Received for publication February 12, 2007.
Revised May 9, 2007.
Accepted for publication May 10, 2007.

Building Individualized Medicine: Prevention of Adverse Reactions to Warfarin Therapy

Abstract

Warfarin is the most widely used oral anticoagulant in the world for patients with venous thrombosis, pulmonary embolism, chronic atrial fibrillation, and prosthetic heart valves. About 30 genes contribute to therapeutic effects of warfarin, and genetic polymorphisms in these genes may modulate its anticoagulant activity. In contrast to monogenic pharmacogenetic traits, warfarin drug response is a polygenic trait, and development of diagnostic tools predictive of adverse reactions to warfarin requires a novel approach. A combination of two strategies, biochemical isolation of allelic variants, and linkage disequilibrium association studies, was used to find an association between genetic polymorphisms in the candidate genes, and warfarin response. A strong association was found between genetic polymorphisms in six genes including VKORC1, CYP2C9, PROC, EPHX1, GGCX, and ORM1, and inter-individual variability in the anticoagulant effect of warfarin; the strongest predictors were VKORC1 and CYP2C9. Generation of SNP-based dense genetic maps made it possible to identify haplotypes associated with drug response phenotypes. Discrimination between haplotypes associated with warfarin dose phenotypes can be achieved by a limited set of informative polymorphisms (tag SNPs). The use of tag SNPs in pharmacogenomic analysis provides a promising tool for dissecting polygenic traits of drug response.

Key words: Pharmacogenomics, adverse drug reactions, genotype, metabolism, polymorphism, warfarin