CYP2D6 genotyping and the clinical impact on outcomes in breast cancer tamoxifen-treated patients.

Aims: To report the distribution of allele frequencies of CYP2D6 gene and to evaluate their influence on the clinical outcomes of a group of breast cancer patients receiving adjuvant tamoxifen treatment from Uruguay. Patients & methods: 199 samples were genotyped through real-time polymerase chain reaction assays. Metabolization profiles were inferred from the genotypes. Correlations were evaluated using Pearson's χ2 test. Results: Phenotype frequencies were 0.65 normal (NM), 0.30 intermediate (IM) and 0.05 poor metabolizers (PM). Similar clinical outcomes between NM and (PM + IM) patient groups (odds ratio = 1.011, 95% CI = 0.2703-3.7826; p = 0.987) were found. Conclusion: CYP2D6 allele frequencies were analyzed for the first time in a cohort from Uruguay. Results did not support any impact of CYP2D6 gene polymorphisms on clinical outcomes.

An updated examination of the perception of barriers for pharmacogenomics implementation and the usefulness of drug/gene pairs in Latin America and the Caribbean.

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region's continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the "need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics". Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%-99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC.

Genetic and epigenetic characteristics of patients with colorectal cancer from Uruguay.

Colorectal cancer (CRC), the 3rd most frequent cancer worldwide, affects both men and women. This pathology arises from the progressive accumulation of genetic and epigenetic alterations. In this study, KRAS, NRAS, PIK3CA, and BRAF gene mutations, mismatch repair (MMR) genes methylation profile, microsatellite instability (MSI) and CpG Island Methylator Phenotype (CIMP) status were assessed. The associations of these molecular features with clinicopathological data were also investigated. A hundred and eight unselected CRC samples and their histological and clinical data, were gathered between 2017 and 2020. The prevalence of KRAS, NRAS and BRAF gene mutations was similar to that described in other populations. 28.7% of tumors were KRAS-mutated, mostly in men, distal location, with a CIMP-negative status. BRAFV600E frequency was 6.5% and associated with MSI (p = 0.048), MLH1-methylated (p < 0.001) and CIMP-High (p < 0.001) status. We also confirmed that BRAFV600E tumors were more prevalent in older women and proximal location. A striking different result was the lack of most common variants in the PIK3CA gene. A complete absence of PIK3CA-mutated tumors in a population has not been previously reported. Among MMR genes, the only with an aberrant methylation pattern was MLH1 gene. Its frequency was 9.25%, lower than previously reported. Methylated tumors were most frequent in patients older than 70 years old and proximal tumor location. Finally, CIMP-High status was mainly observed in moderately differentiated tumors with a rate of 15.7%. Our findings were consistent with previous reports in other populations, but also showed some features unique to our cohort. This study is the first to report the analysis of a large number molecular biomarkers of CRC in Uruguay and one of the few performed in Latin-America.

Activity of the Calcineurin Pathway in Patients on the Liver Transplantation Waiting List: Factors of Variability and Response to Tacrolimus Inhibition.

BACKGROUND: We sought to evaluate, in patients on a liver transplantation waiting list, potential biomarkers of the base calcineurin pathway activity with use of a new model of nonstimulated peripheral blood mononuclear cells (PBMC) and ex vivo response to tacrolimus (TAC). METHODS: The calcineurin pathway activity was explored ex vivo in stimulated and nonstimulated PBMC from 19 patients. The inhibition of NFAT1 translocation to PBMC nuclei, expression of intracellular IL-2, and membrane CD25 in different T-cell subsets were measured by multiparametric flow cytometry before and after exposure to TAC. We also studied the influence on the individual response of polymorphisms in 3 key genes of the calcineurin pathway: PPIA, PPP3CA, and IL2RA. RESULTS: All pharmacodynamics profiles closely fitted an I/Imax sigmoid model. Interindividual variability was higher in nonstimulated than in stimulated conditions, as well as in the presence of TAC. IL-2+CD8+ cells at TAC Imax showed the highest interindividual variability, suggesting its usefulness as a biomarker of individual TAC effects integrating many different sources of regulation and variability. Moreover, in the absence of TAC, patients with end-stage liver disease exhibited lower NFAT1 translocation and T-cell activation than healthy volunteers from a previous study under similar conditions. Multivariate statistical analysis showed strong and significant associations between TAC pharmacodynamic parameters and 2 polymorphisms in the gene-coding cyclophilin A (rs8177826 and rs6850). CONCLUSIONS: We show the feasibility of using nonstimulated PBMCs to explore the calcineurin pathway under more physiologic conditions and point toward potential biomarkers for TAC pharmacodynamic monitoring. ClinicalTrials.gov Identifier: NCT01760356.

Methotrexate pharmacogenetics in Uruguayan adults with hematological malignant diseases.

BACKGROUND: Individual variability is among the causes of toxicity and interruption of treatment in acute lymphoblastic leukemia (ALL) and severe non-Hodgkin lymphoma (NHL) patients under protocols including Methotrexate (MTX): 2,4-diamino-N10-methyl propyl-glutamic acid. METHODS: 41 Uruguayan patients were recruited. Gene polymorphisms involved in MTX pathway were analyzed and their association with treatment toxicities and outcome was evaluated. RESULTS: Genotype distribution and allele frequency were determined for SLC19A1 G80A, MTHFR C677T and A1298C, TYMS 28bp copy number variation, SLCO1B1 T521C, DHFR C-1610G/T, DHFR C-680A, DHFR A-317G and DHFR 19bp indel. Multivariate analysis showed that DHFR-1610G/T (OR=0.107, p=0.018) and MTHFR677T alleles (OR=0.12, p=0.026) had a strong protective effect against hematologic toxicity, while DHFR-1610CC genotype increased this toxicity (OR=9, p=0.045). No more associations were found. CONCLUSIONS: The associations found between gene polymorphisms and toxicities in this small cohort are encouraging for a more extensive research to gain a better dose individualization in adult ALL and NHL patients. Besides, genotype distribution showed to be different from other populations, reinforcing the idea that genotype data from other populations should not be extrapolated to ours.

Molecular characterization of genes modifying the age at onset in Huntington's disease in Uruguayan patients.

Huntington's disease (HD) is a hereditary neurodegenerative disorder. The genetic cause is an expansion of CAG repeats located in the IT15 gene. Though the number of CAG repeats ((CAG)n) can largely explain the age at onset (AAO) of symptoms, a percentage of its variation could be attributed to modifier genes and to environmental factors. The study aimed to evaluate the influence of genetic modifiers of the AAO of HD including: (CAG)n and del2642 in the IT15 gene, ADORA2A rs5751876, HAP1 rs4523977, PGC1-α rs7665116 and UCH-L1 rs5030732. Eighteen patients with positive family history and HD-suggestive symptoms were recruited. The (CAG)n and gene polymorphisms were determined by different molecular biology techniques. We observed that the (CAG)n influenced in a 64.5% of the variability in the AAO. We also showed that the rs5751876 variant significantly affected this variability. However, the influence of UCH-L1, del2642, HAP1 and PGC1-α gene polymorphisms could not be replicated, perhaps due to small sample size. Genetic studies including the molecular determination of (CAG)n, in addition to other genetic modifiers involved in the variability of the AAO, were first performed in Uruguay. We could replicate in our cohort the anticipation effect on the AAO by the ADORA2A rs5751876. Our results confirm the usefulness of an expanded molecular characterization in HD patients.

Biological studies in animal models using [99mTc](CO)3 recombinant annexin V as diagnostic agent of apoptotic processes.

INTRODUCTION: There are many diseases associated with variations in the expression of apoptosis such as organ rejection after transplantation, myocardial ischemia or infarct and neurodegenerative diseases. For this reason, the early visualization of this process is relevant to set fast and effective therapeutic strategies. METHODS: The precursor was prepared according to the procedure reported by R. Alberto, R. Schibli, P. Schubiger, U. Abram, and T. Kaden [Reactions with the technetium and rhenium carbonyl complexes (NEt(4))[MX(3)(CO)(3)]. Synthesis and structure of Tc(CN-But)(3)(CO)(3)](NO(3)) and (Net(4))[Tc(2)(µ-SCH(2)CH(2)OH)(3)(CO)(3)], Polyhedron 1996;15: 1079-89]. Recombinant annexin V was incubated with [(99m)Tc](H(2)O)3(CO)(3)(+) solution, previously neutralized with buffer. Biodistribution studies were performed in 8-week-old female Wistar rats. Animals were housed and treated in compliance with institutional guidelines related to animal experimentation. Work protocol was previously approved by the Animal Ethics Committee of the university. Two groups of rats were defined. One was used as control and the other group was previously injected with 150 mg/kg ip of cyclophosphamide to induce apoptosis. RESULTS: The synthesis of carbonyl precursor achieved yields higher than 90%, and the radiolabeled protein was obtained with 92% of radiochemical purity and high stability in vitro. An important uptake in apoptotic tissues was confirmed by biodistributions, scintigraphic images and histological studies. CONCLUSIONS: Biodistribution studies revealed hepatobiliary elimination, high stability in vivo and important uptake in the reticuloendothelial system. In the pathologic model, higher uptake values correspond to the liver, spleen, lungs and femur. Histological studies confirmed the development of apoptosis at 8 and 24 h postinduction in the spleen and lymphocyte bulks in the peribronchial area. Scintigraphic images confirmed high uptake both the spleen and the lungs.

Farmacogenética y reacción adversa a medicamentos: valor predictivo delpolimorfismo en el gen de la uridindifosfato glucuronosil transferasa 1A1 / Farmacogenetics and adverse reaction to drugs: predictive value of polymorphism in the uridine diphosphate glucoronosyltransferase 1A1 gene

Introducción: las reacciones adversas a medicamentos constituyen un problema fundamental para los servicios de salud, la industria farmacéutica y los organismos reguladores. Gran parte de estas reacciones son relativamente leves y desaparecen al modificar la dosis, pero otras son más graves, pudiendo llegar a la muerte del individuo. El irinotecán es un agentecitotóxico activo en cáncer colorrectal y pulmonar. Está asociado a una severa toxicidad hematológica y gastrointestinal, impredecibles en la práctica. Su metabolito activo (SN-38)es detoxificado mediante la enzima UDP-glucuronosiltransferasa-1A1 (UGT1A1). La variación en la actividad de esta enzima ha sido relacionada con polimorfismos en el gen UGT1A1, produciendo los efectos adversos observados. El polimorfismo más importante se presenta en la región promotora y consiste en un número variable de repeticiones timinaadenina.El alelo mayoritario tiene seis repeticiones (TA)6, siendo el polimorfismo de siete repeticiones la variante alélica más frecuente.Objetivo: diseño de un ensayo molecular para el estudio de las variantes alélicas de la región promotora del gen UGT1A1.Material y método: se seleccionó un grupo de 50 voluntarios sin vínculo familiar. Las determinaciones moleculares se realizaron mediante amplificación y posterior secuenciaciónde la región promotora. Resultados y conclusiones: se logró la puesta a punto del diagnóstico molecular propuesto yse determinó que 8% de esa población es homocigoto (TA)7. Planteamos la ventaja de incorporar los resultados de este ensayo molecular en la toma de decisiones terapéuticas y así tender a una farmacoterapia personalizada en medicina oncológica.

Introduction: adverse reactions to drugs constitute an essential problem for health services, the pharmaceuticalindustry and the regulatory bodies. Most of these reactions are relatively mild and they disappear when dosageis modified, although others are more serious and they may result in death. Irinotecan is an active cytotoxic agentin colorectal and lung cancer. It is associated to severe hematological and gastrointestinal toxicity, unpredictablein practice. Its active metabolite (SN-38) is detoxified by the uridine diphosphate glucoronosyltransferase1A1enzyme (UGT1A1). (UGT1A1). Variation in the activity of this enzyme has been associated to polymorphismsin the UGT1A1 gene, what results in the adverse reactions observed. The most important polymorphisms appearin the polymorphism of the promoting region, which consists in a variable repetition of thymine-adenine repetitions. The main allele has six repetitions (TA)6, being the seven repetition polymorphism the most frequent allelic variant. Objetive: to design a molecular test to study allelicvariants of the promoting region in the UGT1A1 gene. Method: We selected a group of 50 volunteers with no family bonds. Amplification and subsequent sequencing of the promoting region were used to determine molecules.Results: we managed to update the suggested molecular diagnosis and determined that 8% of this populationis a homozygote (TA)7. We propose the advantage of incorporating the results of this molecular test for the making of therapeutic decisions and thus make progress toward a more personalized oncologic medicine.

Introdução: as reações adversas a medicamentos são um problema importante para os serviços de saúde, a indústria farmacêutica e os organismos reguladores. Muitas destas reações são relativamente leves e desaparecem com a modificação da dose, porém outras são mais graves podendo levar à morte do paciente. O irinotecan é um agentecitotóxico ativo em câncer colorretal e pulmonar. Está associado à toxicidade hematológica e gastrointestinal grave, imprevisível na prática. Seu metabólito ativo (SN-38) é detoxificado pela enzima UDP-glucuronosiltransferase-1A1 (UGT1A1). A variação da atividade desta enzima foi relacionada com polimorfismos no gene UGT1A1,produzindo os efeitos adversos observados. O polimorfismo mais importante se apresenta na região promotora e consiste num número variável de repetições timinaadenina.O alelo mais numeroso tem seis repetições (TA)6, sendo que o polimorfismo de sete repetições é a variante alélica mais frequente.Objetivo: projeto de um ensaio molecular para estudar as variantes dos alelos da região promotora do geneUGT1A1. Material e método: um grupo de 50 voluntários sem vínculo familiar foi selecionado. As determinações moleculares foram realizadas por amplificação e posterior seqüenciação da região promotora. Resultados e conclusões: foi possível realizar o diagnóstico molecular proposto e determinar que 8% da população estudada era homozigota. (TA)7. Discutimos a vantagem de incorporar os resultados deste ensaio molecularna tomada de decisões terapêuticas e dessa forma estabelecer uma tendência à farmacoterapia personalizadaem oncologia.