESCC). We demonstrated that DHODH directly bound to the NH2 terminal of β-catenin, thereby, interrupting the interaction of GSK3β with β-catenin and leading to the abrogation of β-catenin degradation and accumulation of β-catenin in the nucleus, which in turn, resulted in the activation of β-catenin downstream genes, including CCND1, E2F3, Nanog, and OCT4. We further demonstrated that the regulation of β-catenin by DHODH was independent of DHODH catalyzing activity. Univariate and multivariate analyses suggested that DHODH expression might be an independent prognostic factor for ESCC patients. Collectively, our study highlights the pivotal role of DHODH mediated β-catenin signaling and indicates that DHODH may act as a multi-functional switcher from catalyzing pyrimidine metabolism to regulating tumor-related signaling pathways in ESCC.
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Affiliation(s)
- Yu Qian
- Cancer Institute, Peking University Shenzhen Hospital, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, 518035, Shenzhen, People's Republic of China.,Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China
| | - Xiao Liang
- Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China
| | - Pengzhou Kong
- Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China
| | - Yikun Cheng
- Cancer Institute, Peking University Shenzhen Hospital, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, 518035, Shenzhen, People's Republic of China
| | - Heyang Cui
- Cancer Institute, Peking University Shenzhen Hospital, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, 518035, Shenzhen, People's Republic of China.,Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China
| | - Ting Yan
- Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China
| | - Jinghao Wang
- Department of Obstetrics & Gynecology, the Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ling Zhang
- Cancer Institute, Peking University Shenzhen Hospital, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, 518035, Shenzhen, People's Republic of China.,Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China
| | - Yiqian Liu
- Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China
| | - Shiping Guo
- Department of Tumor Surgery, Shanxi Cancer Hospital, Taiyuan, Shanxi, China
| | - Xiaolong Cheng
- Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, 030001, Taiyuan, Shanxi, People's Republic of China.
| | - Yongping Cui
- Cancer Institute, Peking University Shenzhen Hospital, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, 518035, Shenzhen, People's Republic of China.
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7
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Rosenzweig M, Palmer J, Tsai NC, Synold T, Wu X, Tao S, Hammond SN, Buettner R, Duarte L, Htut M, Karanes C, Nathwani N, Pichiorri F, Sahebi F, Sanchez JF, Chowdhury A, Krishnan A, Forman SJ, Rosen ST. Repurposing leflunomide for relapsed/refractory multiple myeloma: a phase 1 study. Leuk Lymphoma 2020; 61:1669-1677. [PMID: 32268821 DOI: 10.1080/10428194.2020.1742900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The inexpensive, well-tolerated, immunomodulatory agent leflunomide, used extensively for the treatment of rheumatoid arthritis, has been shown to produce significant activity against multiple myeloma (MM) in pre-clinical studies. We conducted a phase 1 study (clinicaltrials.gov: NCT02509052) of single agent leflunomide in patients with relapsed/refractory MM (≥3 prior therapies). At dose levels 1 and 2 (20 and 40 mg), no dose-limiting toxicities (DLTs) were observed. At dose level 3 (60 mg), one patient experienced elevated alanine aminotransferase; an additional three patients were enrolled at this dose level without further DLTs. Overall, toxicities were infrequent and manageable. Nine out of 11 patients achieved stable disease (SD), two subjects experiencing SD for nearly one year or longer. The tolerable safety profile of leflunomide, combined with a potential disease stabilization, is motivating future studies of leflunomide, in combination with other MM drugs, or as an approach to delay progression of smoldering MM.
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Affiliation(s)
- Michael Rosenzweig
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Joycelynne Palmer
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, CA, USA.,Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ni-Chun Tsai
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Tim Synold
- Department of Cancer Biology, City of Hope, Duarte, CA, USA
| | - Xiwei Wu
- Integrative Genomics Core, City of Hope, Duarte, CA, USA
| | - Shu Tao
- Integrative Genomics Core, City of Hope, Duarte, CA, USA
| | - Samantha N Hammond
- Department of Clinical Protocol Development, City of Hope, Duarte, CA, USA
| | - Ralf Buettner
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Lupe Duarte
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Myo Htut
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Chatchada Karanes
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Flavia Pichiorri
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Firoozeh Sahebi
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA.,Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - James F Sanchez
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Arnab Chowdhury
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Amrita Krishnan
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Steven T Rosen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
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8
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Machaj F, Rosik J, Szostak B, Pawlik A. The evolution in our understanding of the genetics of rheumatoid arthritis and the impact on novel drug discovery. Expert Opin Drug Discov 2019; 15:85-99. [PMID: 31661990 DOI: 10.1080/17460441.2020.1682992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Rheumatoid arthritis (RA) is an autoimmune disease that is characterized by chronic inflammation of the joints and affects 1% of the population. Polymorphisms of genes that encode proteins that primarily participate in inflammation may influence RA occurrence or become useful biomarkers for certain types of anti-rheumatic treatment.Areas covered: The authors summarize the recent progress in our understanding of the genetics of RA. In the last few years, multiple variants of genes that are associated with RA risk have been identified. The development of new technologies and the detection of new potential therapeutic targets that contribute to novel drug discovery are also described.Expert opinion: There is still the need to search for new genes which may be a potential target for RA therapy. The challenge is to develop appropriate strategies for achieving insight into the molecular pathways involved in RA pathogenesis. Understanding the genetics, immunogenetics, epigenetics and immunology of RA could help to identify new targets for RA therapy. The development of new technologies has enabled the detection of a number of new genes, particularly genes associated with proinflammatory cytokines and chemokines, B- and T-cell activation pathways, signal transducers and transcriptional activators, which might be potential therapeutic targets in RA.
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Affiliation(s)
- Filip Machaj
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | - Jakub Rosik
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | - Bartosz Szostak
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
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9
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Pistono C, Osera C, Boiocchi C, Mallucci G, Cuccia M, Bergamaschi R, Pascale A. What's new about oral treatments in Multiple Sclerosis? Immunogenetics still under question. Pharmacol Res 2017; 120:279-293. [PMID: 28396093 DOI: 10.1016/j.phrs.2017.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 02/06/2023]
Abstract
Multiple Sclerosis (MS) is a chronic pathology affecting the Central Nervous System characterized by inflammatory processes that lead to demyelination and neurodegeneration. In MS treatment, disease modifying therapies (DMTs) are essential to reduce disease progression by suppressing the inflammatory response responsible for promoting lesion formation. Recently, in addition to the classical injectable DMTs like Interferons and Glatiramer acetate, new orally administered drugs have been approved for MS therapy: dimethyl fumarate, teriflunomide and fingolimod. These drugs act with different mechanisms on the immune system, in order to suppress the harmful inflammatory process. An additional layer of complexity is introduced by the influence of polymorphic gene variants in the Human Leukocyte Antigen region on the risk of developing MS and its progression. To date, pharmacogenomic studies have mainly focused on the patient's response following admission of injectable drugs. Therefore, greater consideration must be made to pharmacogenomics with a view to developing more effective and personalized therapies. This review aims to shed light on the mechanism of action of the new oral drugs dimethyl fumarate, teriflunomide and fingolimod, taking into account both the importance of immunogenetics in drug response and pharmacogenomic studies.
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Affiliation(s)
- Cristiana Pistono
- Laboratory of Immunogenetics, Department of Biology & Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy.
| | - Cecilia Osera
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy.
| | - Chiara Boiocchi
- Laboratory of Immunogenetics, Department of Biology & Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Giulia Mallucci
- Inter-Department Multiple Sclerosis Research Centre, National Neurological Institute "C. Mondino", Pavia, Italy
| | - Mariaclara Cuccia
- Laboratory of Immunogenetics, Department of Biology & Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Roberto Bergamaschi
- Inter-Department Multiple Sclerosis Research Centre, National Neurological Institute "C. Mondino", Pavia, Italy
| | - Alessia Pascale
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
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Shen W, Ren X, Zhu J, Xu Y, Lin J, Li Y, Zhao F, Zheng H, Li R, Cui X, Zhang X, Lu X, Zheng Z. Discovery of a new structural class of competitive hDHODH inhibitors with in vitro and in vivo anti-inflammatory, immunosuppressive effects. Eur J Pharmacol 2016; 791:205-212. [PMID: 27597161 DOI: 10.1016/j.ejphar.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022]
Abstract
Human dihydroorotate dehydrogenase (hDHODH) is an inner mitochondrial membrane enzyme that involves in the fourth step of the biosynthesis of pyrimidine base. Inhibitors of hDHODH have been proven efficacy for the treatments of inflammation, rheumatoid arthritis, multiple sclerosis and cancer. In the present study, ascochlorin (ASC) and its derivatives, natural compounds from fungal metabolites, were discovered as hDHODH inhibitors by high-throughput screening. Enzyme kinetics studies showed that ASC competitively binds to hDHODH at the site of coenzyme Q substrate. In ex vivo study, ASC significantly inhibited the ConA-stimulated T lymphocytes proliferation and interleukin-2, interferon-γ production. Furthermore, ASC showed significant in vivo anti-inflammatory and immunosuppressive effects on the mice ears swelling, allogenic skin grafts and rat collagen-induced arthritis animal disease models. ASC significantly reduced ears edema level of mice, increased the survival time of allogenic skin implanted on the mice and attenuated arthritis severity of rat model. In conclusion, ASC was identified as a new structural class of hDHODH inhibitors with efficient anti-inflammatory, immunosuppressive activity, and may be a promising candidate for the development of new therapy in the treatment of autoimmune diseases.
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Affiliation(s)
- Wenbin Shen
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Xiao Ren
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Jingtong Zhu
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Yan Xu
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Jie Lin
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Yeying Li
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Feng Zhao
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Haizhou Zheng
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Ruolan Li
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Xiaolan Cui
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Xuexia Zhang
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China
| | - Xinhua Lu
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China.
| | - Zhihui Zheng
- New Drug Research & Development Center, North China Pharmaceutical Group Corporation, National Microbial Medicine Engineering & Research Center, Hebei Industry Microbial Metabolic Engineering & Technology Research Center, No. 388 Heping East Road, Shijiazhuang 050015, Hebei, China.
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Cascella R, Strafella C, Longo G, Maccarone M, Borgiani P, Sangiuolo F, Novelli G, Giardina E. Pharmacogenomics of multifactorial diseases: a focus on psoriatic arthritis. Pharmacogenomics 2016; 17:943-51. [DOI: 10.2217/pgs.16.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This review will outline the current pharmacogenomics knowledge about psoriatic arthritis with a special attention to the perspectives and the challenges for its implementation in the clinical practice. To date, different drugs have been developed to contrast the symptoms and the progression of psoriatic arthritis. However, patients have shown high variability of drug response in relation to their genetic makeup. In this context, the advances made in the knowledge and the potentialities of genome-drugs associations paved the path for the development of a precision medicine. In fact, these associations may be successfully combined with the environment information to provide new strategies able to prevent and improve the disease management as well as to enhance the patients quality of life.
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Affiliation(s)
- Raffaella Cascella
- Department of Biomedicine & Prevention, School of Medicine, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
- Emotest Laboratory, via M. Licola patria 60, 80078 Pozzuoli, Italy
| | - Claudia Strafella
- Department of Biomedicine & Prevention, School of Medicine, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
| | - Giuliana Longo
- Department of Biomedicine & Prevention, School of Medicine, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
| | | | - Paola Borgiani
- Department of Biomedicine & Prevention, School of Medicine, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
| | - Federica Sangiuolo
- Department of Biomedicine & Prevention, School of Medicine, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine & Prevention, School of Medicine, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
| | - Emiliano Giardina
- Department of Biomedicine & Prevention, School of Medicine, University of Rome “Tor Vergata”, via Montpellier 1, 00133 Rome, Italy
- Molecular Genetics Laboratory UILDM, Santa Lucia Foundation, via Ardeatina 306, 00146 Rome, Italy
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Abstract
TNF-blocking agents, non-biological disease-modifying anti-rheumatic drugs (nbDMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed treatments in psoriatic arthritis. A large proportion of patients do not respond to these medications, although unfortunately clinically useful biomarkers that predict future response are currently lacking. Several candidate gene polymorphisms have been associated with responses to biologic therapies and nbDMARDs; however, replication and validation of these variants in large prospective psoriatic arthritis cohorts are required before translating these to clinical practice. In this review, we discuss the advances made in pharmacogenetics of treatment response in psoriatic arthritis to date, with focus on biologic therapies approved for use, nbDMARDs and NSAIDs, as well as outline emerging methodologies to obtain data that will help inform a future precision medicine approach in this condition.
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Affiliation(s)
- Meghna Jani
- Arthritis Research UK Centre for Genetics and Genomics; Centre for Musculoskeletal Research, University of Manchester, Room 2.704, Stopford Building, Oxford Road, Manchester, M13 9PT, UK,
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Hopkins AM, Wiese MD, Proudman SM, O'Doherty CE, Upton RN, Foster DJR. Genetic polymorphism of CYP1A2 but not total or free teriflunomide concentrations is associated with leflunomide cessation in rheumatoid arthritis. Br J Clin Pharmacol 2016; 81:113-23. [PMID: 26331989 PMCID: PMC4693574 DOI: 10.1111/bcp.12760] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/01/2015] [Accepted: 08/27/2015] [Indexed: 01/06/2023] Open
Abstract
AIM Leflunomide, via its active metabolite teriflunomide, is used in rheumatoid arthritis (RA) treatment, yet approximately 20 to 40% of patients cease due to toxicity. The aim was to develop a time-to-event model describing leflunomide cessation due to toxicity within a clinical cohort and to investigate potential predictors of cessation such as total and free teriflunomide exposure and pharmacogenetic influences. METHODS This study included individuals enrolled in the Early Arthritis inception cohort at the Royal Adelaide Hospital between 2000 and 2013 who received leflunomide. A time-to-event model in nonmem was used to describe the time until leflunomide cessation and the influence of teriflunomide exposure and pharmacogenetic variants. Random censoring of individuals was simultaneously described. The clinical relevance of significant covariates was visualized via simulation. RESULTS Data from 105 patients were analyzed, with 34 ceasing due to toxicity. The baseline dropout hazard and baseline random censoring hazard were best described by step functions changing over discrete time intervals. No statistically significant associations with teriflunomide exposure metrics were identified. Of the screened covariates, carriers of the C allele of CYP1A2 rs762551 had a 2.29 fold increase in cessation hazard compared with non-carriers (95% CI 2.24, 2.34, P = 0.016). CONCLUSIONS A time-to-event model described the time between leflunomide initiation and cessation due to side effects. The C allele of CYP1A2 rs762551 was linked to increased leflunomide toxicity, while no association with teriflunomide exposure was identified. Future research should continue to investigate exposure-toxicity relationships, as well as potentially toxic metabolites.
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Affiliation(s)
- Ashley M. Hopkins
- Australian Centre for Pharmacometrics, School of Pharmacy and Medical SciencesUniversity of South AustraliaFrome Road, GPO Box 2471AdelaideSouth Australia5000
- School of Pharmacy and Medical SciencesUniversity of South Australia, Sansom Institute for Health ResearchFrome Road, GPO Box 2471AdelaideSouth Australia5000
| | - Michael D. Wiese
- School of Pharmacy and Medical SciencesUniversity of South Australia, Sansom Institute for Health ResearchFrome Road, GPO Box 2471AdelaideSouth Australia5000
| | - Susanna M. Proudman
- Department of RheumatologyRoyal Adelaide HospitalNorth TerraceAdelaideSouth Australia5000
- Discipline of MedicineAdelaide UniversityNorth TerraceAdelaideSouth Australia5000Australia
| | - Catherine E. O'Doherty
- School of Pharmacy and Medical SciencesUniversity of South Australia, Sansom Institute for Health ResearchFrome Road, GPO Box 2471AdelaideSouth Australia5000
| | - Richard N. Upton
- Australian Centre for Pharmacometrics, School of Pharmacy and Medical SciencesUniversity of South AustraliaFrome Road, GPO Box 2471AdelaideSouth Australia5000
- School of Pharmacy and Medical SciencesUniversity of South Australia, Sansom Institute for Health ResearchFrome Road, GPO Box 2471AdelaideSouth Australia5000
| | - David J. R. Foster
- Australian Centre for Pharmacometrics, School of Pharmacy and Medical SciencesUniversity of South AustraliaFrome Road, GPO Box 2471AdelaideSouth Australia5000
- School of Pharmacy and Medical SciencesUniversity of South Australia, Sansom Institute for Health ResearchFrome Road, GPO Box 2471AdelaideSouth Australia5000
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Tarnowski M, Paradowska-Gorycka A, Dąbrowska-Zamojcin E, Czerewaty M, Słuczanowska-Głąbowska S, Pawlik A. The effect of gene polymorphisms on patient responses to rheumatoid arthritis therapy. Expert Opin Drug Metab Toxicol 2015; 12:41-55. [PMID: 26609565 DOI: 10.1517/17425255.2016.1121233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a systemic disease leading to joint destruction. The therapy of RA is mainly based on disease-modifying anti-rheumatic drugs (DMARDs) and biological drugs. The response to treatment is different among patients. Therefore, we have searched for factors that may predict the efficacy and toxicity during therapy in individual patients. AREAS COVERED This review presents the role of genetic polymorphisms as predictors of the efficacy and toxicity during the therapy of RA patients with DMARDs (methotrexate, leflunomide, sulfasalazine) and biological drugs (anti-TNF-alpha antagonists, Tocilizumab, Rituximab). EXPERT OPINION Despite studies having shown an association between genetic polymorphisms and response to therapy in RA patients, the majority of these findings are still inconclusive and inconsistent. We are still far from applying pharmacogenetic tests in routine clinical practice that can predict the outcome of treatment. Several factors, such as small sample size with low statistical power, variability in the outcome definitions and the heterogeneity of the cohorts, limited number of tested single nucleotide polymorphisms (SNPs), small effect for the selected variant, and a lack of consideration of epigenetic factors, may contribute to the inconsistency observed and may lead to limited success in personalizing therapy.
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Affiliation(s)
- Maciej Tarnowski
- a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland
| | - Agnieszka Paradowska-Gorycka
- b Department of Biochemistry and Molecular Biology , National Institute of Geriatrics, Rheumatology and Rehabilitation , 02-637 Warszawa , Poland
| | | | - Michal Czerewaty
- a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland
| | | | - Andrzej Pawlik
- a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland
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Hopkins AM, Wiese MD, Proudman SM, O'Doherty CE, Foster D, Upton RN. Semiphysiologically Based Pharmacokinetic Model of Leflunomide Disposition in Rheumatoid Arthritis Patients. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2015. [PMID: 26225264 PMCID: PMC4505830 DOI: 10.1002/psp4.46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A semiphysiologically based pharmacokinetic (semi-PBPK) population model was used to evaluate the influence of enterohepatic recycling and protein binding, as well as the effect of genetic variability in CYP1A2, CYP2C19, and ABCG2, on the large interindividual variability of teriflunomide (active metabolite) concentrations following leflunomide administration in rheumatoid arthritis (RA) patients. The model was developed with total and free teriflunomide concentrations determined in RA patients taking leflunomide, as well as mean teriflunomide concentrations following the administration of leflunomide or teriflunomide extracted from the literature. Once developed, the 15-compartment model was able to predict total and free teriflunomide concentrations and was used to screen demographic and genotypic covariates, of which only fat-free mass and liver function (ALT) improved prediction. This approach effectively evaluated the effects of multiple covariates on both total and free teriflunomide concentrations, which have only been explored previously through simplistic one-compartment models for total teriflunomide.
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Affiliation(s)
- A M Hopkins
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy and Medical Sciences Adelaide, South Australia, Australia ; University of South Australia, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences Adelaide, South Australia, Australia
| | - M D Wiese
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences Adelaide, South Australia, Australia
| | - S M Proudman
- Royal Adelaide Hospital, Department of Rheumatology Adelaide, South Australia, Australia ; Adelaide University, Discipline of Medicine Adelaide, South Australia, Australia
| | - C E O'Doherty
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences Adelaide, South Australia, Australia
| | - Djr Foster
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy and Medical Sciences Adelaide, South Australia, Australia
| | - R N Upton
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy and Medical Sciences Adelaide, South Australia, Australia
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Genetic polymorphisms affect efficacy and adverse drug reactions of DMARDs in rheumatoid arthritis. Pharmacogenet Genomics 2015; 24:531-8. [PMID: 25144752 DOI: 10.1097/fpc.0000000000000085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disease-modifying antirheumatic drugs (DMARDs) and biological agents are critical in preventing the severe complications of rheumatoid arthritis (RA). However, the outcome of treatment with these drugs in RA patients is quite variable and unpredictable. Drug-metabolizing enzymes (dihydrofolate reductase, cytochrome P450 enzymes, N-acetyltransferases, etc.), drug transporters (ATP-binding cassette transporters), and drug targets (tumor necrosis factor-α receptors) are coded for by variant alleles. These gene polymorphisms may influence the pharmacokinetics, pharmacodynamics, and side effects of medicines. The cause for differences in efficacy and adverse drug reactions may be genetic variation in drug metabolism among individuals. Polymorphisms in drug transporter genes may change the distribution and excretion of medicines, and the sensitivity of the targets to drugs is strongly influenced by genetic variations. In this article, we review the genetic polymorphisms that affect the efficacy of DMARDs or the occurrence of adverse drug reactions associated with DMARDs in RA.
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Hronová K, Šíma M, Světlík S, Matoušková O, Slanař O. Pharmacogenetics and immunosuppressive drugs. Expert Rev Clin Pharmacol 2014; 7:821-35. [PMID: 25301406 DOI: 10.1586/17512433.2014.966811] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Several candidate genes have been proposed as potential biomarkers for altered pharmacodynamics or pharmacokinetics of immunosuppressive drugs. However, there is usually only limited clinical evidence substantiating the implementation of biomarkers into clinical practice. Testing for thiopurine-S-methyltransferase polymorphisms has been put into routine clinical use quite widely, while the other pharmacogenetic tests are much less frequently used. Relatively good evidence appeared for tacrolimus-related biomarkers; thus, their utilization may be envisaged in the near future. Although the biomarkers related to mycophenolate, sirolimus or other drugs in the therapeutic class may be promising, further research is necessary to provide more robust evidence. The present review focuses on immunosuppressive drugs, excluding biological treatment.
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Affiliation(s)
- Karolína Hronová
- Department of Pharmacology, First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Albertov 4, CZ-128 00 Prague 2, Czech Republic
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18
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Hopkins AM, O'Doherty CE, Foster DJR, Suppiah V, Upton RN, Spargo LD, Cleland LG, Proudman SM, Wiese MD. The rheumatoid arthritis susceptibility polymorphism PTPN22 C1858T is not associated with leflunomide response or toxicity. J Clin Pharm Ther 2014; 39:555-60. [PMID: 25040563 DOI: 10.1111/jcpt.12189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 06/02/2014] [Indexed: 12/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE A common polymorphism (C1858T) in the gene that encodes the protein tyrosine phosphatase non-receptor type 22 (PTPN22) is associated with altered T-cell responses and increased susceptibility to rheumatoid arthritis (RA) and other autoimmune diseases. Teriflunomide, the active metabolite of leflunomide, reduces T-cell responses through inhibition of tyrosine kinase p56LCK. We examined a potential association between PTPN22 genotype and response or toxicity to leflunomide in Caucasian RA patients taking leflunomide in combination with other disease-modifying antirheumatic drugs (DMARDs). METHODS Patients enrolled in the Royal Adelaide Hospital RA inception cohort and taking leflunomide were eligible for inclusion. Participants were followed for 12 months after leflunomide initiation or until either another DMARD was added or leflunomide was ceased. Clinical response according to change in 28-joint Disease Activity Score (DAS28) and cessation due to toxicity were assessed. RESULTS AND DISCUSSION A total of 94 participants were included in the study, 75 of whom carried the CC genotype, 18 the CT, whereas one individual carried the TT genotype. Over the first 12 months of leflunomide treatment, there was no statistically significant relationship between carrying the T allele and change in DAS28 (-0·84 vs. -1·15, P = 0·446) nor with cessation of leflunomide treatment due to side effects (P = 0·433). These results indicate that PTPN22 C1858T genotype has no effect on response or toxicity outcomes in leflunomide-treated RA patients. WHAT IS NEW AND CONCLUSION This is the first study to evaluate the biologically plausible hypothesis that PTPN22 genotype might be a predictor of response/toxicity to leflunomide therapy. Despite this, PTPN22 genotype was not associated with leflunomide response or toxicity in patients with RA.
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Affiliation(s)
- A M Hopkins
- Sansom Institute for Health Research and School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
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Wiese MD, Suppiah V, O'Doherty C. Metabolic and safety issues for multiple sclerosis pharmacotherapy--opportunities for personalised medicine. Expert Opin Drug Metab Toxicol 2014; 10:1145-59. [PMID: 24910969 DOI: 10.1517/17425255.2014.925880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION A number of disease-modifying therapies have become available to treat multiple sclerosis (MS) in recent years. As the effects of these medications are unpredictable and they are generally used for a number of years, the selection of the most appropriate disease-modifying agent must be based on the long-term efficacy and toxicity profile, thus strategies to personalise treatment to optimise responses may be potentially very useful. AREAS COVERED This review provides an overview of the efficacy and toxicity of disease-modifying agents used in MS and specifically discusses any metabolic side effects and advances in personalising the use of each of these agents. Medline and EMBASE were searched for any articles regarding the efficacy, toxicity and personalised use of the medicines discussed in this review. EXPERT OPINION Disease-modifying agents used to treat MS differ substantially in their efficacy and toxicity profile, but metabolic side effects appear to be limited to alemtuzumab, teriflunomide and IFN-β. Although personalised treatment strategies to assist in selection of the most appropriate disease-modifying agent for MS are limited, there is substantial potential to use genetic sub-studies of the many recent trials investigating disease-modifying agents to develop personalised treatment strategies.
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Affiliation(s)
- Michael D Wiese
- University of South Australia, School of Pharmacy and Medical Sciences , GPO Box 2471, Adelaide 5001 , Australia +618 8302 2312 ; +618 8302 1010 ;
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Hopkins AM, O'Doherty CE, Foster DJ, Upton RN, Proudman SM, Wiese MD. Individualization of leflunomide dosing in rheumatoid arthritis patients. Per Med 2014; 11:449-461. [PMID: 29783485 DOI: 10.2217/pme.14.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Leflunomide is largely considered to be a second-line treatment option for rheumatoid arthritis (RA). Those who fail to respond, tend to progress to treatment with expensive biological agents, which can also be associated with serious toxicities. Optimizing leflunomide treatment to meet the needs of individuals would hence be beneficial in terms of patient outcomes and health care expenditure. In this respect, therapeutic drug monitoring (TDM) may be useful, as plasma concentrations of leflunomide's active metabolite, teriflunomide, correlate with response to treatment, but are highly variable between patients. A number of pharmacogenetic markers have also been identified that influence response and toxicity. Incorporation of these findings into clinical practice could facilitate more efficient use of leflunomide.
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Affiliation(s)
- Ashley M Hopkins
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia.,University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Catherine E O'Doherty
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - David Jr Foster
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Richard N Upton
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Susanna M Proudman
- Royal Adelaide Hospital, Department of Rheumatology, North Terrace, Adelaide, South Australia, 5000, Australia.,Adelaide University, Discipline of Medicine, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Michael D Wiese
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
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Wiese MD, Rowland A, Polasek TM, Sorich MJ, O'Doherty C. Pharmacokinetic evaluation of teriflunomide for the treatment of multiple sclerosis. Expert Opin Drug Metab Toxicol 2013; 9:1025-35. [DOI: 10.1517/17425255.2013.800483] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Current World Literature. Curr Opin Rheumatol 2013; 25:398-409. [DOI: 10.1097/bor.0b013e3283604218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Umićević Mirkov M, Coenen MJH. Pharmacogenetics of disease-modifying antirheumatic drugs in rheumatoid arthritis: towards personalized medicine. Pharmacogenomics 2013; 14:425-44. [DOI: 10.2217/pgs.13.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Rheumatoid arthritis is a disease showing considerable heterogeneity in all its aspects, including response to therapy. The efficacy of disease-modifying antirheumatic drugs (DMARDs), with or without biological activity, has been unambiguously established. DMARDs improve the symptoms associated with the disease, and, even more importantly, are capable of stagnating the joint damage associated with the disease. Nonetheless, a considerable proportion of patients fail to achieve an adequate response and/or experience toxicity. This variability in treatment response between individuals has given rise to an extensive search for prognostic markers in order to personalize and optimize therapy in rheumatoid arthritis patients. Pharmacogenetics, the study of genetic variation underlying differential responses to drugs, is a rapidly progressing field in rheumatology that might enable personalized therapy in rheumatic diseases. This review will summarize the pharmacogenetics of commonly used synthetic and biological DMARDs.
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Affiliation(s)
- Maša Umićević Mirkov
- Department of Human Genetics, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marieke JH Coenen
- Department of Human Genetics, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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