The distribution of genetic polymorphism of CYP3A5, CYP3A4 and ABCB1 in patients subjected to renal transplantation

  • Neven Vavić Center for Transplantation of Solid Organs, Military Medical Academy, Belgrade, Serbia
  • Nemanja Rančić Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Bojana Cikota-Aleksić Center for Clinical Pharmacology,Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
  • Zvonko Magić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
  • Jelena Cimeša Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Katarina Obrenčević Center for Transplantation of Solid Organs,Military Medical Academy, Belgrade, Serbia
  • Milorad Radojević Center for Transplantation of Solid Organs, Military Medical Academy, Belgrade, Serbia
  • Momir Mikov Center for Transplantation of Solid Organs,Military Medical Academy, Belgrade, Serbia
  • Viktorija Dragojević-Simić Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Keywords: tacrolimus, kidney transplantation, polymorphism, genetic, cyp3a4 protein, human, cyp3a5 protein, abcb1 protein,

Abstract


Background/Aim. Polymorphisms of genes which encode transporter P-glycoprotein and most important enzymes for tacrolimus pharmacokinetics can have significant influence reflecting on blood concentrations of this drug. The aim of this study was to examine the distribution of polymorphisms of CYP3A5, CYP3A4 and ABCB1 genes in patients subjected to renal transplantation, for the first time in our transplantation center. Methods. The research was designed as a prospective cross-sectional study which included 211 patients subjected to renal transplantation in the Centre for Solid Organ Transplantation of the university tertiary health care hospital, Military Medical Academy, Belgrade, Serbia. Patients of both genders, 22−69-year-old, Caucasians, subjected to immunosuppressive regimen, including tacrolimus, were recruited for the study. CYP3A5 6986A>G (the *3 or *1, rs776746), CYP3A4 -392A>G (the *1 or *1B, rs2740574) and ABCB1 3435C>T (rs1045642) genotypes were determined by TaqMan® SNP genotyping assays. Results. Most of our patients (94.8%) had functional CYP3A4 enzyme, while 87.7% of all the patients had diminished CYP3A5 enzymatic activity. On the other hand, about one third of them, 31.3%, had functional ABCB1 transporter. Conclusion. A total of 84.8% of our patients were found to express both the CYP3А5*3*3 genotype (associated with diminished CYP3А5 enzymatic activity) and CYP3А4*1*1/*1*1B (associated with functional CYP3А4 enzymatic activity), while out of all the patients with diminished CYP3A5 enzymatic activity, 68.7% had diminished activity of ABCB1 transporter. However, further studies are necessary in order to show the influence of these genetic polymorphisms on tacrolimus blood concentrations in patients after renal transplantation.

References

Ponticelli C. Present and future of immunosuppressive therapy in kidney transplantation. Transplant Proc 2011; 43(6): 2439−40.

Provenzani A, Santeusanio A, Mathis E, Notarbartolo M, Labbozzetta M, Poma P, et al. Pharmacogenetic considerations for optimizing tacrolimus dosing in liver and kidney transplant patients. World J Gastroenterol 2013; 19(48): 9156−73.

Venkataramanan R, Swaminathan A, Prasad T, Jain A, Zuckerman S, Warty V, et al. Clinical pharmacokinetics of tacrolimus. Clin Pharmacokinet 1995; 29(6): 404−30.

Undre N, Stevenson P, Schäfer A. Pharmacokinetics of tacro-limus: clinically relevant aspects. Transplant Proc 1999; 31(7A): 21S−4S.

Krensky MA, Bennett MW, Vincenti F. Immunosuppressants, to-lerogens and immunostimulants. In: Brunton LL, editor. Goodman & Gilman's The pharmacological Basis of Thera-peutics. New York: McGraw-Hill Book Company; 2011. p. 1005−31.

Danesi R, Mosca M, Boggi U, Mosca F, del Tacca M. Genetics of drug response to immunosuppressive treatment and prospects for personalized therapy. Mol Med Today 2000; 6(12): 475−82.

Yagil Y, Yagil C. Insights into pharmacogenomics and its im-pact upon immunosuppressive therapy. Transpl Immunol 2002; 9(2−4): 203−9.

Vavic N, Rancic N, Dragojevic-Simic V, Draskovic-Pavlovic B, Bo-konjic D, Ignjatovic L, et al. The influence of comedication on tacrolimus blood concentration in patients subjected to kidney transplantation: a retrospective study. Eur J Drug Metab Pharmacokinet 2014; 39(4): 243−53.

Rancic N, Dragojevic-Simic V, Vavic N, Kovacevic A, Segrt Z, Draskovic-Pavlovic B, et al. Tacrolimus concentration/dose ratio as a therapeutic drug monitoring strategy: The influence of gender and comedication. Vojnosanit Pregl 2015; 72(9): 813−22.

Hesselink DA, van Schaik RH, van der Heiden IP, van der Werf M, Gregoor PJ, Lindemans J, et al. Genetic polymorphisms of the CYP3A4, CYP3A5, and MDR-1 genes and pharmacokinetics of the calcineurin inhibitors cyclosporine and tacrolimus. Clin Pharmacol Ther 2003; 74(3): 245−54.

Kuehl P, Zhang J, Lin Y, Lamba J, Assem M, Schuetz J, et al. Se-quence diversity in CYP3A promoters and characterization of the genetic basis of polymorphic CYP3A5 expression. Nat Genet 2001; 27(4): 383−91.

Staatz CE, Goodman LK, Tett SE. Effect of CYP3A and ABCB1 single nucleotide polymorphisms on the pharmacoki-netics and pharmacodynamics of calcineurin inhibitors: Part II. Clin Pharmacokinet 2010; 49(4): 207−21.

Tang H, Xie H, Yao Y, Hu Y. Lower tacrolimus daily dose re-quirements and acute rejection rates in the CYP3A5 nonex-pressers than expressers. Pharmacogenet Genomics 2011; 21(11): 713−20.

Lamba JK, Lin YS, Thummel K, Daly A, Watkins PB, Strom S, et al. Common allelic variants of cytochrome P4503A4 and their prevalence in different populations. Pharmacogenetics 2002; 12(2): 121−32.

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 Toksi-kol 2009; 60(2): 217−42.

Chakkera HA, Chang Y, Bodner JK, Behmen S, Heilman RL, Reddy KS, et al. Genetic differences in Native Americans and tacrolimus dosing after kidney transplantation. Transplant Proc 2013; 45(1): 137−41.

Westlind A, Löfberg L, Tindberg N, Andersson TB, Ingelman-Sundberg M. Interindividual differences in hepatic expression of CYP3A4: relationship to genetic polymorphism in the 5'-upstream regulatory region. Biochem Biophys Res Commun 1999; 259(1): 201−5.

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 pharma-cokinetics in kidney transplant recipients. Clin Chem 2011; 57(11): 1574−83.

Sinues B, Vicente J, Fanlo A, Vasquez P, Medina JC, Mayayo E, et al. CYP3A5*3 and CYP3A4*1B allele distribution and genotype combinations: differences between Spaniards and Central Americans. Ther Drug Monit 2007; 29(4): 412−6.

Macphee IA, Fredericks S, Tai T, Syrris P, Carter ND, Johnston A, et al. Tacrolimus pharmacogenetics: polymorphisms associated with expression of cytochrome p4503A5 and P-glycoprotein correlate with dose requirement. Transplantation 2002; 74(11): 1486−9.

Herrero MJ, Sánchez-Plumed J, Galiana M, Bea S, Marqués MR, Aliño SF. Influence of pharmacogenetic polymorphisms in routine immunosuppression therapy after renal transplanta-tion. Transplant Proc 2010; 42(8): 3134−6.

Cheung CY. Pharmacogenetics and renal transplantation. In: Trzcinski M , editor. Kidney transplantation- new perspectives. Rijeka, Croatia: InTech; 2011. p. 147−62.

Chen Y, Han L, Xue F, Shen C, Lu J, Yang T, et al. Persona-lized Tacrolimus Dose Requirement by CYP3A5 but Not ABCB1 or ACE Genotyping in Both Recipient and Donor after Pediatric Liver Transplantation. PLoS ONE 2014; 9(10): e109464.

Zhang J, Zhang H, Ding X, Ma S, Miao L. Effect of the P450 oxidoreductase 28 polymorphism on the pharmacokinetics of tacrolimus in Chinese healthy male volunteers. Eur J Clin Pharmacol 2013; 69(4): 807−12.

de Jonge H, Metalidis C, Naesens M, Lambrechts D, Kuypers DR. The P450 oxidoreductase *28 SNP is associated with low ini-tial tacrolimus exposure and increased dose requirements in CYP3A5-expressing renal recipients. Pharmacogenomics 2011; 12(9): 1281−91.

Elens L, Capron A, van Schaik RH, De MM, De PL, Eddour DC, et al. Impact of CYP3A4*22 allele on tacrolimus pharmacoki-netics in early period after renal transplantation: toward up-dated genotype-based dosage guidelines. Ther Drug Monit 2013; 35(5): 608−16.

Published
2017/03/20
Section
Original Paper