title: The impact of CYP2D6 genetic polymorphisms on postoperative morphine consumption.
abstract: BACKGROUND
  Endogenous morphine-like compounds have been identified in humans and are released in response to stress. Human monocytes and granulocytes express the micro opiate receptor, micro3, which is morphine selective but opiate peptide insensitive. Recent studies have shown that CYP2D6 acts at critical steps for endogenous morphine biosynthesis. We theorized that ultrarapid (UM) CYP2D6 metabolizers may have an enhancement of their endogenous pain modulating mechanisms.
  
  
  METHODS
  After institutional review board approval, a previously developed surgical patient database was evaluated for information concerning CYP2D6 genotypes and morphine consumption. One hundred forty-two patients were found to have adequate information to be included in this current analysis. The study group was divided, based on morphine consumption, into two subgroups: low morphine consumers (LMC) (< or =10 mg/4 h, N = 80) and high morphine consumers (HMC) (>10 mg/4 h, N = 62). DNA was extracted from blood in all patients and was genotyped by the Amplichip (Roche, Pleasanton, CA) to determine the specific CYP2D6 genotypes.
  
  
  RESULTS
  CYP2D6 UM were found to occur more frequently in the LMC group than in the HMC group (8/80 vs 0/62, P = 0.0091). No significant differences were noted for the poor, intermediate, or extensive metabolizers.
  
  
  CONCLUSIONS
  Our current results suggest that CYP2D6 UM appear to require less morphine in the acute postoperative period compared with other CYP2D6 metabolizer groups. One possible mechanism for this observation is that CYP2D6 UM may have higher efficiency in synthesizing endogenous morphine compared with other metabolizers, thus increasing endogenous pain modulation and reducing the need for exogenous morphine.
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, Florida 33101, USA. kcandiotti@miami.edu
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
authors.forename: Zongqi
authors.initials: Z
authors.lastname: Yang
authors.forename: Yiliam
authors.initials: Y
authors.lastname: Rodriguez
authors.forename: Andres
authors.initials: A
authors.lastname: Crescimone
authors.forename: Greys C
authors.initials: GC
authors.lastname: Sanchez
authors.forename: Peter
authors.initials: P
authors.lastname: Takacs
authors.forename: Carlos
authors.initials: C
authors.lastname: Medina
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zhang
authors.forename: Huanliang
authors.initials: H
authors.lastname: Liu
authors.forename: Melvin C
authors.initials: MC
authors.lastname: Gitlin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D000758:Anesthesia; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use*; D020411:Oligonucleotide Array Sequence Analysis; D010149:Postoperative Pain / Q000188:drug therapy* / Q000235:genetics*; D011110:Polymorphism, Genetic; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D019389:Cytochrome P-450 CYP2D6