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Fatal intoxication cases: cytochrome P450 2D6 and 2C19 genotype distributions
A L Zackrisson1, P Holmgren, A B Gladh
1National Board of Forensic Medicine, Department of Forensic Genetics,, University Hospital, 581 85 Linköping, Sweden. annza@imv.liu.se
Individuals lacking the CYP2D6 enzyme, crucial for drug metabolism, were less frequent in fatal intoxication cases than expected. This suggests a protective effect against drug overdose in some individuals.
Area of Science:
- Pharmacogenomics
- Toxicology
- Genetics
Background:
- The cytochrome P450 enzyme debrisoquine 4-hydroxylase (CYP2D6) metabolizes many common pharmaceuticals and illegal drugs.
- A significant portion of Caucasians (7-10%) are poor metabolizers (PMs) of CYP2D6, increasing their risk of adverse drug reactions and intoxication.
- Fatal outcomes can occur due to impaired drug metabolism in individuals with specific genetic variations.
Purpose of the Study:
- To investigate the prevalence of CYP2D6 and CYP2C19 genetic variations in individuals who died from pharmaceutical intoxication.
- To compare genotype frequencies in fatal intoxication cases with a healthy blood donor reference group.
- To determine if specific CYP2D6 or CYP2C19 alleles are associated with an increased risk of fatal drug intoxication.
Main Methods:
- Genotyping of 242 individuals deceased from pharmaceutical intoxication and 281 blood donors for CYP2D6 and CYP2C19 alleles.
- Utilized single nucleotide polymorphism (SNP) analysis for common CYP2D6 (*1, *2, *3, *4, *6) and CYP2C19 (*1, *2, *3, *4) alleles.
- Employed multiplex amplification of long DNA fragments to detect CYP2D6 allele *5 (gene deletion).
Main Results:
- The prevalence of CYP2D6 poor metabolizer (PM) genotypes was lower in fatal intoxication cases (4.7%) compared to blood donors (8.5%).
- A significantly lower frequency of the CYP2D6*4 allele was observed in individuals with fatal intoxication (P<0.005).
- No significant differences in CYP2C19 genotype frequencies were found between the fatal intoxication group and the blood donor group.
Conclusions:
- Confirms earlier findings of a lower frequency of CYP2D6 PM genotypes in fatal intoxication cases.
- Suggests that individuals with CYP2D6 poor metabolizer genotypes may be underrepresented in fatal intoxication cases.
- This study provides novel evidence that intoxication victims might exhibit a lower frequency of CYP2D6 PMs than the general population.
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