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The AmpliChip™ CYP450 Genoty** Test

Integrating a New Clinical Tool

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Abstract

The AmpliChip™ CYP450 Test, which analyzes patient genotypes for cytochrome P450 (CYP) genes CYP2D6 and CYP2C19, is a major step toward introducing personalized prescribing into the clinical environment. Interest in adverse drug reactions (ADRs), the genetic revolution, and pharmacogenetics have converged with the introduction of this tool, which is anticipated to be the first of a new wave of such tools to follow over the next 5–10 years. The AmpliChip™ CYP450 Test is based on microarray technology, which combines hybridization in precise locations on a glass microarray and a fluorescent labeling system. It classifies individuals into two CYP2C19 phenotypes (extensive metabolizers [EMs] and poor metabolizers [PMs]) by testing three alleles, and into four CYP2D6 phenotypes (ultrarapid metabolizers [UMs], EMs, intermediate metabolizers [IMs], and PMs) by testing 27 alleles, including seven duplications.

CYP2D6 is a metabolic enzyme with four activity levels (or phenotypes): UMs with unusually high activity; normal subjects, known as EMs; IMs with low activity; and PMs with no CYP2D6 activity (7% of Caucasians and 1–3% in other ethnic groups). Levels of evidence for the association between CYP2D6 PMs and ADRs are relatively reasonable and include systematic reviews of case-control studies of some typical antipsychotics and tricyclic antidepressants (TCAs). Evidence for other phenotypes is considerably more limited. The CYP2D6 PM phenotype may be associated with risperidone ADRs and discontinuation due to ADRs. Venlafaxine, aripiprazole, duloxetine, and atomoxetine are newer drugs metabolized by CYP2D6 but studies of the clinical relevance of CYP2D6 genotypes are needed. Non-psychiatric drugs metabolized by CYP2D6 include metoprolol, tamoxifen, and codeine-like drugs.

CYP2C19 PMs (3–4% of Caucasians and African Americans, and 14–21% of Asians) may require dose adjustment for some TCAs, moclobemide, and citalopram. Other drugs metabolized by CYP2C19 are diazepam and omeprazole.

The future of pharmacogenetics depends on the ability to overcome serious obstacles, including the difficulties of conducting and publishing studies in light of resistance from grant agencies, pharmaceutical companies, and some scientific reviewers. Assuming more studies are published, pharmacogenetic clinical applications may be compromised by economic factors and the lack of physician education. The combination of a US FDA-approved test, such as the AmpliChip™ CYP450 Test, and an FDA definition of CYP2D6 as a ‘valid biomarker’ makes CYP2D6 genoty** a prime candidate to be the first successful pharmacogenetic test in the clinical environment. One can use microarray technology to test for hundreds of single nucleotide polymorphisms (SNPs) but, taking into account the difficulties for single gene approaches such as CYP2D6, it is unlikely that very complex pharmacogenetic approaches will reach the clinical market in the next 5–10 years.

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Acknowledgments

The genoty** studies of psychiatric patients included in this article were conducted at the University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA.

Jose de Leon, M.D., has received support for his laboratory and research-initiated grants and honoraria from Roche-Molecular Systems, Inc., but has not received any consultant payments and has no other financial arrangements with Roche Molecular Systems, Inc. He has no stocks from Roche or Affymetrix. Dr de Leon has also served on an advisory board for Bristol-Myers Squibb, and has received researcher-initiated grants and honoraria from Eli Lilly. Many of the ideas presented in this article are the distillation of years of discussion and collaboration of Jose de Leon with Dr Walter Koch. The authors thank Lorraine Maw, Tita Forrest and Michele Nikoloff for editorial assistance.

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  1. University of Kentucky Mental Health Research Center at Eastern State Hospital, 627 West Fourth St, Lexington, Kentucky, 40508, USA

    Jose de Leon, Margaret T. Susce & Elaina Murray-Carmichael

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de Leon, J., Susce, M.T. & Murray-Carmichael, E. The AmpliChip™ CYP450 Genoty** Test. Mol Diag Ther 10, 135–151 (2006). https://doi.org/10.1007/BF03256453

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