Mizutani Takaharu
Department of Drug Metabolism and Disposition, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan.
Drug Metab Rev. 2003 May-Aug;35(2-3):99-106. doi: 10.1081/dmr-120023681.
Many administered drugs are first activated by phase I drug-metabolizing enzymes, such as cytochrome P450 (CYP), and then conjugated with ligands such as UDPGA, PAPS, and glutathione by phase II drug-metabolizing enzymes, and finally excreted by transporters. There are some defective activity mutants due to CYP polymorphisms. In these cases, drugs are not metabolized [poor metabolizer (PM)], the high drug levels in blood are maintained, and toxic effects appear in the patients. To clarify the ratio of PMs, in the general population, it is necessary to estimate the drug level to not only prevent toxic reactions, but also to provide more efficient drug therapies, according to their polymorphic information about CYPs. In Caucasians and Asians, PM and allele frequency levels of CYPs (CYP2A6, CYP2C9, CYP2C19, CYP2D6, and CYP3A4) are summarized from previous findings. In Caucasians, high PM ratios (7%) of CYP2D6 deriving from the high frequency of CYP2D64 and CYP2D65, and 2% CYP2C19 from CYP2C192, were found. Meanwhile, in Asians, high PM ratios (19%) of CYP2C19 from high frequencies of CYP2C192 and CYP2C193, and 2% to 4% CYP2A6 from CYP2A64, were found. In both populations, the PM frequencies of the CYP3A4 of major drug-metabolizing CYP and CYP2C9 were low.
许多施用的药物首先由I相药物代谢酶(如细胞色素P450,CYP)激活,然后由II相药物代谢酶与UDPGA、PAPS和谷胱甘肽等配体结合,最后由转运体排出。由于CYP多态性存在一些活性缺陷突变体。在这些情况下,药物无法代谢[代谢不良者(PM)],血液中药物水平维持在高位,患者会出现毒性作用。为了明确普通人群中PM的比例,根据其关于CYPs的多态性信息,不仅有必要估计药物水平以预防毒性反应,而且要提供更有效的药物治疗。在白种人和亚洲人中,根据先前的研究结果总结了CYPs(CYP2A6、CYP2C9、CYP2C19、CYP2D6和CYP3A4)的PM和等位基因频率水平。在白种人中,发现由于CYP2D64和CYP2D65的高频率导致CYP2D6的高PM比例(7%),以及由于CYP2C192导致CYP2C19的2%。同时,在亚洲人中发现,由于CYP2C192和CYP2C19*3的高频率导致CYP2C