1
|
Kim JS, Lee S, Yee J, Park K, Jang EJ, Chang BC, Gwak HS. Novel Gene Polymorphisms for Stable Warfarin Dose in a Korean Population: Genome-Wide Association Study. Biomedicines 2023; 11:2308. [PMID: 37626805 PMCID: PMC10452379 DOI: 10.3390/biomedicines11082308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Warfarin has a narrow therapeutic window and high intra- and inter-individual variability. Considering that many published papers on genotype-guided dosing are derived from European populations, the aim of this study was to investigate novel genetic variants associated with the variability of stable warfarin dose in the Korean population with cardiac valve replacement, using the GWAS approach. This retrospective cohort study was performed from January 1982 to December 2020 at the Severance Cardiovascular Hospital of Yonsei University College of Medicine. GWAS was performed to identify associations between genotypes and the warfarin maintenance dose, by comparing the allele frequency of genetic variants between individuals. Then, the extent of genetic and non-genetic factors on the dose variability was determined by multivariable regression analysis. The study enrolled 214 participants, and the most robust signal cluster was detected on chromosome 16 around VKORC1. Followed by VKORC1, three novel variants (NKX2-6 rs310279, FRAS1 rs4386623, and FAM201A rs1890109) showed an association with stable warfarin dose requirement in univariate analysis. The algorithm was constructed by using multivariable analysis that includes genetic and non-genetic factors, and it could explain 58.5% of the variations in stable warfarin doses. In this variability, VKORC1 rs9934438 and FRAS1 rs4386623 accounted for 33.0% and 9.9%, respectively. This GWAS analysis identified the fact that three novel variants (NKX2-6 rs310279, FRAS1 rs4386623, and FAM201A rs1890109) were associated with stable warfarin doses. Additional research is necessary to validate the results and establish personalized treatment strategies for the Korean population.
Collapse
Affiliation(s)
- Jung Sun Kim
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea; (J.S.K.); (J.Y.); (E.J.J.)
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Jeong Yee
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea; (J.S.K.); (J.Y.); (E.J.J.)
| | - Kyemyung Park
- Department of Biomedical Engineering, College of Information and Biotechnology, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea;
| | - Eun Jeong Jang
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea; (J.S.K.); (J.Y.); (E.J.J.)
| | - Byung Chul Chang
- Department of Thoracic and Cardiovascular Surgery, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Thoracic and Cardiovascular Surgery, Bundang CHA Medical Center, CHA University, Seongnam 13496, Republic of Korea
| | - Hye Sun Gwak
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea; (J.S.K.); (J.Y.); (E.J.J.)
| |
Collapse
|
5
|
Mizzi C, Dalabira E, Kumuthini J, Dzimiri N, Balogh I, Başak N, Böhm R, Borg J, Borgiani P, Bozina N, Bruckmueller H, Burzynska B, Carracedo A, Cascorbi I, Deltas C, Dolzan V, Fenech A, Grech G, Kasiulevicius V, Kádaši Ľ, Kučinskas V, Khusnutdinova E, Loukas YL, Macek M, Makukh H, Mathijssen R, Mitropoulos K, Mitropoulou C, Novelli G, Papantoni I, Pavlovic S, Saglio G, Setric J, Stojiljkovic M, Stubbs AP, Squassina A, Torres M, Turnovec M, van Schaik RH, Voskarides K, Wakil SM, Werk A, del Zompo M, Zukic B, Katsila T, Lee MTM, Motsinger-Rief A, Mc Leod HL, van der Spek PJ, Patrinos GP. A European Spectrum of Pharmacogenomic Biomarkers: Implications for Clinical Pharmacogenomics. PLoS One 2016; 11:e0162866. [PMID: 27636550 PMCID: PMC5026342 DOI: 10.1371/journal.pone.0162866] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/30/2016] [Indexed: 12/26/2022] Open
Abstract
Pharmacogenomics aims to correlate inter-individual differences of drug efficacy and/or toxicity with the underlying genetic composition, particularly in genes encoding for protein factors and enzymes involved in drug metabolism and transport. In several European populations, particularly in countries with lower income, information related to the prevalence of pharmacogenomic biomarkers is incomplete or lacking. Here, we have implemented the microattribution approach to assess the pharmacogenomic biomarkers allelic spectrum in 18 European populations, mostly from developing European countries, by analyzing 1,931 pharmacogenomics biomarkers in 231 genes. Our data show significant inter-population pharmacogenomic biomarker allele frequency differences, particularly in 7 clinically actionable pharmacogenomic biomarkers in 7 European populations, affecting drug efficacy and/or toxicity of 51 medication treatment modalities. These data also reflect on the differences observed in the prevalence of high-risk genotypes in these populations, as far as common markers in the CYP2C9, CYP2C19, CYP3A5, VKORC1, SLCO1B1 and TPMT pharmacogenes are concerned. Also, our data demonstrate notable differences in predicted genotype-based warfarin dosing among these populations. Our findings can be exploited not only to develop guidelines for medical prioritization, but most importantly to facilitate integration of pharmacogenomics and to support pre-emptive pharmacogenomic testing. This may subsequently contribute towards significant cost-savings in the overall healthcare expenditure in the participating countries, where pharmacogenomics implementation proves to be cost-effective.
Collapse
Affiliation(s)
- Clint Mizzi
- Erasmus University Medical Center, Faculty of Medicine, Department of Bioinformatics, Rotterdam, the Netherlands
- University of Malta, Faculty of Medicine and Surgery, Department of Physiology and Biochemistry, Msida, Malta
| | - Eleni Dalabira
- University of Patras School of Health Sciences, Department of Pharmacy, Patras, Greece
| | - Judit Kumuthini
- Center for Proteomic and Genomic Research, Observatory, Cape Town, South Africa
| | - Nduna Dzimiri
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | | - Ruwen Böhm
- University of Kiel, Institute for Experimental and Clinical Pharmacology, Kiel, Germany
| | - Joseph Borg
- University of Malta, Department of Applied Biomedical Science, Faculty of Health Sciences, Msida, Malta
| | - Paola Borgiani
- University of Rome “Tor Vergata”, Department of Biomedicine and Prevention, Rome, Italy
| | | | - Henrike Bruckmueller
- University of Kiel, Institute for Experimental and Clinical Pharmacology, Kiel, Germany
| | - Beata Burzynska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | | | - Ingolf Cascorbi
- University of Kiel, Institute for Experimental and Clinical Pharmacology, Kiel, Germany
| | - Constantinos Deltas
- University of Cyprus, Molecular Medicine Research Center, Department of Biological Sciences, Nicosia, Cyprus
| | - Vita Dolzan
- University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
| | - Anthony Fenech
- University of Malta, Faculty of Medicine, Department of Surgery, Msida, Malta
| | - Godfrey Grech
- University of Malta, Faculty of Medicine, Department of Surgery, Msida, Malta
| | - Vytautas Kasiulevicius
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ľudevít Kádaši
- Comenius University, Faculty of Natural Sciences, Bratislava, Slovakia
- Center for Molecular Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vaidutis Kučinskas
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Elza Khusnutdinova
- Institute of Biochemistry and Genetics, Ufa Scientific Center, Russian Academy of Sciences, Ufa, Russia
- Department of Genetics and Fundamental Medicine, Bashkir State University, Ufa, Russia
| | - Yiannis L. Loukas
- University of Athens, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Athens, Greece
| | - Milan Macek
- Charles University, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Halyna Makukh
- Institute of Hereditary Pathology, Ukrainian National Academy of Medical Sciences, Lviv, Ukraine
| | - Ron Mathijssen
- Erasmus University Medical Center, Department of Clinical Chemistry, Rotterdam, the Netherlands
| | | | - Christina Mitropoulou
- Erasmus University Medical Center, Department of Clinical Chemistry, Rotterdam, the Netherlands
| | - Giuseppe Novelli
- University of Rome “Tor Vergata”, Department of Biomedicine and Prevention, Rome, Italy
| | - Ioanna Papantoni
- University of Patras School of Health Sciences, Department of Pharmacy, Patras, Greece
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering University of Belgrade, Laboratory of Molecular Biomedicine, Belgrade, Serbia
| | | | - Jadranka Setric
- University Hospital Centre, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maja Stojiljkovic
- Institute of Molecular Genetics and Genetic Engineering University of Belgrade, Laboratory of Molecular Biomedicine, Belgrade, Serbia
| | - Andrew P. Stubbs
- Erasmus University Medical Center, Faculty of Medicine, Department of Bioinformatics, Rotterdam, the Netherlands
| | - Alessio Squassina
- University of Cagliari, Department of Biomedical Sciences, Cagliari, Italy
| | - Maria Torres
- University of Santiago de Compostela, Santiago, Spain
| | - Marek Turnovec
- Charles University, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Ron H. van Schaik
- Erasmus University Medical Center, Department of Clinical Chemistry, Rotterdam, the Netherlands
| | - Konstantinos Voskarides
- University of Cyprus, Molecular Medicine Research Center, Department of Biological Sciences, Nicosia, Cyprus
| | - Salma M. Wakil
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Anneke Werk
- University of Kiel, Institute for Experimental and Clinical Pharmacology, Kiel, Germany
| | - Maria del Zompo
- University of Cagliari, Department of Biomedical Sciences, Cagliari, Italy
| | - Branka Zukic
- Institute of Molecular Genetics and Genetic Engineering University of Belgrade, Laboratory of Molecular Biomedicine, Belgrade, Serbia
| | - Theodora Katsila
- University of Patras School of Health Sciences, Department of Pharmacy, Patras, Greece
| | - Ming Ta Michael Lee
- RIKEN Institute, Center for Genomic Medicine, Laboratory for International Alliance, Yokohama, Japan
| | - Alison Motsinger-Rief
- North Carolina State University, Department of Statistics, Raleigh, NC, United States of America
| | | | - Peter J. van der Spek
- Erasmus University Medical Center, Faculty of Medicine, Department of Bioinformatics, Rotterdam, the Netherlands
| | - George P. Patrinos
- Erasmus University Medical Center, Faculty of Medicine, Department of Bioinformatics, Rotterdam, the Netherlands
- University of Patras School of Health Sciences, Department of Pharmacy, Patras, Greece
- * E-mail:
| |
Collapse
|
7
|
Tang T, Liu J, Zuo K, Cheng J, Chen L, Lu C, Han S, Xu J, Jia Z, Ye M, Pei E, Zhang X, Li M. Genotype-Guided Dosing of Coumarin Anticoagulants. J Cardiovasc Pharmacol Ther 2015; 20:387-94. [PMID: 25575537 DOI: 10.1177/1074248414565666] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/14/2014] [Indexed: 11/16/2022]
Abstract
Background: Coumarin anticoagulants (acenocoumarol, phenprocoumon, and warfarin) are generally used for the prevention of stroke in patients with atrial fibrillation or for the therapy and prevention of venous thromboembolism. However, the safe use of coumarin anticoagulants is restricted by a narrow therapeutic window and large interindividual dosing variations. Some studies found that the effectiveness and safety of coumarin anticoagulants therapy were increased by pharmacogenetic-guided dosing algorithms, while others found no significant effect of genotype-guided therapy. Methods: Four electronic databases were searched from January 1, 2000, to March 1, 2014, for randomized controlled trials of patients who received coumarin anticoagulants according to genotype-guided dosing algorithms. The primary outcome was the percentage of time that the international normalized ratio (INR) was within the normal range (2.0-3.0). Secondary outcomes included major bleeding events, thromboembolic events, and INR ≥4 events. Results: Eight studies satisfied the inclusion and exclusion criteria. Genotype-guided dosing of coumarin anticoagulants improved the percentage of time within the therapeutic INR range (95% confidence interval [CI], 0.02-0.28; P = .02; I2 = 70%). Subgroup analysis was performed after dividing the nongenotype-guided group into a standard-dose group (95% CI, 0.14-0.49; P = .0004; I2 = 50%) and a clinical variables-guided dosing algorithm group (95% CI, −0.07-0.15; P = .48; I2 = 34%). There is a statistically significant reduction in numbers of secondary outcomes (INR ≥4 events, major bleeding events, and thromboembolic events; 95% CI, 0.79-1.00; P = .04). Subgroup analysis of secondary outcomes showed no significant difference between genotype-guided dosing and clinical variables-guided dosing (95% CI, 0.84-1.10; P = .57; I2 = 11%), but genotype-guided dosing reduced secondary outcomes compared with standard dosing (95% CI, 0.62-0.92; P = .006; I2 = 0%). Conclusions: This meta-analysis showed that genotype-guided dosing increased the effectiveness and safety of coumarin therapy compared with standard dosing but did not have advantages compared with clinical variables-guided dosing.
Collapse
Affiliation(s)
- Tao Tang
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Jie Liu
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Keqiang Zuo
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Jie Cheng
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Linyin Chen
- Department of Ophthalmology, Tai Zhou Hospital of Zhejiang Province, Taizhou, China
| | - Chenhui Lu
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Shilong Han
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Jichong Xu
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Meng Ye
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Erli Pei
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Xiaoping Zhang
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
- Institute of Intervention Vessel, Tongji University, Shanghai, China
| | - Maoquan Li
- Department of Interventional and Vascular surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
- Institute of Intervention Vessel, Tongji University, Shanghai, China
| |
Collapse
|