Human Genetics Flashcards
(154 cards)
Why pharmacogenetics?
to improve clinical outcomes - less side effects, make the drug more effective
-Cost savings = it will reduce ineffective treatments, reduce the adverse drug events
- For personalised medicine = pharmacogenetics profile
- It is beneficial to know how a genetic variation can influence the drug response as well as to know how genes can be targeted for novel therapies
What can be the cause of the side effects of a drug?
due to ineffective drug prescription, improper dosage; negative drug-drug interactions
What is the purpose of pharmacogenomics in general?
- preventing adverse drug reactions
- Predicting drug dose
- enabling drug discovery/development
- Developing targeted drugs for cancer therapy
- Predicting the activation of prodrugs
- Improving efficacy
What is the consequence of being a non-metabolizer of an active drug?
active drug not efficiently converted to inactive form = leads to too much of the active drugs staying in the body and that can lead to side effects - toxicity → stronger and prolonged effect
What does bimodal distribution indicate? And what a smooth distribution?
-that it is a monogenic mutation/variation
-that it is polygenic mutation and there are cases with middle-level response
Explain the function of CYP2D6 gene
-encodes for P450 isoform 2D6
- Involved in the metabolism of around 20% of the drugs commonly used for different purposes
- Function in the metabolism of xenobiotics (mainly in the liver)
What do mutations in the CYP2D6 gene contribute to?
-SNVs of the gene may inhibit the enzyme function = variants associated with decreased function;
-variants that lead to splice defect (in 15% of European population)
-CNV - variations that will not affect small nucleotide but large stretches of DNA = big delitions, duplications; <2 copies → reduced function and >2 copies → increased function
Explain the categories of different metabolizers
- poor metabolizers = for active drug lower dose or alternative drug needed; drugs metabolized slowly or not at all; leads to toxicity and high doses of the drug staying too long in the body
- intermediate metabolizers = reduced enzyme activity –> slower drug breakdown
- extensive metabolizer = Normal enzyme function → expected drug metabolism.
- Ultra-rapid metabolizer: Extra enzyme copies (gene duplications) → very fast drug metabolism; reduced drug efficacy; the drug is broken down very quickly (for active drugs) which leads to reduced effectiveness; for prodrugs → the drug is activated too quickly leading to stronger effects or toxicity
What does pharmacokinetics mean?
-relates to ADME = absorption, distribution, metabolism and excretion
-Genetic variability in the drug-metabolizing enzymes or drug-transport proteins
-The process of the uptake of the drug by the body and the biotransformation that the drug undergoes in the body
- The distribution of the drugs and their metabolites in the tissues
- The elimination of the drugs and their metabolites from the body over a period of time
How is pharmacokinetics seen in practice?
- Is the dose too high → adverse events
Poor metabolizers - reduced degradation of active drug; eg. CYP2D6 and debrisoquine
Ultra rapid metabolizers - too much activation of prodrug e.g CYP2D6 and codeine → morphine - Is the dose too low → no efficacy
Ultra rapid metabolizers = too much degradation of the active drug
Poor metabolizers = reduced activation of the prodrug
What does pharmacodynamics mean?
- drug and target interaction
-Genetic variability in drug target or target pathway
-Pharmacological actions on living systems - Also reactions with and binding to cell constituents
- And physiological consequences of these actions
Responders vs. non-responders
Responders (response + no adverse event; response + target related or off-target related event)
- non-responders (no response + no adverse event; no response + target related or off-target related adverse event)
How is pharmacodynamics seen in practice?
- How the drug responds in the body
- Beta blocker does something to the receptor and if the receptor is changed the drug may bind better or worse
- Variations in the genes encoding for receptors can affect the response to certain drugs
- Drug and target protein interactions; depending on the drug x target proteins interaction variations in the related genes may affect the response as well
- The drug efficacy might be affected by binding of the drug to the target
- Reduced or increased affinity causing poor efficacy or adverse events respectively
Adverse events that can arise due to binding of the drug to off-target
What is reactive testing and when is it used and which technique is most commonly used?
Reactive testing → specific genes:
- Sanger sequencing and RT qPCR
- Testing is done (usually) after a patient has already experienced an issue with a medication
- it is case-specific and focuses on a single drug that the patient is currently taking
What is preventive testing and when is it used and which technique is most commonly used?
- all known pharmacogenes: SNP-array, or Whole genome sequencing
- testing is done before prescribing any medications, usually as part of a broader genetic screening
- Results are stored in medical records and used whenever a drug is prescribed
- Before starting medications with known genetic risks (e.g. antidepressants);
- In patients requiring long-term medication use (e.g., cancer therapy, psychiatric drugs);
- As part of personalized medicine programs.
What are the pros and cons of using Sanger sequencing for studying pharmacogenetics?
- Pros: detailed information about specific regions of interest in the genome; Fast and everything can be done in the house
- Cons: not high throughput and no information about CNVs
What are the pros and cons of using RT qPCR for studying pharmacogenetics?
Pros: can detect CNVs based on expression
Cons: Measures RNA and not DNA; not high throughput
What are the pros and cons of using SNP-array for studying pharmacogenetics?
- Pros: asses multiple genes at the same time; possibility to detect CNVs (if there is a higher signal on the spot on the chip that corresponds to that SNP→ multiplications and if there is lower or no signal on the spot on the chip that corresponds to the SNP → deletion); customize array for SNPs of interest; cheap
- Cons: does not detect rare variants
What are the pros and cons of using Whole genome sequencing for studying pharmacogenetics?
-Pros: asses multiple genes at once; possibility to detect CNVs; possibility to detect almost all single nucleotide variants
-Cons: costly; what to do with the variants that have not been seen before
What is the difference between monogenic and polygenic disorders?
monogenic: caused by one gene = monogenic; variations with large effect size; environment plays no role; specific inheritance patterns; rare disorders;
complex: caused by several genes = polygenic; variations with small effect; no inheritance pattern; envirnment plays a large role; common disorders
What are DNA variants and where can they be localized in the genome?
- DNA variants are changes in the nucleotide sequences
- They can be localized in the non-coding or coding sequence
– Non-coding: may change gene expression
– Splice site: may change mRNA splicing of a gene
– Coding: can change the protein linked to the gene:
* Missense/nonsense/frameshift
* This affects the size of effect that a variant has
What are SNPs?
A SNP is a common genomic variant at a single base position in
the DNA.
What does common mean? Usually a minor allele frequency of (MAF) > 1%.\
SNPs are depicted as rsID (e.g. rs1111)
Majority of the SNPs are in the non coding regions of the genome: intronic/intergenic, 5ÚTR and 3ÚTR and smaller fraction can be exonic;
disease related variants exist on a spectrum from very rare to common MAF and small to large effect size
What are GWAS?
-they link the variants with the diseases;
- workflow: Collecting samples → extracting genomic DNA → genotype with SNP-array → quality control → statistics → interpret findings
- You need to make two groups of diseased and non diseased individuals and compare differences to discover SNPs associated with disease
-Genotyping with Sequencing (Next or Third Generation) or SNP array
- Effect sizes of SNPs on disease are small, so we need thousands
of samples to identify associations
- Comparing the SNPs between controls and cases; - See which variant(s) are more common for the diseased individuals compared to the controls; SNPs that are closer together are often inherited together
Explain SNP array
-techinique for capturing SNPs at many different loci simultaneously;
- DNA is isolated and fragmented → the fragmented DNA is labeled with fluorescent dyes and then hybridized (bound) to a microarray chip that contains probes (short sequences complementary to known SNP sites) → PCR → the microarray scanner detects which SNP variants are present based on the fluorescence intensity indicating whether the individual has homozygous or heterozygous genotypes at specific positions → The detected SNPs are compared to a reference genome to identify genetic variations