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Xu RJ, Kong WM, An XF, Zou JJ, Liu L, Liu XD. Physiologically-Based Pharmacokinetic-Pharmacodynamics Model Characterizing CYP2C19 Polymorphisms to Predict Clopidogrel Pharmacokinetics and Its Anti-Platelet Aggregation Effect Following Oral Administration to Coronary Artery Disease Patients With or Without Diabetes. Front Pharmacol 2021; 11:593982. [PMID: 33519456 PMCID: PMC7845657 DOI: 10.3389/fphar.2020.593982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background and Objective: Clopidogrel (CLOP) is commonly used in coronary artery disease (CAD) patients with or without diabetes (DM), but these patients often suffer CLOP resistance, especially those with diabetes. This study was aimed to develop a physiologically-based pharmacokinetic-pharmacodynamic (PBPK-PD) model to describe the pharmacokinetics and pharmacodynamics of clopidogrel active metabolite (CLOP-AM) in CAD patients with or without DM. Methods: The PBPK-PD model was first established and validated in healthy subjects and then in CAD patients with or without DM. The influences of CYP2C19, CYP2C9, CYP3A4, carboxylesterase 1 (CES1), gastrointestinal transit rates (Kt,i) and platelets response to CLOP-AM (kirre) on predicted pharmacokinetics and pharmacodynamics were investigated, followed with their individual and integrated effects on CLOP-AM pharmacokinetics due to changes in DM status. Results: Most predictions fell within 0.5–2.0 folds of observations, indicating successful predictions. Sensitivity analysis showed that contributions of interested factors to pharmacodynamics were CES1> kirre> Kt,i> CYP2C19 > CYP3A4> CYP2C9. Mimicked analysis showed that the decreased exposure of CLOP-AM by DM was mainly attributed to increased CES1 activity, followed by decreased CYP2C19 activity. Conclusion: The pharmacokinetics and pharmacodynamics of CLOP-AM were successfully predicted using the developed PBPK-PD model. Clopidogrel resistance by DM was the integrated effects of altered Kt,i, CYP2C19, CYP3A4, CES1 and kirre.
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Affiliation(s)
- Ru-Jun Xu
- Center of Pharmacokinetics and Metabolism, College of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Wei-Min Kong
- Center of Pharmacokinetics and Metabolism, College of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiao-Fei An
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinse Medicine, Nanjing, China
| | - Jian-Jun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Li Liu
- Center of Pharmacokinetics and Metabolism, College of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiao-Dong Liu
- Center of Pharmacokinetics and Metabolism, College of Pharmacy, China Pharmaceutical University, Nanjing, China
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Modak AS. Point-of-care companion diagnostic tests for personalizing psychiatric medications: fulfilling an unmet clinical need. J Breath Res 2017; 12:017101. [PMID: 28920579 DOI: 10.1088/1752-7163/aa8d2e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the last decade stable isotope-labeled substrates have been used as probes for rapid, point-of-care, non-invasive and user-friendly phenotype breath tests to evaluate activity of drug metabolizing enzymes. These diagnostic breath tests can potentially be used as companion diagnostics by physicians to personalize medications, especially psychiatric drugs with narrow therapeutic windows, to monitor the progress of disease severity, medication efficacy and to study in vivo the pharmacokinetics of xenobiotics. Several genotype tests have been approved by the FDA over the last 15 years for both cytochrome P450 2D6 and 2C19 enzymes, however they have not been cleared for use in personalizing medications since they fall woefully short in identifying all non-responders to drugs, especially for the CYP450 enzymes. CYP2D6 and CYP2C19 are among the most extensively studied drug metabolizing enzymes, involved in the metabolism of approximately 30% of FDA-approved drugs in clinical use, associated with large individual differences in medication efficacy or tolerability essentially due to phenoconversion. The development and commercialization via FDA approval of the non-invasive, rapid (<60 min), in vivo, phenotype diagnostic breath tests to evaluate polymorphic CYP2D6 and CYP2C19 enzyme activity by measuring exhaled 13CO2 as a biomarker in breath will effectively resolve the currently unmet clinical need for individualized psychiatric drug therapy. Clinicians could personalize treatment options for patients based on the CYP2D6 and CYP2C19 phenotype by selecting the optimal medication at the right initial and subsequent maintenance dose for the desired clinical outcome (i.e. greatest efficacy and minimal side effects).
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Affiliation(s)
- Anil S Modak
- Cambridge Isotope Laboratories, Inc., 3 Highwood Drive, Tewksbury, MA 01876, United States of America
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Klieber M, Oberacher H, Hofstaetter S, Beer B, Neururer M, Amann A, Alber H, Modak A. CYP2C19 Phenoconversion by Routinely Prescribed Proton Pump Inhibitors Omeprazole and Esomeprazole: Clinical Implications for Personalized Medicine. J Pharmacol Exp Ther 2015; 354:426-30. [PMID: 26159874 DOI: 10.1124/jpet.115.225680] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/08/2015] [Indexed: 12/23/2022] Open
Abstract
The phenotype pantoprazole-(13)C breath test (Ptz-BT) was used to evaluate the extent of phenoconversion of CYP2C19 enzyme activity caused by commonly prescribed proton pump inhibitors (PPI) omeprazole and esomprazole. The Ptz-BT was administered to 26 healthy volunteers and 8 stable cardiovascular patients twice at baseline and after 28 days of PPI therapy to evaluate reproducibility of the Ptz-BT and changes in CYP2C19 enzyme activity (phenoconversion) after PPI therapy. The average intrapatient interday variability in CYP2C19 phenotype (n = 31) determined by Ptz-BT was considerably low (coefficient of variation, 17%). Phenotype conversion resulted in 25 of 26 (96%) nonpoor metabolizer (non-PM) volunteers/patients as measured by the Ptz-BT at baseline and after PPI therapy. The incidence of PM status by phenotype following administration of omeprazole/esomeprazole (known inhibitors of CYP2C19) was 10-fold higher than those who are genetically PMs in the general population, which could have critical clinical implications for personalizing medications primarily metabolized by CYP2C19, such as clopidogrel, PPI, cyclophosphamide, thalidomide, citalopram, clonazepam, diazepam, phenytoin, etc. The Ptz-BT can rapidly (30 minutes) evaluate CYP2C19 phenotype and, more importantly, can identify patients with phenoconversion in CYP2C19 enzyme activity caused by nongenetic factors such as concomitant drugs.
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Affiliation(s)
- Martin Klieber
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Herbert Oberacher
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Silvia Hofstaetter
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Beate Beer
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Martin Neururer
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Anton Amann
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Hannes Alber
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
| | - Anil Modak
- Breath Research Institute of University of Innsbruck, Dornbirn, Austria (M.K., M.N., A.A.); Department of Anesthesiology and Critical Care Medicine (M.K., M.N., A.A.), Institute of Legal Medicine and Core Facility Metabolomics (H.O., S.H., B.B.), and University Clinic for Internal Medicine III (Cardiology) (H.A.), Innsbruck Medical University, Innsbruck, Austria; Department of Cardiology, Rehabilitation Centre Münster in Tyrol, Münster, Austria (H.A.); and Cambridge Isotopes Laboratories, Tewksbury, Massachusetts (A.M.)
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Preissner SC, Hoffmann MF, Preissner R, Dunkel M, Gewiess A, Preissner S. Polymorphic cytochrome P450 enzymes (CYPs) and their role in personalized therapy. PLoS One 2013; 8:e82562. [PMID: 24340040 PMCID: PMC3858335 DOI: 10.1371/journal.pone.0082562] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/24/2013] [Indexed: 11/19/2022] Open
Abstract
The cytochrome P450 (CYP) enzymes are major players in drug metabolism. More than 2,000 mutations have been described, and certain single nucleotide polymorphisms (SNPs) have been shown to have a large impact on CYP activity. Therefore, CYPs play an important role in inter-individual drug response and their genetic variability should be factored into personalized medicine. To identify the most relevant polymorphisms in human CYPs, a text mining approach was used. We investigated their frequencies in different ethnic groups, the number of drugs that are metabolized by each CYP, the impact of CYP SNPs, as well as CYP expression patterns in different tissues. The most important polymorphic CYPs were found to be 1A2, 2D6, 2C9 and 2C19. Thirty-four common allele variants in Caucasians led to altered enzyme activity. To compare the relevant Caucasian SNPs with those of other ethnicities a search in 1,000 individual genomes was undertaken. We found 199 non-synonymous SNPs with frequencies over one percent in the 1,000 genomes, many of them not described so far. With knowledge of frequent mutations and their impact on CYP activities, it may be possible to predict patient response to certain drugs, as well as adverse side effects. With improved availability of genotyping, our data may provide a resource for an understanding of the effects of specific SNPs in CYPs, enabling the selection of a more personalized treatment regimen.
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Affiliation(s)
- Sarah C Preissner
- Charité Universitätsmedizin Berlin, ECRC - Structural Bioinformatics Group, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Berlin, Germany
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Xie X, Ma YT, Yang YN, Li XM, Ma X, Fu ZY, Zheng YY, Chen BD, Liu F. CYP2C19 phenotype, stent thrombosis, myocardial infarction, and mortality in patients with coronary stent placement in a Chinese population. PLoS One 2013; 8:e59344. [PMID: 23555019 PMCID: PMC3595238 DOI: 10.1371/journal.pone.0059344] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/13/2013] [Indexed: 11/23/2022] Open
Abstract
Background Several studies have indicated that CYP2C19 loss-of-function polymorphisms have a higher risk of stent thrombosis (ST) after percutaneous coronary interventions (PCIs). However, this association has not been investigated thoroughly in a Chinese population. In this study, we aimed to determine the effect of CYP2C19*2 and CYP2C19*3 loss-of-function polymorphisms on the occurrence of ST and other adverse clinical events in a Chinese population. Methods We designed a cohort study among 1068 consecutive patients undergoing intracoronary stent implantation after preloading with 600 mg of clopidogrel. CYP2C19*2 and CYP2C19*3 were genotyped by using polymerase chain reaction-restriction fragment length polymorphism analysis. The adverse clinical events recorded were ST, death, myocardial infarction (MI), and bleeding events. The primary end point of the study was the incidence of cumulative ST within 1 year after PCI. The secondary end point was other adverse clinical outcomes 1 year after the procedure. Results The cumulative 1-year incidence of ST was 0.88% in patients with extensive metabolizers (EMs) (CYP2C19*1/*1 genotype), 4.67% in patients with intermediate metabolizers (IMs) (CYP2C19*1/*2 or *1/*3 genotype), and 10.0% in patients with poor metabolizers (PMs) (CYP2C19*2/*2, *2/*3, or *3/*3 genotype) (P<0.001). The one-year event-free survival was 97.8% in patients with EMs, 96.5% in patients with IMs, and 92.0% in patients with PMs (P = 0.014). Multivariate analysis confirmed the independent association of CYP2C19 loss-of-function allele carriage with ST (P = 0.009) and total mortality (P<0.05). Conclusion PM patients had an increased risk of ST, death, and MI after coronary stent placement in a Chinese population.
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Affiliation(s)
- Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
- * E-mail:
| | - Yi-Ning Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Xiao-Mei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Zhen-Yan Fu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Bang-Dang Chen
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, P.R. China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, P.R. China
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Furuta T, Sugimoto M, Shirai N. Individualized therapy for gastroesophageal reflux disease: potential impact of pharmacogenetic testing based on CYP2C19. Mol Diagn Ther 2012. [PMID: 22873740 DOI: 10.2165/11634960-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The main therapeutic agent for gastroesophageal reflux disease (GERD) is a proton pump inhibitor (PPI). Plasma levels and the acid inhibitory effect of PPIs depend on the activity of cytochrome P450 (CYP) 2C19, which is polymorphic. Genotypes of CYP2C19 are classified into three groups: rapid metabolizers (RMs: *1/*1), intermediate metabolizers (IMs: *1/*X), and poor metabolizers (PMs: *X/*X), where *1 and X represent the wild type and the mutant allele, respectively. RMs include ultra-rapid metabolizers, who possess the CYP2C19*17 allele. The pharmacokinetics and pharmacodynamics of PPIs differ among different CYP2C19 genotype groups. Plasma PPI levels and intragastric pH values during PPI treatment are lowest in the RM group, intermediate in the IM group, and highest in the PM group. These CYP2C19-genotype-dependent differences in the pharmacokinetics and pharmacodynamics of PPIs influence the healing and recurrence of GERD during PPI treatment, suggesting the need for CYP2C19 genotype-based tailored therapy for GERD. CYP2C19 pharmacogenetics should be taken into consideration for the personalization of PPI-based therapy. However, the clinical usefulness of CYP2C19 genotype testing in GERD therapy should be verified in clinical studies.
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Affiliation(s)
- Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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