title: The impact of CYP2C9 genetics and oral contraceptives on cytochrome P450 2C9 phenotype.
abstract: CYP2C9-dependent drug metabolism is subject to large interindividual variation. To some extent, this is explained by genetic polymorphism with expression of enzyme variants that differ in catalytic activity. The aim of this study was to characterize the variation in CYP2C9 phenotype in relation to genotype, with further analysis of the CYP2C9 gene in metabolic outliers. A study population of 126 healthy white subjects were recruited and genotyped for the variant alleles, CYP2C9*1-3. In CYP2C9 phenotyping with losartan, three subpopulations were distinguished that differed in the number of CYP2C9*3 alleles (0, 1, or 2). A three-fold higher metabolic ratio (MR; urinary losartan/carboxymetabolite) was found comparing CYP2C9*1/*3 (n = 20) to CYP2C9*1/*1 (n = 81), but there was considerable variation within each genotype. Subjects genotyped as CYP2C9*1/*1, but with an unexpectedly slow oxidation of losartan, were selected for DNA-sequencing analysis of the CYP2C9 gene. Interestingly, single nucleotide polymorphisms (SNPs) could not be identified either in the 5'-flanking region, the nine exons, or exon-intron boundaries. However, sequencing of the CYP2C9 gene was also carried out in patients genotyped as CYP2C9*1/*1 but with an exceptionally low steady-state clearance of S-warfarin. Here, five different SNPs were identified. In further analysis of the healthy volunteers, it became evident that women on oral contraceptives (OCs) had slower oxidation of losartan (MR of losartan: 1.7) than women without OCs (MR of losartan: 0.86). This novel finding was not explained by a different frequency of variant alleles. In summary, CYP2C9 genotype and oral contraceptives both contribute to a large interindividual variation in CYP2C9 activity.
authors.affiliation: Division of Clinical Pharmacology, Karolinska University Hospital at Huddinge, SE 141 86 Stockholm, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: Sandberg
authors.forename: Inger
authors.initials: I
authors.lastname: Johansson
authors.forename: Magnus
authors.initials: M
authors.lastname: Christensen
authors.forename: Anders
authors.initials: A
authors.lastname: Rane
authors.forename: Erik
authors.initials: E
authors.lastname: Eliasson
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics* / Q000378:metabolism*; D003276:Contraceptives, Oral / Q000378:metabolism*; D065729:Cytochrome P-450 CYP2C9; D005260:Female; D014644:Genetic Variation / Q000235:genetics; D006801:Humans; D016014:Linear Models; D008297:Male; D010641:Phenotype
chemical_list: D003276:Contraceptives, Oral; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases