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Shi X, Zhang Y, Zhang Y, Zhang R, Lin B, Han J, Li W, Fang Z, Yan J, Wang Y, Zheng Z, Lv Y, Lin Y. Personalized Antiplatelet Therapy Based on CYP2C19 Genotypes in Chinese ACS Patients Undergoing PCI: A Randomized Controlled Trial. Front Cardiovasc Med 2021; 8:676954. [PMID: 34222372 PMCID: PMC8242578 DOI: 10.3389/fcvm.2021.676954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical benefits of cytochrome P450 (CYP) 2C19 genotype-guided antiplatelet therapy in Asians remain unclear. In this study, we aimed to investigate the clinical outcomes of pharmacogenomic antiplatelet therapy in Chinese patients. Methods: Patients with acute coronary syndrome planning to undergo percutaneous coronary intervention were eligible for this study and were randomly divided into a genotype-guided treatment (GT) group and routine treatment (RT) group, with a ratio of 2:1. Patients in the GT group underwent CYP2C19 genotyping (*2 and *3 alleles), and the results were considered in selecting P2Y12 receptor inhibitors. Patients in the RT group were treated with P2Y12 receptor inhibitors according to their clinical characteristics. The primary endpoint was a composite of major adverse cardiovascular or cerebrovascular events (MACCE). The secondary endpoint was significant bleeding events. Results: Finally, 301 patients were enrolled; 75.1% were men and the mean age was 59.7 ± 9.8 years. In total, 281 patients completed the follow-up procedure. The primary endpoint occurred in 16 patients, 6 patients in the GT group and 10 in the RT group. The GT group showed lower MACCE rates than the RT group (6/189 vs. 10/92, 3.2 vs. 10.9%, hazard ratio: 0.281, 95% confidence interval: 0.102-0.773, P = 0.009). There was no statistically difference in significant bleeding events between the GT and RT groups (4.2 vs. 3.3%, hazard ratio: 1.315, 95% confidence interval: 0.349-4.956, P = 0.685). Conclusion: Personalized antiplatelet therapy that is based on CYP2C19 genotypes could decrease MACCE within a 12-month period in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention. Clinical Trial Registration: http://www.chictr.org.cn, identifier: ChiCTR2000034352.
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Affiliation(s)
- Xiujin Shi
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yunnan Zhang
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Ru Zhang
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Baidi Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Jialun Han
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Wenzheng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhenwei Fang
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jialin Yan
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Yifan Wang
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Ze Zheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuan Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
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Ahsan T, Sajib AA. Drug-response related genetic architecture of Bangladeshi population. Meta Gene 2019. [DOI: 10.1016/j.mgene.2019.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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3
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Yeo KK, Armstrong EJ, López JE, Chen DC, Westin GG, Li CS, Anderson D, Hua A, Singapuri A, Amsterdam EA, Chiamvimonvat N, Laird JR. Aspirin and clopidogrel high on-treatment platelet reactivity and genetic predictors in peripheral arterial disease. Catheter Cardiovasc Interv 2018; 91:1308-1317. [PMID: 29411531 DOI: 10.1002/ccd.27453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 11/19/2017] [Accepted: 11/26/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Our aims were to examine the prevalence and genetic predictors of aspirin and clopidogrel high on-treatment platelet reactivity (HoTPR), and associated adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). BACKGROUND The association of aspirin and clopidogrel HoTPR with outcomes in PAD remains unclear. METHODS This is a prospective cohort study of patients with angiographically documented PAD involving carotid and lower extremity arteries. Aspirin and clopidogrel HoTPR (using the VerifyNow Assay) and associated genetic predictors were compared to clinical outcomes. The primary end-point was a composite of major adverse cardiovascular events: all-cause mortality, myocardial infarction, stroke, target vessel revascularization (TVR) and limb-loss in patients who underwent extremity intervention. RESULTS The study was stopped prematurely due to slow patient enrolment. Of 195 patients enrolled, the primary analysis was performed in 154 patients taking both drugs. Aspirin HoTPR was present in 31 (20%) and clopidogrel HoTPR in 76 (49%) patients. There was a trend toward more primary composite outcome events with PRU ≥ 235 (52% freedom-from-event rate vs. 70% for PRU < 235; P = 0.09). TVR was higher in those with PRU ≥ 235 (20 vs. 6%, unadjusted P = 0.02). There was no association between aspirin HoTPR and combined outcomes. Single nucleotide polymorphisms in serum paraoxonase/arylesterase 1 (PON1) gene was associated with aspirin HoTPR (P = 0.005) while SNP in phospholipase A2, group III (PLA2G3) gene was associated with clopidogrel HoTPR (P = 0.002). CONCLUSION Clopidogrel HoTPR was significantly associated with TVR, while aspirin HoTPR was not associated with adverse clinical outcomes in patients with PAD.
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Affiliation(s)
- Khung-Keong Yeo
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis, California.,Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Ehrin J Armstrong
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis, California.,Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Javier E López
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Debbie C Chen
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory G Westin
- Division of Vascular and Endovascular Surgery, NYU Langone Medical Center, New York, New York
| | - Chin-Shang Li
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California
| | - David Anderson
- Department of Internal Medicine, University of California, San Francisco, California
| | - Amy Hua
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Anil Singapuri
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Ezra A Amsterdam
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Nipavan Chiamvimonvat
- Division of Cardiovascular Medicine, University of California, Davis, California.,Department of Veterans Affairs, Northern California Health Care System, Mather, California
| | - John R Laird
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis, California
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Freynhofer M, Siller-Matula J, Schrör K, Huber K, Yukhanyan L. Genetic variability in response to clopidogrel therapy and its clinical implications. Thromb Haemost 2017; 105 Suppl 1:S55-9. [DOI: 10.1160/ths10-11-0747] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 04/01/2011] [Indexed: 11/05/2022]
Abstract
SummaryThis article concentrates on individual genetic differences responsible for variations of action of clopidogrel, which have been found to be partially responsible for increased cardiovascular events in patients with coronary artery disease under dual antiplatelet therapy. According to these results, genotyping for the relevant gene polymorphisms, especially for the CYP2C19 loss-of-function alleles, has been discussed to be an effective method of individualising and optimising clopidogrel treatment. However, due to the facts that 1) there are no prospective studies demonstrating a clinical benefit of personalising antiplatelet therapy based on genotyping; 2) CYP2C19 polymorphisms account for only approximately 12% of variability in clopidogrel platelet response; 3) the positive predictive value of CYP2C19 loss-of-function polymorphisms for cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention is only approximately 12% – 20%; 4) it is likely that other clinical factors and risk constellations might be of greater clinical importance; and 5) it is unknown whether a specific genetic polymorphism is capable of influencing outcome for the individual patient; genetic profiling cannot be recommended for routine use at present but will remain of considerable scientific interest.
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Ge H, Lv X, Ren H, Jin H, Jiang Y, He H, Liu P, Li Y. Influence of CYP2C19 genetic polymorphisms on clinical outcomes of intracranial aneurysms treated with stent-assisted coiling. J Neurointerv Surg 2017; 9:958-962. [PMID: 27634953 DOI: 10.1136/neurintsurg-2016-012635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/27/2016] [Accepted: 08/31/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the influence of CYP2C19 genetic polymorphisms on clinical outcomes of intracranial aneurysms treated with stent-assisted coiling. METHODS Between September 2014 and October 2015, we prospectively recruited 215 patients with intracranial aneurysms who were treated with stent-assisted coiling. CYP2C19 genotypes were determined and clopidogrel response was tested. The primary endpoints included symptomatic or silent ischemic events, and bleeding events. The secondary endpoint was clinical outcome at 3 months. RESULTS Of the 215 patients, 108 (50.2%) were classified as intermediate metabolizers (IMs, CYP2C19*1/*2, *1/*3), 76 (35.3%) as extensive metabolizers (EMs, CYP2C19*1/*1) and 31 (14.4%) as poor metabolizers (PMs, CYP2C19*2/*2, *2/*3, *3/*3). Carriers of CYP2C19 loss-of-function (LOF) alleles (*2 or *3, p=0.001), especially PMs (p=0.004), had an increased risk for clopidogrel resistance. After the procedures, cerebral ischemic events occurred in 69 patients (32.1%) and bleeding was seen in 20 patients (9.3%). In comparison with IMs and PMs, EMs had a lower risk for ischemic events (21.1% vs 37.0% and 41.9%, p=0.02 and 0.027, respectively) and a relatively higher risk for bleeding events (18.4% vs 5.6% and 0%, p=0.006 and 0.01, respectively). Based on multivariate analysis, the carriage of CYP2C19 LOF alleles (p=0.032) and clopidogrel resistance (p=0.047) were considered as predictors of cerebral ischemic events, and EMs were significantly associated with bleeding (p=0.002). Posterior circulation aneurysms (p=0.038), hemorrhagic history (p=0.001) and poor metabolic genotypes (p=0.001) could result in poor clinical outcomes (modified Rankin Scale >2). CONCLUSIONS CYP2C19 genetic polymorphisms had significant influence on the antiplatelet effect of clopidogrel, and could be considered as risk factors of ischemic or bleeding events and even clinical outcomes of patients with intracranial aneurysms treated with stent-assisted coiling.
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Affiliation(s)
- Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Hui Ren
- Laboratory Diagnosis Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Hongwei He
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
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Tang QJ, Lin HM, He GD, Liu JE, Wu H, Li XX, Zhong WP, Tang L, Meng JX, Zhang MZ, Li HP, Chen JY, Zhong SL, Wang LY. Plasma miR-142 accounting for the missing heritability of CYP3A4/5 functionality is associated with pharmacokinetics of clopidogrel. Pharmacogenomics 2016; 17:1503-17. [PMID: 27556885 DOI: 10.2217/pgs-2016-0027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIM To investigate whether plasma miRNAs targeting CYP3A4/5 have an impact on the variance of pharmacokinetics of clopidogrel. MATERIALS & METHODS The contribution of 13 miRNAs to the CYP3A4/5 gene expression and activity was investigated in 55 liver tissues. The association between plasma miRNAs targeting CYP3A4/5 mRNA and clopidogrel pharmacokinetics was analyzed in 31 patients with coronary heart disease who received 300 mg loading dose of clopidogrel. RESULTS Among 13 miRNAs, miR-142 was accounting for 12.2% (p = 0.002) CYP3A4 mRNA variance and 9.4% (p = 0.005) CYP3A5 mRNA variance, respectively. Plasma miR-142 was negatively associated with H4 Cmax (r = -0.5269; p = 0.0040) and associated with H4 AUC0-4h (r = -0.4986; p = 0.0069) after 300 mg loading dose of clopidogrel in coronary heart disease patients. CONCLUSION miR-142 could account for a part of missing heritability of CYP3A4/5 functionality related to clopidogrel activation.
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Affiliation(s)
- Qian-Jie Tang
- School of Pharmacy, Guangdong Metabolic Diseases Research Center of Integrated Chinese & Western Medicine, Guangdong Pharmaceutical University, Guangzhou, China.,Medical Research Center of Guangdong General Hospital, Guangzhou, China
| | - Hao-Ming Lin
- Department of Biliary & Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guo-Dong He
- Medical Research Center of Guangdong General Hospital, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ju-E Liu
- Medical Research Center of Guangdong General Hospital, Guangzhou, China.,Department of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hong Wu
- Department of Biliary & Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin-Xin Li
- Medical Research Center of Guangdong General Hospital, Guangzhou, China
| | - Wan-Ping Zhong
- Medical Research Center of Guangdong General Hospital, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lan Tang
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Jin-Xiu Meng
- Medical Research Center of Guangdong General Hospital, Guangzhou, China
| | - Meng-Zhen Zhang
- Medical Research Center of Guangdong General Hospital, Guangzhou, China
| | - Han-Ping Li
- Medical Research Center of Guangdong General Hospital, Guangzhou, China
| | - Ji-Yan Chen
- Medical Research Center of Guangdong General Hospital, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shi-Long Zhong
- Medical Research Center of Guangdong General Hospital, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lai-You Wang
- School of Pharmacy, Guangdong Metabolic Diseases Research Center of Integrated Chinese & Western Medicine, Guangdong Pharmaceutical University, Guangzhou, China
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7
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Ford NF. The Metabolism of Clopidogrel: CYP2C19 Is a Minor Pathway. J Clin Pharmacol 2016; 56:1474-1483. [DOI: 10.1002/jcph.769] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/06/2016] [Accepted: 05/06/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Neville F. Ford
- Woodfield Clinical Consulting LLC; Green Valley AZ USA
- Rutgers-RWJ Medical School; New Brunswick NJ USA
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8
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Deshpande N, V S, V V RK, H V V M, M S, Banerjee R, Tandan M, D NR. Rapid and ultra-rapid metabolizers with CYP2C19*17 polymorphism do not respond to standard therapy with proton pump inhibitors. Meta Gene 2016; 9:159-64. [PMID: 27419077 PMCID: PMC4932617 DOI: 10.1016/j.mgene.2016.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/03/2016] [Accepted: 06/17/2016] [Indexed: 02/08/2023] Open
Abstract
Introduction and objective Polymorphisms in genes encoding drug metabolizing enzymes may lead to varied enzyme activity and inter-individual variability in drug efficacy and/or toxicity. Since CYP2C19 and CYP3A4 genes code for enzymes involved in metabolizing wide variety of drugs including proton pump inhibitors, we sought to identify polymorphisms in these genes in order to study their impact on drug metabolism in subjects. Methods DNA was isolated from healthy individuals including tribals and genotyped for 11 single nucleotide polymorphisms in CYP2C19 and 6 polymorphisms in CYP3A4. Individuals were categorized into different phenotypes based on their drug metabolizing genotype. Volunteers from each group were administered proton pump inhibitors (Esomeprazole, Pantoprazole; 40 mg/day) for 5 days followed by pharmacokinetic studies and measurement of intra-gastric pH. Results Of the 17 polymorphisms studied, only CYP2C19*2,*3,*17 and CYP3A4*1B polymorphisms were observed. In comparison to urban individuals, a significantly (p = 0.0003) higher number of poor metabolizers were noted in the tribal individuals. Pantoprazole was found to be most effective in poor metabolizers in terms of area under the curve and Tmax. No significant difference was observed in the intra-gastric pH at baseline and day 6 in rapid and ultra-rapid metabolizers. Conclusion Our study has demonstrated that 19.7% of our subjects are carriers of the CYP2C19*17 allele who did not respond to the standard dose of proton pump inhibitors. Genetic screening to identify subjects with variant alleles would thus be useful for personalization of therapy with proton pump inhibitors. Frequency of poor metabolizers varies significantly in two distinct ethnic groups studied. Subjects with CYP2C19*17 polymorphism are not responsive to standard PPI dose. Identifying individuals with these variants may aid in tailoring drug dose for hyper acidic conditions.
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Affiliation(s)
- Neha Deshpande
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
| | - Sharanya V
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
| | - Ravi Kanth V V
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
| | - Murthy H V V
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
| | - Sasikala M
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
| | - Rupa Banerjee
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
| | - Manu Tandan
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
| | - Nageshwar Reddy D
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, Telangana, India
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Birner P, Tchorbanov A, Natchev S, Tuettenberg J, Guentchev M. The chemokine receptor CXCR7 influences prognosis in human glioma in an IDH1-dependent manner. J Clin Pathol 2015; 68:830-4. [DOI: 10.1136/jclinpath-2015-202886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/28/2015] [Indexed: 12/28/2022]
Abstract
AimsThe chemokine receptor CXCR7 is found on glioma cells and glioma-associated vessels and dependent upon its localisation on tumour or endothelial cells the CXCR7 receptor can mediate glioma cell invasion and tumour angiogenesis. Its expression predicts survival in several types of cancers.MethodsWe immunohistochemically studied the expression of CXCR7 and its ligand SDF1α in a cohort of 354 human patients with glioma. In an in vivo glioma model, we studied the effect of selective CXCR7 inhibition on mean vascular density.ResultsHere we show that expression of either mutant isocitrate dehydrogenase (IDH) 1 or podoplanin (PDPN), two proteins present in basically non-overlapping glioma populations, predicts the prognostic significance of CXCR7. Specifically, expression of CXCR7 on endothelial cells in IDH1 mutant cases predicted poor outcome. Surprisingly, in PDPN expressing gliomas, one of the marker genes for the recently identified mesenchymal subgroup, expression of CXCR7 predicts diminished prognosis on tumour cells and better prognosis on endothelial cells.ConclusionsSince CXCR7 is expressed on migrating cells our data suggest that, although ubiquitously present, angiogenesis and invasion are outcome-relevant events in specific glioma subgroups, providing a potentially important tool for targeted therapy assignment.
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Leonard CE, Bilker WB, Brensinger CM, Flockhart DA, Freeman CP, Kasner SE, Kimmel SE, Hennessy S. Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors. Stroke 2015; 46:722-31. [PMID: 25657176 DOI: 10.1161/strokeaha.114.006866] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE There is controversy and little information about whether individual proton pump inhibitors (PPIs) differentially alter the effectiveness of clopidogrel in reducing ischemic stroke risk. We, therefore, aimed to elucidate the risk of ischemic stroke among concomitant users of clopidogrel and individual PPIs. METHODS We conducted a propensity score-adjusted cohort study of adult new users of clopidogrel, using 1999 to 2009 Medicaid claims from 5 large states. Exposures were defined by prescriptions for esomeprazole, lansoprazole, omeprazole, rabeprazole, and pantoprazole-with pantoprazole serving as the referent. The end point was hospitalization for acute ischemic stroke, defined by International Classification of Diseases Ninth Revision Clinical Modification codes in the principal position on inpatient claims, within 180 days of concomitant therapy initiation. RESULTS Among 325 559 concomitant users of clopidogrel and a PPI, we identified 1667 ischemic strokes for an annual incidence of 2.4% (95% confidence interval, 2.3-2.5). Adjusted hazard ratios for ischemic stroke versus pantoprazole were 0.98 (0.82-1.17) for esomeprazole; 1.06 (0.92-1.21) for lansoprazole; 0.98 (0.85-1.15) for omeprazole; and 0.85 (0.63-1.13) for rabeprazole. CONCLUSIONS PPIs of interest did not increase the rate of ischemic stroke among clopidogrel users when compared with pantoprazole, a PPI thought to be devoid of the potential to interact with clopidogrel.
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Affiliation(s)
- Charles E Leonard
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.).
| | - Warren B Bilker
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Colleen M Brensinger
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - David A Flockhart
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Cristin P Freeman
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Scott E Kasner
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Stephen E Kimmel
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
| | - Sean Hennessy
- From the Center for Clinical Epidemiology and Biostatistics (C.E.L., W.B.B., C.M.B., C.P.F., S.E. Kimmel, S.H.), Center for Pharmacoepidemiology Research and Training (C.E.L., W.B.B., D.A.F., C.P.F., S.E. Kimmel, S.H.), Department of Psychiatry (W.B.B.), Department of Neurology (S.E. Kasner), Division of Cardiovascular Medicine, Department of Medicine (S.E. Kimmel), and Department of Systems Pharmacology and Translational Therapeutics (S.H.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.A.F.)
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11
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Ford NF. Clopidogrel: What Is a Cardiologist to Do? J Clin Pharmacol 2014; 54:881-3. [DOI: 10.1002/jcph.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/09/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Neville F. Ford
- Woodfield Clinical Consulting LLC; 5481 S. Acacia Creek Drive Green Valley AZ 85622 USA
- Rutgers; RWJ School of Medicine; New Brunswick NJ 08901 USA
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Zhou JH, Liu BR. Proton pump inhibitors. Shijie Huaren Xiaohua Zazhi 2013; 21:3083-3088. [DOI: 10.11569/wcjd.v21.i29.3083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Proton pump inhibitors (PPIs) can bind to the proton pump and inhibit it to secrete hydrogen ions. Since currently used PPIs have a short plasma half-life and can interact with other drugs, there is still an urgent need to develop new and interesting PPIs that can overcome these problems. This review summarizes the latest progress in research of PPIs with regard to the mechanism of action, side effects, and interactions with other drugs and provides an update of the status of acid-suppression therapy.
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Ford NF, Taubert D. Clopidogrel, CYP2C19, and a Black Box. J Clin Pharmacol 2013; 53:241-8. [DOI: 10.1002/jcph.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/09/2012] [Indexed: 11/09/2022]
Affiliation(s)
| | - Dirk Taubert
- Department of Pharmacology; University Hospital of Cologne; Cologne; Germany
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14
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Relative Copy Number Variations of CYP2C19 in South Indian Population. Mol Biol Int 2012; 2012:643856. [PMID: 22792463 PMCID: PMC3389726 DOI: 10.1155/2012/643856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 04/28/2012] [Indexed: 01/19/2023] Open
Abstract
CYP2C19 is a polymorphic enzyme involved in the metabolism of clinically important drugs. Genotype-phenotype association studies of CYP2C19 have reported wide ranges in the metabolic ratios of its substrates. These discrepancies could be attributed to the variations in the promoter region and this aspect has been reported recently. The observations in the recent reports on the influence of promoter region variants on the metabolism of CYP2C19 substrates might also have been influenced by the copy number variations of CYP2C19. In this paper, we describe copy number variations of CYP2C19 using real-time polymerase chain reaction by comparative Ct method. No copy number variations were observed in the south Indian population indicating the observed discrepancies in genotype-phenotype association studies might be due to the regulatory region polymorphisms as reported earlier.
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Lin SL, Chang HM, Liu CP, Chou LP, Chan JW. Clinical evidence of interaction between clopidogrel and proton pump inhibitors. World J Cardiol 2011; 3:153-64. [PMID: 21666816 PMCID: PMC3110904 DOI: 10.4330/wjc.v3.i5.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 03/16/2011] [Accepted: 03/23/2011] [Indexed: 02/06/2023] Open
Abstract
Clopidogrel is approved for reduction of atherothrombotic events in patients with cardiovascular (CV) and cerebrovascular disease. Dual antiplatelet therapy with aspirin and clopidogrel decreases the risk of major adverse cardiac events after acute coronary syndrome or percutaneous coronary intervention, compared with aspirin alone. Due to concern about gastrointestinal bleeding in patients who are receiving clopidogrel and aspirin therapy, current guidelines recommend combined use of a proton pump inhibitor (PPI) to decrease the risk of bleeding. Data from previous pharmacological studies have shown that PPIs, which are extensively metabolized by the cytochrome system, may decrease the ADP-induced platelet aggregation of clopidogrel. Results from retrospective cohort studies have shown a higher incidence of major CV events in patients receiving both clopidogrel and PPIs than in those without PPIs. However, other retrospective analyses of randomized clinical trials have not shown that the concomitant PPI administration is associated with increased CV events among clopidogrel users. These controversial results suggest that large specific studies are needed. This article reviews the metabolism of clopidogrel and PPIs, existing clinical data regarding the interaction between clopidogrel and PPIs, and tries to provide recommendations for health care professionals.
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Affiliation(s)
- Shoa-Lin Lin
- Shoa-Lin Lin, Chun-Peng Liu, Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
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Grady BJ, Ritchie MD. Statistical Optimization of Pharmacogenomics Association Studies: Key Considerations from Study Design to Analysis. CURRENT PHARMACOGENOMICS AND PERSONALIZED MEDICINE 2011; 9:41-66. [PMID: 21887206 PMCID: PMC3163263 DOI: 10.2174/187569211794728805] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Research in human genetics and genetic epidemiology has grown significantly over the previous decade, particularly in the field of pharmacogenomics. Pharmacogenomics presents an opportunity for rapid translation of associated genetic polymorphisms into diagnostic measures or tests to guide therapy as part of a move towards personalized medicine. Expansion in genotyping technology has cleared the way for widespread use of whole-genome genotyping in the effort to identify novel biology and new genetic markers associated with pharmacokinetic and pharmacodynamic endpoints. With new technology and methodology regularly becoming available for use in genetic studies, a discussion on the application of such tools becomes necessary. In particular, quality control criteria have evolved with the use of GWAS as we have come to understand potential systematic errors which can be introduced into the data during genotyping. There have been several replicated pharmacogenomic associations, some of which have moved to the clinic to enact change in treatment decisions. These examples of translation illustrate the strength of evidence necessary to successfully and effectively translate a genetic discovery. In this review, the design of pharmacogenomic association studies is examined with the goal of optimizing the impact and utility of this research. Issues of ascertainment, genotyping, quality control, analysis and interpretation are considered.
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Affiliation(s)
- Benjamin J. Grady
- Department of Molecular Physiology & Biophysics, Center for Human Genetics Research, Vanderbilt University, Nashville, TN, USA
| | - Marylyn D. Ritchie
- Department of Molecular Physiology & Biophysics, Center for Human Genetics Research, Vanderbilt University, Nashville, TN, USA
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18
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Dolgin E. Behind the paper: Stepping up to the antiplatelet. Nat Med 2011; 17:42. [DOI: 10.1038/nm0111-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Reitman ZJ, Yan H. Isocitrate dehydrogenase 1 and 2 mutations in cancer: alterations at a crossroads of cellular metabolism. J Natl Cancer Inst 2010; 102:932-41. [PMID: 20513808 DOI: 10.1093/jnci/djq187] [Citation(s) in RCA: 378] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dysregulation of metabolism is a common phenomenon in cancer cells. The NADP(+)-dependent isocitrate dehydrogenases 1 and 2 (IDH1 and IDH2) function at a crossroads of cellular metabolism in lipid synthesis, cellular defense against oxidative stress, oxidative respiration, and oxygen-sensing signal transduction. We review the normal functions of the encoded enzymes, frequent mutations of IDH1 and IDH2 recently found in human cancers, and possible roles for the mutated enzymes in human disease. IDH1 and IDH2 mutations occur frequently in some types of World Health Organization grades 2-4 gliomas and in acute myeloid leukemias with normal karyotype. IDH1 and IDH2 mutations are remarkably specific to codons that encode conserved functionally important arginines in the active site of each enzyme. To date, all IDH1 mutations have been identified at the Arg132 codon. Mutations in IDH2 have been identified at the Arg140 codon, as well as at Arg172, which is aligned with IDH1 Arg132. IDH1 and IDH2 mutations are usually heterozygous in cancer, and they appear to confer a neomorphic enzyme activity for the enzymes to catalyze the production of D-2-hydroxyglutarate. Study of alterations in these metabolic enzymes may provide insights into the metabolism of cancer cells and uncover novel avenues for development of anticancer therapeutics.
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Affiliation(s)
- Zachary J Reitman
- Department of Pathology, The Pediatric Brain Tumor Foundation Institute, Duke University Medical Center, Durham, NC 27710, USA.
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Sofi F, Giusti B, Marcucci R, Gori AM, Abbate R, Gensini GF. Cytochrome P450 2C19*2 polymorphism and cardiovascular recurrences in patients taking clopidogrel: a meta-analysis. THE PHARMACOGENOMICS JOURNAL 2010; 11:199-206. [DOI: 10.1038/tpj.2010.21] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Lanas A. Inhibidores de la bomba de protones y clopidogrel en el paciente cardiovascular: ¿riesgo cardiovascular versus riesgo gastrointestinal? GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:1-5. [DOI: 10.1016/j.gastrohep.2009.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022]
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