Genetic variants of N-acetyltransferase 2, CYP2E1 and Glutathione S-transferase: relation with therapeutic safety in patients with tuberculosis / Variantes genéticas da N-acetiltransferase 2, CYP2E1 e glutationa S-transferase: relação com a segurança terapêutica em pacientes com tuberculose

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Polymorphisms in N-acetiltransferase 2 (NAT2), CYP2E1 and glutatione S-transferase (GST) have been associated with differences in response to antituberculosis drugs. The role of the NAT2, CYP2E1 and GSTM1/GSTT1 variants on safety profile of the anti-tuberculosis therapy was evaluated in 99 tuberculosis patients, without co-infection by HIV or hepatitis virus, treated during 6 months. Blood samples were collected before and after the therapy to evaluate serum markers for hepatocelullar damage (ASLT and AST), cholestasis (ALP, GGT and bilirrubin) and kidney function (creatinine). Genomic DNA was extracted from EDTA-blood samples by salting-out method. NAT2 polymorphisms were analyzed by PCR-RFLP and DNA sequencing. CYP2E1 promoter region polymorphisms were detected by PCR-RFLP and for analysis of the null genotypes GSTM1 (GSTM1*0) e GSTT1 (GSTT1*0) PCR multiplex technique was used. During the therapy, 59.6% of the patients had adverse drug reactions (ADR) and alterations on hepatocellular damage and cholestasis serum markers, with increase of 1 to 4 times the upper limit reference level. There was a significant relationship between ADR and serum markers alterations (p<0,05), as well as, the concomitant medicine (p<0,001). The frequencies of the NAT2*4 and NAT2*6 alleles were higher and lower, respectively, when compared to other studies in the Brazilian population. The slow acetilator profile (NAT2*5, NAT2*6 and NAT2*7 alleles) was associated with ADR and hepatotoxicity manifestations. The NAT2*4/*5 and NAT2*5/*5 genotypes carriers had, respectively, 2.4 and 5.0 times higher risk for ADR than those carrying the other NAT2 genotypes (p<0,05). The functional genotype GSTM1*1/GSTT1*1 was associated with enhanced variations on ALT, AST and ALP (p<0.05). No relationship was found between CYP2E1 variants and variations on biochemical profile or risk for ADR or hepatotoxicity. In conclusion, the NAT2 slow acetilator profile and the GSTM1/GSTT1 functional genotype increase the susceptibility to hepatocellular damage and other ADR induced by antibiotics used in tuberculosis therapy.

ASSUNTO(S)

cyp2e1 gst hepatotoxicidade tuberculosis adverse drug reactions tuberculose (tratamento; epidemiologia) cyp2e1 nat2 polymorphism reações adversas a medicamentos expressão gênica nat2 gst polimorfismo (estudo clínico) gene expression hepatotoxicity

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