Türk böbrek nakilli hastalarda üridine difosfat-glukuronoziltransferaz polimorfizmlerinin mikofenolik asit’in kan konsantrasyonları üzerine etkileri

Yıl 2017, Cilt: 80 Sayı: 3, 104 - 110, 01.09.2017

Hayriye Şentürk Çiftçi Tzevat Tefik Meltem Savran Karadeniz Erol Demir İsmet Nane Fatma Savran Oğuz Aydın Türkmen

https://doi.org/10.18017/iuitfd.363585

Öz

Amaç: Mikofenolik asit’in
(MPA) farmakokinetiğinde bireyler arasında farklılıklar vardır. MPA öncelikle
uridin difosfat-glukuronosiltransferazlar (UGT) tarafından metabolize olur.
UGT2B7, MPA glukuronidasyonu için önemli bir UGT’dir.
Çalışmanın amacı, Türk böbrek nakilli hastalarda UGT2B7 His268Tyr (802C>T)
polimorfizmlerinde MPA farmakokinetiğini incelemektir.

Gereç ve Yöntem: Çalışmaya renal transplant
yapılmış, 65 hasta dahil edildi. UGT2B7 His268Tyr (802C>T) genotiplemesi
PCR-RFLP kullanılarak yapıldı. MPA konsantrasyonları Klonlanmış Enzim Donör
Immunoassay (CEDIA) ile belirlendi. Tüm hastalar çalışma süresi boyunca akut
rejeksiyon ve greft fonksiyonu açısından izlendi.

Bulgular: Hastalar arasında UGT2B7
(802C>T) CC, CT ve TT genotip frekansları sırasıyla 24 (%36,9), 36 (%55,4)
ve 5 (%7,7) idi. Üçüncü ve altıncı aylarda MPA düzeyleri UGT2B7 (802C>T) TT
taşıyıcılarında CT ve CC taşıyanlara göre sırasıyla istatistiksel olarak
anlamlı derecede yüksek bulundu (p=0,038, p=0,021). MPA’nın
doz/kan konsantrasyonu oranı nakil sonrası altıncı ayda TT genotipi
taşıyanlarda CC ve CT genotipi taşıyanlara göre daha yüksekti (p=0,042). TT
genotipi taşıyan bireyler sırasıyla CC ve CT genotiplerine kıyasla üçüncü ve
altıncı ayda düşük doz gereksinimleri göstermişlerdir (p=0,109, p=0,238).
Ayrıca UGT2B7 (802C>T) polimorfizmi ile akut rejeksiyon arasında bir ilişki
bulunmamıştır (p>0,05).

Sonuç: Bizim sonuçlarımız, böbrek nakilli
hastalarda UGT2B7 (802C>T) polimorfizmi ile MPA farmakokinetiği arasında bir
korelasyon olduğunu göstermiştir. UGT2B7 polimorfizminin saptanması, en uygun
MPA kan konsantrasyonları hedefi belirlenmesine yardımcı olabilir.

Anahtar Kelimeler

Böbrek nakli; farmakogenetik; immünsupresif tedavi; polimorfizm; mikofenolik asit

Effect of uridine diphosphate-glucuronosyltransferase polymorphisms on the plasma concentrations of mycophenolic acid in Turkish renal transplant patients

Öz

Objective: The pharmacokinetics of
mycophenolic acid (MPA) differ among individuals. MPA is primarily metabolized
by uridine diphosphate-glucuronosyltransferase (UGT), and UGT2B7 is an
important UGT for the glucuronidation of MPA. This study aimed to examine the
pharmacokinetics of MPA in Turkish renal transplant patients with UGT2B7
His268Tyr (802C>T) polymorphisms.

Materials and Methods: Sixty-five renal
transplants patients were included in this study. UGT2B7 (802C>T) genotyping
was performed using PCR-RFLP. Concentrations of MPA were determined using a cloned
enzyme donor immunoassay (CEDIA). All patients were monitored for acute
rejection and graft function during the study period.

Results: The UGT2B7 (802C>T) CC, CT, and
TT genotype frequencies among patients were 24 (36.9%), 36 (55.4%), and 5
(7.7%) respectively. At three and six months post-transplant respectively,
levels of MPA were significantly higher in UGT2B7 (802C>T) TT carriers than
in CT and CC carriers (p=0.038; p=0.021). The ratio of plasma concentration to
MPA dosage for patients with 802C>T TT genotype was higher than that of CC
and CT genotypes at six months post-transplant (p=0.042). Individuals carrying
the TT genotype demonstrated lower dose requirements at three and six months
compared with those of the CC and CT genotypes respectively (p=0.109, p=0.238).
Additionally, there was no association found between UGT2B7 (802C>T)
polymorphism and acute rejection (p>0.05).

Conclusion: Our results demonstrated a
correlation between the UGT2B7 (802C>T) polymorphism and MPA
pharmacokinetics among renal transplant patients. Determination of UGT2B7
polymorphism may be helpful for determining the optimum dose of MPA to achieve
the target plasma concentration. 

Anahtar Kelimeler

Renal transplantation; pharmacogenetics; immunosuppressive therapy; polymorphism; mycophenolic acid

Kaynakça

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