Genetic profiling of CYP3A4 variants influencing carbamazepine metabolism and their gender-specific association among patients with epilepsy in Khyber Pakhtunkhwa

Authors

  • Ayesha Jamil Khyber Girls Medical College Peshawar
  • Muhammad Saleh Faisal Khyber Medical College
  • Niaz Ali Khyber Medical University Peshawar
  • Gulmakay Zaman Kabir Medical College Peshawar
  • Rizwan Faisal Rehman Medical College Peshawar
  • Hasnain Ali Shah Kabir Medical College Peshawar

DOI:

https://doi.org/10.59736/IJP.22.04.928

Keywords:

Carbamazepine, CYP3A4 polymorphism, Minor Allele frequency, Sanger sequencing

Abstract

Background: Cytochrome P450 plays a pivotal role in metabolizing drugs, hormones, and vitamins with genetic variability influencing enzymatic activity. Genetic consortiums categorize variables such as CYP3A4-rs2242480 and rs2740574 as third-level evidence, indicating the need for further research into their health implications and pharmacogenetic relevance in carbamazepine metabolism. This study explores the distribution patterns of selected genes and their correlation with gender in our study population, aiming to advance personalized treatment approaches.

Methods: Using Sanger sequencing, Pashtun patients diagnosed with epilepsy and treated with carbamazepine monotherapy were genotyped for CYP3A4-rs2242480 and rs2740574 polymorphisms. The genetic variations were identified through Finch TV and analyzed for gender correlations.

Results: Minor Allele Frequency (MAF) of CYP3A4-rs2242480 and rs2740574 in 223 Pashtun patients with epilepsy was 27.8% and 1.7%, respectively. The genotype frequency of CYP3A4-rs2242480 was as follows: CC at 53.8%, with females 35% & males 65%; CT at 36.7%, with females 36.5% & males 63.4%; and TT at 9.4%, with females 47.6% & males 52.3%. For CYP3A4-rs2740574, the genotype frequencies were 0% CC, 3.6% CT, and 96.4% TT. Among individuals with the CT genotype, the distribution was evenly split between males (50%) and females (50%). For those carrying the TT genotype, females comprised 36.2% of the group, while males made up 63.7%.

Conclusion: The study uncovered genotype distributions of carbamazepine-metabolizing enzymes in the previously unexplored Pashtun population, revealing significant differences in CYP3A4-rs2740574 and rs2242480 frequencies compared to global ethnic groups. Also, no significant association was observed between genotype distribution patterns across genders.

Author Biographies

  • Ayesha Jamil, Khyber Girls Medical College Peshawar

    Associate Professor Pharmacology

  • Muhammad Saleh Faisal, Khyber Medical College

    Assistant Professor, Pharmacology

  • Niaz Ali, Khyber Medical University Peshawar

    Professor Pharmacology

  • Hasnain Ali Shah, Kabir Medical College Peshawar

    Assistant Professor, Department of Pharmacology

References

Sadee W, Wang D, Hartmann K, Toland AE. Pharmacogenomics: driving personalized medicine. Pharmacol Rev. 2023;75(4):789-814.

Zhao M, Ma J, Li M, Zhang Y, Jiang B, Zhao X, et al. Cytochrome P450 enzymes and drug metabolism in humans. Int J Mol Sci. 2021;22(23):12808.

Klyushova LS, Perepechaeva ML, Grishanova AY. The role of CYP3A in health and disease. Biomedicines. 2022;10(11):2686.

Stanley L. Drug metabolism. Pharmacognosy: Elsevier; 2024. p. 597-624.

Masamrekh RA, Kuzikov AV, Haurychenka YI, Shcherbakov KA, Veselovsky AV, Filimonov DA, et al. In vitro interactions of abiraterone, erythromycin, and CYP3A4: implications for drug–drug interactions. Fundam Clin pharmacol. 2020;34(1):120-30.

Iannaccone T, Sellitto C, Manzo V, Colucci F, Giudice V, Stefanelli B, et al. Pharmacogenetics of carbamazepine and valproate: focus on polymorphisms of drug metabolizing enzymes and transporters. Pharmaceuticals. 2021;14(3):204.

Mohammadzadeh P, Nazarbaghi S. The prevalence of drug-resistant-epilepsy and its associated factors in patients with epilepsy. Clin Neurol Neurosurg. 2022;213:107086.

Beydoun A, DuPont S, Zhou D, Matta M, Nagire V, Lagae L. Current role of carbamazepine and oxcarbazepine in the management of epilepsy. Seizure. 2020;83:251-63.

Brigo F, Leo A, Russo E, Striano P, Belcastro V. Intravenous carbamazepine for the treatment of epilepsy. Expert Opin Pharmacother. 2018;19(7):743-7.

Uckun Z, Baskak B, Özdemir H, Özel-kızıl ET, Devrimci-Özgüven H, Süzen SH. Genotype and allele frequency of CYP3A4-392A> G in Turkish patients with major depressive disorder. 2018.

Collins JM, Wang D. Regulation of CYP3A4 and CYP3A5 by a lncRNA: a potential underlying mechanism explaining the association between CYP3A4* 1G and CYP3A metabolism. Pharmacogenet Genom. 2022;32(1):16-23.

Johannessen Landmark C, Johannessen SI, Patsalos PN. Therapeutic drug monitoring of antiepileptic drugs: current status and future prospects. Expert Opin Drug Metab Toxicol. 2020;16(3):227-38.

Zhao G-X, Zhang Z, Cai W-K, Shen M-L, Wang P, He G-H. Associations between CYP3A4, CYP3A5 and SCN1A polymorphisms and carbamazepine metabolism in epilepsy: A meta-analysis. Epilepsy Res. 2021;173:106615.

Gong L, Whirl‐Carrillo M, Klein TE. PharmGKB, an integrated resource of pharmacogenomic knowledge. Curr Protoc. 2021;1(8):e226.

Lee JS, Cheong HS, Kim LH, Kim JO, Seo DW, Kim YH, et al. Screening of genetic polymorphisms of CYP3A4 and CYP3A5 genes. Korean J Physiol Pharmacol. 2013;17(6):479.

Mohammadpour A. Evaluation of a modified salt-out method for DNA extraction from whole blood lymphocytes: A simple and economical method for gene polymorphism. Pharm Biomed Res. 2018;4(2):28-32.

De Cario R, Kura A, Suraci S, Magi A, Volta A, Marcucci R, et al. Sanger validation of high-throughput sequencing in genetic diagnosis: still the best practice? Front Genet. 2020;11:592588.

Zhang Jing ZJ, Dai Ying DY, Liu ZhiHong LZ, Zhang MinXin ZM, Li Chen LC, Chen DingXiong CD, et al. Effect of CYP3A4 and CYP3A5 genetic polymorphisms on the pharmacokinetics of sirolimus in healthy Chinese volunteers. 2017.

Qi G, Han C, Zhou Y, Wang X. Allele and genotype frequencies of CYP3A4, CYP3A5, CYP3A7, and GSTP1 gene polymorphisms among mainland Tibetan, Mongolian, Uyghur, and Han Chinese populations. Clin Exp Pharmacol Physiol. 2022;49(2):219-27.

Xia B, Li Y, Zhang Y, Xue M, Li X, Xu P, et al. UHPLC-MS/MS method for determination of atorvastatin calcium in human plasma: Application to a pharmacokinetic study based on healthy volunteers with specific genotype. J Pharm Biomed Anal. 2018;160:428-35.

Mustafina O, Tuktarova I, Karimov D, Somova RS, Nasibullin T. CYP2D6, CYP3A5, and CYP3A4 gene polymorphisms in Russian, Tatar, and Bashkir populations. Russ J Genet. 2015;51:98-107.

Garsa AA, McLeod HL, Marsh S. CYP3A4 and CYP3A5 genotyping by Pyrosequencing. BMC Med Genet. 2005;6:1-5.

Kassogue Y, Diakite B, Kassogue O, Konate I, Tamboura K, Diarra Z, et al. Distribution of alleles, genotypes and haplotypes of the CYP2B6 (rs3745274; rs2279343) and CYP3A4 (rs2740574) genes in the Malian population: Implication for pharmacogenetics. Medicine. 2021;100(29):e26614.

Espindola LMT, López MDJC, Flores ADU, Espinosa LR, Granados J, Pacheco JLC, et al. Genetic polymorphism of CYP3A4 is associated with poor response to ifosfamide treatment in children with solid embryonic tumors. Arch Med Sci. 2021;17(6):1766.

Rojo M, Roco AM, Suarez M, Lavanderos MA, Verón G, Bertoglia MP, et al. Functionally significant coumarin-related variant alleles and time to therapeutic range in Chilean cardiovascular patients. Clin Appl Thromb Hemost. 2020;26:1076029620909154

Downloads

Published

2025-01-07

Issue

Section

Original article

How to Cite

1.
Jamil A, Faisal MS, Ali N, Zaman G, Faisal R, Shah HA. Genetic profiling of CYP3A4 variants influencing carbamazepine metabolism and their gender-specific association among patients with epilepsy in Khyber Pakhtunkhwa. Int J Pathol [Internet]. 2025 Jan. 7 [cited 2025 Jan. 9];22(4):164-73. Available from: https://jpathology.com/index.php/OJS/article/view/928