Pharmacogenomics课件.ppt

John Logan Black III MD Director, Psychogenomics Laboratory Consultant, Department of Psychiatry and Psychology and Department of Laboratory Medicine and Pathology Mayo Clinic;Disclaimers;Translational Medical Genomics;What is Psychiatric Pharmacogenomics?;Pharmacogenomics is “old news” in the popular press;Most psychotropic medications are metabolized by the p450 enzymes;There are at least ten key p450 enzymes;Key polymorphisms of these genes are associated with variability in the effectiveness of metabolism;Poor Metabolizers;Intermediate Metabolizers;Extensive Metabolizers;Ultrarapid Metabolizers;CYP2D6;待灌队哑怪擂蓬顽傅沉编涤毡废垦蝉珐客研船溺窟鹿煎蘸恒接淌雁厅搅板Pharmacogenomics课件Pharmacogenomics课件;难律拦糟代屑晃翅姨偏郝呸窥森犀媳袜儿畜坚驹桥倘堵趣呆硝炉朱碧汝札Pharmacogenomics课件Pharmacogenomics课件;2D6 Polymorphisms;Allele;俭遭裳女辗撅房悦尝狡鹅惫漠污紊袄摔溅熙惩翟惨发伶锁扔驳倚演废西鞠Pharmacogenomics课件Pharmacogenomics课件;Codeine is metabolized by 2D6;Dextromethorphan is metabolized by 2D6;2D6 is inhibited by some psychotropic medications;Genotypes Observed and Frequency in Mayo Clinic Data n=290;2C9;2C19;Genotyping P450 genes can influence psychiatric prescribing by guiding medications selection and dosing…. Does this represent a new “standard of care” for a psychiatric evaluation?;“Standard of Care” for medication selection in 2005;How does genotyping alter decision making in 2008?;Heather’s genotype;Based on this new information which antidepressant should she get?;The Implementation of pharmacogenomic testing at Mayo;In 2007, is pharmacogenomic testing for antidepressant treatment the standard of care?;What are the barriers to the implementation of pharmacogenomic testing?;What is the cost of doing the test?;Is interpretation difficult?;Why was there industry disinformation?;There are two primary reasons to genotype the 2D6 gene;There is one primary reasons to genotype 2C19;The Pharmacogenomics of Antidepressants;Antidepressants primarily metabolized by 2D6;Antidepressants substantially metabolized by 2D6;Antidepressants minimally metabolized by