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Truby LK, Maamari D, Saha A, Farr M, Abdulrahim J, Billia F, Peltz M, Khush KK, Wang TJ. Towards Allograft Longevity: Leveraging Omics Technologies to Improve Heart Transplant Outcomes. Curr Heart Fail Rep 2023; 20:493-503. [PMID: 37966542 DOI: 10.1007/s11897-023-00631-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Heart transplantation (HT) remains the optimal therapy for patients living with end-stage heart disease. Despite recent improvements in peri-transplant management, the median survival after HT has remained relatively static, and complications of HT, including infection, rejection, and allograft dysfunction, continue to impact quality of life and long-term survival. RECENT FINDINGS Omics technologies are becoming increasingly accessible and can identify novel biomarkers for, and reveal the underlying biology of, several disease states. While some technologies, such as gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA), are routinely used in the clinical care of HT recipients, a number of emerging platforms, including pharmacogenomics, proteomics, and metabolomics, hold great potential for identifying biomarkers to aid in the diagnosis and management of post-transplant complications. Omics-based assays can improve patient and allograft longevity by facilitating a personalized and precision approach to post-HT care. The following article is a contemporary review of the current and future opportunities to leverage omics technologies, including genomics, transcriptomics, proteomics, and metabolomics in the field of HT.
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Affiliation(s)
- Lauren K Truby
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Dimitri Maamari
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amit Saha
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Maryjane Farr
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | | | | | - Matthias Peltz
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Kiran K Khush
- Stanford University Medical Center, Palo Alto, CA, USA
| | - Thomas J Wang
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
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Brady A, Misra S, Abdelmalek M, Kekic A, Kunze K, Lim E, Jakob N, Mour G, Keddis MT. The Value of Pharmacogenomics for White and Indigenous Americans after Kidney Transplantation. Pharmacy (Basel) 2023; 11:125. [PMID: 37624080 PMCID: PMC10457738 DOI: 10.3390/pharmacy11040125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND There is a paucity of evidence to inform the value of pharmacogenomic (PGx) results in patients after kidney transplant and how these results differ between Indigenous Americans and Whites. This study aims to identify the frequency of recommended medication changes based on PGx results and compare the pharmacogenomic (PGx) results and patients' perceptions of the findings between a cohort of Indigenous American and White kidney transplant recipients. METHODS Thirty-one Indigenous Americans and fifty White kidney transplant recipients were studied prospectively. Genetic variants were identified using the OneOme RightMed PGx test of 27 genes. PGx pharmacist generated a report of the genetic variation and recommended changes. Pre- and post-qualitative patient surveys were obtained. RESULTS White and Indigenous American subjects had a similar mean number of medications at the time of PGx testing (mean 13 (SD 4.5)). In the entire cohort, 53% received beta blockers, 30% received antidepressants, 16% anticoagulation, 47% pain medication, and 25% statin therapy. Drug-gene interactions that warranted a clinical action were present in 21.5% of patients. In 12.7%, monitoring was recommended. Compared to the Whites, the Indigenous American patients had more normal CYP2C19 (p = 0.012) and CYP2D6 (p = 0.012) activities. The Indigenous American patients had more normal CYP4F2 (p = 0.004) and lower VKORC (p = 0.041) activities, phenotypes for warfarin drug dosing, and efficacy compared to the Whites. SLC6A4, which affects antidepressant metabolism, showed statistical differences between the two cohorts (p = 0.017); specifically, SLC6A4 had reduced expression in 45% of the Indigenous American patients compared to 20% of the White patients. There was no significant difference in patient perception before and after PGx. CONCLUSIONS Kidney transplant recipients had several drug-gene interactions that were clinically actionable; over one-third of patients were likely to benefit from changes in medications or drug doses based on the PGx results. The Indigenous American patients differed in the expression of drug-metabolizing enzymes and drug transporters from the White patients.
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Affiliation(s)
- Alexandra Brady
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Suman Misra
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mina Abdelmalek
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Adrijana Kekic
- Department of Pharmacy Clinical Practice, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Katie Kunze
- Department of Statistics, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Elisabeth Lim
- Department of Statistics, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Nicholas Jakob
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Girish Mour
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mira T. Keddis
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
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Vigia E, Ramalhete L, Ribeiro R, Barros I, Chumbinho B, Filipe E, Pena A, Bicho L, Nobre A, Carrelha S, Sobral M, Lamelas J, Coelho JS, Ferreira A, Marques HP. Pancreas Rejection in the Artificial Intelligence Era: New Tool for Signal Patients at Risk. J Pers Med 2023; 13:1071. [PMID: 37511684 PMCID: PMC10381793 DOI: 10.3390/jpm13071071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Pancreas transplantation is currently the only treatment that can re-establish normal endocrine pancreatic function. Despite all efforts, pancreas allograft survival and rejection remain major clinical problems. The purpose of this study was to identify features that could signal patients at risk of pancreas allograft rejection. METHODS We collected 74 features from 79 patients who underwent simultaneous pancreas-kidney transplantation (SPK) and used two widely-applicable classification methods, the Naive Bayesian Classifier and Support Vector Machine, to build predictive models. We used the area under the receiver operating characteristic curve and classification accuracy to evaluate the predictive performance via leave-one-out cross-validation. RESULTS Rejection events were identified in 13 SPK patients (17.8%). In feature selection approach, it was possible to identify 10 features, namely: previous treatment for diabetes mellitus with long-term Insulin (U/I/day), type of dialysis (peritoneal dialysis, hemodialysis, or pre-emptive), de novo DSA, vPRA_Pre-Transplant (%), donor blood glucose, pancreas donor risk index (pDRI), recipient height, dialysis time (days), warm ischemia (minutes), recipient of intensive care (days). The results showed that the Naive Bayes and Support Vector Machine classifiers prediction performed very well, with an AUROC and classification accuracy of 0.97 and 0.87, respectively, in the first model and 0.96 and 0.94 in the second model. CONCLUSION Our results indicated that it is feasible to develop successful classifiers for the prediction of graft rejection. The Naive Bayesian generated nomogram can be used for rejection probability prediction, thus supporting clinical decision making.
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Affiliation(s)
- Emanuel Vigia
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Luís Ramalhete
- Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Blood and Transplantation Center of Lisbon, Instituto Português do Sangue e da Transplantação, Alameda das Linhas de Torres, n 117, 1769-001 Lisbon, Portugal
- iNOVA4Health, Advancing Precision Medicine, RG11, Reno-Vascular Diseases Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Rita Ribeiro
- Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Inês Barros
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Beatriz Chumbinho
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Edite Filipe
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Ana Pena
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Luís Bicho
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Ana Nobre
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Sofia Carrelha
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Mafalda Sobral
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Jorge Lamelas
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - João Santos Coelho
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Aníbal Ferreira
- iNOVA4Health, Advancing Precision Medicine, RG11, Reno-Vascular Diseases Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Nephrology, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
| | - Hugo Pinto Marques
- Hepatobiliopancreatic and Transplantation Center, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, R. da Beneficência 8, 1050-099 Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
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Morris SA, Nguyen DG, Patel JN. Pharmacogenomics in allogeneic hematopoietic stem cell transplantation: Implications on supportive therapies and conditioning regimens. Best Pract Res Clin Haematol 2023; 36:101470. [PMID: 37353294 DOI: 10.1016/j.beha.2023.101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/25/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation mortality has declined over the years, though prevention and management of treatment-related toxicities and post-transplant complications remains challenging. Applications of pharmacogenomic testing can potentially mitigate adverse drug outcomes due to interindividual variability in drug metabolism and response. This review summarizes clinical pharmacogenomic applications relevant to hematopoietic stem cell transplantation, including antifungals, immunosuppressants, and supportive care management, as well as emerging pharmacogenomic evidence with conditioning regimens.
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Affiliation(s)
- Sarah A Morris
- Department of Cancer Pharmacology & Pharmacogenomics Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - D Grace Nguyen
- Department of Cancer Pharmacology & Pharmacogenomics Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - Jai N Patel
- Department of Cancer Pharmacology & Pharmacogenomics Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
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Udomkarnjananun S, Francke MI, De Winter BCM, Mulder MB, Baan CC, Metselaar HJ, den Hoed CM, Hesselink DA. Therapeutic drug monitoring of immunosuppressive drugs in hepatology and gastroenterology. Best Pract Res Clin Gastroenterol 2021; 54-55:101756. [PMID: 34874840 DOI: 10.1016/j.bpg.2021.101756] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 01/31/2023]
Abstract
Immunosuppressive drugs have been key to the success of liver transplantation and are essential components of the treatment of inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH). For many but not all immunosuppressants, therapeutic drug monitoring (TDM) is recommended to guide therapy. In this article, the rationale and evidence for TDM of tacrolimus, mycophenolic acid, the mammalian target of rapamycin inhibitors, and azathioprine in liver transplantation, IBD, and AIH is reviewed. New developments, including algorithm-based/computer-assisted immunosuppressant dosing, measurement of immunosuppressants in alternative matrices for whole blood, and pharmacodynamic monitoring of these agents is discussed. It is expected that these novel techniques will be incorporate into the standard TDM in the next few years.
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