Polymorphism of CYP2D6 in Black populations: implications for psychopharmacology

Drug-metabolizing enzymes found primarily in the liver (CYP450) are a major determinant of therapeutic drug response. Polymorphism dependent upon race/ethnic origin for CYP2D6 is now well-established. Despite consistent reports of ethnic differences in pharmacologic response to antidepressants and neuroleptics, there is a paucity of data on controlled clinical trials and studies determining polymorphic characteristics of CYP2D6 enzymes in African-Americans. There is little and conflicting information available on black populations (Africans, bushmen, Australian Aborigines or African Americans). The prevalence of poor metabolizers in Black populations has been estimated from 0 to 19%, compared with consistent reports of poor metabolizer status in Caucasians (5-10%) and Asians (0-2%). Within the extensive metabolizer category, Asians have higher metabolic ratios (that is, slower metabolism) than Caucasian extensive metabolizers. A high frequency of a mutant gene, CYP2D6*10 has been associated with the slower metabolic rate in Asians. Previous research suggests that slower metabolic rates compared with Caucasians may also be characteristic of Black populations. Recent reports suggest that a novel gene mutant in Black populations, CYP2D6*17, associated with a slower metabolic rate, may occur in a high frequency in these populations. Common clinical practice, supported by controlled clinical studies in Asians, have led to a reduction in dosage recommendations for many antidepressants and neuroleptics for this ethnic group. It is imperative that the determinants of bioavailability be established in African-Americans in order to establish rational drug therapy guidelines for this population.