Polymorphisms in the host CYP2C19 gene and antibiotic-resistance attributes of Helicobacter pylori isolates influence the outcome of triple therapy

Ram M., Ravishankar and Teh, Xinsheng and Rajakumar, Tamayanthi and Goh, Khean Lee and Leow, Alex Hwong Ruey and Poh, Bee Hoon and Mariappan, Vanitha and Shankar, Esaki Muthu and Loke, Mun Fai and Vadivelu, Jamuna (2018) Polymorphisms in the host CYP2C19 gene and antibiotic-resistance attributes of Helicobacter pylori isolates influence the outcome of triple therapy. Journal of Antimicrobial Chemotherapy, 74 (1). pp. 11-16. ISSN 0305-7453, DOI https://doi.org/10.1093/jac/dky401.

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Official URL: https://doi.org/10.1093/jac/dky401


Objectives: Eradication of Helicobacter pylori is influenced by susceptibility to antimicrobial agents, elevated bacterial load and degree of acid inhibition, which can be affected by genotypes of drug-metabolizing enzymes [cytochrome P450 (CYP) 2C19 polymorphism]. Theoretically, the choice and dose of proton pump inhibitor may also influence the suppression of H. pylori infection. The CYP2C19 genotype has recently been found to have an impact on peptic ulcer healing, H. pylori eradication and therapeutic efficacy of proton pump inhibitors. Methods: Here, we investigated the impact of the CYP2C19 genotype polymorphism and the success of triple therapy (fluoroquinolones/metronidazole/clarithromycin) on antibiotic-resistant strains in eradicating H. pylori in human subjects with non-ulcer dyspepsia (NUD), in human subjects with peptic ulcer disease (PUD) and in asymptomatic human subjects (positive and negative for H. pylori infection). Results: Based on the CYP2C19 genotypes, determined by Droplet Digital PCR (ddPCR) analysis, we found 11.2%, 62.5% and 26.3% corresponding to rapid metabolizers, intermediate metabolizers and poor metabolizers, respectively. However, we did not find any significant effect for homozygous ABCB1 or CYP2C19*2 and CYP2C19*3 alleles. We detected several participants heterozygous for both ABCB1 and CYP2C19*2, CYP2C19*3 and CYP2C19*17 loci. The participants heterozygous for both ABCB1 and CYP2C19*2 and *3 loci should be defined as intermediate and poor metabolizers according to the haplotype analysis in the NUD, PUD and asymptomatic subjects. Conclusions: Consequently, fluoroquinolones/metronidazole/clarithromycin-based triple therapies can be used to eradicate H. pylori infection, if one does not know the CYP2C19 genotype of the patient.

Item Type: Article
Funders: University of Malaya–Ministry of Education (UM-MOE) High Impact Research (HIR) (grant. no. UM.C/625/1/HIR/MOE/CHAN-13/4; account no. H-50001-A000029), University of Malaya Research Grant (UMRG) (RP013C-13HTM)
Uncontrolled Keywords: Polymorphisms; CYP2C19 gene; Antibiotic-resistance; Helicobacter pylori; Triple therapy
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 15 Jan 2019 02:50
Last Modified: 15 Jan 2019 02:50
URI: http://eprints.um.edu.my/id/eprint/20006

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