The impact of CYP3A4 and CYP3A5 genetic variations on tacrolimus treatment of living-donor Egyptian kidney transplanted patients.

BACKGROUND

Tacrolimus (TAC) is the mainstay of immunosuppressive regimen for kidney transplantations. Its clinical use is complex due to high inter-individual variations which can be partially attributed to genetic variations at the metabolizing enzymes CYP3A4 and CYP3A5. Two single nucleotide polymorphisms (SNPs), CYP3A422 and CYP3A53, have been reported as important causes of differences in pharmacokinetics that can affect efficacy and/or toxicity of TAC.

OBJECTIVE

Investigating the effect of CYP3A422 and CYP3A53 SNPs individually and in combination on the TAC concentration in Egyptian renal recipients.

METHODS

Overall, 72 Egyptian kidney transplant recipients were genotyped for CYP3A422 G>A and CYP3A53 T>C. According to the functional defect associated with CYP3A variants, patients were clustered into: poor (PM) and non-poor metabolizers (Non-PM). The impact on dose adjusted through TAC concentrations (C0) and daily doses at different time points after transplantation was evaluated.

RESULTS

Cyp3A41/22 and PM groups require significantly lower dose of TAC (mg/kg) at different time points with significantly higher concentration/dose (C0/D) ratio at day 10 in comparison to Cyp3A41/1 and Non-PM groups respectively. However, CyP3A53 heterozygous individuals did not show any significant difference in comparison to CyP3A51/*3 individuals. By comparing between PM and Non-PM, the PM group had a significantly lower rate of recipients not reaching target C0 at day 14.

CONCLUSION

This is the first study on Egyptian population to investigate the impact of CYP3A422 and CYP3A53 SNPs individually and in combination on the TAC concentration. This study and future multicenter studies can contribute to the individualization of TAC dosing in Egyptian patients.