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High Frequency of Occurrence of CYP2D6 Gene Duplication/Multiduplication Indicating Ultrarapid Metabolism Among Suicide Cases: High frequency of CYP2D6 ultra-rapid metabolizers among suicide cases
National Board of Forensic Medicine, Linköping.
National Board of Forensic Medicine, Linköping.
National Board of Forensic Medicine, Linköping.
2009 (English)In: Clinical Pharmacology and Therapeutics, ISSN 0009-9236, E-ISSN 1532-6535Article in journal (Other academic) Published
Abstract [en]

In Sweden about 550 individuals die every year due to intoxication with drugs. Many of these drugs are metabolized by CYP-enzymes, such as CYP2D6 and CYP2C19. Lack of these enzymes, resulting in a poor metabolism, can lead to adverse reactions, even leading to a fatal outcome. On the other hand, socalled ultra-rapid metabolism can lead to insufficient drug plasma concentration and with that failed treatment or it can lead to a high amount of active/toxic metabolites. The aim of this project was to study the genetic distributions of CYP2D6 and CYP2C19 in fatal intoxication cases (242), suicide cases (intoxications excluded) (262) and natural death cases (212). PCR followed by pyrosequencing was used for all the analyses. Surprisingly, we found an increased number of individuals carrying more than two active CYP2D6 alleles, corresponding to the phenotype of an ultra-rapid metabolizer, among the suicide cases as compared to the natural death cases (p=0.007).

Place, publisher, year, edition, pages
2009.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17935DOI: 10.1038/clpt.2009.216OAI: oai:DiVA.org:liu-17935DiVA: diva2:213009
Available from: 2009-04-27 Created: 2009-04-27 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Pharmacogenetics from a Forensic Perspective: CYP2D6 and CYP2C19 genotype distributions in autopsy cases
Open this publication in new window or tab >>Pharmacogenetics from a Forensic Perspective: CYP2D6 and CYP2C19 genotype distributions in autopsy cases
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Sweden about 550 individuals die every year due to drug intoxication. A challenge for the forensic toxicologist is to determine whether or not the analytical results can explain intoxication as a cause of death. The most common drugs found among intoxication cases are psychiatric drugs and analgesics. Many of these drugs are metabolised by CYP-enzymes such as CYP2D6 and CYP2C19. Genetic variations, polymorphisms, in the genes coding for these enzymes can lead to an inactive enzyme resulting in poor metabolism, which can lead to adverse drug reactions, even with fatal outcome. The CYP2D6 gene can be multiplied, which can lead to an ultra-rapid metabolism if the alleles are active. Another polymorphism, in the CYP2C19 gene, can also lead to an ultra-rapid metabolism. This increased metabolism can result in insufficient drug plasma concentration and, with that, failed treatment. Alternately, if the drug is a pro-drug and has to be activated by these enzymes, it can lead to a high amount of active metabolites. There is a large inter-individual variation of these polymorphisms and also a large variation between different populations. Additional information about an individual’s pharmacogenetics may possibly facilitate the interpretation of the postmortem result and contribute to solve the “toxicological puzzle”.

The general aim of this thesis was to study if genetic variation in the drug metabolising enzymes, CYP2D6 and CYP2C19 can contribute to fatal intoxication. Reliable and rapid SNP and CNV assays suitable for forensic samples using PCR and pyrosequencing were developed for CYP2D6 and genotype frequencies in a Swedish population were shown to be in concordance with earlier published data. SNP assays were established for polymorphisms in the CYP2C19 gene.

Genotype distributions in fatal intoxication cases were compared with Swedish blood donors and significant difference between the materials were established. The allele CYP2D6*4 was found to be less frequent among the intoxication cases, as compared with the blood donors. No differences in CYP2C19 genotype frequencies were found between the materials. These findings are the opposite of our hypothesis that we expected to find an increased number of individuals carrying genetic variations, leading to poor metabolism among fatal intoxication cases. However, we are convinced that information concerning an individual’s genotype can be of importance in specific intoxication cases. Further studies are required to illuminate this question. Two further autopsy materials were studied; suicide cases (intoxications excluded) and natural death cases. A significant increased number of individuals carrying more than two active CYP2D6 alleles among the suicide cases were found compared to natural death cases. Furthermore, we found some significant differences between the materials when the individuals in each material were grouped according to how many active CYP2D6 alleles they carry in combination with the CYP2C19 genotype, which was divided into six subgroups. We do not currently have any explanation for the differences between the materials.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 82 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1124
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17936 (URN)978-91-7393-639-2 (ISBN)
Public defence
2009-05-15, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-04-27 Created: 2009-04-27 Last updated: 2009-08-21Bibliographically approved

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Zackrisson, Anna-LenaLindblom, BertilAhlner, Johan

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