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Letters to the Editor
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Pharmacogenomics
Creating a new dimension to pharmacy practice
From Dr P. F. Long
It is now over 50 years since Watson and Crick described the structure
of DNA, postulating a copying mechanism that provides a chemical basis
for genetic transmission and a scientific basis for Mendelian inheritance
of traits. In these intervening 50 years or so, we have gone from sequencing
relatively short sequences of DNA to having the enabling technologies
to sequence entire genomes, culminating in 2001 with completion of the
human genome project.
Deciphering the human genome has led to an explosion in genetic tools
to diagnose, manage and treat diseases. What is still poorly understood
is how the genes controlling our growth and development from conception
to birth and on through to adulthood might also interact with gene networks
that influence our response to particular medicines —
this is the science of pharmacogenomics. Being able to predict atypical
drug responses will allow the dose of medicines to be individually tailored
and adapted to avoid toxicity and maximise clinical efficacy.
Pharmacogenomics offers pharmacists an innovative opportunity to create
a new dimension to their practice by accessing genetic services, expanding
current primary delivery in health care promotion and patient management.
Easy-to-use gene chip technology opens up the possibility of risk assessment
even in community-based settings to screen individuals with poor metabolising
phenotypes, developing personalised treatment plans so that the right
patient receives that right drug at the right time.
It is already possible at a reasonable cost to test quickly for polymorphisms
in cytochrome p450 genes, which encode for enzymes that play a major
role in the way an individual metabolises drugs. The ability to distinguish
between fast and slow metabolisers would allow prescription and dispensing
of appropriate drug doses and the monitoring of an individual’s
response to treatment simultaneously.
Genotype profiling could become an integral part of a person’s
medical records. Although this information offers the potential to design
appropriate prevention and intervention priorities, pharmacists must
consider and become knowledgeable about their attendant ethical, legal
and social responsibilities in handling genetic information.
The scope and standards delineating the roles and responsibilities of
pharmacists in providing genetic health care have yet to be defined by
the Royal Pharmaceutical Society, but supporting patients and families,
partnering them to meaningful health decisions and becoming fluent in
the management of genetic health information are just a few of the emerging
roles pharmacogenomics could make a reality for tomorrow’s pharmacy
graduates.
Paul Long
Lecturer in Pharmaceutical Microbiology
School of Pharmacy
University of London
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The
Pharmaceutical Journal