Variants in mycophenolate and CMV antiviral drug pharmacokinetic and pharmacodynamic genes and leukopenia in heart transplant recipients

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:40

Article

Oreschak, Kris¹  Saba, Laura M.¹  Rafaels, Nicholas²  V. Ambardekar, Amrut³  Deininger, Kimberly M.¹  Page, Robert L., II⁴  Lindenfeld, JoAnn⁵  Aquilante, Christina L.¹ 

[1] Univ Colorado, Dept Pharmaceut Sci, Skaggs Sch Pharm & Pharmaceut Sci, Aurora, CO USA

[2] Univ Colorado, Div Biomed Informat & Personalized Med, Dept Med, Sch Med, Aurora, CO USA

[3] Univ Colorado, Div Cardiol, Sch Med, Aurora, CO USA

[4] Univ Colorado, Dept Clin Pharm, Skaggs Sch Pharm & Pharmaceut Sci, Aurora, CO USA

[5] Vanderbilt Univ, Div Cardiol, Med Ctr, Nashville, TN USA

关键词: leukopenia;    heart transplant;    pharmacogenetics;    pharmacogenomics;    mycophenolate;    valganciclovir;    ganciclovir;   

DOI  :  10.1016/j.healun.2021.05.020

来源: Elsevier

【 摘 要 】

BACKGROUND: The objective was to assess the relationship between single nucleotide polymorphisms in mycophenolate and cytomegalovirus antiviral drug pharmacokinetic and pharmacodynamic genes and drug-induced leukopenia in adult heart transplant recipients. METHODS: This retrospective analysis included n = 148 patients receiving mycophenolate and a cytomegalovirus antiviral drug. In total, 81 single nucleotide polymorphisms in 21 pharmacokinetic and 23 pharmacodynamic genes were selected for investigation. The primary and secondary outcomes were mycophenolate and/or cytomegalovirus antiviral drug-induced leukopenia, defined as a white blood cell count < 3.0 x 10(9)/L, in the first six and 12 months post-heart transplant, respectively. RESULTS: Mycophenolate and/or cytomegalovirus antiviral drug-induced leukopenia occurred in 20.3% of patients. HNF1A rs1169288 A>C (p.I27L) was associated with drug-induced leukopenia (unadjusted p = 0.002; false discovery rate < 20%) in the first six months post-transplant. After adjusting for covariates, HNF1A rs1169288 variant C allele carriers had significantly higher odds of leukopenia compared to A/A homozygotes (odds ratio 6.19; 95% CI 1.97-19.43; p = 0.002). Single nucleotide polymorphisms in HNF1A, SLC13A1, and MBOAT1 were suggestively associated (p < 0.05) with the secondary outcome but were not significant after adjusting for multiple comparisons. CONCLUSION: Our data suggest genetic variation may play a role in the development of leukopenia in patients receiving mycophenolate and cytomegalovirus antiviral drugs after heart transplantation. Following replication, pharmacogenetic markers, such as HNF1A rs1169288, could help identify patients at higher risk of drug-induced leukopenia, allowing for more personalized immunosuppressant therapy and cytomegalovirus prophylaxis following heart transplantation. (C) 2021 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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