Glucocorticoid Receptor Polymorphisms and Outcomes in Pediatric Septic Shock

Natalie Z Cvijanovich1, Nick Anas, Geoffrey L Allen

  • 11Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA. 2Department of Pediatrics, Children's Hospital of Orange County, Orange, CA. 3Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO. 4Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA. 5Department of Pediatrics, Akron Children's Hospital, Akron, OH. 6Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 7Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX. 8Department of Pediatrics, Miami Children's Hospital, Miami, FL. 9Department of Pediatrics, C.S. Mott Children's Hospital at the University of Michigan, Ann Arbor, MI. 10Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI. 11Department of Pediatrics, Children's National Health System, Washington, DC. 12Department of Pediatrics, Children's Hospital and Clinics of Minnesota, Minneapolis, MN. 13Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN. 14Department of Pediatrics, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, NJ. 15Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, GA. 16Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH. 17Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

Summary

Glucocorticoid receptor gene polymorphisms did not show a benefit of corticosteroids in children with septic shock. However, wild-type allele homozygotes had worse outcomes with corticosteroid use.

Related Concept Videos

Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase01:11

Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase

Genetic polymorphisms in drug targets have emerged as critical determinants of interindividual variability in drug response and toxicity. Pharmacogenomic investigations increasingly focus on identifying these variations to personalize and optimize therapeutic interventions. A drug target may be a receptor, enzyme, or signaling protein involved in pharmacologic responses or disease-related pathways. While early pharmacogenetic studies focused primarily on drug metabolism, current research...
60
Pharmacogenetic Phenotypes: Alterations in Pharmacokinetics, Drug Targets and Biologic Milieu01:29

Pharmacogenetic Phenotypes: Alterations in Pharmacokinetics, Drug Targets and Biologic Milieu

Genetic variations significantly influence drug response through pharmacokinetics, receptor interactions, and biologic milieu modifications. Pharmacokinetic alterations impact drug metabolism and clearance, affecting efficacy and toxicity. Variants in drug-metabolizing enzymes, such as CYP2C9 and CYP2C19, alter drug activation and elimination. For example, CYP2C9 loss-of-function variants require lower warfarin doses to prevent excessive bleeding, while CYP2C19 variants reduce clopidogrel...
76
Pharmacogenomics: Identification of New Drug Targets01:29

Pharmacogenomics: Identification of New Drug Targets

Advances in genomics have profoundly influenced drug discovery by increasing both the speed and accuracy of pharmaceutical development. Pharmacogenomics, which examines how genetic variation influences drug response, facilitates the identification of novel therapeutic targets and enables patient stratification for personalized treatment. These strategies contribute to improved drug efficacy, minimized adverse effects, and more efficient clinical trial design.Mapping genetic differences...
56
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
304
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
343
Pharmacogenetics of Drug Metabolism: Overview01:27

Pharmacogenetics of Drug Metabolism: Overview

Genetic polymorphism in drug metabolism is crucial to the inter-individual variability observed in drug responses. Drug metabolism primarily involves the chemical modification of drugs and other xenobiotics to enhance their elimination by increasing their polarity. Two main classes of enzymes mediate this biotransformation process: Phase I enzymes, primarily cytochrome P450s, catalyze oxidation and reduction reactions, while other enzymes, such as esterases, mediate hydrolysis, and Phase II...
77