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Printable Handouts
Navigable Slide Index
- Introduction
- Drug response and toxicity is highly variable
- Evolution of human P450 genes
- Parallel evolution of the CYP2D genes in mice and humans
- Forest experiment
- Nicotine induced CYP6CY3 gene amplification
- The human situation: starting in Ethiopia
- Identification of first human gene amplification, gene duplication, and ultrarapid metabolizers
- Major pharmacogenomic biomarkers
- Some pharmacogenomic biomarkers
- The role of CYP2C19 polymorphism on escitalopram pharmacokinetics
- Should the dose be increased? If yes, at what cost?
- CYP2C19 gene is polymorphic and CYP2C19 genotype determines enzymatic capacity
- For CYP2C19 null homozygotes (PM), even 10mg is too much
- Effect of CYP polymorphisms on therapeutic failure in psychiatry
- Meta-analysis of genetics and CNS drugs
- Implementation of pharmacogenomics into drug development
- Top pharmacogenomic drug labels in cancer research
- What are the pharmacogenomic biomarkers?
- Translation into clinical recommendations
- Preemptive genotyping and therapeutic drug monitoring (TDM) during pharmacotherapy
- New approach for personalized strategy
- Types of individualized therapy
- Fraction of clinically used drugs metabolized by P450 isoforms and factors influencing variability
- Shared genetic influence for bipolar disease and schizophrenia
- Use of twin data in pharmacogenomics
- BUT the interindividual variation in pharmacokinetics is very large
- What are the explanations for the missing heritability?
- Causes for missing heritability: rare variants
- Pharmacogenes harbor a plethora of rare genetic variants
- Relative role of common and rare variants
- Analysis of deleterious variants from UK biobank
- Causes for missing heritability: long read sequencing of complex loci
- Fraction of genomic intervals of major ADME genes in complex regions of the genome
- Causes for missing heritability: missing haplotypes
- The CYP2C:TG haplotype
- Causes for missing heritability: genetically variant enzymes differ in substrate specificity
- Causes for missing heritability: polymorphic gene expression control
- Other causes for missing heritability
- Causes for missing heritability: specific polymorphic gene regulation
- Influence of the NFIB polymorphism on the metabolite-to-parent ratio
- Action of the polymorphic NFIB in the regulation of the CYP2D6 gene
- Polygenic risk scores
- The missing heritability for height has been solved!
- Implementation of pharmacogenomics in the clinics
- Conclusions
- Acknowledgments
Topics Covered
- Individualized medicine
- Human P450 genes
- CYP2D genes
- Pharmacogenetic biomarkers
- Escitalopram pharmacokinetics
- Genetic polymorphism
- Drug development
- Pre-emptive genotyping
- Adverse drug reactions (ADRs)
- Missing heritability
Links
Series:
Categories:
External Links
Talk Citation
Ingelman-Sundberg, M. (2023, June 29). Pharmacogenomics: an update [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 27, 2024, from https://doi.org/10.69645/XYJF7448.Export Citation (RIS)
Publication History
Financial Disclosures
- He is the co-founder and co-owner of HepaPredict AB.
A selection of talks on Genetics & Epigenetics
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Magnus
Ingelman-Sundberg.
I work at the Karolinska
Institute in Stockholm, Sweden.
I will tell you
about some updates
in the area of pharmacogenomics.
0:15
We know that drug response and
toxicity is highly variable.
Differential drug
response is common and
only 50%-75% of patients
respond adequately
to medications.
It's dangerous because wrong
medication procedure can cause
adverse drug reactions
and they account for
about 7% of all
hospitalizations.
If one considers elderly people
of more than 70 years of age,
20% of all hospitalizations
are caused by adverse
drug reactions.
In the EU, we count about
190,000 deaths each year due
to adverse drug reactions.
The adverse drug
reactions are expensive.
It accounts for 5%-10% of
annual hospital costs.
In the US, equivalent
to about $80 billion.
Also, the individual differences
in drug response is a major
hurdle for drug development
so 32% of novel medications
are affected by safety events
after the clinical trials
have been terminated.
This is because
the Phase 3 trials
encompass maybe
2,000-5,000 patients,
whereas on the market,
the drug is exposed to
millions of people,
and they have unique
characteristics
which makes them susceptible
for certain drugs.