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Torso NDG, Rodrigues-Soares F, Altamirano C, Ramírez-Roa R, Sosa-Macías M, Galavíz-Hernández C, Terán E, Peñas-LLedó E, Dorado P, LLerena A. CYP2C19 genotype-phenotype correlation: current insights and unanswered questions. Drug Metab Pers Ther 2024; 39:201-206. [PMID: 39663234 DOI: 10.1515/dmpt-2024-0093] [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] [Received: 11/19/2024] [Accepted: 11/19/2024] [Indexed: 12/13/2024]
Abstract
The CYP2C19 enzyme is implicated in the metabolism of several clinically used drugs. Its phenotype is usually predicted by genotyping and indicates the expected enzymatic activity for each patient. However, with a few exceptions, CYP2C19 genotyping has not resulted in a reliable prediction of the metabolizer status, since most of the evidence currently available for this prediction comes from research into populations of predominantly European ancestry. Therefore, this review discusses the main factors that may alter the expected phenotype, as well as the urgent need to include ethnically diverse populations in further studies, so that, in the long term, it is possible to establish guidelines appropriate to these groups.
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Affiliation(s)
- Nadine de Godoy Torso
- School of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
- University Institute for Bio-Sanitary Research of Extremadura, Badajoz, Spain
| | - Fernanda Rodrigues-Soares
- University Institute for Bio-Sanitary Research of Extremadura, Badajoz, Spain
- Department of Pathology, Genetic and Evolution, 74348 Biological and Natural Sciences Institute, Universidade Federal Do Triângulo Mineiro , Uberaba, Brazil
| | - Catalina Altamirano
- Universidad Nacional Autónoma de Nicaragua - León, Facultad de Ciencias Médicas, León, Nicaragua
| | | | - Martha Sosa-Macías
- Instituto Politécnico Nacional-CIIDIR, Academia de Genómica, Durango, México
| | | | | | - Eva Peñas-LLedó
- University Institute for Bio-Sanitary Research of Extremadura, Badajoz, Spain
| | - Pedro Dorado
- University Institute for Bio-Sanitary Research of Extremadura, Badajoz, Spain
| | - Adrián LLerena
- University Institute for Bio-Sanitary Research of Extremadura, Badajoz, Spain
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Guevara M, Rodrigues-Soares F, de la Cruz CG, de Andrés F, Rodríguez E, Peñas-Lledó E, LLerena A, CEIBA Consortium of the Ibero-American Network of Pharmacogenetics and Pharmacogenomics RIBEF. Afro-Latin American Pharmacogenetics of CYP2D6, CYP2C9, and CYP2C19 in Dominicans: A Study from the RIBEF-CEIBA Consortium. Pharmaceutics 2024; 16:1399. [PMID: 39598523 PMCID: PMC11597850 DOI: 10.3390/pharmaceutics16111399] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 10/24/2024] [Accepted: 10/28/2024] [Indexed: 11/29/2024] Open
Abstract
Background/Objectives: Research on pharmacogenetic variability in response to prescribed drugs and across ethnic groups is essential for personalized medicine, particularly in admixed and unstudied populations. For the first time, this study examines CYP2D6, CYP2C9, and CYP2C19 alleles and genotypes in 197 healthy volunteers from the Dominican Republic, as part of the RIBEF-CEIBA collaborative network. Methods: The analysis focuses on the participants' tri-hybrid genomic ancestry, with CYP alleles determined by real-time PCR and molecular ancestry inferred using 90 AIMs. Linear regression was used to associate ancestry components with CYP frequencies. Results: The average ancestry was 23.8% European, 42.6% Native American, and 33.6% African, the latter being higher than in most Latin American populations. Native American ancestry was also higher than expected. Predicted phenotype frequencies based on genotypes were 4.2% poor metabolizers (gPMs) and 3.6% ultrarapid metabolizers (gUMs) for CYP2D6, as well as 3% gPMs, 22.8% rapid metabolizers (gRMs), and 1.5% gUMs for CYP2C19. No gPM individuals were observed for CYP2C9. Certain alleles associated with decreased CYP2D6 activity (*17 and *29) and increased CYP2C19 activity (*17 and gUMs) were positively linked with African ancestry and negatively with Native American ancestry. Rare CYP2C9 alleles (*5 and *6) with clinical relevance were additionally found. Conclusions: These findings build on previous results from the RIBEF-CEIBA collaborative network, demonstrating differences in allele frequencies of CYP2D6, CYP2C9, and CYP2C19 in relation to genomic ancestry. In summary, ethnicity must be considered in the development of pharmacogenetic guidelines for clinical application, research, and regulation to avoid widening the biotechnology gap and to allow Personalized Medicine to reach the entire world population.
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Affiliation(s)
- Mariela Guevara
- Facultad de Ciencias de la Salud, Universidad Nacional Pedro Henríquez Ureña, Santo Domingo 10514, Dominican Republic; (M.G.); (E.R.)
| | - Fernanda Rodrigues-Soares
- Faculty of Medicine and Health Sciences, University Institute for Bio-Sanitary Research of Extremadura INUBE, University of Extremadura, 06006 Badajoz, Spain; (F.R.-S.); (C.G.d.l.C.); (E.P.-L.)
- Department of Pathology, Genetic and Evolution, Universidade Federal do Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Carla González de la Cruz
- Faculty of Medicine and Health Sciences, University Institute for Bio-Sanitary Research of Extremadura INUBE, University of Extremadura, 06006 Badajoz, Spain; (F.R.-S.); (C.G.d.l.C.); (E.P.-L.)
| | - Fernando de Andrés
- Department of Analytical Chemistry and Food Technology, Faculty of Pharmacy, University of Castilla-La Mancha, 02008 Albacete, Spain;
| | - Ernesto Rodríguez
- Facultad de Ciencias de la Salud, Universidad Nacional Pedro Henríquez Ureña, Santo Domingo 10514, Dominican Republic; (M.G.); (E.R.)
| | - Eva Peñas-Lledó
- Faculty of Medicine and Health Sciences, University Institute for Bio-Sanitary Research of Extremadura INUBE, University of Extremadura, 06006 Badajoz, Spain; (F.R.-S.); (C.G.d.l.C.); (E.P.-L.)
| | - Adrián LLerena
- Faculty of Medicine and Health Sciences, University Institute for Bio-Sanitary Research of Extremadura INUBE, University of Extremadura, 06006 Badajoz, Spain; (F.R.-S.); (C.G.d.l.C.); (E.P.-L.)
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Roberts B, Cooper Z, Lu S, Stanley S, Majda BT, Collins KRL, Gilkes L, Rodger J, Akkari PA, Hood SD. Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review. Front Pharmacol 2023; 14:1267294. [PMID: 37795032 PMCID: PMC10545970 DOI: 10.3389/fphar.2023.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.
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Affiliation(s)
- Bradley Roberts
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Zahra Cooper
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Stephanie Lu
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Khan R. L. Collins
- Western Australian Department of Health, North Metropolitan Health Service, Perth, WA, Australia
| | - Lucy Gilkes
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
- Divison of General Practice, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - P. Anthony Akkari
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
- Division of Neurology, Duke University Medical Centre, Duke University, Durham, United States
| | - Sean D. Hood
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
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Peñas-LLedó E, LLerena A. Clinical use of pre-emptive pharmacogenetic programmes. Lancet 2023; 401:320-321. [PMID: 36739126 DOI: 10.1016/s0140-6736(22)02461-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/23/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Eva Peñas-LLedó
- INUBE Extremadura Biosanitary University Research Institute, E 06080 Badajoz, Spain; University of Extremadura Medical School, E 06080 Badajoz, Spain
| | - Adrián LLerena
- INUBE Extremadura Biosanitary University Research Institute, E 06080 Badajoz, Spain; University of Extremadura Medical School, E 06080 Badajoz, Spain; CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.
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