Pharmacogenetic testing improves treatment responses in patients with PLA2R-related membranous nephropathy / 南方医科大学学报

OBJECTIVE@#To evaluate the value of pharmacogenetic testing for improving the efficacy and safety of treatment with cyclosporine, tacrolimus, and cyclophosphamide (CTX) for PLA2R-related membranous nephropathy and for determing individualized and precise treatment plans for the patients.@*METHODS@#A total of 63 patients with PLA2R-related membranous nephropathy hospitalized in the Department of Nephrology at our hospital from January, 2019 to October, 2021 were enrolled in this study. Thirty-three of the patients underwent pharmacogenetic testing before taking the immunosuppressive drugs selected based on the results of genetic screening for sensitive targets, and the other 30 patients were empirically given immunosuppressive drugs according to the guidelines (control group). The clinical efficacy and adverse effects of the immunosuppressive drugs were analyzed for all the patients. The two groups of patients were compared for demographic and biochemical parameters including 24-h urine protein, serum albumin, renal function, and serum anti-phospholipase A2 receptor antibody both before and at 3 months after the beginning of the treatment.@*RESULTS@#Among the 33 patients undergoing pharmacogenetic testing, 51.5% showed a GG genotype for cyclosporine, and 61.6% had an AG genotype for tacrolimus; for CTX, 51.5% of the patients showed a homozygous deletion and 63.6% had an AA genotype. After treatment for 3 months, serum anti-phospholipase A2 receptor antibody, 24-h urine protein, and serum albumin levels were significantly improved in pharmacogenetic testing group as compared with the control group (P < 0.05).@*CONCLUSION@#Individualized and precise administration of immunosuppressive drugs based on pharmacogenetic testing better controls proteinuria and serum antiphospholipase A2 receptor antibodies and increases serum albumin level in patients with PLA2R-related membranous nephropathy.

Strengthening the Reporting of Pharmacogenetic Studies (STROPS) guideline / 中华流行病学杂志

Pharmacogenetic studies are designed to investigate the associations between genetic variation and treatment response for a particular drug in terms of both efficacy and adverse events and have high sample size requirements. To improve the quality of pharmacogenetic studies and facilitate the Meta-analyses to investigate statistically significant associations, Strengthening the Reporting of Pharmacogenetic Studies (STROPS) guideline was developed in 2020 based on the Strengthening the Reporting of Genetic Association Studies (STREGA) statement. The objective of this article is to present a brief introduction to the STROPS guideline and an interpretation of the key points in some items with examples for the better understanding and application.

¿Qué lineamientos bioéticos y biojurídicos se deben seguir al realizar pruebas farmacogenéticas y farmacogenómicas en ensayos clínicos de psiquiatría en Colombia para proteger los datos genéticos y los derechos de los sujetos de investigación? / Which bioethical and bio-legal guidelines should be followed when performing pharmacogenetic and pharmacogenomic tests in psychiatry clinical trials in Colombia, to protect genetic data and the rights of research subjects?

RESUMEN El presente artículo es el resultado de una investigación, desde las perspectivas bioética y biojurídica, acerca de los lineamientos existentes en Colombia para el manejo de las pruebas farmacogenómicas y farmacogenéticas en los ensayos clínicos. La revisión de la legislación existente en nuestro medio se comparó con estándares internacionales y los propuestos por organismos supranacionales. Se encontró que en Colombia falta una regulación específica en esta área, lo que expone a una serie de riesgos bioéticos y jurídicos a los participantes e investigadores. No se deben subestimar estos riesgos, pues comprometen la viabilidad ética de la investigación clínica y básica en nuestro medio. Al final, desde la perspectiva de la ética de los principios, se proponen una serie de acciones para la creación y la promoción a escala nacional de lineamientos que sirvan para conformar una legislación aplicable a la protección de los datos genéticos y, por ende, los derechos de los sujetos que participan en esta clase de estudios de investigación en Colombia.

ABSTRACT This paper is the result of research, from the bioethics and bio-legal perspectives, on the existing guidelines in Colombia for the handling of pharmacogenomic and pharmacogenetic tests in clinical trials. Colombian legislation on this kind of research was reviewed and then compared with international and supranational standards. It was found that Colombia lacks specific legislation in this area, a situation that puts both participants and researchers at risk, from bioethical and legal perspectives. These risks should not be underestimated, as they compromise the ethical viability of clinical and basic research in our setting. In the end, a proposal, based on principles of ethics is made, proposing a series of actions for the creation and promotion nationwide of guidelines which can be used to shape legislation to be applied to protect the genetic data and the rights of subjects participating in these types of research studies in Colombia.

CYP450 y farmacogenética en Guatemala. Revisión narrativa / CYP450 and pharmacogenetics in Guatemala. Narrative review

El proyecto HapMap ha generado información y preguntas sobre la diversidad genética en las distintas poblaciones del mundo. En las últimas décadas, proyectos como la elucidación del genoma del mestizo mexicano han revelado las distancias genéticas entre mestizos y amerindios en México. Cerca de 20 genes son actualmente estudiados en paneles comerciales asociados al metabolismo de fármacos, uno de ellos el gen que expresa la enzima CY P2C19, la cual metaboliza cerca de 26 fármacos de importancia clínica. El objetivo fue revisar la literatura científica en Google Scholar, PubMed y ScienceDirect que reporta resultados sobre estudios farmacogenéticos en Guatemala, otros que presentan hallazgos sobre distancias genéticas en el guatemalteco y se compara con lo que se conoce de otras poblaciones del continente y el mundo, haciendo énfasis en CY P2C19. El mestizaje en Guatemala fue único, por ello es importante investigar sus variantes alélicas asociadas al metabolismo de fármacos, para permitir una terapéutica más efectiva y segura que mejore la calidad de vida del guatemalteco.

The HapMap project has generated information and queries about genetic diversity in the different populations around the world. In recent decades, research projects such as the elucidation of the genome of the Mexican Mestizo, have exposed the genetic distances between mestizos and Amerindians in Mexico. About 20 genes are currently studied in commercial panels associated with drug metabolism. One of them CY P2C19, that expresses the CY P2C19 enzyme, that metabolizes about 26 drugs of clinical importance. The objective was to review the scientific literature in Google Scholar, PubMed and ScienceDirect that reports results on pharmacogenetic studies in Guatemala, others that presented findings over genetic distances in Guatemala, as well as a comparison with the knowledge about other populations of the continent and world, with emphasis in CY P2C19 gen. Miscegenation in Guatemala was unique and is important to investigate the Guatemalan allelic variants associated with drug metabolism to allow a more effective and safe therapeutic and improve their quality of life.

Manual de intervención de las brigadas móviles urbanas. Subvención VIH - fondo mundial / Manual of intervention of urban mobile brigades. HIV grant - global fund

La publicación es un documento técnico que constituye un instrumento de gestión que regula y ordena el trabajo que se desarrolla en el marco de la estrategia de oferta móvil del Ministerio de Salud (MINSA), la cual pretende acercar servicios de testeo de VIH con calidad y calidez a un mayor número de personas gays u hombres que tienen sexo con hombres sin identidad romo/bisexual (HSH) y mujeres trans (MT), quienes constituyen las poblaciones más impactadas y vulnerables frente a la epidemia del VIH. El presente documento está dividido en cuatro partes. La primera, describe un panorama actualizado del escenario del VIH en el Perú, con datos epidemiológicos, una aproximación documentada sobre la cascada o continuo de la atención en VIH, así como las barreras que existen para alcanzar los pilares que la sostienen. La segunda, da cuenta de las experiencias que han precedido la actual intervención de las Brigadas Móviles Urbanas (BMU), para luego arribar a la justificación de la continuidad de la oferta móvil. La tercera, establece los objetivos de las BMU, así como el rol que corresponde desempeñar al sector salud. La cuarta y última parte, desarrolla cada una de las cinco fases de intervención del modelo de las BMU,

Pharmacogenetic Correlates of Antipsychotic-Induced Weight Gain in the Chinese Population / 神经科学通报·英文版

Antipsychotic-induced weight gain (AIWG) is a common adverse effect of this treatment, particularly with second-generation antipsychotics, and it is a major health problem around the world. We aimed to review the progress of pharmacogenetic studies on AIWG in the Chinese population to compare the results for Chinese with other ethnic populations, identify the limitations and problems of current studies, and provide future research directions in China. Both English and Chinese electronic databases were searched to identify eligible studies. We determined that > 25 single-nucleotide polymorphisms in 19 genes have been investigated in association with AIWG in Chinese patients over the past few decades. HTR2C rs3813929 is the most frequently studied single-nucleotide polymorphism, and it seems to be the most strongly associated with AIWG in the Chinese population. However, many genes that have been reported to be associated with AIWG in other ethnic populations have not been included in Chinese studies. To explain the pharmacogenetic reasons for AIWG in the Chinese population, genome-wide association studies and multiple-center, standard, unified, and large samples are needed.

Taking advantage of drug resistance, a new approach in the war on cancer / 医学前沿

Identification of the driver mutations in cancer has resulted in the development of a new category of molecularly targeted anti-cancer drugs. However, as was the case with conventional chemotherapies, the effectiveness of these drugs is limited by the emergence of drug-resistant variants. While most cancer therapies are given in combinations that are designed to avoid drug resistance, we discuss here therapeutic approaches that take advantage of the changes in cancer cells that arise upon development of drug resistance. This approach is based on notion that drug resistance comes at a fitness cost to the cancer cell that can be exploited for therapeutic benefit.We discuss the development of sequential drug therapies in which the first therapy is not given with curative intent, but to induce a major new sensitivity that can be targeted with a second drug that selectively targets the acquired vulnerability. This concept of collateral sensitivity has hitherto not been used on a large scale in the clinic and holds great promise for future cancer therapy.

Pharmacogenetic testing in oncology: a Brazilian perspective

Pharmacogenetics, a major component of individualized or precision medicine, relies on human genetic diversity. The remarkable developments in sequencing technologies have revealed that the number of genetic variants modulating drug action is much higher than previously thought and that a true personalized prediction of drug response requires attention to rare mutations (minor allele frequency, MAF<1%) in addition to polymorphisms (MAF>1%) in pharmacogenes. This has major implications for the conceptual development and clinical implementation of pharmacogenetics. Drugs used in cancer treatment have been major targets of pharmacogenetics studies, encompassing both germline polymorphisms and somatic variants in the tumor genome. The present overview, however, has a narrower scope and is focused on germline cancer pharmacogenetics, more specifically, on drug/gene pairs for which pharmacogenetics-informed prescription guidelines have been published by the Clinical Pharmacogenetics Implementation Consortium and/or the Dutch Pharmacogenetic Working Group, namely, thiopurines/TPMT, fluoropyrimidines/UGT1A1, irinotecan/UGT1A1 and tamoxifen/CYP2D6. I begin by reviewing the general principles of pharmacogenetics-informed prescription, pharmacogenetics testing and the perceived barriers to the adoption of routine pharmacogenetics testing in clinical practice. Then, I highlight aspects of the pharmacogenetics testing of the selected drug-gene pairs and finally present pharmacogenetics data from Brazilian studies pertinent to these drug-gene pairs. I conclude with the notion that pharmacogenetics testing has the potential to greatly benefit patients by enabling precision medicine applied to drug therapy, ensuring better efficacy and reducing the risk of adverse effects.

Pharmacogenetic implications in the management of metabolic diseases in Brazilian populations

Dyslipidemia, diabetes, obesity and hypertension are common metabolic diseases. In the last decades, unhealthy lifestyle and aging have leads to an increased incidence of these diseases, increasing morbidity and mortality by cardiovascular causes. The treatment of metabolic diseases includes life-style interventions as healthy diet and physical exercise, as well as pharmacological interventions. Several drugs are available for the management of metabolic diseases including among others lipid-lowering antidiabetics and antihypertensive drugs. Variability in response to these drugs is influenced by both genetic and non-genetic factors. Polymorphisms in genes related to drug pharmacokinetics and pharmacodynamics have been shown to influence drug efficacy and safety. This review is focused on pharmacogenetic studies related to the management of metabolic diseases in samples of the Brazilian population. Associations of variants in drug metabolizing enzymes and transporters, drug target and metabolism-related genes with the efficacy and safety of lipid-lowering, antidiabetic and antihypertensive drugs are described. Most pharmacogenetic studies in Brazil have focused in pharmacological response to a small group of drugs, as statins and some antihypertensives, while there are almost no studies on antidiabetic and antiobesity drugs. Some studies reported significant associations of gene polymorphisms with drug response confirming previous data from other populations, whereas other works did not replicate, which may relay on the genetic admixture of our population. In conclusion, further studies are necessary considering larger sample sizes, new unexplored drugs and more genetic variants to obtain stronger conclusions to explore clinical applications of pharmacogenetic studies in our population.

Clinical Pharmacogenetic Testing and Application: Laboratory Medicine Clinical Practice Guidelines

Pharmacogenetic testing for clinical applications is steadily increasing. Correct and adequate use of pharmacogenetic tests is important to reduce unnecessary medical costs and adverse patient outcomes. This document contains recommended pharmacogenetic testing guidelines for clinical application, interpretation, and result reporting through a literature review and evidence-based expert opinions for the clinical pharmacogenetic testing covered by public medical insurance in Korea. This document aims to improve the utility of pharmacogenetic testing in routine clinical settings.

Impact of the beta-1 adrenergic receptor polymorphism on tolerability and efficacy of bisoprolol therapy in Korean heart failure patients: association between beta adrenergic receptor polymorphism and bisoprolol therapy in heart failure (ABBA) study

BACKGROUND/AIMS: We evaluated the association between coding region variants of adrenergic receptor genes and therapeutic effect in patients with congestive heart failure (CHF). METHODS: One hundred patients with stable CHF (left ventricular ejection fraction [LVEF] < 45%) were enrolled. Enrolled patients started 1.25 mg bisoprolol treatment once daily, then up-titrated to the maximally tolerable dose, at which they were treated for 1 year. RESULTS: Genotypic analysis was carried out, but the results were blinded to the investigators throughout the study period. At position 389 of the beta-1 adrenergic receptor gene (ADRB1), the observed minor Gly allele frequency (Gly389Arg + Gly389Gly) was 0.21, and no deviation from Hardy-Weinberg equilibrium was observed in the genotypic distribution of Arg389Gly (p = 0.75). Heart rate was reduced from 80.8 +/- 14.3 to 70.0 +/- 15.0 beats per minute (p < 0.0001). There was no significant difference in final heart rate across genotypes. However, the Arg389Arg genotype group required significantly more bisoprolol compared to the Gly389X (Gly389Arg + Gly389Gly) group (5.26 +/- 2.62 mg vs. 3.96 +/- 2.05 mg, p = 0.022). There were no significant differences in LVEF changes or remodeling between two groups. Also, changes in exercise capacity and brain natriuretic peptide level were not significant. However, interestingly, there was a two-fold higher rate of readmission (21.2% vs. 10.0%, p = 0.162) and one CHF-related death in the Arg389Arg group. CONCLUSIONS: The ADRB1 Gly389X genotype showed greater response to bisoprolol than the Arg389Arg genotype, suggesting the potential of individually tailoring beta-blocker therapy according to genotype.

Genotipo de los genes VKORC1 y CYP2C9 en la respuesta individual a la warfarina / Genotype of the VKORC1 and CYP2C9 genes in individual response to warfarin

Introducción: la warfarina es un fármaco ampliamente utilizado como anticoagulante oral. Su estrecho rango terapéutico y marcada variabilidad interindividual en la respuesta requieren un control riguroso en su administración para evitar accidentes hemorrágicos. Objetivos: correlacionar las variantes genéticas de CYP2C9*2 y *3 y VKORC1 (C1173T) con la respuesta y los efectos adversos. Material y método: los genotipos CYP2C9*1, *2, *3, y VKORC1 fueron obtenidos por PCR-RFLP y los resultados analizados usando el paquete estadístico SPSS 12.0. Resultados: hay una tendencia a la reducción de dosis en relación con la presencia de alelos polimórficos. Los portadores de CYP2C9*3 requirieron la menor dosis de mantenimiento, seguidos por los portadores de CYP2C9*2 y homocigotos CYP2C9 *1, en ese orden, (4,4±1,0 vesus 5,4±2,3 versus 7,0±3,6 mg/d, p=0,03). Los portadores CYP2C9*3 tuvieron, además, un aumento del riesgo de sobreanticoagulación y requirieron casi el doble de ajustes de dosis para lograr una adecuada anticoagulación. Para VKORC1, los homocigotas T/T necesitaron la dosis más baja, seguidos por los heterocigotas C/T y homocigotas C/C, en ese orden (3,6±0,6 versus 5,5±0,5 y 7,9±0,7 mg/d, p <0,001). Los pacientes T/T tuvieron un mayor riesgo de sobreanticoagulación que los C/T y C/C. El genotipo T/T de VKORC1 produce en todas las combinaciones con CYP2C9 una disminución cercana a 50% de la dosis diaria de warfarina. Conclusiones: se confirma una sensibilidad aumentada a la warfarina en pacientes portadores de alelos *2 y *3 de CYP2C9, y T de VKORC1. Se demuestra un efecto combinado (aproximadamente aditivo) de los alelos variantes de ambos genes.

Summary Introduction: warfarin is a widely used oral anticoagulant. Its narrow therapeutic range (NTR) and its large interindividual variability requires strict control when administered to avoid hemorrhagic accidents. Objectives: to correlate CYP2C9*2 and *3 and VKORC1 (C1173T) genetic variants with response and adverse side effects. Method: CYP2C9*1, *2, *3, and VKORC1 genotypes were obtained by a commonly used PCR-RFLP procedure. The results were analyzed using SPSS 12.0. statistical package. Results: there is a tendency to reduce the dosage in connection with the presence of polymorphic alleles. CYP2C9*3 carriers require the lower maintenance dosage, followed by CYP2C9*2 carriers and then by CYP2C9 *1 homozygotes (4.4±1.0 versus 5.4±2.3 versus 7.0±3.6 mg/d, p=0.03). CYP2C9*3 carriers also showed an increase in the anticoagulation risk, which required almost twice the number of dose adjustments to achieve appropriate anticoagulation. As to VKORC1, T/T homozygotes needed the lowest dose, followed by the C/T heterozygotes, and then by the C/C homozygotes (3.6±0.6 versus 5.5±0.5 and 7.9±0.7 mg/d, p <0,001). Risk of overcoagulation was higher in T/T patients than in C/T or C/C patients. T/T genotype of VKORC1 causes a decrease of nearly 50% in the warfarine daily dosage for all combinations with CYP2C9. Conclusions: we confirmed an increased sensitivity to warfarine in patient carriers of *2 and *3 CYP2C9 alleles and T VKORC1 alleles. We showed a combined effect (approximately accumulative) of variant alleles in both genes.

Résumé Introduction: la warfarine est une drogue très utilisée comme anticoagulant oral. Étant donné son restreint rang thérapeutique et sa remarquable variabilité interindividuelle, un contrôle rigoureux du dosage s’avère indispensable afin d’éviter des accidents hémorragiques. Objectifs: mettre en rapport les variantes génétiques de CYP2C9*2 et *3 et VKORC1 (C1173T) avec la réponse et les effets adverses. Matériel et méthode: les génotypes CYP2C9*1,*2,*3, et VKORC1 résultent par PCR-RFLP et les résultats analysés au moyen du paquet statistique SPSS 12.0. Résultats: il existe une tendance à réduire la dose par la présence d’allèles polymorphiques. Les porteurs de CYP2C9*3 ont requis une dose plus basse de maintien, puis les porteurs de CYP2C9*2 et homozygotes CYP2C9*1, dans cet ordre, (4,4±1,0 versus 7,0±3,6 mg/d, p=0,03). Les porteurs CYP2C9*3 ont aussi subi une augmentation du risque de suranticoagulation et ont requis presque le double d’ajustement de la dose pour atteindre une anticoagulation adéquate. Pour VKORC1, les homozygotes T/T ont requis une dose plus basse, suivis des hétérozygotes C/T et des homozygotes C/C, dans cet ordre (3,6±0,6 versus 5,5±0,5 et 7,9±0,7 mg/d, p <0,001). Les patients T/T ont subi un plus grand risque de suranticoagulation que les C/T et C/C. Le génotype T/T de VKORC1 provoque dans toutes les combinaisons avec CYP2C9 une diminution de 50% environ de la dose par jour de warfarine. Conclusions: on confirme une sensibilité augmentée à la warfarine chez les patients porteurs d’allèles *2 et *3 de CYP2C9, et T de VKORC1. Un effet combiné (à peu près aditif) des allèles variantes des deux gènes reste évident.

Resumo Introdução: a warfarina é uma droga muito usada como anticoagulante oral. Sua administração deve ser controlada rigorosamente para evitar acidentes hemorrágicos devido a uma aplicação terapêutica restrita e a variação da resposta individual. Objetivos: correlacionar as variantes genéticas de CYP2C9*2 e *3 y VKORC1 (C1173T) com a resposta e os efeitos adversos. Material e método: os genótipos CYP2C9*1, *2, *3, e VKORC1 foram obtidos por PCR-RFLP e os resultados foram analisados usando o programa SPSS 12.0. Resultados: observa-se uma tendência à redução da dose na presença de alelos polimórficos. Os portadores de CYP2C9*3 necessitam doses de manutenção mais baixas, seguidos pelos portadores de CYP2C9*2 e homozigotos CYP2C9 *1 (4,4±1,0 versus 5,4±2,3 versus 7,0±3,6 mg/d, p=0,03). Os portadores de CYP2C9*3 apresentaram também um aumento do risco de sobreanticoagulaçao e necessitam o dobro do número de ajustes de dose para obter uma anticoagulaçao adequada. Para VKORC1, os homozigotos T/T necessitaram a dose mais baixa, seguidos pelos heterozigotos C/T e homozigotos C/C (3,6±0,6 versus 5,5±0,5 y 7,9±0,7 mg/d, p <0,001). Os pacientes T/T apresentaram um risco maior de sobreanticoagulação que os C/T e C/C. O genótipo T/T de VKORC1 produz uma redução de aproximadamente 50% da dose diária de warfarina em todas as combinações com CYP2C9. Conclusões: confirma-se a sensibilidade aumentada à warfarina de pacientes portadores de alelos *2 y *3 de CYP2C9, e T de VKORC1. Demonstram-se um efeito combinado (aproximadamente aditivo) dos alelos variantes de ambos os genes.