Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter February 11, 2017

Genetic polymorphisms of cytochrome P450 enzymes: CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5 in the Croatian population

  • Lana Ganoci ORCID logo EMAIL logo , Tamara Božina , Nikica Mirošević Skvrce , Mila Lovrić , Petar Mas and Nada Božina

Abstract

Background:

Data on the frequency of pharmacogenetic polymorphisms in the Croatian population are limited. We determined and analyzed frequencies for the most important CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5 genetic variants in the Croatian population.

Methods:

2637 subjects were included. Genotyping was performed by real-time polymerase chain reaction (PCR) using TaqMan® DME or TaqMan® SNP Genotyping Assays, and by PCR, and PCR-RFLP analysis.

Results:

For CYP2C9, allele frequencies of *2 and *3 variant were 14.5% and 7.6%, respectively. Among them, 3.98% of subjects were predicted to be poor metabolizers. For CYP2C19, the most frequent variant alleles were *2 (14.8%), and *17 (23.7%), while 2.4% of subjects were predicted to be poor metabolizers, and 5.39% were homozygous carriers of *17 predicted to be ultrarapid metabolizers (UM). For CYP2D6, the frequencies of tested variant alleles were *3 (2.2%), *4 (17.4%), *5 (1%), *6 (1.1%), and *41 (10.8%). Out of these, 5.59% were predicted to be poor metabolizers, 3.19% were classified as UM while 1.0% were carriers of variant alleles duplications (undefined phenotype). For CYP3A4 allele frequencies of *1B and *22 variants were 1.4% and 2.7%, respectively. Allele frequency of CYP3A5*3 was 95.5%. Analyzing CYP3A cluster according to the combination of CYP3A4*22 and CYP3A5*3 revealed 5.34% of subjects to be poor metabolizers, while 8.66% were classified as extensive metabolizers.

Conclusions:

The frequency of the CYP allelic variants, genotypes, and predicted phenotypes in the Croatian population is in accordance with the other European populations, between the values of published data for Middle European and Mediterranean populations.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Nebert DW, Ingelman-Sundberg M, Daly AK. Genetic epidemiology of environmental toxicity and cancer susceptibility: human allelic polymorphisms in drug-metabolizing enzyme genes, their functional importance, and nomenclature issues. Drug Metab Rev 1999;31:467–87.10.1081/DMR-100101931Search in Google Scholar PubMed

2. Bozina N, Bradamante V, Lovrić M. Genetic polymorphism of metabolic enzymes P450 (CYP) as a susceptibility factor for drug response, toxicity, and cancer risk. Arh Hig Rada Toksikol 2009;60:217–42.10.2478/10004-1254-60-2009-1885Search in Google Scholar PubMed

3. Solus JF, Arietta BJ, Harris JR, Sexton DP, Steward JQ, McMunn C, et al. Genetic variation in eleven phase I drug metabolism genes in an ethnically diverse population. Pharmacogenomics 2004;5:895–931.10.1517/14622416.5.7.895Search in Google Scholar PubMed

4. Pericic M, Barac Lauc L, Martinovic Klaric I, Janicijevic B, Rudan P. Review of Croatian genetic heritage as revealed by mitochondrial DNA and Y chromosomal lineages. Croat Med J 2005;46:502–13.Search in Google Scholar

5. Barac L, Pericic M, Klaric IM, Rootsi S, Janicijevic B, Kivisild T, et al. Y chromosomal heritage of Croatian population and its island isolates. Eur J Hum Genet 2003;11:535–42.10.1038/sj.ejhg.5200992Search in Google Scholar PubMed

6. Sistonen J, Fuselli S, Palo JU, Chauhan N, Padh H, Sajantila A. Pharmacogenetic variation at CYP2C9, CYP2C19, and CYP2D6 at global and microgeographic scales. Pharmacogenet Genomics 2009;19:170–9.10.1097/FPC.0b013e32831ebb30Search in Google Scholar PubMed

7. Phillips KA, Veenstra DL, Oren E, Lee JK, Sadee W. Potential role of pharmacogenomics in reducing adverse drug reactions: a systematic review. J Am Med Assoc 2001;286:2270–9.10.1001/jama.286.18.2270Search in Google Scholar PubMed

8. Ehmann F, Caneva L, Prasad K, Paulmichl M, Maliepaard M, Llerena A, et al. Pharmacogenomic information in drug labels: European medicines agency perspective. Pharmacogenomics J 2015;15:201–10.10.1038/tpj.2014.86Search in Google Scholar PubMed

9. Kirchheiner J, Brockmoller J. Clinical consequences of cytochrome P450 2C9 polymorphisms. Clin Pharmacol Ther 2005;77:1–16.10.1016/j.clpt.2004.08.009Search in Google Scholar PubMed

10. Ingelman-Sundberg M, Sim SC, Gomez A, Rodriguez-Antona C. Influence of cytochrome P450 polymorphisms on drug therapies: pharmacogenetic, pharmacoepigenetic and clinical aspects. Pharmacol Ther 2007;116:496–526.10.1016/j.pharmthera.2007.09.004Search in Google Scholar PubMed

11. Wadelius M, Chen LY, Lindh JD, Eriksson N, Ghori MJ, Bumpstead S, et al. The largest prospective warfarin-treated cohort supports genetic forecasting. Blood 2009;113:784–92.10.1182/blood-2008-04-149070Search in Google Scholar PubMed PubMed Central

12. Supe S, Poljakovic Z, Bozina T, Ljevak J, Macolic Sarinic V, Bozina N. Clinical application of genotype-guided dosing of warfarin in patients with acute stroke. Arch Med Res 2015;46:265–73.10.1016/j.arcmed.2015.05.001Search in Google Scholar PubMed

13. Caudle KE, Rettie AE, Whirl-Carrillo M, Smith LH, Mintzer S, Lee MT, et al. Clinical pharmacogenetics implementation consortium guidelines for CYP2C9 and HLA-B genotypes and phenytoin dosing. Clin Pharmacol Ther 2014;96:542–8.10.1038/clpt.2014.159Search in Google Scholar PubMed PubMed Central

14. Fricke-Galindo I, Céspedes-Garro C, Rodrigues-Soares F, Naranjo ME, Delgado Á, de Andrés F, et al. Interethnic variation of CYP2C19 alleles, “predicted” phenotypes and “measured” metabolic phenotypes across world populations. Pharmacogenomics J 2016;16:113–23.10.1038/tpj.2015.70Search in Google Scholar PubMed

15. Sim SC, Risinger C, Dahl ML, Aklillu E, Christensen M, Bertilsson L, et al. A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug response to proton pump inhibitors and antidepressants. Clin Pharmacol Ther 2006;79:103–13.10.1016/j.clpt.2005.10.002Search in Google Scholar PubMed

16. Sibbing D, Gebhard D, Koch W, Braun S, Stegherr J, Morath T, et al. Isolated and interactive impact of common CYP2C19 genetic variants on the antiplatelet effect of chronic clopidogrel therapy. J Thromb Haemost 2010;8:1685–93.10.1111/j.1538-7836.2010.03921.xSearch in Google Scholar PubMed

17. Skierka JM, Black JL. Analysis of compound heterozygous CYP2C19 genotypes to determine cis and trans configurations. Pharmacogenomics 2014;15:1197–205.10.2217/pgs.14.72Search in Google Scholar PubMed

18. Zabalza M, Subirana I, Sala J, Lluis-Ganella C, Lucas G, Tomas M, et al. Meta-analyses of the association between cytochrome CYP2C19 loss- and gain-of-function polymorphisms and cardiovascular outcomes in patients with coronary artery disease treated with clopidogrel. Heart 2012;98:100–8.10.1136/hrt.2011.227652Search in Google Scholar PubMed

19. Hicks JK, Swen JJ, Thorn CF, Sangkuhl K, Kharasch ED, Ellingrod VL, et al. Clinical Pharmacogenetics Implementation Consortium guideline for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants. Clin Pharmacol Ther 2013;93:402–8.10.1038/clpt.2013.2Search in Google Scholar PubMed PubMed Central

20. Hicks JK, Bishop JR, Sangkuhl K, Müller DJ, Ji Y, Leckband SG, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and CYP2C19 genotypes and dosing of selective serotonin reuptake inhibitors. Clin Pharmacol Ther 2015;98:127.10.1002/cpt.147Search in Google Scholar PubMed PubMed Central

21. The Human Cytochrome P450 (CYP) Allele Nomenclature Database. www.cypalleles.ki.se [Internet]. Available at: http://www.cypalleles.ki.se/.Search in Google Scholar

22. Kirchheiner J, Nickchen K, Bauer M, Wong ML, Licinio J, Roots I, et al. Pharmacogenetics of antidepressants and antipsychotics: the contribution of allelic variations to the phenotype of drug response. Mol Psychiatry 2004;9:442–73.10.1038/sj.mp.4001494Search in Google Scholar PubMed

23. Sistonen J, Sajantila A, Lao O, Corander J, Barbujani G, Fuselli S. CYP2D6 worldwide genetic variation shows high frequency of altered activity variants and no continental structure. Pharmacogenet Genomics 2007;17:93–101.10.1097/01.fpc.0000239974.69464.f2Search in Google Scholar PubMed

24. LLerena A, Naranjo ME, Rodrigues-Soares F, Penas-LLedo EM, Farinas H, Tarazona-Santos E. Interethnic variability of CYP2D6 alleles and of predicted and measured metabolic phenotypes across world populations. Expert Opin Drug Metab Toxicol 2014;10:1569–83.10.1517/17425255.2014.964204Search in Google Scholar PubMed

25. Bozina N, Granić P, Lalić Z, Tramisak I, Lovrić M, Stavljenić-Rukavina A. Genetic polymorphisms of cytochromes P450: CYP2C9, CYP2C19, and CYP2D6 in Croatian population. Croat Med J 2003;44:425–8.Search in Google Scholar

26. Ingelman-Sundberg M. Genetic polymorphisms of cytochrome P450 2D6 (CYP2D6): clinical consequences, evolutionary aspects and functional diversity. Pharmacogenomics J 2005;5:6–13.10.1038/sj.tpj.6500285Search in Google Scholar PubMed

27. Teh LK, Bertilsson L. Pharmacogenomics of CYP2D6: molecular genetics, interethnic differences and clinical importance. Drug Metab Pharmacokinet 2012;27:55–67.10.2133/dmpk.DMPK-11-RV-121Search in Google Scholar

28. Crews KR, Gaedigk A, Dunnenberger HM, Leeder JS, Klein TE, Caudle KE, et al. Clinical Pharmacogenetics Implementation Consortium guidelines for cytochrome P450 2D6 genotype and codeine therapy: 2014 update. Clin Pharmacol Ther 2014;95:376–82.10.1038/clpt.2013.254Search in Google Scholar PubMed PubMed Central

29. Zanger UM, Schwab M. Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation. Pharmacol Ther 2013;138:103–41.10.1016/j.pharmthera.2012.12.007Search in Google Scholar PubMed

30. Kuehl P, Zhang J, Lin Y, Lamba J, Assem M, Schuetz J, et al. Sequence diversity in CYP3A promoters and characterization of the genetic basis of polymorphic CYP3A5 expression. Nat Genet 2001;27:383–91.10.1038/86882Search in Google Scholar PubMed

31. Tseng E, Walsky RL, Luzietti RA, Harris JJ, Kosa RE, Goosen TC, et al. Relative contributions of cytochrome CYP3A4 versus CYP3A5 for CYP3A-cleared drugs assessed in vitro using a CYP3A4-selective inactivator (CYP3cide). Drug Metab Dispos 2014;42:1163–73.10.1124/dmd.114.057000Search in Google Scholar PubMed

32. Birdwell KA, Decker B, Barbarino JM, Peterson JF, Stein CM, Sadee W, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP3A5 Genotype and Tacrolimus Dosing. Clin Pharmacol Ther 2015;98:19–24.10.1002/cpt.113Search in Google Scholar PubMed PubMed Central

33. Elens L, Becker ML, Haufroid V, Hofman A, Visser LE, Uitterlinden AG, et al. Novel CYP3A4 intron 6 single nucleotide polymorphism is associated with simvastatin-mediated cholesterol reduction in the Rotterdam Study. Pharmacogenet Genomics 2011;21:861–6.10.1097/FPC.0b013e32834c6edbSearch in Google Scholar PubMed

34. Aouam K, Kolsi A, Kerkeni E, Ben Fredj N, Chaabane A, Monastiri K, et al. Influence of combined CYP3A4 and CYP3A5 single-nucleotide polymorphisms on tacrolimus exposure in kidney transplant recipients: a study according to the post-transplant phase. Pharmacogenomics 2015;16:2045–54.10.2217/pgs.15.138Search in Google Scholar PubMed

35. Wang D, Guo Y, Wrighton SA, Cooke GE, Sadee W. Intronic polymorphism in CYP3A4 affects hepatic expression and response to statin drugs. Pharmacogenomics J 2011;11:274–86.10.1038/tpj.2010.28Search in Google Scholar PubMed PubMed Central

36. Miller SA, Dykes DD, Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res 1988;16:1215.10.1093/nar/16.3.1215Search in Google Scholar PubMed PubMed Central

37. The 1000 Genomes database. The 1000 Genomes database [Internet]. Available from: http://www.1000genomes.org/.Search in Google Scholar

38. Scordo MG, Caputi AP, D’Arrigo C, Fava G, Spina E. Allele and genotype frequencies of CYP2C9, CYP2C19 and CYP2D6 in an Italian population. Pharmacol Res 2004;50:195–200.10.1016/j.phrs.2004.01.004Search in Google Scholar PubMed

39. Kapedanovska Nestorovska A, Jakovski K, Naumovska Z, Hiljadnikova Bajro M, Sterjev Z, Eftimov A, et al. Distribution of the most common genetic variants associated with a variable drug response in the population of the Republic of Macedonia. Balk J Med Genet 2014;17:5–14.10.2478/bjmg-2014-0069Search in Google Scholar PubMed PubMed Central

40. Daly AK. Pharmacogenetics of drug metabolizing enzymes in the United Kingdom population: review of current knowledge and comparison with selected European populations. Drug Metab Pers Ther 2015;30:165–74.10.1515/dmdi-2014-0034Search in Google Scholar PubMed

41. Céspedes-Garro C, Fricke-Galindo I, Naranjo ME, Rodrigues-Soares F, Fariñas H, de Andrés F, et al. Worldwide interethnic variability and geographical distribution of CYP2C9 genotypes and phenotypes. Expert Opin Drug Metab Toxicol 2015;11:1893–905.10.1517/17425255.2015.1111871Search in Google Scholar PubMed

42. Scordo MG, Aklillu E, Yasar U, Dahl ML, Spina E, Ingelman-Sundberg M. Genetic polymorphism of cytochrome P450 2C9 in a Caucasian and a black African population. Br J Clin Pharmacol 2001;52:447–50.10.1046/j.0306-5251.2001.01460.xSearch in Google Scholar PubMed PubMed Central

43. Arvanitidis K, Ragia G, Iordanidou M, Kyriaki S, Xanthi A, Tavridou A, et al. Genetic polymorphisms of drug-metabolizing enzymes CYP2D6, CYP2C9, CYP2C19 and CYP3A5 in the Greek population. Fundam Clin Pharmacol 2007;21:419–26.10.1111/j.1472-8206.2007.00510.xSearch in Google Scholar PubMed

44. Dorado P, Berecz R, Norberto MJ, Yasar U, Dahl ML, LLerena A. CYP2C9 genotypes and diclofenac metabolism in Spanish healthy volunteers. Eur J Clin Pharmacol 2003;59:221–5.10.1007/s00228-003-0588-0Search in Google Scholar PubMed

45. Burian M, Grosch S, Tegeder I, Geisslinger G. Validation of a new fluorogenic real-time PCR assay for detection of CYP2C9 allelic variants and CYP2C9 allelic distribution in a German population. Br J Clin Pharmacol 2002;54:518–21.10.1046/j.1365-2125.2002.01693.xSearch in Google Scholar

46. Yasar U, Eliasson E, Dahl ML, Johansson I, Ingelman-Sundberg M, Sjoqvist F. Validation of methods for CYP2C9 genotyping: frequencies of mutant alleles in a Swedish population. Biochem Biophys Res Commun 1999;254:628–31.10.1006/bbrc.1998.9992Search in Google Scholar

47. Gaikovitch EA, Cascorbi I, Mrozikiewicz PM, Brockmoller J, Frotschl R, Kopke K, et al. Polymorphisms of drug-metabolizing enzymes CYP2C9, CYP2C19, CYP2D6, CYP1A1, NAT2 and of P-glycoprotein in a Russian population. Eur J Clin Pharmacol 2003;59:303–12.10.1007/s00228-003-0606-2Search in Google Scholar

48. Ragia G, Arvanitidis KI, Tavridou A, Manolopoulos VG. Need for reassessment of reported CYP2C19 allele frequencies in various populations in view of CYP2C19*17 discovery: the case of Greece. Pharmacogenomics 2009;10:43–9.10.2217/14622416.10.1.43Search in Google Scholar

49. Sibbing D, Koch W, Gebhard D, Schuster T, Braun S, Stegherr J, et al. Cytochrome 2C19*17 allelic variant, platelet aggregation, bleeding events, and stent thrombosis in clopidogrel-treated patients with coronary stent placement. Circulation 2010;121:512–18.10.1161/CIRCULATIONAHA.109.885194Search in Google Scholar

50. Aynacioglu AS, Sachse C, Bozkurt A, Kortunay S, Nacak M, Schroder T, et al. Low frequency of defective alleles of cytochrome P450 enzymes 2C19 and 2D6 in the Turkish population. Clin Pharmacol Ther 1999;66:185–92.10.1053/cp.1999.v66.100072001Search in Google Scholar

51. Bernal ML, Sinues B, Johansson I, McLellan RA, Wennerholm A, Dahl ML, et al. Ten percent of North Spanish individuals carry duplicated or triplicated CYP2D6 genes associated with ultrarapid metabolism of debrisoquine. Pharmacogenetics 1999;9:657–60.10.1097/00008571-199910000-00013Search in Google Scholar

52. Naranjo ME, de Andrés F, Delgado A, Cobaleda J, Peñas-Lledó EM, LLerena A. High frequency of CYP2D6 ultrarapid metabolizers in Spain: controversy about their misclassification in worldwide population studies. Pharmacogenomics J 2016;16:485–90.10.1038/tpj.2016.47Search in Google Scholar

53. Zeigler-Johnson C, Friebel T, Walker AH, Wang Y, Spangler E, Panossian S, et al. CYP3A4, CYP3A5, and CYP3A43 genotypes and haplotypes in the etiology and severity of prostate cancer. Cancer Res 2004;64:8461–7.10.1158/0008-5472.CAN-04-1651Search in Google Scholar

54. Ball SE, Scatina J, Kao J, Ferron GM, Fruncillo R, Mayer P, et al. Population distribution and effects on drug metabolism of a genetic variant in the 5′ promoter region of CYP3A4. Clin Pharmacol Ther 1999;66:288–94.10.1016/S0009-9236(99)70037-8Search in Google Scholar

55. Elens L, Bouamar R, Hesselink DA, Haufroid V, Van Der Heiden IP, Van Gelder T, et al. A new functional CYP3A4 intron 6 polymorphism significantly affects tacrolimus pharmacokinetics in kidney transplant recipients. Clin Chem 2011;57:1574–83.10.1373/clinchem.2011.165613Search in Google Scholar PubMed

56. Tavira B, Coto E, Diaz-Corte C, Alvarez V, Lopez-Larrea C, Ortega F. A search for new CYP3A4 variants as determinants of tacrolimus dose requirements in renal-transplanted patients. Pharmacogenet Genomics 2013;23:445–8.10.1097/FPC.0b013e3283636856Search in Google Scholar PubMed

57. Gijsen VM, van Schaik RH, Elens L, Soldin OP, Soldin SJ, Koren G, et al. CYP3A4*22 and CYP3A combined genotypes both correlate with tacrolimus disposition in pediatric heart transplant recipients. Pharmacogenomics 2013;14:1027–36.10.2217/pgs.13.80Search in Google Scholar PubMed

58. Baxter SD, Teft WA, Choi YH, Winquist E, Kim RB. Tamoxifen-associated hot flash severity is inversely correlated with endoxifen concentration and CYP3A4*22. Breast Cancer Res Treat 2014;145:419–28.10.1007/s10549-014-2963-1Search in Google Scholar PubMed

59. Diekstra MH, Klumpen HJ, Lolkema MP, Yu H, Kloth JS, Gelderblom H, et al. Association analysis of genetic polymorphisms in genes related to sunitinib pharmacokinetics, specifically clearance of sunitinib and SU12662. Clin Pharmacol Ther 2014;96:81–9.10.1038/clpt.2014.47Search in Google Scholar PubMed

60. Kitzmiller JP, Sullivan DM, Phelps MA, Wang D, Sadee W. CYP3A4/5 combined genotype analysis for predicting statin dose requirement for optimal lipid control. Drug Metabol Drug Interact 2013;28:59–63.10.1515/dmdi-2012-0031Search in Google Scholar PubMed PubMed Central

61. Luzum JA, Theusch E, Taylor KD, Wang A, Sadee W, Binkley PF, et al. Individual and combined associations of genetic variants in CYP3A4, CYP3A5, and SLCO1B1 with simvastatin and simvastatin acid plasma concentrations. J Cardiovasc Pharmacol 2015;66:80–5.10.1097/FJC.0000000000000246Search in Google Scholar PubMed PubMed Central

62. Leusink M, de Keyser CE, Onland-Moret NC, Hofman A, Visser LE, Stricker BH, et al. No association between CYP3A4*22 and statin effectiveness in reducing the risk for myocardial infarction. Pharmacogenomics 2014;15:1471–7.10.2217/pgs.14.90Search in Google Scholar PubMed

63. Ragia G, Kolovou V, Tavridou A, Elens L, Tselepis AD, Elisaf M, et al. No effect of CYP3A4 intron 6 C>T polymorphism (CYP3A4*22) on lipid-lowering response to statins in Greek patients with primary hypercholesterolemia. Drug Metab Pers Ther 2015;30:43–8.10.1515/dmdi-2014-0021Search in Google Scholar PubMed

64. Elens L, van Gelder T, Hesselink DA, Haufroid V, van Schaik RH. CYP3A4*22: promising newly identified CYP3A4 variant allele for personalizing pharmacotherapy. Pharmacogenomics 2013;14:47–62.10.2217/pgs.12.187Search in Google Scholar PubMed

Received: 2016-10-12
Accepted: 2016-12-19
Published Online: 2017-2-11
Published in Print: 2017-3-1

©2017 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 16.5.2024 from https://www.degruyter.com/document/doi/10.1515/dmpt-2016-0024/html
Scroll to top button