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P2RY 基因多态性影响肥厚型心肌病猫对氯吡格雷的反应。

A genetic polymorphism in P2RY impacts response to clopidogrel in cats with hypertrophic cardiomyopathy.

机构信息

Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.

Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, USA.

出版信息

Sci Rep. 2021 Jun 15;11(1):12522. doi: 10.1038/s41598-021-91372-3.

Abstract

Clopidogrel is converted to its active metabolite by cytochrome P450 isoenzymes and irreversibly inhibits platelet activation by antagonizing the adenosine-diphosphate (ADP) receptor. It is frequently used in cats with hypertrophic cardiomyopathy (HCM) to prevent thromboembolic complications. However, significant interpatient variability of the response to clopidogrel therapy has been suspected. In this study, we assessed the impact of single nucleotide polymorphisms (SNPs) within ADP receptor (P2RY1, P2RY12) and cytochrome P450 isoenzyme (CYP2C41) genes on platelet inhibition by clopidogrel administration in cats with HCM. Forty-nine cats completed the study, and blood samples were obtained before and after clopidogrel therapy to assess the degree of platelet inhibition based on flow cytometry and whole blood platelet aggregometry. Plasma concentrations of clopidogrel metabolites were measured after the last dose of clopidogrel. Whole blood platelet aggregometry revealed a significant reduction of platelet inhibition by clopidogrel in cats with the P2RY1:A236G and the P2RY12:V34I variants. The association with the P2RY1:A236G variant and clopidogrel resistance remained significant after adjustment for multiple comparisons. This study demonstrated that a genetic polymorphism in the P2RY1 gene altered response to clopidogrel therapy and suggests that clinicians may consider alternative or additional thromboprophylactic therapy in cats with the P2RY1:A236G variant.

摘要

氯吡格雷通过细胞色素 P450 同工酶转化为其活性代谢物,并通过拮抗二磷酸腺苷(ADP)受体不可逆地抑制血小板活化。它常用于患有肥厚型心肌病(HCM)的猫中,以预防血栓栓塞并发症。然而,已经怀疑氯吡格雷治疗的反应存在显著的个体间变异性。在这项研究中,我们评估了 ADP 受体(P2RY1、P2RY12)和细胞色素 P450 同工酶(CYP2C41)基因内的单核苷酸多态性(SNPs)对 HCM 猫中氯吡格雷给药后血小板抑制的影响。49 只猫完成了这项研究,在氯吡格雷治疗前后采集血样,通过流式细胞术和全血血小板聚集测定来评估血小板抑制程度。在最后一次氯吡格雷给药后测量氯吡格雷代谢物的血浆浓度。全血血小板聚集测定显示,P2RY1:A236G 和 P2RY12:V34I 变异的猫的血小板抑制作用显著降低。在调整了多重比较后,与 P2RY1:A236G 变异相关的氯吡格雷抵抗仍然具有统计学意义。这项研究表明,P2RY1 基因中的遗传多态性改变了对氯吡格雷治疗的反应,并提示临床医生可能需要考虑在 P2RY1:A236G 变异的猫中使用替代或额外的抗血栓形成治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0216/8206363/ef487971f719/41598_2021_91372_Fig1_HTML.jpg

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