The PharmVar GeneFocus: SLCO1B1 paper has just been published by Clinical Pharmacology & Therapeutics.
This review provides a general overview of SLCO1B1 as well as a deeper dive into its nomenclature. This GeneFocus covers genetic variability, functional impact, clinical relevance, gene nomenclature before and after PharmVar updates, methods for allele characterization and how the new nomenclature impacts pharmacogenetic testing and interpretation. Specific details of changes to allele definitions can be found on the PharmVar SLCO1B1 page and on the Change Log tab of the SLCO1B1 Allele Definition Table available from PharmGKB.
For more details, please see:
Clin Pharmacol Ther. 2022 Jul 7. doi: 10.1002/cpt.2705.
Laura B. Ramsey, Li Gong, Seung-been Lee, Jonathan B. Wagner, Xujia Zhou, Katrin Sangkuhl, Solomon M. Adams, Robert J. Straka, Philip E. Empey, Erin C. Boone, Teri E. Klein, Mikko Niemi, Andrea Gaedigk.
PharmVar and PharmGKB are excited to share that CYP2A6 has been transitioned into the PharmVar database. CYP2A6 metabolizes several substates including coumarin, nicotine, aflatoxin B1, nitrosamines, and some pharmaceuticals. Owing to its highly polymorphic nature, CYP2A6 activity varies considerably between individuals. Due to the complex nature of the CYP2A gene locus that contains not only CYP2A6, but also the highly similar CYP2A7 and CYP2A13 genes, CYP2A6 genotype analysis and characterization of allelic variants is not trivial. It is therefore of utmost importance to have up-to-date information regarding sequence variation and star allele (haplotype) definitions to facilitate accurate genetic testing, data interpretation and phenotype prediction in the research and clinical settings.
The PharmVar CYP2A6 gene experts have systematically reviewed and curated all star allele definitions that were previously issued by the CYP450 Nomenclature databases (these were last updated in 2014 and can be accessed through the archive). Some notable changes include:
Changes made are detailed in the ‘Change Log’ document and other important information about CYP2A6 and the information displayed by PharmVar can be found in the ‘Read Me’ document. All accompanying documents can be accessed at the PharmVar CYP2A6 page at https://www.pharmvar.org/gene/CYP2A6.
Since there are no CPIC guidelines for CYP2A6, the PharmVar CYP2A6 page does not provide information for ‘CPIC clinical function’. The expert panel has, however, compiled a table in the ‘Read Me’ document summarizing function information for selected star alleles.
Lastly, we would like to thank the PharmVar CYP2A6 experts Rachel Tyndale, Alec Langlois, Meghan Chenoweth, Giada Scantamburlo, Charity Nofziger, David Twesigmwe, Rachel Huddart and Andrea Gaedigk for their tireless efforts that made this massive update possible.
A Haiku about PGx for National Poetry Month.
Diagnosed star one,
Yet severe toxicity.
What did the lab test?
What does *1 really mean? And why does that matter?
The star alleles of the drug metabolizing enzyme genes are an unusual way of defining variation and are perhaps one of the most misunderstood aspects of pharmacogenomics. Arising from attempts to describe and standardize the molecular basis of different drug phenotypes; debrisoquine poor metabolizer phenotype, etc [PMID: 7773298, PMID: 8807658]. Sometimes authors use the term “wild type”, even for humans, to describe the most common form of the gene or protein in a given population where it displays the expected drug metabolism phenotype. The *1 allele is generally used to denote the absence of the variants tested. However, it is not a stable assignment; a *1/*1 individual only tested at one locus may not have the same genetic sequence as a *1/*1 individual tested for a panel of 10 variants in the same gene. This really matters when evaluating the likelihood of drug phenotype - the "reference" is only as good as the number of variants that were checked. *1 is rather a placeholder, it is the absence of certainty, because even with a panel that covers variants that represent 99% of known variation (in the populations examined so far which are not representative of the full global population) there may still be rare variants with significant impact on protein function that we may not yet have documented. While a *1/*1 may not be at increased risk of toxicity (or other phenotypes), or require a change of dosage immediately, they still have the baseline level of risk and it shouldn’t be a huge surprise if they exhibit an adverse reaction to a drug.
Recent publications of case studies that concluded a lack of involvement of known pharmacogenes without documenting what was tested:
PMID:35180762 - “Acral Skin Rash Caused by Altered Mercaptopurine
Metabolism in Maintenance Therapy for B-Cell
Acute Lymphoblastic Leukemia” excerpt “TPMT and NUDT15 genotype at diagnosis were wildtype alleles and therefore we started with full 6-MP dosing.”
This issue is not limited to pharmacogenes using star allele nomenclature: “5-Fluorouracil Neurotoxicity in the Absence of Dihydropyrimidine Dehydrogenase Deficiency Case Report” [PMID:35419161] excerpt “Our patient tested negative for DPD mutations, but it remains possible she harbored a genetic variant not accounted for in the genetic testing panel. Other known risk factors include mutations in the orotate phosphoribosyltransferase and thymidylate synthase genes… “
We recommend authors always include the list of all variants that were tested, and other features see [PMID:30406943].
