Clopidogrel and genetic testing for drugs: Is it necessary?
Feb 28, 2022
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Bengaluru, March 1, 2022:
Mapmygenome India opened its Genomics Experience Center in Bengaluru on March 1. The NABL & ICMR certified center is located at Sector 7, HSR Layout. The new center is an expansion of Mapmygenome’s services provided in Hyderabad and Delhi. Now, customers get access to distinctive services such as genetic tests, genetic counseling, blood tests, health screening tests, antibody tests and COVID-19 RT-PCR tests.
Dr C N Ashwath Narayan, Minister of Information Technology and Biotechnology inaugurated the center. “We welcome Mapmygenome to Bengaluru and we welcome you with open arms. We will support this venture in any way possible,” said Dr Ashwath Narayan, during his inaugural address. “Mapmygenome’s mission is commendable and it will definitely help ten crore people of the state, in facilitating preventive healthcare,” he said.
Dr Kiran Mazumdar-Shaw, Chairperson of Biocon Limited and Biocon Biologics Limited, was the guest of honor. “India is at the cusp of genomic revolution and I think Mapmygenome is at the forefront of this revolution. The pandemic has really shown us the need for genomic expertise,” said Dr Kiran Mazumdar-Shaw. “With this backdrop, it is great to have a company like Mapmygenome expanding their services to preventive genomics that combines genomic sequencing and biochemistry,” she added.
The move to launch a genomics center in the Mecca of startups, aims to provide more personalized experience in genetic testing and its possibilities among the tech-savvy customers of Bengaluru. Mapmygenome witnessed a solid demand for its genetics and health screening tests from the Garden City. With the new center, customers get a real-time experience about the process of genetic testing and actionable
When one of your friends, family or well-wishers suffer from a brain stroke due to bleeding, whom or what do you suspect ? It would be a mystery unless a doctor performs an autopsy on the patient. What if one can prevent brain stroke even while consuming blood thinning drugs such as Clopidogrel (by the way is a major cause of stroke due to bleeding ) beforehand ?
It is possible when the patient, even before taking clopidogrel, gets tested for drug efficacy with pharmacogenomics testing such as MedicaMap.
What is in the name?
Clopidogrel is a medication used to decrease one’s risk of heart and brain disease due to blood components known as platelets. Platelets stick with one another forming clumps which clog the arteries thereby reducing blood supply to vital organs such as heart and brain. It is mostly prescribed to patients who underwent stenting in the heart to prevent blockage. Clopidrogel comes as a tablet to take orally and its efficacy will last for five days.
Drug interaction: a matter of enzymes
Clopidogrel transforms into various compounds inside the body due to various enzymes. These enzymes are known as cytochrome P-450 (CYP). They are produced according to genes present in DNA. Now these enzyme producing genes are not the same in each individual. Different genes produce different enzymes. Some enzymes transform clopidogrel drugs in such a way that some individuals have reduced enzyme function and some have increased enzyme function leading to various levels of efficacy.
The following table shows genes associated with cytochrome P-450 (CYP) enzymes.
The numbers with stars are different variants of the same gene and are known as star alleles. DNA sequence variations in genes, alters proteins, which are notified as star alleles and is directly proportional to a person‘s drug response. Star alleles are discovered and analyzed in Medicamap, a go-to product for pharmacogenomics in India.
Personalising medicine: an emerging practice
In Pharmacogenomics, personalising medicine according to a person’s DNA is the key.
A sure shot way to make it happen is through Medicamap. It is a cutting-edge pharmacogenomic test, which analyses an individual‘s response to medicines, based on his/her genetic makeup. From tolerance to risk of adverse reactions, this unique genetic testing kit uses highly validated genetic markers to analyse an individual’s drug-response profile based on their genetic makeup for 100+ drugs across specialties.
How does it work?
As the first step, a blood sample of the patient is taken for DNA sequencing.It shows the types of alleles present in DNA for that particular enzyme. This combination of alleles makes drug metabolism different for different people.
The following table shows the drug absorption according to clopidogrel metabolism. So every patient is divided into different categories based on their ability of drug absorption, according to the DNA read of that particular drug. Some are categorized as EM extensive metabolizer, IM intermediate metabolizer, PM poor metabolizer and UM ultra-rapid metabolizer.
Patients who are categorized as extensive, intermediate and poor metabolizers have the efficacy of clopidogrel decreasing in order. Poor metabolizers need an increased number of doses/dosages to attain the same efficacy as extensive metabolizers. Majority of people are extensive metabolizers. Extensive metabolizers need a normal range of dose decreasing the adverse effects of clopidogrel.
Poor metabolizers are prone to the negative effects of drugs even at the normal range of dose/dosages. According to CPIC (Clinical Pharmacogenetics Implementation Consortium) guidelines, adverse effects include brain stroke, heart attack and stent blockages. CPIC provides evidence-based clinical practice guidelines for pharmacogenetics implementation, and assigns clinical actionability to gene/drug pairs. This research led FDA to add blackbox warning on drug labels for doctors to advise alternate drugs for poor and intermediate metabolizers.
Medicamap: A precise genetic testing
This is why a precise genetic testing is necessary.Medica Map detects poor and intermediate metabolyzers. It acts as a prescription testing for drug advice.
Genetic variation leads to different levels of drug metabolism leading to different dosages and different adverse effects. Hence,every patient consuming clopidogrel should undergo genetic testing before personalizing the drug’s dosage. Personalized medicine is the way to go !
References:
1. Cytochrome P-450 Polymorphisms and Response to Clopidogrel (N Engl J Med 2009; 360:354-362)
2. https://en.wikipedia.org/wiki/Clopidogrel
3. CPIC guidelines : https://files.cpicpgx.org/data/guideline/publication/clopidogrel/2022/35034351.pdf
4. Clopidogrel Pharmacogenetics — Why the Wait? (https://www.nejm.org/doi/full/10.1056/NEJMe1911496)
5. Clopidogrel Pharmacogenetics : State-of-the-Art Review and the TAILOR-PCI Study (https://doi.org/10.1161/CIRCINTERVENTIONS.119.007811)
Anu Acharya, CEO of Mapmygenome, said,
“We are calling this a genomics experience center as we will combine genomics with lifestyle and preventive biochemistry. We also have nutrition, medical and genetic counseling for our customers. We chose Bengaluru as our first experience center as it is a melting pot of the modern and the traditional .”
The data confidentiality of each customer is a priority in the Genomics Experience Center and is powered through secure Biotracker LIMS. The center also ensures long-term engagement with the customers including tests and health updates using latest sequencing technology and genetic sequencing platforms.
Mapmygenome® is India’s largest personal genomics company that encourages people to be proactive about their health. Mapmygenome offers personalized health solutions based on genetic tests that help people get to understand their genetic selves. By combining genetic health profiles, health history, and genetic counseling, Mapmygenome provides actionable steps for individuals to lead healthier lives.
Founded in 2013, Mapmygenome started as India’s pioneering Personal Genomics Company with a vision to “Touch 100 million lives and save a million lives by 2030.” Mapmygenome’s teams at Hyderabad and Delhi comprise biotechnologists, statisticians, geneticists, bioinformaticians, and medical counselors. Mapmygenome has analyzed thousands of samples from all over India and various countries and has provided personalized genetic reports that have been used in early detection of disease and increased quality of life.
Mapmygenome was among the first private diagnostic labs to receive approval from Telangana State Government for COVID-19 testing. Their lab analyses samples for SARS-CoV-2 from walk-in customers, healthcare partners, home collections, and corporate clients. In November 2020, they launched a new NABL and ICMR approved COVID testing lab at Hyderabad International Airport.
Recently Mapmygenome started its Delhi lab for genomic testing, blood tests, imaging and genetic counseling.
Genomepatri is Mapmygenome‘s flagship product that provides a comprehensive assessment of health risks on the basis of a DNA sample through a simple buccal swab test. Through decoding the DNA and analyzing certain regions of the genome known to be associated with health conditions, Genomepatri gives insights about genetic predisposition to certain health conditions, drug efficacy, sensitivities and more. Then, our expert team guide in creating an action plan on preventive measures.
Other major products include Genomepatri Heritage, Medicamap, Oncomap, Mother & Child, NGS based tests and many more.
For more information, visit Mapmygenome
Mapmygenome is synonymous with genetic sequencing in India- Dr. Krian Mazumdar Shaw
Dr. Kiran Mazumdar Shaw, Chairperson of Biocon Limited & Biocon Biologics Limited, congratulates Mapmygenome for its expansion to Bengaluru with Genomics Experience Center. "I think it is great to have a company like Mapmygenome basically expanding their services into preventive genomics which includes the combination of both genomic sequencing and biochemistry," she said.
