Phenotype-genotype analysis of CYP2C19 in Colombian mestizo individuals

Carlos Isaza, Julieta Henao, José H Isaza Martínez, Juan C Sepúlveda Arias, Leonardo Beltrán, Carlos Isaza, Julieta Henao, José H Isaza Martínez, Juan C Sepúlveda Arias, Leonardo Beltrán

Abstract

Background: Omeprazole is metabolized by the hepatic cytochrome P450 (CYP) 2C19 enzyme to 5-hydroxyomeprazole. CYP2C19 exhibits genetic polymorphisms responsible for the presence of poor metabolizers (PMs), intermediate metabolizers (IMs) and extensive metabolizers (EMs). The defective mutations of the enzyme and their frequencies change between different ethnic groups; however, the polymorphism of the CYP2C19 gene has not been studied in Colombian mestizos. The aim of this study was to evaluate the genotype and phenotype status of CYP2C19 in Colombian mestizos, in order to contribute to the use of appropriate strategies of drug therapy for this population.

Methods: 189 subjects were genotyped using the multiplex SNaPshot technique and a subgroup of 44 individuals received 20 mg of omeprazole followed by blood collection at 3 hours to determine the omeprazole hydroxylation index by HPLC.

Results: 83.6%, 15.3% and 1.1% of the subjects were genotyped as EMs, IMs and PMs, respectively. The frequencies of the CYP2C29*1 and CYP2C19*2 alleles were 91.3% and 8.7% respectively whereas the *3, *4, *5, *6 and *8 alleles were not found. No discrepancies were found between the genotype and phenotype of CYP2C19.

Conclusion: The frequency of poor metabolizers (1.1%) in the Colombian mestizos included in this study is similar to that in Bolivian mestizos (1%) but lower than in Mexican-Americans (3.2%), West Mexicans (6%), Caucasians (5%) and African Americans (5.4%). The results of this study will be useful for drug dosage recommendations in Colombian mestizos.

Figures

Figure 1
Figure 1
Frequency distribution of the hydroxylation indexes of Omeprazole in Colombian mestizos. The arrow shows the antimode (0.63). Individuals with an MR ≥ 0.63 were phenotyped as PMs.
Figure 2
Figure 2
Probit plot obtained by curve fitting of the log MR data from 44 healthy volunteers. The analysis revealed bimodality with the intersecting point at X = 0.63.

References

    1. Meyer UA, Zanger UM. Molecular mechanisms of genetic polymorphisms of drug metabolism. Annu Rev Pharmacol Toxicol. 1997;37:269–296. doi: 10.1146/annurev.pharmtox.37.1.269.
    1. Desta Z, Zhao X, Shin JG, Flockhart DA. Clinical significance of the cytochrome P450 2C19 genetic polymorphism. Clin Pharmacokinet. 2002;41:913–958. doi: 10.2165/00003088-200241120-00002.
    1. Yamazaki H, Inoue K, Shaw PM, Checovich WJ, Guengerich FP, Shimada T. Different contributions of cytochrome P450 2C19 and 3A4 in the oxidation of omeprazole by human liver microsomes: effects of contents of these two forms in individual human samples. J Pharmacol Exp Ther. 1997;283:434–442.
    1. Brosen K, de Morais SM, Meyer UA, Goldstein JA. A multifamily study on the relationship between CYP2C19 genotype and s-mephenytoin oxidation phenotype. Pharmacogenetics. 1995;5:312–317. doi: 10.1097/00008571-199510000-00007.
    1. Garcia-Barcelo M, Chow LY, Kum Chiu HF, Wing YK, Shing Lee DT, Lam KL, Waye MM. Frequencies of defective CYP2C19 alleles in a Hong Kong Chinese population: detection of the rare allele CYP2C19*4. Clin Chem. 1999;45:2273–2274.
    1. Ibeanu GC, Blaisdell J, Ferguson RJ, Ghanayem BI, Brosen K, Benhamou S, Bouchardy C, Wilkinson GR, Dayer P, Goldstein JA. A novel transversion in the intron 5 donor splice junction of CYP2C19 and a sequence polymorphism in exon 3 contribute to the poor metabolizer phenotype for the anticonvulsant drug S-mephenytoin. J Pharmacol Exp Ther. 1999;290:635–640.
    1. Ferguson RJ, De Morais SM, Benhamou S, Bouchardy C, Blaisdell J, Ibeanu G, Wilkinson GR, Sarich TC, Wright JM, Dayer P, et al. A new genetic defect in human CYP2C19: mutation of the initiation codon is responsible for poor metabolism of S-mephenytoin. J Pharmacol Exp Ther. 1998;284:356–361.
    1. Ibeanu GC, Goldstein JA, Meyer U, Benhamou S, Bouchardy C, Dayer P, Ghanayem BI, Blaisdell J. Identification of new human CYP2C19 alleles (CYP2C19*6 and CYP2C19*2B) in a Caucasian poor metabolizer of mephenytoin. J Pharmacol Exp Ther. 1998;286:1490–1495.
    1. Xiao ZS, Goldstein JA, Xie HG, Blaisdell J, Wang W, Jiang CH, Yan FX, He N, Huang SL, Xu ZH, et al. Differences in the incidence of the CYP2C19 polymorphism affecting the S-mephenytoin phenotype in Chinese Han and Bai populations and identification of a new rare CYP2C19 mutant allele. J Pharmacol Exp Ther. 1997;281:604–609.
    1. Xie HG, Kim RB, Stein CM, Wilkinson GR, Wood AJ. Genetic polymorphism of (S)-mephenytoin 4'-hydroxylation in populations of African descent. Br J Clin Pharmacol. 1999;48:402–408. doi: 10.1046/j.1365-2125.1999.00009.x.
    1. Blaisdell J, Mohrenweiser H, Jackson J, Ferguson S, Coulter S, Chanas B, Xi T, Ghanayem B, Goldstein JA. Identification and functional characterization of new potentially defective alleles of human CYP2C19. Pharmacogenetics. 2002;12:703–711. doi: 10.1097/00008571-200212000-00004.
    1. Furuta T, Shirai N, Xiao F, Ohashi K, Ishizaki T. Effect of high-dose lansoprazole on intragastic pH in subjects who are homozygous extensive metabolizers of cytochrome P4502C19. Clin Pharmacol Ther. 2001;70:484–492.
    1. Kita T, Sakaeda T, Aoyama N, Sakai T, Kawahara Y, Kasuga M, Okumura K. Optimal dose of omeprazole for CYP2C19 extensive metabolizers in anti-Helicobacter pylori therapy: pharmacokinetic considerations. Biol Pharm Bull. 2002;25:923–927. doi: 10.1248/bpb.25.923.
    1. Sapone A, Vaira D, Trespidi S, Perna F, Gatta L, Tampieri A, Ricci C, Cantelli-Forti G, Miglioli M, Biagi GL, et al. The clinical role of cytochrome p450 genotypes in Helicobacter pylori management. Am J Gastroenterol. 2003;98:1010–1015. doi: 10.1111/j.1572-0241.2003.07427.x.
    1. Kawamura M, Ohara S, Koike T, Iijima K, Suzuki J, Kayaba S, Noguchi K, Hamada S, Noguchi M, Shimosegawa T. The effects of lansoprazole on erosive reflux oesophagitis are influenced by CYP2C19 polymorphism. Aliment Pharmacol Ther. 2003;17:965–973. doi: 10.1046/j.1365-2036.2003.01539.x.
    1. Kawabata H, Habu Y, Tomioka H, Kutsumi H, Kobayashi M, Oyasu K, Hayakumo T, Mizuno S, Kiyota K, Nakajima M, et al. Effect of different proton pump inhibitors, differences in CYP2C19 genotype and antibiotic resistance on the eradication rate of Helicobacter pylori infection by a 1-week regimen of proton pump inhibitor, amoxicillin and clarithromycin. Aliment Pharmacol Ther. 2003;17:259–264. doi: 10.1046/j.1365-2036.2003.01406.x.
    1. Klotz U. Clinical impact of CYP2C19 polymorphism on the action of proton pump inhibitors: a review of a special problem. Int J Clin Pharmacol Ther. 2006;44:297–302.
    1. Furuta T, Shirai N, Sugimoto M, Ohashi K, Ishizaki T. Pharmacogenomics of proton pump inhibitors. Pharmacogenomics. 2004;5:181–202. doi: 10.1517/phgs.5.2.181.27483.
    1. Take S, Mizuno M, Ishiki K, Nagahara Y, Yoshida T, Inaba T, Yamamoto K, Okada H, Yokota K, Oguma K, et al. Interleukin-1beta genetic polymorphism influences the effect of cytochrome P 2C19 genotype on the cure rate of 1-week triple therapy for Helicobacter pylori infection. Am J Gastroenterol. 2003;98:2403–2408.
    1. Miki I, Aoyama N, Sakai T, Shirasaka D, Wambura CM, Maekawa S, Kuroda K, Tamura T, Kita T, Sakaeda T, et al. Impact of clarithromycin resistance and CYP2C19 genetic polymorphism on treatment efficacy of Helicobacter pylori infection with lansoprazole- or rabeprazole-based triple therapy in Japan. Eur J Gastroenterol Hepatol. 2003;15:27–33. doi: 10.1097/00042737-200301000-00006.
    1. Kimura M, Ieiri I, Wada Y, Mamiya K, Urae A, Iimori E, Sakai T, Otsubo K, Higuchi S. Reliability of the omeprazole hydroxylation index for CYP2C19 phenotyping: possible effect of age, liver disease and length of therapy. Br J Clin Pharmacol. 1999;47:115–119. doi: 10.1046/j.1365-2125.1999.00858.x.
    1. Gonzalez HM, Romero EM, Peregrina AA, de JCT, Escobar-Islas E, Lozano F, Hoyo-Vadillo C. CYP2C19- and CYP3A4-dependent omeprazole metabolism in West Mexicans. J Clin Pharmacol. 2003;43:1211–1215. doi: 10.1177/0091270003258170.
    1. Chong E, Ensom MH. Pharmacogenetics of the proton pump inhibitors: a systematic review. Pharmacotherapy. 2003;23:460–471. doi: 10.1592/phco.23.4.460.32128.
    1. Arango R, Sanchez E. Los pueblos indígenas de Colombia (Guía etnográfica de Colombia para actividades de planeación) DNP P: Departamento Nacional de Planeación; 1988.
    1. Tamminga WJ, Wemer J, Oosterhuis B, Brakenhoff JP, Gerrits MG, de Zeeuw RA, de Leij LF, Jonkman JH. An optimized methodology for combined phenotyping and genotyping on CYP2D6 and CYP2C19. Eur J Clin Pharmacol. 2001;57:143–146. doi: 10.1007/s002280100273.
    1. Bender K. SNaPshot for pharmacogenetics by minisequencing. Methods Mol Biol. 2005;297:243–252.
    1. Tanigawara Y, Kita T, Hirono M, Sakaeda T, Komada F, Okumura K. Identification of N-acetyltransferase 2 and CYP2C19 genotypes for hair, buccal cell swabs, or fingernails compared with blood. Ther Drug Monit. 2001;23:341–346. doi: 10.1097/00007691-200108000-00004.
    1. Morita J, Kobayashi K, Wanibuchi A, Kimura M, Irie S, Ishizaki T, Chiba K. A novel single nucleotide polymorphism (SNP) of the CYP2C19 gene in a Japanese subject with lowered capacity of mephobarbital 4'-hydroxylation. Drug Metab Pharmacokinet. 2004;19:236–238. doi: 10.2133/dmpk.19.236.
    1. Gonzalez HM, Romero EM, Chavez Tde J, Peregrina AA, Quezada V, Hoyo-Vadillo C. Phenotype of CYP2C19 and CYP3A4 by determination of omeprazole and its two main metabolites in plasma using liquid chromatography with liquid-liquid extraction. J Chromatogr B Analyt Technol Biomed Life Sci. 2002;780:459–465. doi: 10.1016/S1570-0232(02)00573-1.
    1. Kortunay S, Basci NE, Bozkurt A, Isimer A, Sayal A, Kayaalp SO. The hydroxylation of omeprazole correlates with S-mephenytoin and proguanil metabolism. Eur J Clin Pharmacol. 1997;53:261–264. doi: 10.1007/s002280050373.
    1. Relling MV, Giacomini KM. Pharmacogenetics. In: Brunton LL, Lazo JS, Parker KL, editor. Goodman and Gilman's, The Pharmacological Basis of Therapeutics. 11. McGraw Hill; 2006. pp. 93–117.
    1. Luo HR, Poland RE, Lin KM, Wan YJ. Genetic polymorphism of cytochrome P450 2C19 in Mexican Americans: a cross-ethnic comparative study. Clin Pharmacol Ther. 2006;80:33–40. doi: 10.1016/j.clpt.2006.03.003.
    1. Xie HG, Stein CM, Kim RB, Wilkinson GR, Flockhart DA, Wood AJ. Allelic, genotypic and phenotypic distributions of S-mephenytoin 4'-hydroxylase (CYP2C19) in healthy Caucasian populations of European descent throughout the world. Pharmacogenetics. 1999;9:539–549.
    1. Inaba T, Jorge LF, Arias TD. Mephenytoin hydroxylation in the Cuna Amerindians of Panama. Br J Clin Pharmacol. 1988;25:75–79.
    1. Bravo-Villalta HV, Yamamoto K, Nakamura K, Baya A, Okada Y, Horiuchi R. Genetic polymorphism of CYP2C9 and CYP2C19 in a Bolivian population: an investigative and comparative study. Eur J Clin Pharmacol. 2005;61:179–184. doi: 10.1007/s00228-004-0890-5.
    1. Lehmann DF, Medicis JJ, Franklin PD. Polymorphisms and the pocketbook: the cost-effectiveness of cytochrome P450 2C19 genotyping in the eradication of Helicobacter pylori infection associated with duodenal ulcer. J Clin Pharmacol. 2003;43:1316–1323. doi: 10.1177/0091270003259389.

Source: PubMed

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