title: Prevalence of CYP2C9 and VKORC1 mutation in patients with valvular heart disease in northern Thailand.
abstract: BACKGROUND
  Warfarin has been widely used for the prevention and treatment of thromboembolism. Warfarin therapy depends on interaction between physiological, environmental, and genetic factors. Vitamin K epoxide reductase (VKORC1) and cytochrome P450 2C9 (CYP2C9) enzyme conjointly determine the warfarin maintenance dose. The prevalence of CYP2C9 and VKORC1 variants varies among ethnic groups. The purpose of the present study was to investigate the prevalence of CYP2C and VKORC1 in the Northern Thai population.
  
  
  METHODS
  Patients with valvular heart disease who regularly took a steady maintenance warfarin dose for at least one month were recruited into the present study. Patients who had taken amiodarone or an anti-inflammatory drug were excluded Clinical data were obtained from medical records. Five milliliters of whole blood was drawn from each patient for gene analysis and prothrombin time with international normalized ratio (INR) measurement.
  
  
  RESULTS
  From 242 patients, CYP2C9 *1/*1 was found in 230 patients (95%) and CYP2C9 *1/*3 was found in 12 patients (5%). Neither mutant CYP2C9*2 allele nor individuals homozygous for CYP2C9*3 were observed. Regarding VKORC1, haplotype AB was found in 83 patients (34.3%) and haplotype AA was found in 154 patients (63.6%). Haplotype BB (wild type) was found in five patients (2.1%).
  
  
  CONCLUSIONS
  The prevalence of CYP2C9 *1/*1 is high while the prevalence of CYP2C9*2 and CYP2C9*3 is very low. VKORC1 haplotype AA is the most common among the Northern Thai population. Further study regarding pharmacogenetic and non-genetic factors to develop warfarin-dosing algorithm is warranted
authors.affiliation: Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand.
authors.forename: Srun
authors.initials: S
authors.lastname: Kuanprasert
authors.forename: Sakchai
authors.initials: S
authors.lastname: Dettrairat
authors.forename: Poonsub
authors.initials: P
authors.lastname: Palacajornsuk
authors.forename: Warunee
authors.initials: W
authors.lastname: Kunachiwa
authors.forename: Arintaya
authors.initials: A
authors.lastname: Phrommintikul
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D065729:Cytochrome P-450 CYP2C9; D005260:Female; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000235:genetics*; D009154:Mutation; D010597:Pharmacogenetics; D011110:Polymorphism, Genetic; D015995:Prevalence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D064417:Vitamin K Epoxide Reductases; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006899:Mixed Function Oxygenases; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases; C578523:VKORC1 protein, human; D064417:Vitamin K Epoxide Reductases