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. 2018 Jan 30;8(1):8. doi: 10.3390/jpm8010008

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© 2018 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

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Systems Medicine tools for CYP450 regulation in Precision Cardiovascular Medicine. Studies in precision cardiovascular medicine have produced results from various omic technologies that help elucidate contributing factors regulating the pharmacogenomic impact of CYP450 variation on antiplatelet therapy. For example, systems biology tools have implicated CYPC219 genomic variants in genome-wide association studies, methylation of P2Y12 in epigenomics, miR-103/107 on CYP2C19 in microRNAomics, transferrin and peroxiredoxin-4 in proteomics, TMAO in metabolomics and microbiomics. Beyond omics, systems medicine and precision medicine incorporate ‘big data’ and clinical variables from the electronic health record with heart rate and activity levels from mobile health technology, along with findings from Imaging (such as high risk plaque, coronary calcium), to predict which individuals may be at low versus high risk for resistance to treatment with clopidogrel. CYP450: cytochrome P450; CYP2C19: cytochrome P450, family 2, subfamily C, polypeptide 19; P2Y12: the adenosine diphosphate receptor on the surface of platelets, to which clopidogrel binds; miR-103/107: microRNA-103 and microRNA-107; TMAO: trimethylene N-oxide.