Glucuronidation clearance of 8-hydroxyclomipramine in relation to sparteine and mephenytoin phenotype.
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The identification of a novel CYP2D6 allele from a healthy Caucasian poor metabolizer was achieved by using a previously described polymerase chain reaction/single-strand conformation polymorphism strategy. Among the four point mutations that this allele carries, a missense mutation in exon 1 (212 G-->A or D6-H) seems to be responsible for the loss of CYP2D6 function. Although the mutation D6-H has a low prevalence in a randomly selected population of healthy Caucasians, its identification should further increase the phenotype prediction rate by genotyping.
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Discovery of genetic polymorphism in drug metabolism has contributed a great deal to understanding the variability in dose-concentration relationships introduced by genetic factors, thereby elucidating the mechanisms responsible for unexpected drug reactions. This knowledge should find its way into clinical practice in order to make therapy more efficient and safe. Moreover, genetic factors in drug metabolism should be taken into account during drug development. Therefore, in vitro methods for identifying the metabolic pattern of new compounds during early stages of drug development should be improved. This review summarizes in vitro methods available to identify genetic polymorphism in drug oxidation, in particular the CYP2D6-related polymorphism.
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