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Njagi LN, Mecha JO, Mureithi MW, Otieno LE, Nduba V. Towards pharmacogenomics-guided tuberculosis (TB) therapy: N-acetyltransferase-2 genotypes among TB-infected Kenyans of mixed ethnicity. BMC Med Genomics 2024; 17:14. [PMID: 38184575 PMCID: PMC10770971 DOI: 10.1186/s12920-023-01788-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/25/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Though persons of African descent have one of the widest genetic variability, genetic polymorphisms of drug-metabolising enzymes such as N-Acetyltransferase-2 (NAT2) are understudied. This study aimed to identify prevalent NAT2 single nucleotide polymorphisms (SNPs) and infer their potential effects on enzyme function among Kenyan volunteers with tuberculosis (TB) infection. Genotypic distribution at each SNP and non-random association of alleles were evaluated by testing for Hardy-Weinberg Equilibrium (HWE) and Linkage Disequilibrium (LD). METHODS We isolated genomic DNA from cryopreserved Peripheral Blood Mononuclear Cells of 79 volunteers. We amplified the protein-coding region of the NAT2 gene by polymerase chain reaction (PCR) and sequenced PCR products using the Sanger sequencing method. Sequencing reads were mapped and aligned to the NAT2 reference using the Geneious software (Auckland, New Zealand). Statistical analyses were performed using RStudio version 4.3.2 (2023.09.1 + 494). RESULTS The most frequent haplotype was the wild type NAT2*4 (37%). Five genetic variants: 282C > T (NAT2*13), 341 T > C (NAT2*5), 803A > G (NAT2*12), 590G > A (NAT2*6) and 481C > T (NAT2*11) were observed with allele frequencies of 29%, 18%, 6%, 6%, and 4% respectively. According to the bimodal distribution of acetylation activity, the predicted phenotype was 76% rapid (mainly consisting of the wildtype NAT2*4 and the NAT2*13A variant). A higher proportion of rapid acetylators were female, 72% vs 28% male (p = 0.022, odds ratio [OR] 3.48, 95% confidence interval [CI] 1.21 to 10.48). All variants were in HWE. NAT2 341 T > C was in strong complete LD with the 590G > A variant (D' = 1.0, r2 = - 0.39) but not complete LD with the 282C > T variant (D' = 0.94, r2 = - 0.54). CONCLUSION The rapid acetylation haplotypes predominated. Despite the LD observed, none of the SNPs could be termed tag SNP. This study adds to the genetic characterisation data of African populations at NAT2, which may be useful for developing relevant pharmacogenomic tools for TB therapy. To support optimised, pharmacogenomics-guided TB therapy, we recommend genotype-phenotype studies, including studies designed to explore gender-associated differences.
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Affiliation(s)
- Lilian N Njagi
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya.
- Department of Medical Microbiology & Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya.
| | - Jared O Mecha
- Department of Clinical Medicine and Therapeutics, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- Molecular Medicine and Infectious Disease Laboratory, University of Nairobi, Nairobi, Kenya
| | - Marianne W Mureithi
- Department of Medical Microbiology & Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Leon E Otieno
- Molecular Medicine and Infectious Disease Laboratory, University of Nairobi, Nairobi, Kenya
| | - Videlis Nduba
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
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Ali MH, Alrasheedy AA, Kibuule D, Hassali MA, Godman B, Abdelwahab MF, Abbadi RY. Isoniazid acetylation phenotypes in the Sudanese population; findings and implications. J Clin Tuberc Other Mycobact Dis 2019; 17:100120. [PMID: 31788562 PMCID: PMC6879993 DOI: 10.1016/j.jctube.2019.100120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Isoniazid (INH) is the mainstay antimicrobial in the treatment of tuberculosis (TB). It is acetlylated in the liver to acetyl-INH. However, there is variation in rate of acetylation of INH among TB patients (i.e. fast, intermediate or slow acetylators) which impacts on the treatment outcomes. Aim The isoniazid acetylation phenotypes in the expatriate Sudanese population were determined to provide future guidance since TB is prevalent in Sudan. Methods A community-based trial among Sudanese expatriates in Saudi Arabia was undertaken to identify INH-acetylation phenotypes. After overnight fasting, a single dose of 200 mg of INH was given to the volunteers. Three hours later, 5 ml of blood were drawn from each volunteer and prepared for High-Performance Liquid Chromatography (HPLC) analysis. The main outcomes were INH and Acetyl-INH concentrations in plasma and the subsequent Acetyl-INH/INH metabolic ratio (MR). Results The findings suggest that slow acetylation is highly prevalent among the study participants (n = 43; 84.31%). Moreover, there was no statistically significant correlation between age and the MR (r = −0.18, P = 0.20). Further, there was no significant association between gender and the MR (P = 0.124). Similarly, no significant association was found between smoking habits and MR (P = 0.24). Conclusion Isoniazid phenotyping suggests predominantly slow acetylation among the Sudanese in this sample. The study found no statistically significant associations between the MR and age or gender or smoking.
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Affiliation(s)
- Monadil H Ali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.,Faculty of Pharmacy, Northern Border University, Saudi Arabia
| | | | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Brian Godman
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - Raef Y Abbadi
- Faculty of Pharmacy, Northern Border University, Saudi Arabia
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McFeely SJ, Yu J, Zhao P, Hershenson S, Kern S, Ragueneau‐Majlessi I, Hartman D. Drug-Drug Interactions of Infectious Disease Treatments in Low-Income Countries: A Neglected Topic? Clin Pharmacol Ther 2019; 105:1378-1385. [PMID: 30771252 PMCID: PMC6563420 DOI: 10.1002/cpt.1397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/03/2019] [Indexed: 12/25/2022]
Abstract
Despite recent advances in recognizing and reducing the risk of drug-drug interactions (DDIs) in developed countries, there are still significant challenges in managing DDIs in low-income countries (LICs) worldwide. In the treatment of major infectious diseases in these regions, multiple factors contribute to ineffective management of DDIs that lead to loss of efficacy or increased risk of adverse events to patients. Some of these difficulties, however, can be overcome. This review aims to evaluate the inherent complexities of DDI management in LICs from pharmacological standpoints and illustrate the unique barriers to effective management of DDIs, such as the challenges of co-infection and treatment settings. A better understanding of comprehensive drug-related properties, population-specific attributes, such as physiological changes associated with infectious diseases, and the use of modeling and simulation techniques are discussed, as they can facilitate the implementation of optimal treatments for infectious diseases at the individual patient level.
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Affiliation(s)
| | - Jingjing Yu
- School of PharmacyUniversity of WashingtonSeattleWashingtonUSA
| | - Ping Zhao
- The Bill & Melinda Gates FoundationSeattleWashingtonUSA
| | | | - Steven Kern
- The Bill & Melinda Gates FoundationSeattleWashingtonUSA
| | | | - Dan Hartman
- The Bill & Melinda Gates FoundationSeattleWashingtonUSA
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Pressiat C, Mea-Assande V, Yonaba C, Treluyer JM, Dahourou DL, Amorissani-Folquet M, Blanche S, Eboua F, Ye D, Lui G, Malateste K, Zheng Y, Leroy V, Hirt D. Suboptimal cotrimoxazole prophylactic concentrations in HIV-infected children according to the WHO guidelines. Br J Clin Pharmacol 2017; 83:2729-2740. [PMID: 28800382 DOI: 10.1111/bcp.13397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/23/2017] [Accepted: 08/04/2017] [Indexed: 12/29/2022] Open
Abstract
AIMS A clinical study was conduct in HIV-infected children to evaluate the prophylactic doses of cotrimoxazole [sulfamethoxazole (SMX) and trimethoprim (TMP)] advised by the WHO. METHODS Children received lopinavir-based antiretroviral therapy with cotrimoxazole prophylaxis (200 mg of SMX/40 mg of TMP once daily). A nonlinear mixed effects modelling approach was used to analyse plasma concentrations. Factors that could impact the pharmacokinetic profile were investigated. The model was subsequently used to simulate individual exposure and evaluate different administration schemes. RESULTS The cohort comprised 136 children [average age: 1.9 years (range: [0.7-4]), average weight: 9.5 kg (range: [6-16.3])]. A dose per kg was justified by the significant influence of implementing an allometrically scaled body size covariate on SMX and TMP pharmacokinetics. SMX and TPM clearance were estimated at 0.49 l h-1 /9.5 kg and 3.06 l h-1 /9.5 kg, respectively. The simulated exposures obtained after administration of oral dosing recommended by the WHO for children from 10 to 15 kg were significantly lower than in adults for SMX and TMP. This could induce a reduction of effectiveness of cotrimoxazole. Simulations show that regimens of 30 mg kg-1 of SMX and 6 mg kg-1 of TMP in the 5-10 kg group and 25 mg kg-1 of SMX and 5 mg kg-1 of TMP in the 10-15 kg group are more suitable doses. CONCLUSIONS In this context of high prevalence of opportunistic infections, a lower exposure to cotrimoxazole in children than adults was noted. To achieve comparable exposure to adults, a dosing scheme per kg was proposed.
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Affiliation(s)
| | | | - Caroline Yonaba
- Pediatric Department, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Jean-Marc Treluyer
- Paris Descartes University, EA 7323, Paris, France.,Clinical Pharmacology Department, AP-HP, Paris Centre Hospital Group, Paris, France
| | - Désiré-Lucien Dahourou
- MONOD Project, ANRS 12206, Centre de Recherche Internationale pour la Santé, Ouagadougou, Burkina Faso.,Centre Muraz, Bobo-Dioulasso, Burkina Faso.,Inserm, Unité U1219, Université Bordeaux, Bordeaux, France
| | | | - Stéphane Blanche
- Paris Descartes University, EA 7323, Paris, France.,Immunology Hematology Pediatric Unit, AP-HP, Necker Hospital, Paris, France
| | - François Eboua
- Pediatric Department, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Diarra Ye
- Department of Paediatrics, CHU Charles de Gaulle, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | | | - Yi Zheng
- Paris Descartes University, EA 7323, Paris, France.,Clinical Pharmacology Department, AP-HP, Paris Centre Hospital Group, Paris, France
| | - Valeriane Leroy
- Inserm, Unité U1027, Université Paul Sabatier of Toulouse 3, Toulouse, France
| | - Déborah Hirt
- Paris Descartes University, EA 7323, Paris, France.,Clinical Pharmacology Department, AP-HP, Paris Centre Hospital Group, Paris, France
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Chelouti H, Khelil M. Arylamine N-acetyltransferase 2 gene polymorphism in an Algerian population. Ann Hum Biol 2017; 44:531-536. [DOI: 10.1080/03014460.2017.1311373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hiba Chelouti
- Département de Biologie Cellulaire et Moléculaire, Faculté des Sciences Biologiques, Université des Sciences et de la Technologie Houari Boumediene, Alger; Algérie
| | - Malika Khelil
- Département de Biologie Cellulaire et Moléculaire, Faculté des Sciences Biologiques, Université des Sciences et de la Technologie Houari Boumediene, Alger; Algérie
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Toure A, Cabral M, Niang A, Diop C, Garat A, Humbert L, Fall M, Diouf A, Broly F, Lhermitte M, Allorge D. Prevention of isoniazid toxicity by NAT2 genotyping in Senegalese tuberculosis patients. Toxicol Rep 2016; 3:826-831. [PMID: 28959610 PMCID: PMC5616082 DOI: 10.1016/j.toxrep.2016.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022] Open
Abstract
Isoniazid (INH), recommended by WHO (World Health Organization) in the treatment of tuberculosis (TB), is metabolized primarily by the genetically polymorphic N-acetyltransferase 2 (NAT2) enzyme. The human population is divided into three different phenotypic groups according to acetylation rate: slow, intermediate, and fast acetylators. The objective of this study was to explore the relationship between NAT2 genotypes and the serum concentrations of INH. Blood samples from 96 patients with TB were taken for the analysis. NAT2 polymorphisms on coding region were examined by polymerase chain reaction (PCR) direct sequencing; the acetylation status was obtained by measuring isoniazid (INH) and its metabolite, acetylisoniazid (AcINH) in plasma was obtained by using the liquid chromatography coupled to mass spectrometry. TB patients were distributed into two groups of fast and slow acetylators according to the acetylation index calculated based on the plasma concentration of INH in the 3rd hour (T3) after an oral dose. Our PCR analysis identified several alleles, where NAT2*4, NAT2*5A, NAT2*6A, and NAT2*13A were the most important. The concentrations of INH varied between 1.10 mg/L and 13.10 mg/L at the 3rd hour and between 0.1 and 9.5 mg/L at the 6th hour. The use of the acetylating index I3 allowed the classification of tested patients into two phenotypic groups: slow acetylators (44.3% of TB patients), and rapid acetylators (55.7%). Patient’s acetylation profile provides valuable information on their therapeutic, pharmacological, and toxicological responses.
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Affiliation(s)
- A Toure
- Laboratoire de Toxicologie et Hydrologie, Faculté de Médecine, Pharmacie et d'Odontologie UCAD, Dakar, Senegal.,EA 4483, Faculté de Médecine H. Warembourg, Pôle Recherche, Lille, France
| | - M Cabral
- Laboratoire de Toxicologie et Hydrologie, Faculté de Médecine, Pharmacie et d'Odontologie UCAD, Dakar, Senegal
| | - A Niang
- Service de Pneumophtisiologie, Centre Hospitalier National de Fann, Dakar, Senegal
| | - C Diop
- Laboratoire de Toxicologie et Hydrologie, Faculté de Médecine, Pharmacie et d'Odontologie UCAD, Dakar, Senegal
| | - A Garat
- Laboratoire de Toxicologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire, Lille, France.,EA 4483, Faculté de Médecine H. Warembourg, Pôle Recherche, Lille, France
| | - L Humbert
- Laboratoire de Toxicologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire, Lille, France
| | - M Fall
- Laboratoire de Toxicologie et Hydrologie, Faculté de Médecine, Pharmacie et d'Odontologie UCAD, Dakar, Senegal
| | - A Diouf
- Laboratoire de Toxicologie et Hydrologie, Faculté de Médecine, Pharmacie et d'Odontologie UCAD, Dakar, Senegal
| | - F Broly
- Laboratoire de Toxicologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire, Lille, France.,EA 4483, Faculté de Médecine H. Warembourg, Pôle Recherche, Lille, France
| | - M Lhermitte
- Laboratoire de Toxicologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire, Lille, France.,EA 4483, Faculté de Médecine H. Warembourg, Pôle Recherche, Lille, France
| | - D Allorge
- Laboratoire de Toxicologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire, Lille, France.,EA 4483, Faculté de Médecine H. Warembourg, Pôle Recherche, Lille, France
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7
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Li XP, Liu Y, Zhang CQ. Correlation Between NAT2 Gene Polymorphism and Cirrhotic Portal Hypertension in the Chinese Population. Genet Test Mol Biomarkers 2015; 19:138-43. [PMID: 25574899 DOI: 10.1089/gtmb.2014.0283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Xiao-Pei Li
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China
- Department of Gastroenterology, Tai'an Central Hospital, Tai'an, People's Republic of China
| | - Ying Liu
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chun-Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China
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Vilčková M, Jurečeková J, Dobrota D, Habalová V, Klimčáková L, Waczulíková I, Slezák P, Kliment J, Sivoňová MK. Variation in N-acetyltransferase 2 (NAT2), smoking and risk of prostate cancer in the Slovak population. Med Oncol 2014; 31:987. [PMID: 24816842 DOI: 10.1007/s12032-014-0987-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/27/2014] [Indexed: 12/14/2022]
Abstract
N-acetyltransferase 2 (NAT2) is an enzyme involved in the biotransformation of xenobiotics, mainly aromatic and heterocyclic amines and hydrazines, all of which represent an important class of carcinogens found in tobacco smoke. Polymorphism in NAT2 gene is reported to be associated with susceptibility to various types of cancer. This study investigated the relationship between the NAT2 polymorphism and the risk of prostate cancer with reference to the link between cigarette smoking and the xenobiotic-metabolizing enzyme NAT2. Overall, 281 cases and 395 controls from Slovakia were studied using polymerase chain reaction-restriction fragment length polymorphism assay. We found no statistically significant association between NAT2 genotypes and prostate cancer risk (slow acetylation vs. rapid acetylation: OR 1.13; 95 % CI 0.83-1.55). We report here a statistically significant correlation between the NAT2*5C/NAT2*6A slow acetylator genotype and the risk for developing prostate cancer (OR 2.91; 95 % CI 1.43-5.94; p = 0.003) when compared with the rapid phenotype. Smokers with NAT2 rapid phenotype had a five percent (5 %) reduced risk of prostate cancer compared with non-smokers carrying the rapid acetylator genotype. The association was reversed among smokers and non-smokers with NAT2 slow phenotype. On the basis of the foregoing, we conclude that the NAT2 phenotypes whether alone or in association with smoking do not correlate with susceptibility to prostate cancer within the Slovak population.
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Affiliation(s)
- Marta Vilčková
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Malá Hora 4, 03601, Martin, Slovakia
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