He kūpono anei ka lāʻau lapaʻau e kuhikuhi ʻia nei iā ʻoe? E kamaʻilio kākou e pili ana i ka Pharmacogenomics!

Ua lohe paha ʻoe he hana like ka lāʻau lapaʻau no ka maʻi like no kekahi poʻe, ʻaʻole hana no kekahi poʻe, a he hopena ʻaoʻao no kekahi poʻe. No ke aha mai ia? No ka mea, he ʻokoʻa ko kākou kino? ʻAe, ʻo ia kekahi kumu. He kumuhana pili kēlā, he paʻakikī iki, akā he mea nui loa a kākou e kamaʻilio ai i kēia lā. Ua kapa ʻia kēia he pharmacogenomics.

He aha ka Pharmacogenomics?

I ka ʻōlelo maʻalahi, ʻo ka pharmacogenomics ke aʻo ʻana i ke ʻano o kā mākou pane ʻana i nā lāʻau lapaʻau e pili ana i kā mākou mau genes. E hoʻomanaʻo, ʻo ka pharmacology ke aʻo ʻana i ka hoʻohana ʻana a me nā hopena o nā lāʻau lapaʻau. ʻO ka genomics ke aʻo ʻana i nā genes a me kā lākou hana. ʻO ka hui pū ʻana o nā mea ʻelua ua kapa ʻia ʻo pharmacogenomics. I kekahi manawa ua kapa ʻia ʻo pharmacogenetics.

Hāʻule maoli kēia ma lalo o ke kahua nui o 'Precision Medicine' . ʻO ia hoʻi, ka hāʻawi ʻana iā ʻoe i kahi hoʻolālā lapaʻau pilikino e pili ana i nā mea e like me kou mau genes, ke kaiapuni āu e noho ai, a me kou nohona. Hiki i ka Pharmacogenomics ke kōkua i kāu kauka e koho i kahi lāʻau lapaʻau i emi iho nā hopena ʻaoʻao a i ʻole e hana maikaʻi loa iā ʻoe .

Akā, pono e hoʻomaopopo ʻia ʻaʻole i hoʻohana ʻia kēia ʻano hana no kēlā me kēia maʻi a i ʻole kēlā me kēia lāʻau lapaʻau. I kēia manawa, hoʻohana nui ʻia ia no kahi helu palena o nā kūlana a me nā lāʻau lapaʻau, e like me ka maʻi HIV, kekahi mau ʻano maʻi kanesa, ke kaumaha, a me nā maʻi puʻuwai. Akā ke ulu wikiwiki nei kēia kahua. Manaʻolana nā kānaka noiʻi e kōkua koke kēia ʻano hana i ke koho ʻana i nā lāʻau lapaʻau maikaʻi aʻe no nā maʻi maʻamau.

Pehea e hoʻopili ai nā genes i ke ʻano o ka hana ʻana o nā lāʻau lapaʻau?

E noʻonoʻo i kēia ʻano: ua like ko kākou mau genes me kahi hoʻonohonoho o nā kuhikuhi no nā cell i loko o ko kākou kino. Kōkua kēia mau genes iā kākou e hana i nā molekala protein i kapa ʻia he enzymes . He miliona mau hana a nā enzymes i loko o ko kākou kino. ʻO kekahi o lākou, ʻo ia ka wāwahi ʻana i nā lāʻau lapaʻau i loko o ke kino, a i ʻole ka metabolize iā lākou . Inā ʻaʻole pane kekahi poʻe i nā lāʻau lapaʻau e like me ka mea i manaʻo ʻia, no ka mea paha he mau loli ko lākou i loko o kā lākou mau genes. Hiki i kēia mau loli ke kumu i ka emi ʻana o ka hana o nā enzymes a i ʻole ka hana pono ʻole o nā enzymes.

I kēia manawa, e noʻonoʻo, he aha ka mea e hana inā e wāwahi koke kou kino i kahi lāʻau lapaʻau, a lohi loa paha, a ʻaʻole loa paha? A laila, ʻaʻole e hana ka lāʻau lapaʻau, i hāʻawi ʻia ma ka mahele maʻamau, e like me ka mea i manaʻo ʻia. Hiki i ka lāʻau lapaʻau ke hana i nā hopena ʻaoʻao koʻikoʻi , a i ʻole ʻaʻohe ona hopena i ka maʻi o kēia manawa.

Eia kekahi laʻana, ʻaʻole hiamoe koke kekahi poʻe ma hope o ka inu ʻana i ke kofe, aʻo kekahi poʻe ʻaʻole. ʻO kekahi kumu no kēia, ʻo ia ka hoʻopilikia ʻana o ko kākou mau genes i ka wikiwiki o ka wāwahi ʻana o ko kākou kino i ka caffeine. Hiki ke hana like me nā lāʻau lapaʻau.

He aha kēia hoʻāʻo pharmacogenomic?

He hoʻāʻo hoʻoilina ka hoʻāʻo pharmacogenomic. Hiki iā ia ke nānā i hoʻokahi a ʻoi aku paha mau genes, e nānā pono i nā ʻano hoʻoilina kikoʻī e hoʻopilikia ai i ka haki ʻana o kahi lāʻau. Ua like ia me ka nānā ʻana i kahi typo i loko o ka 'manual kuhikuhi' o ko mākou kino.

Hoʻohana pinepine nā kauka i kahi hāpana koko a i ʻole kahi swab buccal e hana i kēia. Lawe ʻia kēia hāpana mai ou aku a hoʻouna ʻia i kahi lab. Ma laila, nānā kahi loea i kāu DNA no nā loli kikoʻī. ʻO ka gene a i ʻole nā ​​​​gene a lākou e ʻimi nei e hilinaʻi ʻia i ka hoʻāʻo a kāu kauka i kauoha ai, ke kūlana a lākou e hoʻāʻo nei e mālama, a me nā lāʻau lapaʻau a lākou e hoʻolālā nei e hāʻawi iā ʻoe.

Āhea wau e pono ai i kahi hoʻokolohua pharmacogenomic?

Inā ʻoe e lawe ana i ka lāʻau lapaʻau no kekahi mau kūlana olakino, hiki paha iā ʻoe ke kūpono no ka hoʻāʻo pharmacogenomic. Eia kekahi mau laʻana (a he nui aku paha):

Kolesterol kiʻekiʻe

Ma muli o kekahi mau ʻano like ʻole o ka "gene SLCO1B1" i loko o ko kākou kino, inā ʻoe e lawe i kekahi mau lāʻau lapaʻau i kapa ʻia he statins no ka cholesterol kiʻekiʻe, hiki iā ʻoe ke ʻeha a me ka nāwaliwali o nā ʻiʻo. ʻO nā hiʻohiʻona o kēia mau statins:

• ʻAtorvastatin (e.g. Lipitor®)
• ʻO Fluvastatin (e.g. Lescol®)
• ʻO Lovastatin (e.g. Altoprev®)
• ʻO Pitavastatin (e.g. Livalo®)
• Pravastatin (e.g. Pravachol®)
• ʻO Rosuvastatin (e.g. Crestor®)
• Simvastatin (e.g. Zocor®)

No laila, ma mua o kou hoʻomaka ʻana e lawe i kahi lāʻau lapaʻau e like me kēia, a inā he mau pilikia kāu i ka wā e hoʻohana ana, hiki i kāu kauka ke kamaʻilio me ʻoe e pili ana i kahi hoʻokolohua e like me kēia.

Kaumaha

Hiki i nā ʻano like ʻole o nā genes CYP2D6 a me CYP2C19 ke hoʻopilikia i ka wikiwiki o ka wāwahi ʻana o kou kino i kekahi mau antidepressants. ʻO nā hiʻohiʻona o kēia mau lāʻau lapaʻau:

• ʻO Amitriptyline (e.g. Elavil®) - He ʻano antidepressant tricyclic kēia.
• ʻO ka papa lāʻau lapaʻau ʻo SSRI : ʻO Citalopram (e.g. ʻO Celexa®), ʻO Escitalopram (e.g. ʻO Lexapro®), ʻO Sertraline (e.g. ʻO Zoloft®), ʻO Paroxetine (e.g. ʻO Paxil®) a me ʻO Fluvoxamine (e.g. ʻO Luvox®).
• Venlafaxine (e.g. Effexor®) - He ʻano SNRI kēia.

Hiki ke lilo kēia hoʻāʻo i mea pono i ka hoʻomaka ʻana i nā lāʻau lapaʻau e like me kēia, a i ʻole ke hana ʻole nei kekahi lāʻau lapaʻau a ke hoʻāʻo nei ʻoe e hoʻololi i kekahi.

Nā maʻi kanesa

Inā ʻoe e lawe nei i ka lāʻau lapaʻau no kahi ʻano maʻi kanesa kikoʻī, hiki iā ʻoe ke pōmaikaʻi mai ka hoʻāʻo pharmacogenomic. Eia kekahi mau laʻana:

• Ka maʻi ʻaʻai umauma: Hana wale ka lāʻau lapaʻau trastuzumab (e.g. Herceptin®) i nā poʻe me ka maʻi ʻaʻai umauma HER2-positive . ʻO ke ʻano kēia, he loli genetic ko nā hunaola kanesa e hoʻoulu ai iā lākou e hana i ka nui o ka protein HER2.
• ʻO ka Leukemia Lymphoblastic Acute (ALL): ʻO ka poʻe me nā pae haʻahaʻa o ka enzyme Thiopurine Methyltransferase (TPMT) e loaʻa paha i nā hopena ʻino a me ka piʻi ʻana o ka maʻi inā hāʻawi ʻia i ka mahele maʻamau o Mercaptopurine (e.g. Purinethol®).
• ʻAʻai ʻōpū: ʻO ka poʻe me nā pae haʻahaʻa o ka enzyme UGT1A1 e piʻi aʻe paha ka pilikia o ka maʻi pākī nui a me ka maʻi inā hāʻawi ʻia ka lāʻau Irinotecan (e.g. Camptosar®).

Eia kekahi, ʻo ka lāʻau anticancer fluorouracil, `5-FU` (e.g. Adrucil® - `Adrucil®`), hiki ke hana i nā hopena ʻaoʻao koʻikoʻi inā hāʻawi ʻia ma nā mahele maʻamau i ka poʻe me nā pae haʻahaʻa o ka enzyme dihydropyrimidine dehydrogenase (`Dihydropyrimidine Dehydrogenase - DPD`). Hiki i nā kauka ke kuhikuhi i kēia lāʻau no ke kanesa colorectal, ka umauma, ka ʻōpū a me nā kanesa pancreatic.

Kāohi ʻana i ke koko koko

Pono nā kānaka me kekahi mau ʻano hoʻoilina e lawe i kahi mahele haʻahaʻa o ka lāʻau anticoagulant warfarin (e.g. Coumadin®). ʻO ka nui loa hiki ke hoʻoheheʻe i ke koko.

Eia kekahi, ʻo kahi loli i ka enzyme CYP2C19 i loko o kou akepaʻa e pale aku paha i ka lāʻau antiplatelet clopidogrel (e.g. Plavix®) mai ka hana pono ʻana . He lāʻau lapaʻau kēia i hoʻohana ʻia e pale aku i nā mea e like me nā hōʻeha puʻuwai a me nā hahau.

ka maʻi HIV

Hiki i kekahi ʻano like ʻole o ka gene HLA-B ke hoʻoulu i kahi hopena ʻili koʻikoʻi i ka lāʻau lapaʻau ʻo Abacavir (e like me Ziagen®).

Eia kekahi, hiki i kahi ʻano like ʻole i loko o ka gene CYP2B6 ke hoʻonui i ka pilikia o nā hopena ʻaoʻao e like me nā loli neurological mai ka lāʻau efavirenz (e.g. Sustiva®).

Nā pilikia o ka ʻōnaehana pale

Inā ʻoe e lawe ana i kahi immunosuppressant, hiki iā ʻoe ke pōmaikaʻi mai ka hoʻāʻo pharmacogenomic:

• Ma muli o nā ʻokoʻa o nā protein `TPMT` a me `NUDT15`, hiki ke hoʻopau ʻia ka hana o ka iwi iwi inā ʻoe e lawe i ka lāʻau `Azathioprine` (e.g. `Imuran®`) ma hope o kahi hoʻoili puʻupaʻa a i ʻole no nā kūlana ʻōnaehana pale e like me ka multiple sclerosis.
• Ma muli o nā ʻokoʻa o ka enzyme CYP3A5, inā ʻoe e lawe i ka tacrolimus (e.g. Prograf®) ma hope o kahi hoʻoili kino, hiki ke piʻi aʻe ka pilikia o ka hōʻole ʻia ʻana o ka hoʻoili kino.

He aha nā pōmaikaʻi o ka pharmacogenomics?

I ka hoʻomau ʻana o nā kānaka noiʻi a me nā kauka i ke aʻo ʻana a me ka hoʻohana ʻana i nā pharmacogenomics, hiki iā ia ke loaʻa nā pono he nui. E nānā:

• Hoʻomaikaʻi ʻia ka palekana: E hiki i nā kauka ke pale aku i ke kuhikuhi ʻana i nā lāʻau lapaʻau e hoʻoulu ai i nā hopena ʻino i kekahi poʻe, a i ʻole e hiki ke hoʻoulu i nā pilikia ke lawe ʻia ma ke keu. ʻO ia hoʻi, ʻaʻole ʻoe e ʻeha pono ʻole.
• Ka pono a me ka hoʻemi ʻana i nā kumukūʻai mālama ola: Inā hiki i nā kauka ke ʻike mua i nā lāʻau lapaʻau e hana a me nā mea ʻaʻole, hiki iā lākou ke kuhikuhi mua i nā lāʻau lapaʻau kūpono loa , e mālama ana i ke kālā a me ka manawa .
• Ka hoʻomohala ʻana i nā lāʻau lapaʻau i kuhikuhi ʻia: Hoʻokumu ʻia kekahi mau maʻi e kahi loli kikoʻī (variant) i loko o kahi gene. ʻAe ʻo Pharmacogenomics i nā mea noiʻi e ʻimi i nā lāʻau lapaʻau hou ma o ka kuhikuhi pololei ʻana i kēlā ʻano loli genetic. E like me ka hana ʻana i kahi lāʻau lapaʻau e kūpono i ka maʻi.

He aha nā palena/pōʻino o ka pharmacogenomics?

ʻOiai he mea nui kou ʻano hoʻoilina i ka hoʻoholo ʻana i ka lāʻau lapaʻau maikaʻi loa no nā kūlana he nui, ʻaʻole ia e wehewehe piha i ke ʻano o ka hana ʻana o kou kino i nā lāʻau lapaʻau. Pono nā kauka e noʻonoʻo i nā mea ʻē aʻe i ke koho ʻana i ka lāʻau lapaʻau kūpono. Eia kekahi laʻana:

• Nā lāʻau lapaʻau ʻē aʻe: ʻO nā lāʻau lapaʻau āu e lawe nei e hoʻopilikia paha i ka pono o nā lāʻau lapaʻau hou.
• Nā kūlana olakino ʻē aʻe: Hiki i kekahi mau maʻi ke hoʻololi i ke ʻano o ka hana ʻana o kou kino i nā lāʻau lapaʻau. No ka laʻana, inā ʻaʻole hana pono kou mau puʻupaʻa, e hoʻokuʻu ʻia kekahi mau lāʻau lapaʻau mai kou kino.
• ʻAno o ke Ola: ʻO nā mea e like me kāu mea e ʻai ai, ka nui o kāu hoʻoikaika kino, a me kāu hoʻohana ʻana i ka paka a me ka waiʻona e hiki ke hoʻopilikia i ka maikaʻi o ka wāwahi ʻana o kāu lāʻau lapaʻau.

ʻO nā pilikia ʻē aʻe i ka hoʻomohala ʻana a me ka hoʻohana ʻana i nā pharmacogenomics:

• Kumukūʻai: ʻOiai ke emi mālie nei ke kumukūʻai o ka hoʻāʻo pharmacogenomic, ʻokoʻa pinepine ke kumukūʻai no kēlā me kēia kanaka, a i ʻole nā ​​​​kumukūʻai ma waho o ka ʻeke, ma muli o ka uhi ʻinikua. ʻAʻole paha e loaʻa kēia hoʻāʻo i nā mea āpau.
• Loaʻa:Ma muli o kou wahi e noho ai a me ke ʻano o ke kauka e mālama nei iā ʻoe, hiki ke kaupalena ʻia kou komo ʻana i kekahi mau hoʻokolohua genetic.

I kēia manawa, hiki i nā kauka ke hoʻohana wale i ka pharmacogenomics no kahi helu palena o nā kūlana a me nā lāʻau lapaʻau. Eia nō naʻe, ke ulu wikiwiki nei kēia kahua hoihoi o ka 'lāʻau lapaʻau pololei'. E kamaʻilio me kāu kauka e pili ana i ke ʻano e hiki ai i ka pharmacogenomics ke kōkua i kou olakino a me nā pono e hiki ai ke lawe mai. Hiki iā ʻoe ke nīnau e pili ana i nā hoʻokolohua lapaʻau ma kēia kahua.

ʻO ka mea hope loa , e hoʻomanaʻo i kēia.

ʻAe, no laila, ʻoiai he mea paʻakikī iki ka huaʻōlelo pharmacogenomics a mākou i kamaʻilio ai i kēia lā, ʻo ke ʻano o ia mea , kōkua ia iā mākou e koho i ka lāʻau lapaʻau e kūpono loa iā mākou a he liʻiliʻi loa nā hopena ʻaoʻao, ma muli o kā mākou mau genes.

ʻO kā mākou mau genes kekahi kumu nui no ka hana like ʻole ʻana o ka lāʻau like no nā kānaka a pau. ʻO ka Pharmacogenomics kahi hoʻāʻo e hoʻomaopopo i kēlā mea huna a hāʻawi iā mākou i nā lāʻau lapaʻau pilikino a ʻoi aku ka maikaʻi.

ʻOiai he kahua e ulu nei kēia, loaʻa iā ia ka hiki ke hoʻololi i ke ʻano o ka mālama ʻana i nā maʻi he nui i ka wā e hiki mai ana. Inā he mau nīnau kāu e pili ana i kahi lāʻau lapaʻau, ʻoiai inā e hana ia nou a inā paha e hoʻoulu ia i nā hopena ʻaoʻao, mai makaʻu e kamaʻilio me kāu kauka e pili ana i kēia mau hoʻokolohua pharmacogenomic. He mea kōkua nui paha lākou iā ʻoe.

E hoʻomanaʻo, ʻo kou mau genes kekahi ʻāpana koʻikoʻi o kāu moʻolelo olakino. ʻO ka ʻai maikaʻi, ka hoʻoikaika kino, a me ka hahai ʻana i nā ʻōlelo aʻo a kāu kauka he mea nui like ia!

ʻO ka Pharmacogenomics, nā genes, nā lāʻau lapaʻau, nā lāʻau lapaʻau, ka lāʻau lapaʻau pololei, ka hoʻāʻo ʻana i ka genetics, nā hopena ʻaoʻao