Rapid response to the alpha-1 adrenergic agent phenylephrine in the perioperative period is impacted by genomics and ancestry

Autor: Muh-Ching Yee, Aniwaa Owusu Obeng, Eimear E. Kenny, Omri Gottesman, Stephen B. Ellis, Matthew A. Levin, Stephane Wenric, Erwin P. Bottinger, Thomas T. Joseph, Janina M. Jeff, Gillian M. Belbin
Jazyk: angličtina
Rok vydání: 2020
Předmět:
0301 basic medicine
Male
Genome-wide association study
Blood Pressure
Bioinformatics
Phenylephrine
0302 clinical medicine
Medicine
10. No inequality
0303 health sciences
education.field_of_study
Genomics
Middle Aged
Phenotype
3. Good health
Cohort
Cardiology
Molecular Medicine
Female
medicine.drug
Agonist
medicine.medical_specialty
Mean arterial pressure
medicine.drug_class
Population
Diastole
Alpha (ethology)
Therapeutics
Polymorphism
Single Nucleotide
Article
White People
03 medical and health sciences
Adrenergic Agents
Internal medicine
Genetics
Humans
education
Perioperative Period
030304 developmental biology
Genetic association
Genetic association study
Pharmacology
business.industry
Perioperative
Translational research
Personalized medicine
Black or African American
030104 developmental biology
Blood pressure
Pharmacogenomics
business
030217 neurology & neurosurgery
Genome-Wide Association Study
Zdroj: The Pharmacogenomics Journal
ISSN: 1473-1150
1470-269X
Popis: BackgroundThe emergence of genomic data in biobanks and health systems offers new ways to derive medically important phenotypes, including acute phenotypes that occur during in-patient clinical care. We hypothesized that there is a genetic underpinning to the magnitude of the response to phenylephrine, an α1-adrenergic receptor agonist commonly used to treat hypotension during anesthesia and surgery.MethodsWe quantified the response to phenylephrine by determining the delta between the minimum blood pressure (BP) within five minutes before and the maximum BP within five minutes after bolus administration. We then performed a genome-wide association study (GWAS) adjusted for genetic ancestry, demographics, and relevant clinical covariates to investigate genetic factors underlying individual differences systolic BP response to phenylephrine (ΔSBP), as well as mean arterial pressure (ΔMAP) and diastolic BP (ΔDBP), for both the entire study cohort as well as for each of 3 ancestry sub-cohorts; European American(EA), African American(AA), and Hispanic American(HA).Results4,317 patients met inclusion criteria, of which 3,699 were genotyped. Average ΔBP values over the entire cohort were ΔSBP=17(+-25) mmHg, ΔMAP=14(+-18) mmHg, ΔDBP=11(+-14) mmHg. The largest difference between populations was observed for ΔSBP (ΔSBPEA=20(+-24) mmHg; ΔSBPHA=16(+-25) mmHg; ΔSBPAA=15(+-25) mmHg). The differences remained after adjusting for clinical covariates and ancestry (EA vs. HA: ΔSBP, p-5;ΔMAP,p-4;ΔDBP,p-4). GWAS revealed significant associations between loci and BP response in 5 different genome regions (p-8) in the entire cohort, and suggestive associations in 2 different regions in EAs (p-8,p-8). We observed non-random enrichment in association with SBP drug response in 165 loci previously reported to be associated with systolic blood pressure. Finally, we discovered rare variants, rs188427942 and rs147664194 present at ∼1% in EAs and rs146535276 present at ∼1% in AAs respectively, where patients carrying one copy of these variants show no response to phenylephrine.ConclusionsIt is possible to derive a quantitative phenotype suited for comparative statistics and genome-wide association studies from routinely collected perioperative data. There are population differences in rapid response to phenylephrine, large effect alleles and novel genes affecting pharmaceutical response, and phenylephrine non-responders, with implications for personalized treatment during surgery.
Databáze: OpenAIRE
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