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La pharmacogénomique, meilleur exemple de médecine personnalisée

Abstract : Pharmacogenetics and pharmacogenomics allow for appreciating the individual response to drugs. After reminding that this personalized medicine was already practiced in ancient times, it is only about sixty years ago, that this discipline really appeared after highlighting the toxicity due to gene mutations such as that of acetyltransferases for isoniazide, cytochromes P450 2D6 for many drugs such as pexid, betablockers, antidepressors and cytochrome P450 2C19 for clopidogrel. It is thus necessary to consider the 3 phases of transformation of a drug in the organism (essentially the liver): oxidation, conjugation and transport. Therefore the drugs or their metabolites reach the therapeutic targets such as proteins ((Apolipoprotein E – ApoE) or receptors at the cell surface (cancerous therapy). The final aim is to adapt the right dose of medicines to each patient in order to avoid or diminish the adverse or toxic reactions and to prescribe a substitute drug for therapy-resistant patients. We describe some examples with anticoagulants (coumarin) or antithrombotic (clopidogrel) The improvement of clinical use requires a multilevel strategy (training, information, quality of genotyping methods, clinical trials) in order to transfer this knowledge to clinicians and patients.
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Gérard Siest, Sophie Visvikis-Siest. La pharmacogénomique, meilleur exemple de médecine personnalisée. HEGEL - HEpato-GastroEntérologie Libérale, ALN Editions, 2016, 6 (1), pp.10-21. ⟨10.4267/2042/58962⟩. ⟨hal-01708489⟩

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