The effectiveness of drugs and their potential for both benefit and side effects are not only the result of drug selection and dose but also the rate of drug metabolism and target interaction.  For many drugs, this metabolism is accomplished by the Cytochrome P450 (CYP450) enzyme system located in the liver and small intestine.

Variability in the CYP450 system, accumulated in humans since prehistoric times, results in strikingly different drug levels, drug effectiveness and drug safety among individuals when the recommended dose is designed to treat the "average" person. These variances, particularly relevant to drugs used in mental health and pain control, can now be measured by DNA typing before treatment.  Drug doses can then be tailored to provide safe and effective therapy for individual patients (DNA-Guided Medicine).

For the blood thinning drug warfarin (Coumadin®), its interaction with its target, VKOR (Vitamin K Epoxide Reductase) is critical to its effect and appropriate dose.  Variances in the VKOR gene can also be measured by DNA typing. When combined with those in the CYP450 System, DNA-guided warfarin dosing can be implemented to elicit the desired blood thinning level and avoid serious side effects from bleeding.

The Laboratory for Personalized Health's DNA typing systems analyze the CYP2C9, CYP2C19, CYP2D6 and VKOR genes.  The Laboratory for Personalized Health then assists in the interpretation of these results for DNA-guided medical management of serious side effects and individualized optimization of therapy. 

More information is available on this web site or by contacting the Laboratory for Personalized Health at 860-545-4589.

Personalized Health Portal (PHP): Medical Informatics Enabling DNA-Guided Medicine

The Personalized Health Portal integrates pharmacokinetic information available from the FDA, drug manufacturers, pharmacogenetic databases and studies by Genomas to determine the drugs that each patient would be most likely to tolerate and process given the person's innate drug metabolism capacity determined by the HILOmet PhyzioType System. PHP provides therapeutic guidance for 80 psychotropic medications, including antidepressants, neuroleptics, anticonvulsants, anxiolytics, stimulants, analgesics, and hypnotics.

References:
Personalized Drug Therapy and DNA-Guided Medicine at Hartford Hospital Hartford Hospital Progress Notes, Fall 2007

Personalized Medicine, Channel 12 on Health, Hosted by Gillian Neff, Broadcast 11 December 2010, Norwalk, Connecticut

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