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Hernandez M, Cullell N, Cendros M, Serra-Llovich A, Arranz MJ. Clinical Utility and Implementation of Pharmacogenomics for the Personalisation of Antipsychotic Treatments. Pharmaceutics 2024; 16:244. [PMID: 38399298 PMCID: PMC10893329 DOI: 10.3390/pharmaceutics16020244] [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: 12/27/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Decades of pharmacogenetic research have revealed genetic biomarkers of clinical response to antipsychotics. Genetic variants in antipsychotic targets, dopamine and serotonin receptors in particular, and in metabolic enzymes have been associated with the efficacy and toxicity of antipsychotic treatments. However, genetic prediction of antipsychotic response based on these biomarkers is far from accurate. Despite the clinical validity of these findings, the clinical utility remains unclear. Nevertheless, genetic information on CYP metabolic enzymes responsible for the biotransformation of most commercially available antipsychotics has proven to be effective for the personalisation of clinical dosing, resulting in a reduction of induced side effects and in an increase in efficacy. However, pharmacogenetic information is rarely used in psychiatric settings as a prescription aid. Lack of studies on cost-effectiveness, absence of clinical guidelines based on pharmacogenetic biomarkers for several commonly used antipsychotics, the cost of genetic testing and the delay in results delivery hamper the implementation of pharmacogenetic interventions in clinical settings. This narrative review will comment on the existing pharmacogenetic information, the clinical utility of pharmacogenetic findings, and their current and future implementations.
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Affiliation(s)
- Marta Hernandez
- PHAGEX Research Group, University Ramon Llull, 08022 Barcelona, Spain;
- School of Health Sciences Blanquerna, University Ramon Llull, 08022 Barcelona, Spain
| | - Natalia Cullell
- Fundació Docència i Recerca Mútua Terrassa, 08221 Terrassa, Spain; (N.C.); (A.S.-L.)
- Department of Neurology, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Marc Cendros
- EUGENOMIC Genómica y Farmacogenética, 08029 Barcelona, Spain;
| | | | - Maria J. Arranz
- PHAGEX Research Group, University Ramon Llull, 08022 Barcelona, Spain;
- Fundació Docència i Recerca Mútua Terrassa, 08221 Terrassa, Spain; (N.C.); (A.S.-L.)
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Hernandez MH, Bote V, Serra-LLovich A, Cendros M, Salazar J, Mestres C, Guijarro S, Alvarez A, Lamborena C, Mendez I, Sanchez B, Hervas A, Arranz MJ. CES1 and SLC6A2 Genetic Variants As Predictors of Response To Methylphenidate in Autism Spectrum Disorders. Pharmgenomics Pers Med 2022; 15:951-957. [DOI: 10.2147/pgpm.s377210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
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Arranz MJ, Salazar J, Bote V, Artigas-Baleri A, Serra-LLovich A, Triviño E, Roige J, Lombardia C, Cancino M, Hernandez M, Cendros M, Duran-Tauleria E, Maraver N, Hervas A. Pharmacogenetic Interventions Improve the Clinical Outcome of Treatment-Resistant Autistic Spectrum Disorder Sufferers. Pharmaceutics 2022; 14:999. [PMID: 35631585 PMCID: PMC9143818 DOI: 10.3390/pharmaceutics14050999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Autistic spectrum disorders (ASD) are severe neurodevelopmental alterations characterised by deficits in social communication and repetitive and restricted behaviours. About a third of patients receive pharmacological treatment for comorbid symptoms. However, 30-50% do not respond adequately and/or present severe and long-lasting side effects. METHODS Genetic variants in CYP1A2, CYP2C19, CYP2D6 and SLC6A4 were investigated in N = 42 ASD sufferers resistant to pharmacological treatment. Clinical recommendations based on their pharmacogenetic profiles were provided within 24-48 h of receiving a biological sample. RESULTS A total of 39 participants (93%) improved after the pharmacogenetic intervention according to their CGI scores (difference in basal-final scores: 2.26, SD 1.55) and 37 participants (88%) according to their CGAS scores (average improvement of 20.29, SD 11.85). Twenty-three of them (55%) achieved symptom stability (CGI ≤ 3 and CGAS improvement ≥ 20 points), requiring less frequent visits to their clinicians and hospital stays. Furthermore, the clinical improvement was higher than that observed in a control group (N = 62) with no pharmacogenetic interventions, in which 66% responded to treatment (difference in CGI scores: -0.87, SD 9.4, p = 1 × 10-5; difference in CGAS scores: 6.59, SD 7.76, p = 5 × 10-8). CONCLUSIONS The implementation of pharmacogenetic interventions has the potential to significantly improve the clinical outcomes in severe comorbid ASD populations with drug treatment resistance and poor prognosis.
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Affiliation(s)
- Maria J. Arranz
- Fundació Docència i Recerca Mútua Terrassa, 08221 Terrassa, Spain; (A.S.-L.); (M.H.); (M.C.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Juliana Salazar
- Translational Medical Oncology Laboratory, Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), 08041 Barcelona, Spain;
| | - Valentin Bote
- Department of Child Psychiatry, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (V.B.); (M.C.); (A.H.)
| | | | - Alexandre Serra-LLovich
- Fundació Docència i Recerca Mútua Terrassa, 08221 Terrassa, Spain; (A.S.-L.); (M.H.); (M.C.)
| | - Emma Triviño
- Genetics Department, Catlab, Viladecavalls, 08232 Barcelona, Spain; (E.T.); (J.R.); (C.L.)
| | - Jordi Roige
- Genetics Department, Catlab, Viladecavalls, 08232 Barcelona, Spain; (E.T.); (J.R.); (C.L.)
| | - Carlos Lombardia
- Genetics Department, Catlab, Viladecavalls, 08232 Barcelona, Spain; (E.T.); (J.R.); (C.L.)
| | - Martha Cancino
- Department of Child Psychiatry, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (V.B.); (M.C.); (A.H.)
| | - Marta Hernandez
- Fundació Docència i Recerca Mútua Terrassa, 08221 Terrassa, Spain; (A.S.-L.); (M.H.); (M.C.)
- School of Health Sciences Blanquerna, University Ramon Llull, 08024 Barcelona, Spain
| | - Marc Cendros
- Fundació Docència i Recerca Mútua Terrassa, 08221 Terrassa, Spain; (A.S.-L.); (M.H.); (M.C.)
- EUGENOMIC Genómica y Farmacogenética, 08029 Barcelona, Spain
| | - Enric Duran-Tauleria
- Institut Global d’Atenció Integral al Neurodesenvolupament (IGAIN), 08007 Barcelona, Spain; (E.D.-T.); (N.M.)
| | - Natalia Maraver
- Institut Global d’Atenció Integral al Neurodesenvolupament (IGAIN), 08007 Barcelona, Spain; (E.D.-T.); (N.M.)
| | - Amaia Hervas
- Department of Child Psychiatry, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (V.B.); (M.C.); (A.H.)
- Institut Global d’Atenció Integral al Neurodesenvolupament (IGAIN), 08007 Barcelona, Spain; (E.D.-T.); (N.M.)
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Saldarreaga Marin A, Cendros M, Ciudad CJ, Sabater A. Case Report: Fatigue and Bleeding in a Polymedicated Patient Using Several Herbal Supplementations, Detected with g-Nomic® Software. Pharmgenomics Pers Med 2021; 14:963-970. [PMID: 34408471 PMCID: PMC8367204 DOI: 10.2147/pgpm.s323463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
This was a case report of severe fatigue and bleeding in a 65-year-old man with ischemic heart disease who was wearing a stent and taking multiple medications for hypertension and diabetes. The use of a drug interaction and personalized prescription software (g-Nomic®) revealed potential interactions, involving acetylsalicylic acid and several non-pharmaceutical products including ginger, blueberry extracts, pineapple juice, docosahexaenoic acid and liquorice. Correction of these interactions resulted in complete remission of the reported side effects. This supports the idea that non-pharmaceuticals potentiated the effects of acetylsalicylic acid on haemostasis, producing the bleeding that would have caused fatigue. It is important to use appropriate tools to detect drug interactions that also take into account commonly used non-pharmaceutical products. Drug interactions can be considered illnesses by themselves.
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Affiliation(s)
- Abel Saldarreaga Marin
- Bahía de Cádiz-La Janda Health District, Mobile Emergency Unit of the Andalusian Health Care, Service of Cádiz, Cádiz, Spain
| | | | - Carlos J Ciudad
- Biochemistry and Molecular Biology Unit, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Ana Sabater
- Eugenomic, Barcelona, Spain
- Correspondence: Ana Sabater Eugenomic, c/ Londres 6, Barcelona, 08029, SpainTel +34-93-292-2963 Email
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Sabater A, Ciudad CJ, Cendros M, Dobrokhotov D, Sabater-Tobella J. g-Nomic: a new pharmacogenetics interpretation software. Pharmgenomics Pers Med 2019; 12:75-85. [PMID: 31239753 PMCID: PMC6554524 DOI: 10.2147/pgpm.s203585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/27/2019] [Indexed: 11/23/2022]
Abstract
We present g-Nomic, a pharmacogenetics interpretation software that analyzes globally a prescribed medication taking into account the personal background genetics, drug–drug interactions, lifestyle, nutritional supplements, inhibitors, inducers, and other risks to analyze primary or secondary metabolism pathways. G-Nomic provides a set of recommendations describing the suitability of a given combination of drugs for each patient according to their genes and polymedication. G-Nomic is updated monthly including data from the new drugs to be included, their known interactions, and the relevant pharmacokinetic biomarkers. For the interactions, the list is curated manually, only keeping those with clinical relevance. For each drug, their FDA and EMA drug labels are accessed, to check for relevant enzymes and transport proteins that influence its pharmacokinetics, and for their ability to induce or inhibit other enzymes, particularly the CYP-450 system. When this information is not available, a PubMed search is made to look for these characteristics. In addition, a distinction is made between drugs and prodrugs. A query on the g-Nomic software begins with entering the medication by either their common or commercial name. Non-pharmacological substances can be also added or selected under “lifestyle habits”. The lifestyle list is dynamic, showing only the substances known to interact with the drugs that are currently selected, and includes herb compounds, such as St. John’s wort, as well as proper lifestyle substances such as grapefruit or cigarette smoking. The software provides a list of the genes classified as primary biomarkers as candidates for genetic testing, and a list of the interactions that have been detected. If genetic information is available then, or is made available at a later point, these results can also be entered and the software returns pharmacogenetics recommendations regarding specific genotypes. g-Nomic takes all the above-mentioned parameters in an easy and user-friendly tool making prescription safer.
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Affiliation(s)
- Ana Sabater
- Department of Information Technology, EUGENOMIC, Barcelona 08012, Spain
| | - Carlos J Ciudad
- Department of Biochemistry and Physiology, University of Barcelona, Barcelona 08028, Spain
| | - Marc Cendros
- Department of Information Technology, EUGENOMIC, Barcelona 08012, Spain
| | - Denis Dobrokhotov
- Department of Information Technology, EUGENOMIC, Barcelona 08012, Spain
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