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Wanderley AV, de Moraes FCA, da Costa Nunes GG, Pereira EEB, Leitão LPC, de Oliveira MB, Tavares ÁTM, da Costa Pantoja L, Khayat BCM, Fernandes MR, de Assumpção PP, Dos Santos ÂKR, Burbano RMR, Dos Santos SEB, Ribeiro R, Khayat AS, Dos Santos NPC. Effect of American genomic ancestry on severe toxicities in children with acute lymphoblastic leukemia in the Amazon region. Discov Oncol 2024; 15:171. [PMID: 38761320 PMCID: PMC11102409 DOI: 10.1007/s12672-024-01014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 05/04/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Acute Lymphoblastic Leukemia (ALL) is a neoplasm of the hematopoietic system characterized by a clonal expansion of abnormal lymphocyte precursor cells. ALL is the most common form of cancer in children, but despite advances in treatment, it can still be fatal. Ethnic differences influence survival rates, and genomic ancestry plays an important role, especially in mixed-race populations such as Latin America. This study aims to analyze the influence of genomic ancestry on toxicity in children with ALL in the Amazon region. METHODS The study included 171 patients (protocol number 119,649/2012-Ethics Committee) with ALL treated at a pediatric treatment center in Belém do Pará, in the Brazilian Amazon. The patients were submitted to the BFM protocol of induction therapy for ALL. Toxicity was assessed based on laboratory tests and adverse events, classified according to the CTC-NCI guide. Genomic ancestry was determined using autosomal informative markers. RESULTS The majority of children (94.74%) developed some type of toxicity during treatment, 87.04% of which were severe. Infectious toxicity was the most common, present in 84.8% of cases, 77.24% of which were severe. Amerindian ancestry showed an association with the risk of severe general toxicity and severe infectious toxicity, with a contribution of 35.0% demonstrating a significant increase in risk. In addition, post-induction refractoriness and relapse were also associated with an increased risk of death. CONCLUSION This study highlights the influence of Amerindian genomic ancestry on response to therapy and toxicity in children with ALL in the Amazon region. Understanding these associations can contribute to personalizing treatment and improving clinical outcomes.
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Affiliation(s)
| | - Francisco Cezar Aquino de Moraes
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil.
| | - Giovanna Gilioli da Costa Nunes
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Esdras Edgar Batista Pereira
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | | | - Marcelo Braga de Oliveira
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Ágatha Tereza Miranda Tavares
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Laudreisa da Costa Pantoja
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Bruna Cláudia Meireles Khayat
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Marianne Rodrigues Fernandes
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Paulo Pimentel de Assumpção
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Ândrea Kely Ribeiro Dos Santos
- Laboratory of Human and Medical Genetics, Institute of Biological Science, Federal University of Pará, Belem, 66077-830, Brazil
| | | | | | - Raul Ribeiro
- St. Jude Children's Research Hospital, Memphis, USA
| | - André Salim Khayat
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
| | - Ney Pereira Carneiro Dos Santos
- Oncology Research Center, Federal University of Pará, University Hospital João de Barros de Barreto. , Rua Dos Mundurucus, no 4487, Belem, PA, 66073-005, Brazil
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Ribeiro HP, Baraldi BM, Rodrigues-Soares F, Planello AC. Psychiatric Level 1A evidence pharmacogenomics in a Brazilian admixed cohort and global populations. Pharmacogenomics 2024; 25:69-78. [PMID: 38288577 DOI: 10.2217/pgs-2023-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Purpose: To compare minor allele frequencies (MAFs) of psychiatric drug response variants in a Brazilian admixed cohort with global populations and other Brazilian groups. Methods: PharmGKB MAFs were gathered from publicly available genetic datasets for Brazil and worldwide. Results: Among 146 variants in CYP2D6 and CYP2C19, 41 were present in Brazil, mostly rare (MAF <1%). 11 variants showed significant MAF differences with large effect sizes compared with global populations. CYP2C19*3 (rs4986893), CYP2C19*17 (rs12248560), CYP2D6*17 (rs28371706-A) and CYP2D6*29 (rs61736512) exhibited higher frequencies in Brazil, with the latter three also differing from other Brazilian groups. Conclusion: This study highlights significant pharmacogenomic diversity in Brazil and globally, underscoring the need for more research in personalized psychiatric drug therapy.
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Affiliation(s)
- Helena Pereira Ribeiro
- Department of Morphology & Basic Pathology - Medical School, Faculdade de Medicina de Jundiaí, Jundiaí, 13202-550, Brazil
| | - Beatriz Meza Baraldi
- Department of Morphology & Basic Pathology - Medical School, Faculdade de Medicina de Jundiaí, Jundiaí, 13202-550, Brazil
| | - Fernanda Rodrigues-Soares
- Department of Pathology, Genetics, & Evolution, Institute of Biological & Natural Sciences, Universidade Federal do Triângulo Mineiro, Uberaba, 38035-180, Brazil
| | - Aline Cristiane Planello
- Department of Morphology & Basic Pathology - Medical School, Faculdade de Medicina de Jundiaí, Jundiaí, 13202-550, Brazil
- Department of Bioscience, Faculdade de Odontologia de Piracicaba/Universidade de Campinas, 13414-903, Brazil
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Cohen-Paes A, de Alcântara AL, de Souza Menezes E, Moreira FC, Fernandes MR, Guerreiro JF, Ribeiro-Dos-Santos Â, Dos Santos SEB, dos Santos NPC. Characterization of DNA Polymerase Genes in Amazonian Amerindian Populations. Genes (Basel) 2022; 14:53. [PMID: 36672794 PMCID: PMC9859017 DOI: 10.3390/genes14010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
Due to their continuing geographic isolation, the Amerindian populations of the Brazilian Amazon present a different genetic profile when compared to other continental populations. Few studies have investigated genetic variants present in these populations, especially in the context of next-generation sequencing. Knowledge of the molecular profile of a population is one of the bases for inferences about human evolutionary history, in addition, it has the ability to assist in the validation of molecular biomarkers of susceptibility to complex and rare diseases, and in the improvement of specific precision medicine protocols applied to these populations and to populations with high Amerindian ancestry, such as Brazilians. DNA polymerases play essential roles in DNA replication, repair, recombination, or damage repair, and their influence on various clinical phenotypes has been demonstrated in the specialized literature. Thus, the aim of this study is to characterize the molecular profile of POLA1, POLE, POLG, POLQ, and REV3L genes in Amerindian populations from the Brazilian Amazon, comparing these findings with genomic data from five continental populations described in the gnomAD database, and with data from the Brazilian population described in ABraOM. We performed the whole exome sequencing (WES) of 63 Indigenous individuals. Our study described for the first time the allele frequency of 45 variants already described in the other continental populations, but never before described in the investigated Amerindian populations. Our results also describe eight unique variants of the investigated Amerindians populations, with predictions of moderate, modifier and high clinical impact. Our findings demonstrate the unique genetic profile of the Indigenous population of the Brazilian Amazon, reinforcing the need for further studies on these populations, and may contribute to the creation of public policies that optimize not only the quality of life of this population, but also of the Brazilian population.
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Affiliation(s)
- Amanda Cohen-Paes
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, PA, Brazil
| | | | - Elisa de Souza Menezes
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, PA, Brazil
| | | | | | - João Farias Guerreiro
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, PA, Brazil
| | - Ândrea Ribeiro-Dos-Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, PA, Brazil
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, PA, Brazil
| | - Sidney Emanuel Batista Dos Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, PA, Brazil
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, PA, Brazil
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Bernardes JGB, Fernandes MR, Rodrigues JCG, Vinagre LWMS, Pastana LF, Dobbin EAF, Medeiros JAG, Dias Junior LB, Bernardes GM, Bernardes IMM, Santos NPCD, Demachki S, Burbano RMR. Association of Androgenic Regulation and MicroRNAs in Acinar Adenocarcinoma of Prostate. Genes (Basel) 2022; 13:genes13040622. [PMID: 35456428 PMCID: PMC9030213 DOI: 10.3390/genes13040622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Prostate cancer represents 3.8% of cancer deaths worldwide. For most prostate cancer cells to grow, androgens need to bind to a cellular protein called the androgen receptor (AR). This study aims to demonstrate the expression of five microRNAs (miRs) and its influence on the AR formation in patients from the northern region of Brazil. Material and Methods: Eighty-four tissue samples were investigated, including nodular prostatic hyperplasia (NPH) and acinar prostatic adenocarcinoma (CaP). Five miRs (27a-3p, 124, 130a, 488-3p, and 506) were quantified using the TaqMan® Real Time PCR method and AR was measured using Western blotting. Results: Levels of miRs 124, 130a, 488-3p, and 506 were higher in NPH samples. Conversely, in the CaP cases, higher levels of miR 27a-3p and AR were observed. Conclusion: In the future, these microRNAs may be tested as markers of CaP at the serum level. The relative expression of AR was 20% higher in patients with prostate cancer, which suggests its potential as a biomarker for prostate malignancy.
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Affiliation(s)
- Julio Guilherme Balieiro Bernardes
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém 66050-160, Brazil; (J.G.B.B.); (L.B.D.J.); (I.M.M.B.)
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Marianne Rodrigues Fernandes
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
- Hospital Ophir Loyola, Belém 66063-240, Brazil
- Correspondence:
| | - Juliana Carla Gomes Rodrigues
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Lui Wallacy Morikawa Souza Vinagre
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Lucas Favacho Pastana
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Elizabeth Ayres Fragoso Dobbin
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Jéssyca Amanda Gomes Medeiros
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Leonidas Braga Dias Junior
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém 66050-160, Brazil; (J.G.B.B.); (L.B.D.J.); (I.M.M.B.)
| | | | | | - Ney Pereira Carneiro Dos Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Samia Demachki
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
| | - Rommel Mario Rodriguez Burbano
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-005, Brazil; (J.C.G.R.); (L.W.M.S.V.); (L.F.P.); (E.A.F.D.); (J.A.G.M.); (N.P.C.D.S.); (S.D.); (R.M.R.B.)
- Hospital Ophir Loyola, Belém 66063-240, Brazil
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Population Pharmacokinetic Model of Piperacillin in Critically Ill Patients and Describing Interethnic Variation Using External Validation. Antibiotics (Basel) 2022; 11:antibiotics11040434. [PMID: 35453185 PMCID: PMC9029174 DOI: 10.3390/antibiotics11040434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023] Open
Abstract
Objectives: This study aimed to develop a piperacillin population PK model for critically ill Brazil-ian patients and describe interethnic variation using an external validation. Methods: Plasma samples were obtained from 24 ICU patients during the fifth day of piperacillin treatment and assayed by HPLC-UV. Population pharmacokinetic modelling was conducted using Pmetrics. Empiric dose of 4 g IV 6- and 8-hourly were simulated for 50 and 100% fT > MIC and the probabil-ity of target attainment (PTA) and the fractional target attainment (FTA) determined. Results: A two-compartment model was designed to describe the pharmacokinetics of critically ill Brazillian patients. Clearance and volume of distribution were (mean ± SD) 3.33 ± 1.24 L h−1 and 10.69 ± 4.50 L, respectively. Creatinine clearance was positively correlated with piperacillin clearance and a high creatinine clearance was associated with lower values of PTA and FTA. An external vali-dation was performed using data from two different ethnic ICU populations (n = 30), resulting in acceptable bias and precision. Conclusion: The primary pharmacokinetic parameters obtained from critically ill Brazilian patients were similar to those observed in studies performed in critically ill patients of other ethnicities. Based on our results, the use of dose adjustment based on creati-nine clearance is required in Brazilian patients.
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Stewart AGA, Zimmerman PA, McCarthy JS. Genetic Variation of G6PD and CYP2D6: Clinical Implications on the Use of Primaquine for Elimination of Plasmodium vivax. Front Pharmacol 2021; 12:784909. [PMID: 34899347 PMCID: PMC8661410 DOI: 10.3389/fphar.2021.784909] [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: 09/28/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
Primaquine, an 8-aminoquinoline, is the only medication approved by the World Health Organization to treat the hypnozoite stage of Plasmodium vivax and P. ovale malaria. Relapse, triggered by activation of dormant hypnozoites in the liver, can occur weeks to years after primary infection, and provides the predominant source of transmission in endemic settings. Hence, primaquine is essential for individual treatment and P. vivax elimination efforts. However, primaquine use is limited by the risk of life-threatening acute hemolytic anemia in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. More recently, studies have demonstrated decreased efficacy of primaquine due to cytochrome P450 2D6 (CYP2D6) polymorphisms conferring an impaired metabolizer phenotype. Failure of standard primaquine therapy has occurred in individuals with decreased or absent CYP2D6 activity. Both G6PD and CYP2D6 are highly polymorphic genes, with considerable geographic and interethnic variability, adding complexity to primaquine use. Innovative strategies are required to overcome the dual challenge of G6PD deficiency and impaired primaquine metabolism. Further understanding of the pharmacogenetics of primaquine is key to utilizing its full potential. Accurate CYP2D6 genotype-phenotype translation may optimize primaquine dosing strategies for impaired metabolizers and expand its use in a safe, efficacious manner. At an individual level the current challenges with G6PD diagnostics and CYP2D6 testing limit clinical implementation of pharmacogenetics. However, further characterisation of the overlap and spectrum of G6PD and CYP2D6 activity may optimize primaquine use at a population level and facilitate region-specific dosing strategies for mass drug administration. This precision public health approach merits further investigation for P. vivax elimination.
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Affiliation(s)
| | - Peter A Zimmerman
- The Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, United States
| | - James S McCarthy
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Peter Doherty Institute of Infection and Immunity, Melbourne, VIC, Australia
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Kulmann-Leal B, Ellwanger JH, Chies JAB. CCR5Δ32 in Brazil: Impacts of a European Genetic Variant on a Highly Admixed Population. Front Immunol 2021; 12:758358. [PMID: 34956188 PMCID: PMC8703165 DOI: 10.3389/fimmu.2021.758358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/23/2021] [Indexed: 01/10/2023] Open
Abstract
The genetic background of Brazilians encompasses Amerindian, African, and European components as a result of the colonization of an already Amerindian inhabited region by Europeans, associated to a massive influx of Africans. Other migratory flows introduced into the Brazilian population genetic components from Asia and the Middle East. Currently, Brazil has a highly admixed population and, therefore, the study of genetic factors in the context of health or disease in Brazil is a challenging and remarkably interesting subject. This phenomenon is exemplified by the genetic variant CCR5Δ32, a 32 base-pair deletion in the CCR5 gene. CCR5Δ32 originated in Europe, but the time of origin as well as the selective pressures that allowed the maintenance of this variant and the establishment of its current frequencies in the different human populations is still a field of debates. Due to its origin, the CCR5Δ32 allele frequency is high in European-derived populations (~10%) and low in Asian and African native human populations. In Brazil, the CCR5Δ32 allele frequency is intermediate (4-6%) and varies on the Brazilian States, depending on the migratory history of each region. CCR5 is a protein that regulates the activity of several immune cells, also acting as the main HIV-1 co-receptor. The CCR5 expression is influenced by CCR5Δ32 genotypes. No CCR5 expression is observed in CCR5Δ32 homozygous individuals. Thus, the CCR5Δ32 has particular effects on different diseases. At the population level, the effect that CCR5Δ32 has on European populations may be different than that observed in highly admixed populations. Besides less evident due to its low frequency in admixed groups, the effect of the CCR5Δ32 variant may be affected by other genetic traits. Understanding the effects of CCR5Δ32 on Brazilians is essential to predict the potential use of pharmacological CCR5 modulators in Brazil. Therefore, this study reviews the impacts of the CCR5Δ32 on the Brazilian population, considering infectious diseases, inflammatory conditions, and cancer. Finally, this article provides a general discussion concerning the impacts of a European-derived variant, the CCR5Δ32, on a highly admixed population.
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Affiliation(s)
| | | | - José Artur Bogo Chies
- Laboratório de Imunobiologia e Imunogenética, Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Sridharan K, Al Jufairi M, Al Ansari E, Jasim A, Eltayeb Diab D, Al Marzooq R, Al Madhoob A. Evaluation of urinary acetaminophen metabolites and its association with the genetic polymorphisms of the metabolising enzymes, and serum acetaminophen concentrations in preterm neonates with patent ductus arteriosus. Xenobiotica 2021; 51:1335-1342. [PMID: 34529545 DOI: 10.1080/00498254.2021.1982070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acetaminophen is gaining importance as a first-line drug for treating patent ductus arteriosus (PDA) in neonates. Predominant metabolites of acetaminophen in preterm neonates vary from that of adults; and the drug is predominantly metabolised by conjugation and partly by Cytochrome P450 (CYP) enzymes.We carried out the present study to identify the principal urine metabolites of acetaminophen (glucuronide/sulphate) in preterm neonates with hemodynamically significant PDA receiving intravenous acetaminophen, and to evaluate the prevalence of single nucleotide polymorphisms (SNPs) in the key CYP enzymes (CYP1A2*3, CYP1A2*4, CYP1A2*1C, CYP1A2*1K, CYP1A2*6, CYP2D6*10, CYP2E1*2, CYP2E1*5B, CYP3A4*1B, CYP3A4*2, CYP3A4*3, CYP3A5*3, CYP3A5*7, and CYP3A5*11) and their effect on urinary metabolites and serum acetaminophen concentrations.Nineteen (32.8%) neonates had heterozygous CYP1A2*1C, two (3.3%) with heterozygous CYP1A2*1K, 15 (27.8%) and two (3.7%) had heterozygous and homozygous CYP2D6*10, two (3.7%) had heterozygous CYP2E1*5B, seven (12.3%) and three (5.3%) had heterozygous and homozygous CYP3A4*1B, and three (5.5%) had CYP3A5*7 amongst the study population. Acetaminophen sulphate predominated over glucuronide metabolite at all time points. Postnatal days of life was significantly associated with an increase in the urine acetaminophen metabolites with decreased serum acetaminophen concentrations.A significant prevalence of SNPs in the key CYP enzymes related to acetaminophen metabolism was observed in our neonatal population. Population pharmacokinetic-pharmacodynamic modelling incorporating genetic and metabolite data is urgently needed for implementation of precision medicine in this vulnerable population.
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Affiliation(s)
| | | | | | - Anfal Jasim
- Arabian Gulf University, Manama, Kingdom of Bahrain
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Fernandes MR, Rodrigues JCG, Maroñas O, Latorre-Pellicer A, Cruz R, Guerreiro JF, Burbano RMR, de Assumpção PP, Ribeiro-Dos-Santos A, Dos Santos SEB, Carracedo A, Dos Santos NPC. Genetic Diversity of Drug-Related Genes in Native Americans of the Brazilian Amazon. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:117-133. [PMID: 33519226 PMCID: PMC7837547 DOI: 10.2147/pgpm.s274741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022]
Abstract
Introduction The genetic admixture of the Brazilian population has considerable relevance to the implementation of the principles of pharmacogenomics (PGx), as it may compromise the extrapolation of data obtained in more homogeneous world populations. Purpose This study aims to investigate a panel of 117 polymorphisms in 35 pharmacogenes, which contains label recommendations or clinical evidence by international drug regulatory agencies, in Amazonian Native American populations, and compare the results obtained with continental population data from the 1000 Genomes Project Consortium. Patients and Methods The study population is composed of 109 Native American individuals from three Brazilian Amazon groups. The genotyping of the PGx polymorphisms was performed by allelic discrimination using TaqMan® OpenArray Genotyping with a panel of 120 customized assays on the QuantStudio™ 12K Flex Real-Time PCR System. Results Statistical differences within the Native American populations were observed regarding both genotypes and phenotypes of some genes of the CYP family. The discriminant analysis of principal components (DAPCs) between the NAM group and the continental populations of the 1000 Genomes Project resulted in the clustering of the three Native American populations. Additionally, in general, the NAM group was determined to be closely situated between East Asia, America, and South Asia groups, which enabled us to infer a genetic similarity between these populations. The DAPC analysis further demonstrated that eight polymorphisms and six polymorphisms were more relevant in differentiating the NAM from the continental populations and the NAM populations among themselves, respectively. Conclusion Some investigated polymorphisms show differences among world populations, particularly with populations of European origin, for whom precision medicine protocols are primarily designed. The accumulated knowledge regarding these variations may assist in the design of specific protocols for Native American populations and populations admixed with them.
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Affiliation(s)
- Marianne Rodrigues Fernandes
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil.,Departamento de ensino e pesquisa, Hospital Ophir Loyola, Belém, Pará, Brazil
| | | | - Olalla Maroñas
- Grupo de Medicina Xenómica, Centro Nacional de Genotipado (CEGEN-PRB3), Universidade de Santiago de Compostela, Santiago de Compostela, España
| | - Ana Latorre-Pellicer
- Grupo de Medicina Xenómica, Centro Nacional de Genotipado (CEGEN-PRB3), Universidade de Santiago de Compostela, Santiago de Compostela, España.,Unidad de Genética Clínica y Genómica Funcional, Departamento de Farmacología-Fisiología, Escuela de Medicina, Universidad de Zaragoza, IIS-Aragón, E-50009 Zaragoza, España
| | - Raquel Cruz
- Centro de Investigación Biomédica en Enfermedades Raras (CIBERER), Grupo de Medicina Genómica, CIMUS, Universidad de Santiago de Compostela, Santiago de Compostela, España
| | - João Farias Guerreiro
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Rommel Mario Rodriguez Burbano
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil.,Departamento de ensino e pesquisa, Hospital Ophir Loyola, Belém, Pará, Brazil
| | | | - Andrea Ribeiro-Dos-Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil.,Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Sidney Emanuel Batista Dos Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil.,Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Angel Carracedo
- Grupo de Medicina Xenómica, Centro Nacional de Genotipado (CEGEN-PRB3), Universidade de Santiago de Compostela, Santiago de Compostela, España.,Centro de Investigación Biomédica en Enfermedades Raras (CIBERER), Grupo de Medicina Genómica, CIMUS, Universidad de Santiago de Compostela, Santiago de Compostela, España.,Fundación Pública de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Universidade de Santiago de Compostela, Santiago de Compostela, España
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10
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El Rouby N, Rodrigues Marcatto L, Claudio K, Camargo Tavares L, Steiner H, Botton MR, Lubitz SA, Fallon EN, Yee K, Kaye J, Scott SA, Karnes J, Caleb Junior de Lima Santos P, Duconge J, Cavallari LH. Multi-site Investigation of Genetic Determinants of Warfarin Dose Variability in Latinos. Clin Transl Sci 2020; 14:268-276. [PMID: 32860733 PMCID: PMC7877858 DOI: 10.1111/cts.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022] Open
Abstract
We conducted a multi‐site investigation of genetic determinants of warfarin dose variability in Latinos from the U.S. and Brazil. Patients from four institutions in the United States (n = 411) and Brazil (n = 663) were genotyped for VKORC1 c.‐1639G> A, common CYP2C9 variants, CYP4F2*3, and NQO1*2. Multiple regression analysis was used in the U.S. cohort to test the association between warfarin dose and genotype, adjusting for clinical factors, with further testing in an independent cohort of Brazilians. In the U.S. cohort, VKORC1 and CYP2C9 variants were associated with lower warfarin dose (β = −0.29, P < 2.0 × 10−16; β = −0.21, P = 4.7 × 10−7, respectively) whereas CYP4F2 and NQO1 variants were associated with higher dose (β = 0.10, P = 2 × 10−4; β = 0.10, P = 0.01, respectively). Associations with VKORC1 (β = −0.14, P = 2.0 × 10−16), CYP2C9 (β = −0.07, P = 5.6 × 10−10), and CYP4F2 (β = 0.03, P = 3 × 10−3), but not NQO1*2 (β = 0.01, P = 0.30), were replicated in the Brazilians, explaining 43–46% of warfarin dose variability among the cohorts from the U.S. and Brazil, respectively. We identified genetic associations with warfarin dose requirements in the largest cohort of ancestrally diverse, warfarin‐treated Latinos from the United States and Brazil to date. We confirmed the association of variants in VKORC1, CYP2C9, and CYP4F2 with warfarin dose in Latinos from the United States and Brazil.
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Affiliation(s)
- Nihal El Rouby
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA.,Department of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio, USA
| | - Leiliane Rodrigues Marcatto
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Karla Claudio
- University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Letícia Camargo Tavares
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Heidi Steiner
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | | | - Steve A Lubitz
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Echo N Fallon
- Banner University Medical Center-Tucson, Tucson, Arizona, USA
| | - Kevin Yee
- Banner University Medical Center-Tucson, Tucson, Arizona, USA
| | - Justin Kaye
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Stuart A Scott
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason Karnes
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | | | - Jorge Duconge
- University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
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11
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Suarez-Kurtz G, Kovaleski G, Elias ABR, Motta VLA, Wolch K, Emerenciano M, Mansur MB, Palladino AM, Accioly MT, Ferreira M, Gonçalves AA, de Melo AC. Implementation of a pharmacogenomic program in a Brazilian public institution. Pharmacogenomics 2020; 21:549-557. [DOI: 10.2217/pgs-2020-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This narrative review describes implementation, current status and perspectives of a pharmacogenomic (PGx) program at the Brazilian National Cancer Institute (INCA), targeting the cancer chemotherapeutic drugs – fluoropyrimidines, irinotecan and thiopurines. This initiative, designed as a research project, was supported by a grant from the Brazilian Ministry of Health. A dedicated task force developed standard operational procedures from recruitment of patients to creating PGx reports with dosing recommendations, which were successfully applied to test 100 gastrointestinal cancer INCA outpatients and 162 acute lymphoblastic leukemia pediatric patients from INCA and seven other hospitals. The program has been subsequently expanded to include gastrointestinal cancer patients from three additional cancer treatment centers. We anticipate implementation of routine pre-emptive PGx testing at INCA but acknowledge challenges associated with this transition, such as continuous financing support, availability of trained personnel, adoption of the PGx-informed prescription by the clinical staff and, ultimately, evidence of cost–effectiveness.
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Affiliation(s)
- Guilherme Suarez-Kurtz
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Giovana Kovaleski
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Anna BR Elias
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Vera LA Motta
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Karolyne Wolch
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Mariana Emerenciano
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Marcela B Mansur
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Alexandre M Palladino
- Serviço de Oncologia, Hospital do Câncer I, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Maria T Accioly
- Banco Nacional de Tumores, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Marcos Ferreira
- Serviço de Tecnológica da Informação, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Antonio A Gonçalves
- Serviço de Tecnológica da Informação, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
| | - Andréia C de Melo
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer, Rio de Janeiro, 20231-050, Brazil
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12
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Polymorphisms of ADME-related genes and their implications for drug safety and efficacy in Amazonian Amerindians. Sci Rep 2019; 9:7201. [PMID: 31076604 PMCID: PMC6510895 DOI: 10.1038/s41598-019-43610-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/23/2019] [Indexed: 12/22/2022] Open
Abstract
The variation in the allelic frequencies of polymorphic pharmacogenes among different ethnic groups may be responsible for severe adverse reactions to or altered efficacy of a wide variety of drugs. Amazonian Amerindian populations have a unique genetic profile that may have a fundamental on the efficacy and safety of certain drugs. The genetic characteristics of these populations are poorly known, which can negatively impact the systematic application of treatments guided by pharmacogenomic guidelines. We investigated the diversity of 32 polymorphisms in genes responsible for drug Absorption, Distribution, Metabolism and Excretion (ADME) in Amazonian Amerindians, and compared the findings with populations from other continents available in the 1000 Genomes database. We found significantly different (P ≤ 1.56E-03) allelic frequencies and genotype distributions in many study markers in comparison with African, European, American and Asian populations. Based on FST values, the Amerindian population was also the most distinct (mean FST = 0.09917). These data highlight the unique genetic profile of the indigenous population from the Brazilian Amazon region, which is potentially important from a pharmacogenetic viewpoint. Understanding the diversity of ADME- related genetic markers is crucial to the implementation of individualized pharmacogenomic treatment protocols in Amerindian populations, as well as populations with a high degree of admixture with this ethnic group, such as the general Brazilian population.
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13
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Rodrigues-Soares F, Suarez-Kurtz G. Pharmacogenomics research and clinical implementation in Brazil. Basic Clin Pharmacol Toxicol 2019; 124:538-549. [PMID: 30589990 DOI: 10.1111/bcpt.13196] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/17/2018] [Indexed: 12/23/2022]
Abstract
We searched PubMed entries and the Lattes database of Brazilian Pharmacogenetics Network investigators, for pharmacogenetic/genomic (PGx) studies in the Brazilian population, focusing on the drugs and genes included in the Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. Warfarin was the most extensively studied drug in a PGx context: a genomewide association study targeting warfarin stable dose identified significant signals in VKORC1 and CYP2C9, several PGx dosing algorithms were developed based on these and other genes, and the implications of population admixture on extrapolation of dosing recommendations in the CPIC guidelines were examined. A study in renal transplanted patients disclosed association of CYP3A5*6 and CYP3A5*7 with tacrolimus dosing, which led to addition of these variants to CYP3A5*3 in the CPIC tacrolimus guideline. Studies verified predisposition of HIV-positive carriers of UGT1A1*28 to severe atazanavir-induced hyperbilirubinaemia, intolerance to 5-fluorouracyl in gastrointestinal cancer patients with deleterious DPYD variants, failure of HCV-infected carriers of IFNL3 rs12979860 to obtain a sustained viral response to PEG-IFN-α, and hypersensitivity reactions to abacavir in HIV-positive carriers of HLA-B*57:01. No prospective analyses of drug therapy outcomes or cost-effectiveness assessments of PGx-guided therapy were found. In conclusion, the limited adoption of PGx-informed drug prescription in Brazil reflects combination of recognized barriers to PGx implementation worldwide plus factors specific to the Brazilian population. The latter include rarity/absence of genetic variants on which international PGx guidelines are based (eg HLA-B*15.02 for phenytoin and carbamazepine) and the caveat of extrapolating to the admixed Brazilian population, guidelines based on categorical variables, such as continental ancestry (eg warfarin guidelines), "race" or ethnicity.
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14
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Suarez-Kurtz G, Aklillu E, Saito Y, Somogyi AA. Conference report: pharmacogenomics in special populations at WCP2018. Br J Clin Pharmacol 2019; 85:467-475. [PMID: 30537134 DOI: 10.1111/bcp.13828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022] Open
Abstract
The 18th World Congress of Basic and Clinical Pharmacology (WCP2018), coordinated by IUPHAR and hosted by the Japanese Pharmacological Society and the Japanese Society of Clinical Pharmacology and Therapeutics, was held in July 2018 at the Kyoto International Conference Center, in Kyoto, Japan. Having as its main theme 'Pharmacology for the Future: Science, Drug Development and Therapeutics', WCP2018 was attended by over 4500 delegates, representing 78 countries. The present report is an overview of a symposium at WCP2018, entitled Pharmacogenomics in Special Populations, organized by IUPHAR´s Pharmacogenetics/Genomics (PGx) section. The PGx section congregates distinguished scientists from different continents, covering expertise from basic research, to clinical implementation and ethical aspects of PGx, and one of its major activities is the coordination of symposia and workshops to foster exchange of PGx knowledge (https://iuphar.org/sections-subcoms/pharmacogenetics-genomics/). The symposium attracted a large audience to listen to presentations covering various areas of research and clinical adoption of PGx in Oceania, Africa, Latin America and Asia.
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Affiliation(s)
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yoshiro Saito
- Division of Medical Safety Science, National Institute of Health Sciences, Kawasaki, Japan
| | - Andrew A Somogyi
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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15
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Sivadas A, Scaria V. Population-scale genomics-Enabling precision public health. ADVANCES IN GENETICS 2018; 103:119-161. [PMID: 30904093 DOI: 10.1016/bs.adgen.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The current excitement for affordable genomics technologies and national precision medicine initiatives marks a turning point in worldwide healthcare practices. The last decade of global population sequencing efforts has defined the enormous extent of genetic variation in the human population resulting in insights into differential disease burden and response to therapy within and between populations. Population-scale pharmacogenomics helps to provide insights into the choice of optimal therapies and an opportunity to estimate, predict and minimize adverse events. Such an approach can potentially empower countries to formulate national selection and dosing policies for therapeutic agents thereby promoting public health with precision. We review the breadth and depth of worldwide population-scale sequencing efforts and its implications for the implementation of clinical pharmacogenetics toward making precision medicine a reality.
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Affiliation(s)
- Ambily Sivadas
- GN Ramachandran Knowledge Center for Genome Informatics, CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), New Delhi, India
| | - Vinod Scaria
- GN Ramachandran Knowledge Center for Genome Informatics, CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), New Delhi, India.
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16
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Extended HLA-G genetic diversity and ancestry composition in a Brazilian admixed population sample: Implications for HLA-G transcriptional control and for case-control association studies. Hum Immunol 2018; 79:790-799. [DOI: 10.1016/j.humimm.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/04/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022]
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17
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Abstract
Pharmacogenetics, a major component of individualized or precision medicine, relies on human genetic diversity. The remarkable developments in sequencing technologies have revealed that the number of genetic variants modulating drug action is much higher than previously thought and that a true personalized prediction of drug response requires attention to rare mutations (minor allele frequency, MAF<1%) in addition to polymorphisms (MAF>1%) in pharmacogenes. This has major implications for the conceptual development and clinical implementation of pharmacogenetics. Drugs used in cancer treatment have been major targets of pharmacogenetics studies, encompassing both germline polymorphisms and somatic variants in the tumor genome. The present overview, however, has a narrower scope and is focused on germline cancer pharmacogenetics, more specifically, on drug/gene pairs for which pharmacogenetics-informed prescription guidelines have been published by the Clinical Pharmacogenetics Implementation Consortium and/or the Dutch Pharmacogenetic Working Group, namely, thiopurines/TPMT, fluoropyrimidines/UGT1A1, irinotecan/UGT1A1 and tamoxifen/CYP2D6. I begin by reviewing the general principles of pharmacogenetics-informed prescription, pharmacogenetics testing and the perceived barriers to the adoption of routine pharmacogenetics testing in clinical practice. Then, I highlight aspects of the pharmacogenetics testing of the selected drug-gene pairs and finally present pharmacogenetics data from Brazilian studies pertinent to these drug-gene pairs. I conclude with the notion that pharmacogenetics testing has the potential to greatly benefit patients by enabling precision medicine applied to drug therapy, ensuring better efficacy and reducing the risk of adverse effects.
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Affiliation(s)
- Guilherme Suarez-Kurtz
- Instituto Nacional de Cancer, Rio de Janeiro, RJ, BR
- Rede Nacional de Farmacogenetica, Rio de Janeiro, RJ, BR
- *Corresponding author. E-mail:
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18
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de Carvalho DC, Wanderley AV, Dos Santos AMR, Fernandes MR, Cohen Lima de Castro ADN, Leitão LPC, de Carvalho JAN, de Souza TP, Khayat AS, Dos Santos SEB, de Assumpção PP, Dos Santos NPC. Pharmacogenomics and variations in the risk of toxicity during the consolidation/maintenance phases of the treatment of pediatric B-cell leukemia patients from an admixed population in the Brazilian Amazon. Leuk Res 2018; 74:10-13. [PMID: 30269037 DOI: 10.1016/j.leukres.2018.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
The treatment of Acute Lymphoblastic Leukemia (ALL) in children has a high clinical success rate, although toxicological complications are frequent, and often result in the interruption of the treatment. Various studies have shown that toxicities resulting from the treatment are influenced by pharmacogenetic variants. Most of this research has focused on relatively homogeneous populations, and the influence of these variants in highly admixed populations, such as that of Brazil, is still poorly understood. The present study investigated the association between pharmacogenetic variants and severe toxicities in pediatric B-cell ALL patients from an admixed population of the Brazilian Amazon. The rs2306283 (of SLCO1B1) mutant allele increased the risk of neurotoxicity threefold, and the homozygous mutant rs9895420 (of ABCC3) genotype was associated with a fivefold increase in protection against severe gastrointestinal toxicity. This indicates that the rs2306283 and rs9895420 polymorphisms may be relevant to the prediction of severe toxicity in pediatric ALL patients.
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Affiliation(s)
| | - Alayde Vieira Wanderley
- Núcleo de Pesquisas em Oncologia, Rua dos Mundurucus, 4487, CEP 66073-000, Belém, Pará, Brazil; Hospital Ophir Loyola, Departamento de Pediatria, Avenida Governador Magalhães Barata, 992, CEP 66060-281, Belém, Pará, Brazil.
| | - André Mauricio Ribeiro Dos Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Cidade Universitária Prof. José Silveira Netto, 01 - CEP 66075-900, Belém, Pará, Brazil.
| | | | | | | | | | | | - André Salim Khayat
- Núcleo de Pesquisas em Oncologia, Rua dos Mundurucus, 4487, CEP 66073-000, Belém, Pará, Brazil.
| | - Sidney Emanuel Batista Dos Santos
- Núcleo de Pesquisas em Oncologia, Rua dos Mundurucus, 4487, CEP 66073-000, Belém, Pará, Brazil; Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Cidade Universitária Prof. José Silveira Netto, 01 - CEP 66075-900, Belém, Pará, Brazil.
| | - Paulo Pimentel de Assumpção
- Núcleo de Pesquisas em Oncologia, Rua dos Mundurucus, 4487, CEP 66073-000, Belém, Pará, Brazil; Hospital Universitário João de Barros Barreto, Rua dos Mundurucus, 4487, CEP 66073-000, Belém, Pará, Brazil.
| | - Ney Pereira Carneiro Dos Santos
- Núcleo de Pesquisas em Oncologia, Rua dos Mundurucus, 4487, CEP 66073-000, Belém, Pará, Brazil; Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Cidade Universitária Prof. José Silveira Netto, 01 - CEP 66075-900, Belém, Pará, Brazil.
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19
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Kano EK, Borges JB, Scomparini EB, Curi AP, Ribeiro E. Algorithms for monitoring warfarin use: Results from Delphi Method. ACTA ACUST UNITED AC 2018; 63:842-855. [PMID: 29267485 DOI: 10.1590/1806-9282.63.10.842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/26/2017] [Indexed: 02/08/2023]
Abstract
Warfarin stands as the most prescribed oral anticoagulant. New oral anticoagulants have been approved recently; however, their use is limited and the reversibility techniques of the anticoagulation effect are little known. Thus, our study's purpose was to develop algorithms for therapeutic monitoring of patients taking warfarin based on the opinion of physicians who prescribe this medicine in their clinical practice. The development of the algorithm was performed in two stages, namely: (i) literature review and (ii) algorithm evaluation by physicians using a Delphi Method. Based on the articles analyzed, two algorithms were developed: "Recommendations for the use of warfarin in anticoagulation therapy" and "Recommendations for the use of warfarin in anticoagulation therapy: dose adjustment and bleeding control." Later, these algorithms were analyzed by 19 medical doctors that responded to the invitation and agreed to participate in the study. Of these, 16 responded to the first round, 11 to the second and eight to the third round. A 70% consensus or higher was reached for most issues and at least 50% for six questions. We were able to develop algorithms to monitor the use of warfarin by physicians using a Delphi Method. The proposed method is inexpensive and involves the participation of specialists, and it has proved adequate for the intended purpose. Further studies are needed to validate these algorithms, enabling them to be used in clinical practice.
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Affiliation(s)
- Eunice Kazue Kano
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Jessica Bassani Borges
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Erika Burim Scomparini
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana Paula Curi
- School of Arts, Sciences and Humanities, USP, São Paulo, SP, Brazil
| | - Eliane Ribeiro
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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20
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Suarez-Kurtz G, Parra EJ. Population Diversity in Pharmacogenetics: A Latin American Perspective. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2018; 83:133-154. [PMID: 29801573 DOI: 10.1016/bs.apha.2018.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pharmacogenetics/pharmacogenomics (PGx) relies on human genetic diversity. In this review we initially examine the PGx implications of human demographic history and genetic diversity, and highlight results from recent studies on the worldwide distribution of common and rare variants in pharmacogenes. The abundance of rare variants implies that a substantial effort will be required to identify their putative functional effects and to develop reliable algorithms for PGx-guided prescription. Furthermore, variants in all pharmacogenes relevant to a drug treatment must be considered. This implies a shift of the current paradigm of PGx-informed prescription based on genotyping a few common variants in selected genes toward comprehensive sequencing approaches. The following sections deal with the impact of population admixture on PGx diversity focusing on Latin America, where a kaleidoscopic combination of individual proportions of Native American, European, and sub-Saharan African ancestries prevails. We illustrate this diversity by contrasting Brazil and Mexico, the two most populous countries in Latin America, and show that population average admixture proportions are not predictive of the corresponding proportions at the individual level. As a consequence of admixture, the genetic differentiation of common pharmacogenetic variants in Latin Americans is much attenuated in comparison to their most relevant ancestral populations. Finally, we review data for tacrolimus and warfarin to illustrate the opportunities and challenges presented by Latin American populations for PGx studies and clinical implementation.
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Affiliation(s)
- Guilherme Suarez-Kurtz
- Instituto Nacional de Câncer and Rede Nacional de Farmacogenética, Rio de Janeiro, Brazil.
| | - Esteban J Parra
- University of Toronto at Mississauga, Mississauga, ON, Canada
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21
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Fricke-Galindo I, Jung-Cook H, LLerena A, López-López M. Interethnic variability of pharmacogenetic biomarkers in Mexican healthy volunteers: a report from the RIBEF (Ibero-American Network of Pharmacogenetics and Pharmacogenomics). Drug Metab Pers Ther 2017; 31:61-81. [PMID: 26812836 DOI: 10.1515/dmpt-2015-0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/04/2015] [Indexed: 01/01/2023]
Abstract
Mexico presents a complex population diversity integrated by Mexican indigenous (MI) (7% of Mexico's population) and Mexican mestizos (MMs). This composition highlights the importance of pharmacogenetic studies in Mexican populations. The aims of this study were to analyze the reported frequencies of the most relevant pharmacogenetic biomarkers and metabolic phenotypes in healthy volunteers from Mexican populations and to assess its interethnic variability across MI and MM populations. After a literature search in PubMed, and according to previously defined inclusion criteria, 63 pharmacogenetic studies performed in Mexican healthy volunteers up to date were selected. These reports comprised 56,292 healthy volunteers (71.58% MM). Allele frequencies in 31 pharmacogenetic biomarkers, from 121 searched, are described. Nine of these biomarkers presented variation within MM and MI groups. The frequencies of CYP2D6*3, *4, *5, *10, *17, *35 and *41 alleles in the MM group were different from those reported in the MI group. CYP2C9*2 and *3 alleles were more frequent in MM than in MI populations (χ2 test, p<0.05). CYP2C19*3 allele was not found in the MM or MI populations reported. For UGT1A1*28, only one study was found. HLA-A*31:01 and HLA-B*15:02 were present in some MM and MI populations. Poor metabolizers for CYP2D6 and CYP2C9 were more frequent in MM than in MI groups (χ2 test, p<0.05). Only 26% of the relevant pharmacogenetic biomarkers searched have been studied in Mexican healthy volunteers; therefore, further studies are warranted. The frequency variation of biomarkers in MM and MI populations could be important for the clinical implementation of pharmacogenetics in Mexico.
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African Genetic Diversity: Implications for Cytochrome P450-mediated Drug Metabolism and Drug Development. EBioMedicine 2017; 17:67-74. [PMID: 28237373 PMCID: PMC5360579 DOI: 10.1016/j.ebiom.2017.02.017] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 12/17/2022] Open
Abstract
Genetic diversity is greater in Africa than in other continental populations. Genetic variability in genes encoding drug metabolizing enzymes may contribute to the high numbers of adverse drug reactions reported in Africa. We reviewed publications (1995-April 2016) reporting frequencies of known cytochrome P450 (CYP) variants in African populations. Using principal components analysis (PCA) we identified CYP alleles of potential clinical relevance with a marked difference in distribution in Africa, compared with Asian and Caucasian populations. These were CYP2B6*6, CYP2C8*2, CYP2D6*3, CYP2D6*17, CYP2D6*29, CYP3A5*6, and CYP3A5*7. We show clearly that there is greater diversity in CYP distribution in Africa than in other continental populations and identify a need for optimization of drug therapy and drug development there. Further pharmacogenetic studies are required to confirm the CYP distributions we identified using PCA, to discover uniquely African alleles and to identify populations at a potentially increased risk of drug-induced adverse events or drug inefficacy.
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Lima SFD, Tavares MMF, Macedo JLD, Oliveira RSD, Heráclio SDA, Maia MDMD, Souza PRED, Moura R, Crovella S. Influence of IL-6, IL-8, and TGF-β1 gene polymorphisms on the risk of human papillomavirus-infection in women from Pernambuco, Brazil. Mem Inst Oswaldo Cruz 2016; 111:663-669. [PMID: 27783717 PMCID: PMC5125047 DOI: 10.1590/0074-02760160051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/04/2016] [Indexed: 11/22/2022] Open
Abstract
Human papillomavirus (HPV) infections are strongly associated with the development of
cervical intraepithelial neoplasias and invasive cervical cancer. Polymorphisms in
cytokine-encoding genes and behavioural cofactors could play an important role in
protecting an individual against viral infections and cancer. Here, we investigated
whether IL-6 -174 G>C, IL-8 +396 G>T, and
TGF-β1 +869 G>C and +915 G>C polymorphisms were associated
with susceptibility to HPV infection in women from north-east (Pernambuco) Brazil. We
analysed 108 healthy uninfected women (HC) and 108 HPV-positive women with cervical
lesions. Genetic polymorphisms were assessed using Sanger sequencing and polymerase
chain reaction-restriction fragment length polymorphism. Comparison of the
distribution of the genotypic and allelic frequencies of the IL-18 +396 T>G
polymorphism between HPV infected woman an uninfected controls showed that the GG
genotype and G allele were both more frequent in the HC group, and were associated
with protection from HPV infection (p = 0.0015; OR = 0.29 CI95% = 0.13-0.61; p =
0.0005; OR = 0.45 CI95% 0.29-0.7, respectively). Individuals from the control group
could have previously had HPV infection that was spontaneously eliminated; however,
it was undetectable at the time of sample collection. Based on our findings, we
hypothesize that the IL-8 +396 G>T polymorphism could interfere
with susceptibility to HPV infection, by modulating the ability of immune system to
fight the virus.
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Affiliation(s)
- Sérgio Ferreira de Lima
- Universidade Federal de Pernambuco, Pós-Graduação em Biologia Aplicada à Saúde, Laboratório de Genoma, Recife, PE, Brasil
| | | | | | | | | | | | | | - Ronald Moura
- Universidade Federal de Pernambuco, Departamento de Genética, Recife, PE, Brasil
| | - Sergio Crovella
- Universidade Federal de Pernambuco, Pós-Graduação em Biologia Aplicada à Saúde, Laboratório de Genoma, Recife, PE, Brasil.,Universidade Federal de Pernambuco, Departamento de Genética, Recife, PE, Brasil
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Summaries of plenary, symposia, and oral sessions at the XXII World Congress of Psychiatric Genetics, Copenhagen, Denmark, 12-16 October 2014. Psychiatr Genet 2015; 26:1-47. [PMID: 26565519 DOI: 10.1097/ypg.0000000000000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The XXII World Congress of Psychiatric Genetics, sponsored by the International Society of Psychiatric Genetics, took place in Copenhagen, Denmark, on 12-16 October 2014. A total of 883 participants gathered to discuss the latest findings in the field. The following report was written by student and postdoctoral attendees. Each was assigned one or more sessions as a rapporteur. This manuscript represents topics covered in most, but not all of the oral presentations during the conference, and contains some of the major notable new findings reported.
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Santos PCJL, Marcatto LR, Duarte NE, Gadi Soares RA, Cassaro Strunz CM, Scanavacca M, Krieger JE, Pereira AC. Development of a pharmacogenetic-based warfarin dosing algorithm and its performance in Brazilian patients: highlighting the importance of population-specific calibration. Pharmacogenomics 2015; 16:865-76. [PMID: 26050796 DOI: 10.2217/pgs.15.48] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The main aims of the present study were to develop a pharmacogenetic-based warfarin dosing algorithm and to validate it in a highly admixed population. MATERIALS & METHODS We included two patient cohorts treated with warfarin (first cohort, n = 832; and second cohort, n = 133). RESULTS Our algorithm achieved a determination coefficient of 40% including the variables age, gender, weight, height, self-declared race, amiodarone use, enzyme inducers use, VKORC1 genotypes and predicted phenotypes according to CYP2C9 polymorphisms. CONCLUSION Data suggest that our developed algorithm is more accurate than the IWPC algorithm when the application is focused on patients from the Brazilian population. Population-specific derivation and/or calibration of warfarin dosing algorithms may lead to improved performance compared with general use dosing algorithms currently available. Original submitted 26 November 2014; Revision submitted 9 April 2015.
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Affiliation(s)
- Paulo Caleb Junior Lima Santos
- Laboratory of Genetics & Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, CEP 05403-000, Brazil
| | - Leiliane Rodrigues Marcatto
- Laboratory of Genetics & Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, CEP 05403-000, Brazil
| | - Nubia Esteban Duarte
- Laboratory of Genetics & Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, CEP 05403-000, Brazil
| | - Renata Alonso Gadi Soares
- Laboratory of Genetics & Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, CEP 05403-000, Brazil
| | | | - Maurício Scanavacca
- Clinical Cardiology Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose Eduardo Krieger
- Laboratory of Genetics & Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo, CEP 05403-000, Brazil
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Suarez-Kurtz G, Botton MR. Pharmacogenetics of coumarin anticoagulants in Brazilians. Expert Opin Drug Metab Toxicol 2014; 11:67-79. [PMID: 25345887 DOI: 10.1517/17425255.2015.976201] [Citation(s) in RCA: 12] [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 Coumarin vitamin K antagonists are the mainstay of anticoagulant therapy in atrial fibrillation, prosthetic heart valves and thromboembolic conditions. Concerns with these drugs include large inter-individual variability in dose requirements, narrow therapeutic index and need to monitor prothrombin time repeatedly. AREAS COVERED Pharmacogenetic studies and dosing algorithms for warfarin and phenprocoumon. EXPERT OPINION Gene candidate studies in Brazilian patients verified consistently the association of warfarin and pheprocoumon stable dose requirements with CYP2C9 and VKORC1 polymorphisms, and minor or no influence of other pharmacogenes (e.g., CYP4F2 and F7). The predictive power of warfarin and phenprocoumon dosing algorithms developed for Brazilians compares favorably with those reported for other populations. A warfarin dosing algorithm derived for an admixed cohort performed equally well in self-reported White and Black patients, in marked contrast with the considerably poorer performance of other warfarin algorithms in patients of African descent compared to those of European ancestry. This discrepancy is ascribed to the extensive European/African admixture among Brazilians. Prospective studies of clinical utility of coumarin dosing algorithms, in the context of the Brazilian Public Health System, would represent an important counterpart to recently published trials in European and North American cohorts with predominant or exclusive European ancestry.
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Affiliation(s)
- Guilherme Suarez-Kurtz
- Instituto Nacional de Câncer, Pharmacology Division , Rua André Cavalcanti 37, Rio de Janeiro, CEP 20231-050, RJ , Brazil +5521 3207 6502 ;
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Friedrich DC, Genro JP, Sortica VA, Suarez-Kurtz G, de Moraes ME, Pena SDJ, dos Santos ÂKR, Romano-Silva MA, Hutz MH. Distribution of CYP2D6 alleles and phenotypes in the Brazilian population. PLoS One 2014; 9:e110691. [PMID: 25329392 PMCID: PMC4203818 DOI: 10.1371/journal.pone.0110691] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/15/2014] [Indexed: 12/24/2022] Open
Abstract
The CYP2D6 enzyme is one of the most important members of the cytochrome P450 superfamily. This enzyme metabolizes approximately 25% of currently prescribed medications. The CYP2D6 gene presents a high allele heterogeneity that determines great inter-individual variation. The aim of this study was to evaluate the variability of CYP2D6 alleles, genotypes and predicted phenotypes in Brazilians. Eleven single nucleotide polymorphisms and CYP2D6 duplications/multiplications were genotyped by TaqMan assays in 1020 individuals from North, Northeast, South, and Southeast Brazil. Eighteen CYP2D6 alleles were identified in the Brazilian population. The CYP2D6*1 and CYP2D6*2 alleles were the most frequent and widely distributed in different geographical regions of Brazil. The highest number of CYPD6 alleles observed was six and the frequency of individuals with more than two copies ranged from 6.3% (in Southern Brazil) to 10.2% (Northern Brazil). The analysis of molecular variance showed that CYP2D6 is homogeneously distributed across different Brazilian regions and most of the differences can be attributed to inter-individual differences. The most frequent predicted metabolic status was EM (83.5%). Overall 2.5% and 3.7% of Brazilians were PMs and UMs respectively. Genomic ancestry proportions differ only in the prevalence of intermediate metabolizers. The IM predicted phenotype is associated with a higher proportion of African ancestry and a lower proportion of European ancestry in Brazilians. PM and UM classes did not vary among regions and/or ancestry proportions therefore unique CYP2D6 testing guidelines for Brazilians are possible and could potentially avoid ineffective or adverse events outcomes due to drug prescriptions.
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Affiliation(s)
- Deise C. Friedrich
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Júlia P. Genro
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinicius A. Sortica
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Suarez-Kurtz
- Programa de Farmacologia, Instituto Nacional de Cancer, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Sergio D. J. Pena
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Marco A. Romano-Silva
- Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mara H. Hutz
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Krasniak AE, Knipp GT, Svensson CK, Liu W. Pharmacogenomics of acetaminophen in pediatric populations: a moving target. Front Genet 2014; 5:314. [PMID: 25352860 PMCID: PMC4196544 DOI: 10.3389/fgene.2014.00314] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/21/2014] [Indexed: 11/22/2022] Open
Abstract
Acetaminophen (APAP) is widely used as an over-the-counter fever reducer and pain reliever. However, the current therapeutic use of APAP is not optimal. The inter-patient variability in both efficacy and toxicity limits the use of this drug. This is particularly an issue in pediatric populations, where tools for predicting drug efficacy and developmental toxicity are not well established. Variability in toxicity between age groups may be accounted for by differences in metabolism, transport, and the genetics behind those differences. While pharmacogenomics has been revolutionizing the paradigm of pharmacotherapy for many drugs, its application in pediatric populations faces significant challenges given the dynamic ontogenic changes in cellular and systems physiology. In this review we focused on the ontogenesis of the regulatory pathways involved in the disposition of APAP and on the variability between pediatric, adolescent, and adult patients. We also summarize important polymorphisms of the pharmacogenes associated with APAP metabolism. Pharmacogenetic studies in pediatric APAP treatment are also reviewed. We conclude that while a consensus in pharmacogenetic management of APAP in pediatric populations has not been achieved, a systems biology based strategy for comprehensively understanding the ontogenic regulatory pathway as well as the interaction between age and genetic variations are particularly necessary in order to address this question.
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Affiliation(s)
- Anne E. Krasniak
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, Purdue UniversityWest Lafayette, IN, USA
| | - Gregory T. Knipp
- Industrial and Physical Pharmacy, College of Pharmacy, Purdue UniversityWest Lafayette, IN, USA
| | - Craig K. Svensson
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, Purdue UniversityWest Lafayette, IN, USA
| | - Wanqing Liu
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, Purdue UniversityWest Lafayette, IN, USA
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Li J, Lou H, Yang X, Lu D, Li S, Jin L, Pan X, Yang W, Song M, Mamatyusupu D, Xu S. Genetic architectures of ADME genes in five Eurasian admixed populations and implications for drug safety and efficacy. J Med Genet 2014; 51:614-22. [PMID: 25074363 DOI: 10.1136/jmedgenet-2014-102530] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Drug absorption, distribution, metabolism and excretion (ADME) contribute to the high heterogeneity of drug responses in humans. However, the same standard for drug dosage has been applied to all populations in China although genetic differences in ADME genes are expected to exist in different ethnic groups. In particular, the ethnic minorities in northwestern China with substantial ancestry contribution from Western Eurasian people might violate such a single unified standard. METHODS In this study, we used Affymetrix SNP Array 6.0 to investigate the genetic diversity of 282 ADME genes in five northwestern Chinese minority populations, namely, Tajik, Uyghur, Kazakh, Kirgiz and Hui, and attempted to identify the highly differential SNPs and haplotypes and further explore their clinical implications. RESULTS We found that genetic diversity of many ADME genes in the five minority groups was substantially different from those in the Han Chinese population. For instance, we identified 10 functional SNPs with substantial allele frequency differences, 14 functional SNPs with highly different heterozygous states and eight genes with significant haplotype differences between these admixed minority populations and the Han Chinese population. We further confirmed that these differences mainly resulted from the European gene flow, that is, this gene flow increased the genetic diversity in the admixed populations. CONCLUSIONS These results suggest that the ADME genes vary substantially among different Chinese ethnic groups. We suggest it could cause potential clinical risk if the same dosage of substances (eg, antitumour drugs) is used without considering population stratification.
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Affiliation(s)
- Jing Li
- Max Planck Independent Research Group on Population Genomics, Chinese Academy of Sciences and Max Planck Society (CAS-MPG) Partner Institute for Computational Biology (PICB), Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Haiyi Lou
- Max Planck Independent Research Group on Population Genomics, Chinese Academy of Sciences and Max Planck Society (CAS-MPG) Partner Institute for Computational Biology (PICB), Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Xiong Yang
- Max Planck Independent Research Group on Population Genomics, Chinese Academy of Sciences and Max Planck Society (CAS-MPG) Partner Institute for Computational Biology (PICB), Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Dongsheng Lu
- Max Planck Independent Research Group on Population Genomics, Chinese Academy of Sciences and Max Planck Society (CAS-MPG) Partner Institute for Computational Biology (PICB), Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Shilin Li
- State Key Laboratory of Genetic Engineering and Ministry of Education (MOE) Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering and Ministry of Education (MOE) Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Xinwei Pan
- State Key Laboratory of Genetic Engineering and Ministry of Education (MOE) Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Wenjun Yang
- Key Laboratory of Reproduction and Heredity of Ningxia Region, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Manshu Song
- School of Public Health, Capital Medical University and Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Dolikun Mamatyusupu
- College of the Life Sciences and Technology, Xinjiang University, Urumqi, China
| | - Shuhua Xu
- Max Planck Independent Research Group on Population Genomics, Chinese Academy of Sciences and Max Planck Society (CAS-MPG) Partner Institute for Computational Biology (PICB), Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
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Passos-Bueno MR, Bertola D, Horovitz DDG, de Faria Ferraz VE, Brito LA. Genetics and genomics in Brazil: a promising future. Mol Genet Genomic Med 2014; 2:280-91. [PMID: 25077170 PMCID: PMC4113268 DOI: 10.1002/mgg3.95] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Maria Rita Passos-Bueno
- Centro de Pesquisa sobre o Genoma Humano, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências Universidade de São Paulo São Paulo, Brazil
| | - Debora Bertola
- Centro de Pesquisa sobre o Genoma Humano, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências Universidade de São Paulo São Paulo, Brazil ; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo São Paulo, Brazil
| | - Dafne Dain Gandelman Horovitz
- Centro de Genética Médica, Instituto Nacional de Saúde da Mulher, daCriança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz Rio de Janeiro, Brazil
| | | | - Luciano Abreu Brito
- Centro de Pesquisa sobre o Genoma Humano, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências Universidade de São Paulo São Paulo, Brazil
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Angiotensinogen Variants among Resistant Hypertensive Patients. Int J Hypertens 2014; 2014:424793. [PMID: 24790758 PMCID: PMC3982406 DOI: 10.1155/2014/424793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022] Open
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Clinically actionable genotypes among Brazilians. Clin Pharmacol Ther 2014; 96:25-6. [PMID: 24598719 DOI: 10.1038/clpt.2014.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/25/2014] [Indexed: 01/25/2023]
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Parra EJ, Suarez-Kurtz G. Demographic history and human genetic diversity: pharmacogenomic implications. Pharmacogenomics 2014; 15:253-6. [DOI: 10.2217/pgs.14.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Esteban J Parra
- Department of Anthropology, University of Toronto at Mississauga, Mississauga, Canada
| | - Guilherme Suarez-Kurtz
- Divisao de Farmacologia, Coordenacao de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ 20231-050, Brazil
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