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. 2003 May;52(Suppl 2):ii10–ii18. doi: 10.1136/gut.52.suppl_2.ii10

Pharmacogenomics: marshalling the human genome to individualise drug therapy

W Evans
PMCID: PMC1867751  PMID: 12651877

Abstract

Pharmacogenomics aims to identify the inherited basis for interindividual differences in drug response, and translate this to molecular diagnostics that can be used to individualise drug therapy. This review uses a number of published examples of inherited differences in drug metabolising enzymes, drug transporters, and drug targets (for example, receptors) to illustrate the potential importance of inheritance in determining the efficacy and toxicity of medications in humans. It seems that this field is at the early stages of developing a powerful set of molecular diagnostics that will have profound utility in optimising drug therapy for individual patients.

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Figure 1 .

Figure 1

Polygenetic determinants of drug response (reproduced with the publisher's permission, from Evans and Johnson, Annu Rev Genomics Hum Genet 2001;2:9–39).

Figure 2 .

Figure 2

Genetic polymorphism of thiopurine methyltransferase and its importance in determining response to thiopurine medications (azathioprine, mercaptopurine, and thioguanine) (reproduced with publisher's permission, from Krynetski and Evans Am J Hum Genet 1998;63:11–16).

Figure 3 .

Figure 3

The cytochromes P450 CYP3A4 and CYP3A5 genetic polymorphism. The top panel depicts the distribution of CYP3A4 activity in the white population, assuming that 100% of individuals express CYP3A4, with a 10-fold range of activity in the population. The middle panel depicts CYP3A5 expression, assuming that 25% of the white population express 3A5, with a 10-fold range of activity. The bottom panel depicts the CYP3A4 and CYP3A5 distributions (dashed lines) and the composite distribution for drugs metabolised equally well by both enzymes.

Selected References

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