ABSTRACT
Genetic polymorphism of the cytochrome P450 isoenzymes CYP2D6 and CYP2C19 was determined by phenotyping four ethnic groups of the Israeli population. The groups consisted of Ethiopian subjects, Yemenite subjects, and Russian subjects representing first-generation new immigrants and an Israeli Arab group. Dextromethorphan was used as the probe for CYP2D6 activity and mephenytoin was used for CYP2C19 activity. The two drugs were administered simultaneously and urine samples were collected over a period of 8 hours. The CYP2D6 phenotype was determined from the ratio of dextromethorphan conversion to dextrorphan and the CYP2C19 phenotype from the ratio of S-mephenytoin and R-mephenytoin. The used liquid chromatographic method was able to completely separate dextrorphan and dextromethorphan. Fluorescence detection allowed dextromethorphan quantification at 1 ng/mL. Mephenytoin enantiomers were completely separated in high-performance liquid chromatography and the respective fractions were collected and analyzed using a gas chromatography/mass spectrometry system with selective ion monitoring. The prevalence of poor metabolizer phenotype of dextromethorphan (CYP2D6) in the Yemenite (0%) and Ethiopian groups (0%) was significantly different from the prevalence in the Russian (17%) and Israeli Arab (9%) groups. A significant difference was also found in the distribution of the metabolic ratio of the extensive metabolizer phenotype between the Ethiopian group and the Russian and Yemenite groups. No significant difference was found in the prevalence of poor mephenytoin metabolizer phenotype (CYP2C19) between the Yemenite (8%), Ethiopian (6%), Russian (9%), and Israeli Arab (8%) groups. No difference was observed in the distribution of metabolic ratio within the extensive metabolizer phenotype subgroups of the four ethnic groups.
Subject(s)
Anticonvulsants/pharmacokinetics , Antitussive Agents/pharmacokinetics , Aryl Hydrocarbon Hydroxylases , Cytochrome P-450 CYP2D6/genetics , Cytochrome P-450 Enzyme System/genetics , Dextromethorphan/pharmacokinetics , Mephenytoin/pharmacokinetics , Mixed Function Oxygenases/genetics , White People/genetics , Adult , Anticonvulsants/administration & dosage , Anticonvulsants/urine , Antitussive Agents/administration & dosage , Antitussive Agents/urine , Chromatography, High Pressure Liquid , Cytochrome P-450 CYP2C19 , Cytochrome P-450 CYP2D6/metabolism , Cytochrome P-450 Enzyme System/metabolism , Dextromethorphan/administration & dosage , Dextromethorphan/urine , Drug Administration Schedule , Female , Gas Chromatography-Mass Spectrometry , Humans , Israel , Male , Mephenytoin/administration & dosage , Mephenytoin/urine , Middle Aged , Mixed Function Oxygenases/metabolism , Phenotype , Polymorphism, Genetic , Reference ValuesABSTRACT
Plasmodium falciparum malaria is infrequently recognized in Israel as a cause of infection during pregnancy. We expect that with increasing frequency physicians in Israel will confront patients with malaria. Special concern should be given to malaria in pregnancy because of its serious complications. Thus, prompt diagnosis and treatment are essential. While chloroquine is safe for use in pregnancy, drug resistance is common, especially with Plasmodium falciparum. There is concern about the safety of other antimalarial agents during pregnancy. We recently observed a case of chloroquine-resistant Plasmodium falciparum malaria during pregnancy in a new immigrant primigravida from Ethiopia. Malaria in patients from endemic regions is less severe than in nonimmune hosts. Therefore, we elected to follow the patient's parasitemia periodically without additional antimalarial treatment until after delivery.
