Pharmacogenomics: principles and application on medical practice

Authors

  • Raisa Rodríguez Duque Escuela Superior Politécnica de Chimborazo (ESPOCH). Chimborazo.
  • Pedro Enrique Miguel-Soca Universidad de Ciencias Médicas de Holguín, Holguín.

Keywords:

pharmacogenomics, pharmacogenetics, precision medicine, genetic profile.

Abstract

Introduction: Pharmacogenomics, as part of precision medicine, guarantees patients´ optimal treatment based on their genetic profile.

Objective: To describe the principles of pharmacogenomics and its application in daily clinical practice.

Materials and Methods: A critical review of pharmacogenomics was carried out in SciELO, MedLine/PubMed/PMC, Scopus databases and the Cuban Virtual Health Library using Spanish and English descriptors such as: farmacogenómica/pharmacogenomics, farmacogenética/pharmacogenetics, medicina personalizada/personalized medicine and medicina de precisión/precision medicine. The articles were searched and located during the period between November 2019 and January 2020. The articles published between 2008 and January 2020 were selected.

Results: The principles of pharmacogenomics are based on the knowledge of the human genome that allows the determination of the genetic profile of patients and the best response to drug treatment with a minimum of adverse reactions. It is applied in different medical specialties such as Oncology, Cardiology, Internal Medicine and Endocrinology. The most studied pharmacogenetic biomarkers include:  CACNA1S, RYR1, CYP2D6, SLCO1B1, CYP2C19, F5, CFTR, CYP2C9, CYP4F2, VKORC1, HLA-B, UGT1A1, IFNL3, CYP3A5, TPMT, G6PD, HLA-A, BRCA1, DPYD, RARG, SLC28A3, TPMT and UGT1A6. 

Conclusions: Pharmacogenetic biomarkers are valuable tools for the identification of genes involved in the drug response.  They are very important in the application of personalized medicine which is intended to improve the response to drugs and avoid or minimize adverse effects. However, substantial challenges remain in respect of making it a frequently used tool in medical practice.

Downloads

Download data is not yet available.

Author Biographies

Raisa Rodríguez Duque, Escuela Superior Politécnica de Chimborazo (ESPOCH). Chimborazo.

Especialista en Medicina General Integral. Especialista en Farmacología.

Pedro Enrique Miguel-Soca, Universidad de Ciencias Médicas de Holguín, Holguín.

Especialista Segundo Grado en Bioquímica Clínica. Máster en Medicina Bioenergética y Natural. Profesor e Investigador Auxiliar.

References

1. Quiñones L, Roco A, Cayún JP, Escalante P, Miranda C, Varela N, et al. Farmacogenómica como herramienta fundamental para la medicina personalizada: aplicaciones en la práctica clínica. Rev Med Chile [Internet]. 2017 [Citado 14/01/2020];145:483-500. Disponible en: http://dx.doi.org/10.4067/S0034-98872017000400009

2. Popejoy AB. Diversity In Precision Medicine And Pharmacogenetics: Methodological And Conceptual Considerations For Broadening Participation. Pharmgenomics Pers Med [Internet]. 2019 [Citado 14/01/2020];12:257-71. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800456/pdf/pgpm-12-257.pdf

3. Rico Mata R, Robledo Ortiz CI, Barajas Ornelas R, Soto Arredondo K. Camacho Morales RL. Hernández Cervantes A. Farmacogenómica: Una alternativa para el diseño de nuevos fármacos en diabetes y cáncer de colon. Revista Enlace Químico [Internet]. 2009 [Citado 14/01/2020];2(6):[Aprox. 2p.]. Disponible en: http://www.naturalezaytecnologia.com/index.php/nyt/article/view/181/pdf1

4. Rodríguez Duque R, Leyva BG, Rodríguez Moldón Y, Díaz Armas MT. Las reacciones adversas como causa de hospitalización. Correo Científico Médico [Internet]. 2018 [citado 2019 Dic 9];23(1):[Aprox. 0 p.]. Disponible en: http://www.revcocmed.sld.cu/index.php/cocmed/article/view/2913

5. Khalil H, Huang C. Adverse drug reactions in primary care: a scoping review. BMC Health Serv Res [Internet]. 2020 [Citado 14/01/2020];20(5):[Aprox. 13 p.]. Disponible en: http://doi.org/10.1186/s12913-019-4651-7

6. Roden DM, McLeod HL, Relling MV , Williams MS , Mensah GA , Peterson JF, et al. Pharmacogenomics. Lancet [Internet]. 2019 [Citado 14/01/2020];394 (10197):521-32. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707519

7. Mainet González D. Aspectos bioéticos de la farmacogenómica en la fase clínica de desarrollo de medicamentos. Rev Cubana Invest Bioméd [Internet]. 2016 Mar [Citado 09/12/2019];35(1):[Aprox. 1 p.]. Disponible en: https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-03002016000100006&lng=es

8. García Acero P, Díaz Gimeno P. Farmacología de sistemas: estudio de las bases moleculares de respuesta a fármacos. Genética Médica y Genómica [Internet]. 2019 [Citado 14/01/2020];3(3):75-89. Disponible en: http://genotipia.com/wp-content/uploads/2019/04/GMG3-75-89-Garc%C3%ADa-web.pdf

9. Pierna Álvarez M, Marcos Vadillo E, García Berrocal B, Isidoro García M. Farmacogenómica: la medicina personalizada. Revista del Laboratorio Clínico[Internet]. 2019 [Citado 14/01/2020];12(3):147-54. Disponible en: https://doi.org/10.1016/j.labcli.2018.07.004

10. Sangkuhl K, Whirl Carrillo M, Whaley RM, Woon M, Lavertu A, Altman RB, et al. Pharmacogenomics Clinical Annotation Tool (PharmCAT). Clinical Pharmacology and Therapeutics [Internet]. 2020 [Citado 14/01/2020];107(1):203-10. Disponible en: https://ascpt.onlinelibrary.wiley.com/doi/epdf/10.1002/cpt.1568

11. Moen EL, Godley LA, Zhang W, Dolan ME. Pharmacogenomics of chemotherapeutic susceptibility and toxicity. Genome Medicine [Internet]. 2012 [Citado 14/01/2020];4:90. Disponible en: http://genomemedicine.com/content/4/11/90

12. Orrico KB. Basic Concepts in Genetics and Pharmacogenomics for Pharmacists. Drug Target Insights [Internet]. 2019 [Citado 14/01/2020];13:1-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891005/pdf/10.1177_1177392819886875.pdf

13. National Human Genome Research Institute. What is the Human Genome Project? [Internet]. Bethesda: National Human Genome Research Institute; 2020 [Citado 14/01/2020]Disponible en: https://www.genome.gov/About-Genomics/Introduction-to-Genomics

14. Fuselli S. Beyond drugs: the evolution of genes involved in human response to medications. Proc R Soc B [Internet]. 2019 [Citado 14/01/2020];286:1716. Disponible en: http://dx.doi.org/10.1098/rspb.2019.1716

15. Alshabeeb MA, Deneer VHM, Khan A, Asselbergs FW. Use of Pharmacogenetic Drugs by the Dutch Population. Front Genet [Internet]. 2019 [Citado 14/01/2020];10:567. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614185/pdf/fgene-10-00567.pdf

16. Roblejo Balbuena H, Rosado Ruiz Apodaca I, Esperón Álvarez AA, Collazo Mesa T, Fuentes Smith L. Frecuencia de la variante alélica CYP2D6*6 en una muestra de la población cubana. Revista Habanera de Ciencias Médicas [Internet]. 2014 [Citado 11/01/2020];13(6):[Aprox. 0 p.]. Disponible en: https://www.revhabanera.sld.cu/index.php/rhab/article/view/337

17. LLerena A, Dorado P, Ramírez R, González I, Peñas LLedó EM, Pérez B, Calzadilla LR. CYP2D6 genotype and debrisoquine hydroxylation phenotype in Cubans and Nicaraguans. Pharmacogenomics J [Internet]. 2012 Apr [Citado 14/01/2020];12(2):176-83. Disponible en: http://www.nature.com/articles/tpj201085

18. Aronson SJ, Rehm HL. Building the foundation for genomics in precision medicine. Nature [Internet]. 2015 Oct [Citado 14/01/2020];526(7573):336-42. Disponible en: https://www.nature.com/articles/nature15816

19. Litman T. Personalized medicine—concepts, technologies, and applications in inflammatory skin disease. APMIS [Internet]. 2019 [Citado 14/01/2020];127 (5):386-424. Disponible en: https://doi.org/10.1111/apm.12934

20. Díaz Fernández U, Rodríguez Ferreiro AO. Aplicaciones de la biotecnología en el desarrollo de la medicina personalizada. MEDISAN [Internet]. 2016 [Citado 03/11/2019];20(5):[Aprox. 17 p.]. Disponible en: http://scielo.sld.cu/scielo.php?pid=S1029-30192016000500013&script=sci_arttext&tlng=en

21. Espinosa Brito A. La medicina centrada en las personas y la medicina personalizada. Medisur [Internet]. 2015 [Citado 14/12/2019];13(6):[Aprox. 4 p.]. Disponible en: http://www.medisur.sld.cu/index.php/medisur/article/view/3149

22. Aguirre Fernández RE, Serra Valdes MA, Aguirre Posada ME. Visión holística de nuevos desafíos: paradigmas tecnológicos y fundamentos bioéticos en la Medicina futurista. Revista Habanera de Ciencias Médicas [Internet]. 2017 [Citado 14/01/2020];16(5):[Aprox. 10 p.]. Disponible en: http://www.revhabanera.sld.cu/index.php/rhab/article/view/2027

23. Eissenberg JC, Aurora R. Pharmacogenomics: What the Doctor Ordered?. Mo Med [Internet]. 2019 May-Jun [Citado 14/01/2020];116(3):217-25. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690297/pdf/ms116_p0217.pdf

24. Quiñones L, Roco A, Miranda C. Farmacogenómica: Aplicaciones cardiovasculares. Revista Médica Clínica Las Condes [Internet]. 2015 [Citado 14/01/2020];26(2):198-209. Disponible en: https://doi.org/10.1016/j.rmclc.2015.04.008

25. Garrido P, Aldaz A, Calleja MA, Álava E de, Lamas MJ, Martín M, et al. Propuesta para la creación de una Estrategia Nacional sobre Medicina de Precisión en Cáncer: posicionamiento de la SEOM, SEAP y SEFH. Farm Hosp [Internet]. 2017 [Citado 03/11/2019];41(6):[Aprox. 11 p.]. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-63432017000600688&lng=es&nrm=iso&tlng=es

26. Giri J Moyer AM, Bielinski SJ, Caraballo PJ. Concepts Driving Pharmacogenomics Implementation Into Everyday Healthcare. Pharmgenomics Pers Med [Internet]. 2019 [Citado 03/11/2019];12:305-18. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826176/pdf/pgpm-12-305.pdf

27. Legrand J, Gogdemir R, Bousquet C, Dalleau K, Devignes MD, Digan W, et al. PGxCorpus, a manually annotated corpus for pharmacogenomics. Scientific data[Internet]. 2020 [Citado 03/11/2019];7(1):3. Disponible en: https://doi.org/10.1038/s41597-019-0342-9

28. Daneshjou R, Huddart R, Klein T, Altman R. Pharmacogenomics in Dermatology: Tools for understanding gene-drug associations. Semin Cutan Med Surg[Internet]. 2019 Mar [Citado 03/11/2019];38(1):E19–E24. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681802/pdf/nihms-1040668.pdf

29. Guio H, Levano KS, Sánchez C, Tarazona D. Rol de la farmacogenómica en el régimen de tratamiento de tuberculosis. Rev Perú Med Exp Salud Publica [Internet]. 2015 Oct [Citado 09/12/2019];32(4):794-800. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1726-46342015000400024&lng=es

30. Madrazo Moya CF, Cancino Muñoz I, CuevasCórdoba B, González Covarrubias V, Barbosa Amezcua M, Soberón X, et al. Whole genomic sequencing as a tool for diagnosis of drug and multidrug-resistance tuberculosis in an endemic region in Mexico. PLoS ONE [Internet]. 2019 [Citado 14/01/2020];14(6):e0213046. Disponible en: https://doi.org/10.1371/journal.pone.0213046

31. Gameiro GR, Sinkunas V, Liguori GR, Auler Júnior JOC. Precision Medicine: Changing the way we think about healthcare. Clinics (Sao Paulo) [Internet]. 2018 [Citado 03/11/2019];73:[Aprox. 15 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251254

32. Goodspeed A, Kostman N, Kriete TE, Longtine JW, Smith SM, Marshall P, et al. Leveraging the utility of pharmacogenomics in psychiatry through clinical decision support: a focus group study. Ann Gen Psychiatry [Internet]. 2019 [Citado 14/01/2020];18:13. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688280/pdf/12991_2019_Article_237.pdf

33. Maggo SDS, Sycamore KLV, Miller AL, Kennedy MA. The Three Ps: Psychiatry, Pharmacy, and Pharmacogenomics, a Brief Report From New Zealand. Front Psychiatry [Internet]. 2019 [Citado 14/01/2020];10:690. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764017/pdf/fpsyt-10-00690.pdf

34. Reis SS, Carvalho AS, Fernandes R. Pharmacogenomics, CYP2D6, and Tamoxifen: A Survey of the Reasons Sustaining European Clinical Practice Paradigms. Medicina (Kaunas) [Internet]. 2019 Jul [Citado 14/01/2020];55(7):344. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681270/pdf/medicina-55-00344.pdf

35. Food and Drug Aadministration. FDA approves first treatment for breast cancer with a certain inherited genetic mutation [Internet].Beltsville: Food and Drug Aadministration; 2018 [Citado 14/12/2019] Disponible en: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm592347.htm

36. Iriart JAB. Medicina de precisión/medicina personalizada: análisis crítico de los movimientos de transformación de la biomedicina a inicios del siglo XXI. Cad Saúde Pública [Internet]. 2019 [Citado 14/12/2019];35(3):e00153118. Available from: http://dx.doi.org/10.1590/0102-311x00153118

37. Miguel Soca P, Argüelles González I, Peña González M. Genetic factors for breast carcinogenesis. Rev Finlay [Internet]. 2016 Dic [Citado 15/12/ 2019]; 6(4):299-316. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2221-24342016000400007&lng=es

38. Orozco Hernández JP, Marín Medina DS, Martínez Muñoz MA, Martínez José W. Genes de predisposición al cáncer de mama. Salud, Barranquilla [Internet]. 2018 Dec [Citado 17/01/2020];34(3):766-83. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-55522018000300766&lng=en

39. Vélez Gómez S, Torres I, Manrique RD, Duque M, Gallo JE. Aplicación farmacogenómica de los genes CYP2C19, CYP2C9 y VKORC1 implicados en el metabolismo de los fármacos clopidogrel y warfarina. Rev Colomb Cardiol [Internet]. 2018 [Citado 14/01/2020];25(6):396-404. Disponible en: https://doi.org/10.1016/j.rccar.2018.05.005

40. Elewa H, Awaisu A. Pharmacogenomics In Pharmacy Practice: Current Perspectives. Integr Pharm Res Pract [Internet]. 2019 [Citado 14/01/2020];8:97-104. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850702/pdf/iprp-8-97.pdf

41. Kanuri SH, Kreutz RP. Pharmacogenomics of Novel Direct Oral Anticoagulants: Newly Identified Genes and Genetic Variants. J Pers Med [Internet]. 2019 [Citado 14/01/2020];9(7):[Aprox. 2p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463033/pdf/jpm-09-00007.pdf

42. Robledo M, Torres I, Manrique RD, Duque M, Gallo JE. Utilidad del gen SLCO1B1 como marcador de interés en la farmacogenómica de las estatinas. Rev Colomb Cardiol [Internet]. 2019 Feb [Citado 09/12/2019];26(1):24-30. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-56332019000100024&lng=en. http://dx.doi.org/10.1016/j.rccar.2018.05.006

43. Hippman C, Nislow C. Pharmacogenomic Testing: Clinical Evidence and Implementation Challenges. J Pers Med [Internet]. 2019 Sep [Citado 14/01/2020];9(3):40. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789586/pdf/jpm-09-00040.pdf

44. Pearson ER. Diabetes: Is There a Future for Pharmacogenomics Guided Treatment? Clin Pharmacol Ther [Internet]. 2019 Aug [Citado 14/01/2020]; 106(2):329-337. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771467/pdf/CPT-106-329.pdf

45. Miret Casals L, Sebastián D, Brea J, Rico Leo EM, Palacín M, Fernández Salguero PM, et al. Identification of New Activators of Mitochondrial Fusion Reveals a Link between Mitochondrial Morphology and Pyrimidine Metabolism. Cell Chemical Biology [Internet]. 2018 [Citado 14/01/2020];25:268-78. Disponible en: https://doi.org/10.1016/j.chembiol.2017.12.001

46. Oliveira Paula GH, Pereira SC, Tanus Santos JE, Lacchini R. Pharmacogenomics And Hypertension: Current Insights. Pharmgenomics Pers Med [Internet]. 2019 [Citado 14/01/2020];12:341-359. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878918/pdf/pgpm-12-341.pdf

47. Turner ST, Boerwinkle E, O’Connell JR, Bailey KR, Gong Y, Arlene B. Chapman AB, et al. Genomic association analysis of common variants influencing antihypertensive response to hydrochlorothiazide. Hypertension [Internet]. 2013 [Citado 14/01/2020];62(2):391-7. Disponible en: https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.111.00436

48. Johnson R, Dludla P, Mabhida S, Benjeddou M, Louw J, February F. Pharmacogenomics of amlodipine and hydrochlorothiazide therapy and the quest for improved control of hypertension: a mini review. Heart Failure Reviews [Internet]. 2019 [Citado 14/01/2020];24:343-57. Disponible en: https://doi.org/10.1007/s10741-018-09765-y

49. Vormfelde S, Brockmöller J. The genetics of loop diuretic effects. Pharmacogenomics J [Internet]. 2012 [Citado 14/01/2020];12:45-53. Disponible en: https://doi.org/10.1038/tpj.2010.68

50. Turner ST, Bailey KR, Fridley BL, Chapman AB, Schwartz GL, Chai HS, et al. Genomic association analysis suggests chromosome 12 locus influencing antihypertensive response to thiazide diuretic. Hypertension [Internet]. 2008 [Citado 14/01/2020];52(2):359-65. Disponible en: https://www.ahajournals.org/doi/full/10.1161/hypertensionaha.107.104273

51. Duarte JD, Turner ST, Tran B, Chapman AB, Bailey KR, Gong Y, et al. Association of chromosome 12 locus with antihypertensive response to hydrochlorothiazide may involve differential YEATS4 expression. Pharmacogenomics J [Internet]. 2013 [Citado 14/01/2020];13(3):257-63. Disponible en: https://www.nature.com/articles/tpj20124

52. Singh S, Rouby NE, McDonough CW, Gong Y, Bailey KR, Boerwinkle E, et al. Genomic Association Analysis Reveals Variants Associated With Blood Pressure Response to Beta‐Blockers in European Americans. Clin Transl Sci [Internet]. 2019 Sep [Citado 14/01/2020];12(5):497-504. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742943/pdf/CTS-12-497.pdf

53. Pharm GKB. Clinical Guideline Annotations [Internet]. Stanford:Pharm GKB; 2019 [Citado 14/01/2020]. Disponible en: https://www.pharmgkb.org/guidelineAnnotations

54. Rey López JP, Sá TH de, Rezende LFM de. Why precision medicine is not the best route to a healthier world. Rev Saúde Pública [Internet]. 2018 [Citado 03/11/2019];52:[Aprox. 10 p.]. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102018000100600

55. Krebs K, Milani L. Translating pharmacogenomics into clinical decisions: do not let the perfect be the enemy of the good. Hum Genomics [Internet]. 2019 [Citado 14/01/2020];13:39. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712791/pdf/40246_2019_Article_229.pdf

Published

2020-12-07

How to Cite

1.
Rodríguez Duque R, Miguel-Soca PE. Pharmacogenomics: principles and application on medical practice. Rev haban cienc méd [Internet]. 2020 Dec. 7 [cited 2025 Jun. 21];19(6):e3128. Available from: https://revhabanera.sld.cu/index.php/rhab/article/view/3128

Issue

Section

Biomedical Basic Sciences