Branka Kosarac1, Amanda A Fox, Charles D Collard. 1. Baylor College of Medicine Division of Cardiovascular Anesthesiology at the Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Abstract
PURPOSE OF REVIEW: Opioid administration is a mainstay of anesthetic practice both for treating acute perioperative pain and for chronic pain syndromes. Growing pharmacogenetic data make it evident that many opiate-related phenomena are influenced by genetics. Genetic variation may significantly affect opiate absorption, distribution, metabolism, excretion and toxicity. We provide a current review of opiate pharmacogenetics. RECENT FINDINGS: Gene association studies should ideally be conducted in highly phenotyped populations of homogenous ethnic admixture with identified associations adjusted for patient demographics, risk factors and medications. Patients' phenotype responses to opiates are the result of a complex interplay between genetic and environmental variables. Although most pharmacogenetic studies to date have assessed the association between individual single nucleotide polymorphisms that exist within selected single gene regions (e.g. opioid receptor mu-1, catechol-O-methyltransferase, cytochrome P450 2D6) and opiate effects, more recent studies have begun to assess the potential influences of gene-gene interactions. SUMMARY: Knowledge of genetic factors that affect opioid efficacy, metabolism, and side effects have the potential for personalizing both acute and chronic pain management, and for designing more effective opiate pain medications with lower side effect profiles.
PURPOSE OF REVIEW: Opioid administration is a mainstay of anesthetic practice both for treating acute perioperative pain and for chronic pain syndromes. Growing pharmacogenetic data make it evident that many opiate-related phenomena are influenced by genetics. Genetic variation may significantly affect opiate absorption, distribution, metabolism, excretion and toxicity. We provide a current review of opiate pharmacogenetics. RECENT FINDINGS: Gene association studies should ideally be conducted in highly phenotyped populations of homogenous ethnic admixture with identified associations adjusted for patient demographics, risk factors and medications. Patients' phenotype responses to opiates are the result of a complex interplay between genetic and environmental variables. Although most pharmacogenetic studies to date have assessed the association between individual single nucleotide polymorphisms that exist within selected single gene regions (e.g. opioid receptor mu-1, catechol-O-methyltransferase, cytochrome P450 2D6) and opiate effects, more recent studies have begun to assess the potential influences of gene-gene interactions. SUMMARY: Knowledge of genetic factors that affect opioid efficacy, metabolism, and side effects have the potential for personalizing both acute and chronic pain management, and for designing more effective opiatepain medications with lower side effect profiles.
Authors: Kenneth Blum; Thomas J H Chen; John Bailey; Abdalla Bowirrat; John Femino; Amanda L C Chen; Thomas Simpatico; Siobhan Morse; John Giordano; Uma Damle; Mallory Kerner; Eric R Braverman; Frank Fornari; B William Downs; Cynthia Rector; Debmayla Barh; Marlene Oscar-Berman Journal: Mol Neurobiol Date: 2011-09-24 Impact factor: 5.590
Authors: Kenneth Blum; Marlene Oscar-Berman; John Femino; Roger L Waite; Lisa Benya; John Giordano; Joan Borsten; William B Downs; Eric R Braverman; Raquel Loehmann; Kristina Dushaj; David Han; Thomas Simpatico; Mary Hauser; Debmalya Barh; Thomas McLaughlin Journal: J Addict Res Ther Date: 2013-04-23