Open AccessCYP2C19 genotype-guided antiplatelet therapy: promises and pitfalls
Author(s) -
Moataz Ellithi,
Jordan Baye,
Russell A. Wilke
Publication year - 2020
Publication title -
pharmacogenomics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.541
H-Index - 91
eISSN - 1744-8042
pISSN - 1462-2416
DOI - 10.2217/pgs-2020-0046
Subject(s) - cyp2c19 , clopidogrel , context (archaeology) , medicine , pharmacogenetics , percutaneous coronary intervention , pharmacology , platelet aggregation inhibitor , genotyping , pharmacogenomics , genotype , biology , genetics , gene , myocardial infarction , aspirin , cytochrome p450 , paleontology , metabolism
Pharmacogenetic variants can alter the mechanism of action (pharmacodynamic gene variants) or kinetic processes such as absorption, distribution, metabolism and elimination (pharmacokinetic gene variants). Many initial successes in precision medicine occurred in the context of genes encoding the cytochromes P450 (CYP enzymes). CYP2C19 activates the antiplatelet drug clopidogrel, and polymorphisms in the CYP2C19 gene are known to alter the outcome for patients taking clopidogrel in the context of cardiovascular disease. CYP2C19 loss-of-function alleles are specifically associated with increased risk for coronary stent thrombosis and major adverse cardiovascular events in patients taking clopidogrel following percutaneous coronary intervention. We explore successes and challenges encountered as the clinical and scientific communities advance CYP2C19 genotyping in the context of routine patient care.