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Ranasinghe P, Sirisena N, Senadeera V, Anandagoda G, Dissanayake VHW. Diversity of pharmacogenomic variants affecting warfarin metabolism in Sri Lankans. Pharmacogenomics 2022; 23:917-923. [DOI: 10.2217/pgs-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To describe the diversity of pharmacogenomic variants affecting warfarin metabolism in Sri Lankans. Materials & methods: Genotype data were filtered out from an anonymized database of 400 Sri Lankans, and minor allele frequencies (MAF) were calculated. Variants of CYP2C9, VKORC1 and CYP4F2 genes were studied. Results: Overall, CYP2C9*2 and CYP2C9*3 alleles had MAFs of 2.25% (95% CI: 0.80–3.70) and 10.38% (95% CI: 7.50–13.50), respectively. CYP2C9*11 and CYP2C9*14 alleles had MAFs of 0.13% (95% CI: 0–0.74) and 2.50% (95% CI: 0.97–4.03), respectively. MAFs of VKORC1 variants rs7294, rs9934438, rs8050894 and rs2884737 were 47.25% (95% CI: 42.36–52.14), 10.13% (95% CI: 7.28–13.22), 9.88% (95% CI: 7.06–12.94) and 4.88% (95% CI: 2.86–7.14), respectively. MAF of CYP4F2 variant rs2108622 was 45.63% (95% CI: 40.87–50.63). Conclusion: Compared with other populations, the frequencies of some studied variants were significantly different in Sri Lankans, and these are likely to account for variability in warfarin dosage requirements.
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Affiliation(s)
- Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | - Nirmala Sirisena
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | - Vidarsha Senadeera
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | - Gayani Anandagoda
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | - Vajira HW Dissanayake
- Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
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Sambyalova AY, Bairova TA, Belyaeva EV, Ershova OA, Sargaeva DS, Kolesnikov SI. CYP2C9, CYP4F2, VKORC1 Gene Polymorphism in Buryat Population. RUSS J GENET+ 2021. [DOI: 10.1134/s1022795420120121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Veeregowda SH, Krishnaswamy B, Balakrishna S. Effect of Vitamin K Epoxide Reductase Complex 1 Polymorphism on Warfarin Dose Requirement among Patients in Tertiary Care Hospital. Int J Appl Basic Med Res 2020; 10:97-101. [PMID: 32566525 PMCID: PMC7289213 DOI: 10.4103/ijabmr.ijabmr_341_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/11/2019] [Accepted: 01/23/2020] [Indexed: 11/04/2022] Open
Abstract
Background Warfarin, anticoagulant is used for thromboembolic disorders. Inter-individual variation in clinical response to warfarin is due to various factors, including polymorphism of Vitamin K epoxide reductase complex 1 (VKORC1)-1639G>A. The aim of our study was to evaluate the effect of VKORC1 polymorphism on the maintenance dose of warfarin. Materials and Methods Cross-sectional study conducted by the departments of Pharmacology, Cell Biology and Molecular Genetics on patients attending cardiology clinic, receiving warfarin for at least 2 months. Genomic deoxyribonucleic acid was extracted and genotyping was done by Polymerase Chain Reaction - Restriction Fragment Length Polymorphism. The correlation between VKORC1 gene polymorphism and warfarin maintenance dose was analyzed. Results A total of 102 patients with a mean age of 47.72 ± 10.31 years, of which 58 (56.86%) were male. The frequency of VKORC1 G>A for GG, GA, and AA genotypes was 74.51%, 19.61%, and 5.88%, respectively. Variant allele AA was less frequent than the wild type. Mean weekly warfarin dose was 23.12 ± 8.08, 22.93 ± 8.21, and 15.6 ± 5.35 mg in patients with GG, GA, and AA genotypes, respectively. Patients with GG genotype required therapeutic dose compared to variant type (P = 0.001). Multiple stepwise regression model showed 26.3% variability in warfarin dose was due to VKORC1 genotype (R = 0.513, R2 = 0.263, adjusted R2 = 0.256, P = 0.0001). Conclusion VKORC1 polymorphism alone influence 26.3% variability in warfarin dose and AA genotype patients required lower dose.
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Affiliation(s)
- Sahana Hadihalli Veeregowda
- Department of Pharmacology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Bhuvana Krishnaswamy
- Department of Pharmacology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Sharath Balakrishna
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
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S R K, G B, Jain S, Christopher R. Significance of CYP4F2 polymorphism on oral anticoagulation therapy with acenocoumarol in South Indian patients with mechanical heart valves. Meta Gene 2019. [DOI: 10.1016/j.mgene.2019.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Zhang J, Wang H, Niu G, Liu Y, Wang Y, Zhang L, Pei Y, Zhu H, Dai P, Chen C. Deciphering DMET genetic data: comprehensive assessment of Northwestern Han, Tibetan, Uyghur populations and their comparison to eleven 1000 genome populations. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 46:S1176-S1185. [PMID: 30688101 DOI: 10.1080/21691401.2018.1533849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We investigated the allele frequencies of drug absorption, distribution, metabolism and elimination (ADME)-related drug-metabolizing enzymes and transporters (DMET) genes in the Northwestern Han, Tibetan and Uyghur populations and compared the related genes in these three populations with those in eleven 1000 Genome populations. We examined 1936 single nucleotide polymorphisms of 225 DMET genes involved in ADME processes and found 732, 679 and 804 sites were polymorphic in Han, Tibetan and Uyghur. Tibetan differed from Han in only four sites (p < .05), whereas Uyghur differed from Han and Tibetan in 24 and 21 sites, respectively (p < .05). The distributions of 1058 genotyping data of 245 individuals from Han, Tibetan and Uyghur were compared with 1207 other individuals from the eleven 1000 Genomes populations. The top four populations in Han that exhibited the smallest pairwise Fst values were CHB, Tibetan, CHD and JPT; those in Tibetan were Han, CHB, Uyghur and CHD; and those in Uyghur were Han, Tibetan, GIH and CEU. MEGA results revealed that CHB, CHD, JPT, Han, Tibetan and Uyghur were grouped in cluster 1. GIH, MEX, CEU and TSI were grouped in cluster 2. MKK, ASW, LWK and YRI were grouped in cluster 3.
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Affiliation(s)
- Jiayi Zhang
- a College of Life Science , Northwest University , Xi'an , China
| | - Huijuan Wang
- a College of Life Science , Northwest University , Xi'an , China
| | - Geng Niu
- a College of Life Science , Northwest University , Xi'an , China
| | - Yongkang Liu
- a College of Life Science , Northwest University , Xi'an , China
| | - Yanxia Wang
- a College of Life Science , Northwest University , Xi'an , China
| | - Lirong Zhang
- a College of Life Science , Northwest University , Xi'an , China
| | - Yanrui Pei
- a College of Life Science , Northwest University , Xi'an , China
| | - Hongli Zhu
- a College of Life Science , Northwest University , Xi'an , China.,b National Engineering Research Center for Miniaturized Detection Systems , Northwest University , Xi'an , China
| | - Penggao Dai
- a College of Life Science , Northwest University , Xi'an , China.,b National Engineering Research Center for Miniaturized Detection Systems , Northwest University , Xi'an , China
| | - Chao Chen
- a College of Life Science , Northwest University , Xi'an , China.,b National Engineering Research Center for Miniaturized Detection Systems , Northwest University , Xi'an , China
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Saksena D, Mishra YK, Muralidharan S, Kanhere V, Srivastava P, Srivastava CP. Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario. Indian J Thorac Cardiovasc Surg 2019; 35:3-44. [PMID: 33061064 PMCID: PMC7525528 DOI: 10.1007/s12055-019-00789-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. METHODS A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. RESULTS The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. CONCLUSIONS Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.
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Harikrishnan S, Koshy L, Subramanian R, Sanjay G, Vineeth CP, Nair AJ, Nair GM, Sudhakaran PR. Value of VKORC1 (-1639G>A) rs9923231 genotyping in predicting warfarin dose: A replication study in South Indian population. Indian Heart J 2018; 70 Suppl 3:S110-S115. [PMID: 30595241 PMCID: PMC6310074 DOI: 10.1016/j.ihj.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Warfarin is the most commonly prescribed oral anticoagulant, although having a narrow therapeutic index and wide interindividual variability. The aim of this study was to replicate the utility of VKORC1 (-1639G>A) rs9923231 genotyping in predicting the mean daily dose and to evaluate its ability to categorize warfarin-treated patients to high-, intermediate-, or low-dose categories in the South Indian population. MATERIALS AND METHODS A cohort of 222 warfarin-treated patients was genotyped using restriction fragment length polymorphism method. The influence of the rs9923231 polymorphism on the variations in the mean daily dose was compared using one-way analysis of variance and linear regression analysis. Discriminatory ability of the rs9923231 polymorphism to group the patients into ordered dose categories was assessed by estimating the proportional odds ratios using the ordered logit regression analysis. RESULTS The frequency of AA genotype and A allele in the study sample was found to be 1.8% and 9.23%, respectively, which was similar to reports from other South Indian populations. The mean daily dose required to achieve the optimum international normalized ratio was significantly lower in AA homozygous genotype carriers (3.99 ± 1.67 mg/day) and GA heterozygous (4.26 ± 1.57 mg/day) compared to the GG genotype carriers (5.51 ± 2.13 mg/day), p = 0.003. The A allele carriers (GA+AA genotypes) had a 3.23 higher odds of being grouped as a low-dose requiring category compared to non-carriers (95% CI 1.49-6.98, p = 0.003). CONCLUSIONS These preliminary results strongly support the use of VKORC1 (-1639G>A) rs9923231 polymorphism for genetically guided initial warfarin dosing in South Indian patients with heart valve replacements.
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Affiliation(s)
- S Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - Linda Koshy
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
| | - Ram Subramanian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - G Sanjay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - C P Vineeth
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - A Jayakumaran Nair
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
| | - G M Nair
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
| | - P R Sudhakaran
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
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Zhang J, Chen Z, Chen C. Impact of CYP2C9, VKORC1 and CYP4F2 genetic polymorphisms on maintenance warfarin dosage in Han-Chinese patients: A systematic review and meta-analysis. Meta Gene 2016; 9:197-209. [PMID: 27617219 PMCID: PMC5006145 DOI: 10.1016/j.mgene.2016.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction Warfarin is the most commonly used antithrombotic drug. Single nucleotide polymorphisms (SNPs) of CYP2C9, CYP4F2, VKORC1 1173 and VKORC1-1639 influence warfarin maintenance dosage. We aimed to determine the impact of SNPs of these genes on mean daily warfarin dosage (MDWD) in Han-Chinese patients. Methods Strict literature inclusion criteria were established, and literature searching was performed on PubMed, Embase and Cochrane Library for English articles and CNKI, CBM and Wanfang database for Chinese articles before September 2, 2014. Revman 5.3 was used to analyze the relationship between gene SNPs and MDWD in Han-Chinese subjects. Results We included 33 studies researching the impact of gene SNPs on MDWD in Han-Chinese subjects. CYP2C9 *3/*3, *1/*3 and *3 carriers needed a 72% (95% confidence interval [CI]: 62.0%–81.0%), 28% (22.0%–33.0%) and 26% (21.0%–32.0%) lower MDWD, respectively, than CYP2C9 *1/*1 carriers. CYP4F2 TT, CT and T carriers required a 18% (7.0%–30.0%), 7% (7.0%–7.0%) and 11% (7.0%–14.0%) higher MDWD, respectively, than CYP4F2 CC carriers. VKORC1 1173 CC, CT and C carriers required a 98% (78.0%–118.0%), 49% (37.0%–62.0%) and 56% (44.0%–67.0%) higher MDWD, respectively, than VKORC1 1173 TT carriers. VKORC1-1639 GG, GA and G carriers needed a 101% (53.0%–149.0%), 40% (36.0%–45.0%) and 38% (35.0%–42.0%) higher MDWD, respectively, than VKORC1-1639 AA carriers. Conclusions This meta-analysis is the first to report the relationship between genotypes and MDWD among Han-Chinese patients. The results showed that SNPs of CYP2C9, CYP4F2, VKORC1 1173 and VKORC1-1639 significantly influenced the MDWD in Han-Chinese patients. This meta-analysis examined the effects of genotype on mean daily warfarin dosage. CYP2C9, CYP4F2 and VKORC1 genotypes were studied in Han-Chinese patients. CYP2C9, CYP4F2, VKORC1-1173 and VKORC1-1639 polymorphisms affected warfarin dosage. VKORC1-1173 C and VKORC1-1639 G mutations had similar frequencies and effects. Either genotype can be tested for to guide drug usage and lower medical costs.
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Key Words
- AF, Atrial Fibrillation
- AVR, Atrial Valve Replacement
- CI, Confidence Interval
- CYP2C9
- CYP2C9, Cytochrome P450 Complex Subunit 2C9
- CYP4F2, Cytochrome P450 Complex Subunit 4F2
- DVT, Deep Vein Thrombosis
- HVR, Heart Valve Replacement
- Han-Chinese
- INR, International Normalized Ratio
- MD, Mean Difference
- MDWD, Mean Daily Warfarin Dose
- MHVR, Mechanical Heart Valve Replacement
- MVR, Mitral Valve Replacement
- Meta-analysis
- NVAF, Non Valvular Atrial Fibrillation
- PE, Pulmonary Embolism
- RHD, Rheumatic Heart Disease
- SD, Standard Deviation
- SNPs, Single Nucleotide Polymorphisms
- VKORC1
- VKORC1, Vitamin K Epoxide Reductase Complex Subunit 1
- VTE, Venous Thromboembolism
- Warfarin
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Affiliation(s)
- Jinhua Zhang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou 350001, PR China
| | - Zhijie Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, PR China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, PR China
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Multiplex pyrosequencing method to determine CYP2C9*3, VKORC1*2, and CYP4F2*3 polymorphisms simultaneously: its application to a Korean population and comparisons with other ethnic groups. Mol Biol Rep 2014; 41:7305-12. [DOI: 10.1007/s11033-014-3617-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
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Gaikwad T, Shetty S, Ghosh K. Warfarin pharmacogenetics: How close are we to clinical practice? INDIAN JOURNAL OF HUMAN GENETICS 2013; 19:277-8. [PMID: 24339537 PMCID: PMC3841549 DOI: 10.4103/0971-6866.120806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tejasvita Gaikwad
- Department of Thrombosis and Haemostasis, National Institute of Immunohaematology (ICMR), KEM Hospital, Parel, Mumbai, Maharashtra, India
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