Pharmacogenomics of thiopurines: distribution of TPMT and NUDT15 polymorphisms in the Brazilian Amazon (original) (raw)
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Pharmacogenetics of thiopurines: can posology be guided by laboratory data?
Radiol, 2004
Background. The purpose of this study was to investigate the relationships between the presence of mutations in the TPMT gene, the consequent reduced enzymatic activity, and the clinical toxicity of the treatment with thiopurine antimetabolite drugs. Materials and methods. The study was performed on 44 patients with inflammatory bowel disease treated with AZA. DNA was extracted from blood samples collected from each patient, and genotyping was performed using specific polymerase chain reaction assays in order to detect the three more frequent mutations of the gene. Enzymatic activity was measured on red blood cell lysates by HPLC. Results. Among the subjects, 4 (9.0%) were heterozygous for mutations in the TPMT gene; no subject was homozygous for mutations in the TPMT gene. A complete concordance between TPMT mutated genotype and reduced enzymatic activity could be determined. The incidence of toxicity in the subjects with a mutated genotype was not different from that observed in the patients with a normal TPMT gene. Conclusion. Genotyping methods provide a simple and reliable DNA-based strategy to identify TPMT homozygotes that should avoid thiopurines administration. However, it seems that the most common, less dangerous forms of thiopurine toxicity could be caused by factors different from TPMT gene mutations examined.
Clinical Pharmacology & Therapeutics, 2019
Thiopurine methyltransferase (TPMT) activity exhibits a monogenic codominant inheritance and catabolizes thiopurines. TPMT variant alleles are associated with low enzyme activity and pronounced pharmacologic effects of thiopurines. Loss-of-function alleles in the NUDT15 gene are common in Asians and Hispanics and reduce the degradation of active thiopurine nucleotide metabolites, also predisposing to myelosuppression. We provide recommendations for adjusting starting doses of azathioprine, mercaptopurine, and thioguanine based on TPMT and NUDT15 genotypes (updates on www.cpicpgx.org). This document is an update to the Clinical Implementation Consortium (CPIC) Guidelines for Thiopurine Methyltransferase Genotype and Thiopurine guideline updated last in April 2013. The guideline text, evidence table, and recommendations have been updated to reflect new evidence. Specifically, this guideline adds a recommendation for NUDT15 genotype with minor changes to the TPMT recommendations. Although most of the dosing recommendations have been generated from clinical studies in just a few diseases, we have extrapolated recommended doses to all conditions, given the pharmacokinetic nature of the genotype/phenotype associations. CPIC guidelines are published and periodically updated on www.cpicpgx.org. Detailed guidelines for use of phenotypic tests (e.g., TPMT activity and thiopurine metabolite levels) as well as analyses of cost-effectiveness are beyond the scope of this document.
Distribution of Genetic Polymorphisms of Genes Implicated in Thiopurine Drugs Metabolism
Therapeutic Drug Monitoring, 2018
Thiopurine-S-methyltransferase (TPMT) and inosine triphosphate pyrophosphatase (ITPA) are crucial enzymes involved in the metabolism of thiopurine drugs. Significant interethnic variation in the expression of TPMT and ITPA is caused by single nucleotide polymorphisms of genes encoding these proteins. The aim of this study was to describe the distribution of TPMT and ITPA polymorphisms in healthy Tunisian subjects and to establish the metabolizer status of thiopurine drugs in this population. A total of 309 healthy Tunisian subjects were recruited among blood donors of Fattouma Bourguiba Hospital of Monastir. A written informed consent was obtained from all subjects. Whole blood samples were collected from every subject in ethylenediaminetetraacetic acid tubes. TPMT (c.238 G. C, c.460 G. A and c.719A. G) and ITPA (c.94C. A and IVS2+21A. C) mutations were genotyped using polymerase chain reaction-restriction fragment length polymorphism. The observed frequencies of TPMT*3A and TPMT*3C alleles were both 0.8%. The phenotype distribution of TPMT was bimodal: 96.8% of subjects were extensive metabolizers and 3.2% were intermediate metabolizers. Genotyping of ITPA revealed frequencies of 9% and 3% for IVS2+21A. C and c.94C. A mutations, respectively. Accordingly, a trimodal phenotype distribution was found: 75.4% of the subjects were extensive metabolizers, 23.4% were intermediate metabolizers, and 1.2% wereslow metabolizers. Combination of TPMT and ITPA genotyping has revealed that a quarter of the Tunisian Population carries polymorphisms that reduce the metabolic activities of these enzymes.
[Frequency of thiopurine S-methyltransferase alleles in different ethnic groups living in Spain]
Medicina clínica, 2006
Thiopurine S-methyltransferase (TPMT) metabolizes thiopurine drugs regulating their cytotoxicity and clinical response. TPMT activity is inherited as an autosomal recessive trait and several mutations in the TPMT gene have been identified which correlate with a low activity phenotype. A variable number of tandem repeat within the TPMT promoter has been reported to modulate the levels of this enzyme activity. The allelic variants of the TPMT gene were analyzed in ethnic groups living in Spain. The frequency of 4 allelic variants of the TPMT gene as well as the genotype in the promoter region were analyzed in 138 Spanish blood donors, 95 gypsies and 51 Basque subjects. In the group of 138 blood donors, we identified: 13 carriers of a mutated TPMT allele (*3A, *3B, *3C), one homozygous TPMT*3B and a compound heterozygote (TPMT*3A/TPMT*3B). In the Basque group, 3 subjects were TPMT*3A carriers and one case was a TPMT*3B heterozygote. In the gypsy group one subject carried a TPMT*3A alle...
Genetic polymorphism of thiopurine S-methyltransferase in Argentina
Annals of Clinical Biochemistry, 2003
Background Thiopurine methyltransferase (TPMT) catalyses the S-methylation of 6-thiopurine drugs, which are commonly used in the treatment of autoimmune diseases, leukaemia and organ transplantation. TPMT activity is polymorphic as a result of gene mutations. Ethnic variations in phenotype and genotype have been identified in previous population studies, but no information was available within Latin-American populations.
Pharmacogenomics of Thiopurine S-Methyltransferase: Clinical Applicability of Genetic Variants
Clinical Applications of Pharmacogenetics, 2012
Here, we provide an overview of the genetic variants of thiopurine S-methyltransferase (TPMT) gene that influence inter-individual dosing of thiopurine drugs, to highlight a tangible benefit of translating genomic knowledge into clinical practice. Particular single nucleotide polymorphisms (SNPs) in TPMT g e n e h a v e p r o v e n t o b e a p p l i c a b l e f o r optimising the dosage in pursuit of maximum efficacy and minimum adverse effects. Thus,
Aim: We investigated candidate genes associated with thiopurine metabolism and clinical response in childhood acute lymphoblastic leukemia. Materials & methods: We performed genome-wide SNP association studies of 6-thioguanine and 6-mercaptopurine cytotoxicity using lymphoblastoid cell lines. We then genotyped the top SNPs associated with lymphoblastoid cell line cytotoxicity, together with tagSNPs for genes in the ‘thiopurine pathway’ (686 total SNPs), in DNA from 589 Caucasian UK ALL97 patients. Functional validation studies were performed by siRNA knockdown in cancer cell lines. Results: SNPs in the thiopurine pathway genes ABCC4, ABCC5, IMPDH1, ITPA, SLC28A3 and XDH, and SNPs located within or near ATP6AP2, FRMD4B, GNG2, KCNMA1 and NME1, were associated with clinical response and measures of thiopurine metabolism. Functional validation showed shifts in cytotoxicity for these genes. Conclusion: The clinical response to thiopurines may be regulated by variation in known thiopurine pathway genes and additional novel genes outside of the thiopurine pathway.
Thiopurine methyltransferase phenotypes and genotypes in Brazilians
Pharmacogenetics, 2003
The polymorphism of thiopurine methyltransferase (TPMT) was studied in 306 healthy Brazilians who were classed, on the basis of self-declared colour and ancestry, as Euroderived (n 81), Afro-derived (n 18) or having interethnic admixture (n 204). TPMT activity (range 0.17-25.93 U) displayed a trimodal distribution of high (> 11.3 U; 9% of individuals), intermediate (5-11.3 U; 9.8%) and low (0.17 U; 0.3%) phenotypes. The occurrence of the TPMT mutations 238G>C, 460G>A and 719A>G was investigated in all individuals with low or intermediate phenotype, and in 43 with high-activity phenotype. None and two mutant alleles were associated with high-or low-activity phenotypes, respectively, whereas one mutant allele was detected in 26 of the 30 intermediate phenotype individuals. The allele frequencies of TPMT Ã 2, TPMT Ã 3A and TPMT Ã 3C did not differ between individuals classed as Euro-derived (0.76%, 2.03% and 2.54%, respectively) or having interethnic admixture (0.60%, 1.81% and 1.81%, respectively). Furthermore, within each of these groups, the frequencies of TPMT Ã 3A and TPMT Ã 3C were not significantly different.
Thiopurine S-methyltransferase pharmacogenetics: variant allele functional and comparative genomics
Pharmacogenetics and Genomics, 2005
The thiopurine S-methyltransferase (TPMT) genetic polymorphism is one of the most 'mature' examples in pharmacogenetics. That is true because of its importance clinically for the individualization of thiopurine drug therapy and also because TPMT has provided novel insights into molecular mechanisms responsible for the functional effects of common genetic polymorphisms. This review will summarize the development of our understanding of the role of inheritance in the regulation of TPMT as well as the clinical implications of that genetic regulation. It will also summarize recent studies in which TPMT pharmacogenetics has enhanced our understanding of molecular mechanisms by which common polymorphisms influence or alter function. TPMT pharmacogenetics highlights the potential clinical importance of the translation of pharmacogenetics from bench to bedside, the potential for basic pharmacogenetic research to provide insight into mechanisms by which genetic polymorphisms can alter function, and the challenges associated with the achievement of both of those goals.