A study to survey susceptible genetic factors responsible for troglitazone‐associated hepatotoxicity in Japanese patients with type 2 diabetes mellitus

  • Ichiro Watanabe
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Aiko Tomita
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Miho Shimizu
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Mie Sugawara
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Hiroaki Yasumo
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Ryuta Koishi
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Tohru Takahashi
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Kaoru Miyoshi
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Kouichi Nakamura
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Takashi Izumi
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Yasuyuki Matsushita
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Hidehiko Furukawa
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Hideyuki Haruyama
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan
  • Teiichiro Koga
    Biomedical Research Laboratories Pharmacokinetics and Drug Delivery Research Laboratories, and Regulatory Affairs Department, Sankyo Co, Ltd. Tokyo Japan

抄録

<jats:sec><jats:title>Background and objective</jats:title><jats:p>Troglitazone is a 2,4‐thiazolidinedione antidiabetic agent with insulin‐sensitizing activities. This agent had been used efficiently in a large number of patients but was withdrawn from the market in March 2000 because of its association with idiosyncratic hepatotoxicity. To address the susceptible genetic factors responsible for the hepatotoxicity associated with this agent, we performed a genetic polymorphic analysis by a target gene approach in troglitazone‐treated Japanese patients with type 2 diabetes mellitus.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>One hundred ten patients treated with troglitazone were recruited into this study. The case patients (n = 25) were recruited through medical professionals who had previously reported abnormal increases in the levels of ALT or AST among their patients. The control patients (n = 85) were recruited through physicians prescribing troglitazone. For statistical accuracy, efforts were made to maximize the size of the case group. Genotype analysis was performed in 68 polymorphic sites of 51 candidate genes related to drug metabolism, apoptosis, roduction and elimination of reactive oxygen species, and signal transduction pathways of peroxisome proliferator–activated receptor gamma 2 and insulin.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The strong correlation with transaminase elevations was observed in the combined glutathione‐S‐transferase <jats:italic>GSTT1</jats:italic>‐<jats:italic>GSTM1</jats:italic> null genotype (odds ratio, 3.692; 95% confidence interval, 1.354‐10.066; <jats:italic>P</jats:italic> = .008).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The double null mutation of <jats:italic>GSTT1</jats:italic> and <jats:italic>GSTM1</jats:italic> might influence troglitazone‐associated abnormal increases of liver enzyme levels.</jats:p><jats:p><jats:italic>Clinical Pharmacology & Therapeutics</jats:italic> (2003) <jats:bold>73</jats:bold>, 435–455; doi: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="doi" xlink:href="10.1016/S0009-9236(03)00014-6">10.1016/S0009‐9236(03)00014‐6</jats:ext-link></jats:p></jats:sec>

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