The CYP2C19*17 variant is not independently associated with clopidogrel response
- Manuscript handled by: M. Cattaneo
- Final decision: P. H. Reitsma, 4 June 2013
Cytochrome P450 2C19 (CYP2C19) is the principal enzyme responsible for converting clopidogrel into its active metabolite, and common genetic variants have been identified, most notably CYP2C19*2 and CYP2C19*17, that are believed to alter its activity and expression, respectively.
We evaluated whether the consequences of the CYP2C19*2 and CYP2C19*17 variants on clopidogrel response were independent of each other or genetically linked through linkage disequilibrium (LD).
We genotyped the CYP2C19*2 and CYP2C19*17 variants in 621 members of the Pharmacogenomics of Anti-Platelet Intervention (PAPI) Study and evaluated the effects of these polymorphisms singly and then jointly, taking into account LD, on clopidogrel prodrug level, clopidogrel active metabolite level, and adenosine 5′-diphosphate (ADP)-stimulated platelet aggregation before and after clopidogrel exposure.
The CYP2C19*2 and CYP2C19*17 variants were in LD (|D′| = 1.0; r2 = 0.07). In association analyses that did and did not account for the effects of CYP2C19*17, CYP2C19*2 was strongly associated with levels of clopidogrel active metabolite (β = −5.24, P = 3.0 × 10−9 and β = −5.36, P = 3.3 × 10−14, respectively) and posttreatment ADP-stimulated platelet aggregation (β = 7.55, P = 2.9 × 10−16 and β = 7.51, P = 7.0 × 10−15, respectively). In contrast, CYP2C19*17 was marginally associated with clopidogrel active metabolite levels and ADP-stimulated platelet aggregation before (β = 1.57, P = 0.04 and β = −1.98, P = 0.01, respectively) but not after (β = 0.40, P = 0.59 and β = −0.13, P = 0.69, respectively) adjustment for the CYP2C19*2 variant. Stratified analyses of CYP2C19*2/CYP2C19*17 genotype combinations revealed that CYP2C19*2, and not CYP2C19*17, was the primary determinant in altering clopidogrel response.
Our results suggest that CYP2C19*17 has a small (if any) effect on clopidogrel-related traits and that the observed effect of this variant is due to LD with the CYP2C19*2 loss-of-function variant.