title: Pharmacogenomics as an aspect of molecular autopsy for forensic pathology/toxicology: does genotyping CYP 2D6 serve as an adjunct for certifying methadone toxicity?
abstract: Pharmacogenomics, applied as an aspect of molecular autopsy, may be used as an adjunct for certifying methadone fatalities. Methadone is metabolized by cytochrome P-450 (CYP) 1A2, 3A4, and 2D6. We hypothesized that methadone toxicity may be partially due to CYP 2D6 *3, *4, and *5 variant alleles, resulting in poor drug metabolism. A retrospective analysis was performed on covariables and risk factors of 21 methadone cases from the Milwaukee County Medical Examiner's Office (1998-2000). PCR genotyping showed: one heterozygous for 2D6*3, two homozygous for 2D6*4, five heterozygous for 2D6*4, and one heterozygous for both 2D6*3 and *4. This limited number of cases showed that the prevalence of poor metabolizer was higher but not significantly different from that of a control group (n = 23) (P > 0.05, Fisher Exact Test). Thus, CYP 2D6 mutations may not yet be directly associated with methadone toxicity. However, pharmacogenomics, complementing other case findings, served as an adjunct in interpreting methadone toxicity of poor and intermediate metabolizers.
authors.affiliation: Milwaukee County Medical Examiners' Office, Milwaukee, WI, USA. shwong@mcw.edu
authors.forename: Steven H
authors.initials: SH
authors.lastname: Wong
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wagner
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Jentzen
authors.forename: Chuck
authors.initials: C
authors.lastname: Schur
authors.forename: Jeanette
authors.initials: J
authors.lastname: Bjerke
authors.forename: Susan B
authors.initials: SB
authors.lastname: Gock
authors.forename: Chung-Che
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000483:Alleles; D016022:Case-Control Studies; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics*; D005260:Female; D005554:Forensic Medicine / Q000379:methods*; D006580:Genetic Carrier Screening; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D008297:Male; D008691:Methadone / Q000493:pharmacokinetics / Q000506:poisoning*; D008875:Middle Aged; D009294:Narcotics / Q000493:pharmacokinetics / Q000506:poisoning*; D011041:Poisoning / Q000235:genetics; D016133:Polymerase Chain Reaction / Q000379:methods; D012189:Retrospective Studies
chemical_list: D009294:Narcotics; D019389:Cytochrome P-450 CYP2D6; D008691:Methadone