Dabigatran etexilate activation is affected by the CES1 genetic polymorphism G143E (rs71647871) and gender.
The oral anticoagulant prodrug dabigatran etexilate (DABE) is sequentially metabolized by intestinal carboxylesterase 2 (CES2) and hepatic carboxylesterase 1 (CES1) to form its active metabolite dabigatran (DAB). A recent genome-wide association study reported that the CES1 single nucleotide polymorphisms (SNPs) rs2244613 and rs8192935 were associated with lower DAB plasma concentrations in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) study participants. In addition, gender differences in exposure to DAB were observed in clinical studies. The aim of this study was to examine the effect of CES1 genetic polymorphisms and gender on DABE activation using several in vitro approaches. The genotypes of the CES1 SNPs rs2244613, rs8192935, and the known loss-of-function CES1 variant rs71647871 (G143E), and the activation of DABE and its intermediate metabolites M1 and M2 were determined in 104 normal human liver samples. DABE, M1, and M2 activations were found to be impaired in human livers carrying the G143E variant. However, neither rs2244613 nor rs8192935 was associated with the activation in human livers. The incubation study of DABE with supernatant fractions (S9) prepared from the G143E-transfected cells showed that the G143E is a loss-of-function variant for DABE metabolism. Moreover, hepatic CES1 activity on M2 activation was significantly higher in female liver samples than male. Our data suggest that CES1 genetic variants and gender are important contributing factors to variability in DABE activation in humans. A personalized DABE treatment approach based on patient-specific CES1 genotypes and sex may have the potential to improve the efficacy and safety of DABE pharmacotherapy.
Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States.
Jian
J
Shi
Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States.
Xinwen
X
Wang
Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States.
Jenny-Hoa
JH
Nguyen
Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, NM, United States.
Barry E
BE
Bleske
Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States; The Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China.
Yan
Y
Liang
Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States; The Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China.
Li
L
Liu
Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States. Electronic address: hjzhu@med.umich.edu.
Hao-Jie
HJ
Zhu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000378:metabolism / Q000493:pharmacokinetics*; D043182:Carboxylesterase / Q000235:genetics / Q000378:metabolism; D002265:Carboxylic Ester Hydrolases / Q000235:genetics / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D000069604:Dabigatran / Q000378:metabolism / Q000493:pharmacokinetics*; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D046509:Tissue Culture Techniques; D055815:Young Adult
D000925:Anticoagulants; D002265:Carboxylic Ester Hydrolases; C474609:CES1 protein, human; C517204:CES2 protein, human; D043182:Carboxylesterase; D000069604:Dabigatran
Activation; Carboxylesterase 1; Carboxylesterase 2; Dabigatran etexilate; Gender difference; Pharmacogenetics