Pharmacogenomics and Nutrigenomics: Synergies and Differences
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European Journal of Clinical Nutrition (2007) 61, 567–574 & 2007 Nature Publishing Group All rights reserved 0954-3007/07 $30.00 www.nature.com/ejcn REVIEW Pharmacogenomics and nutrigenomics: synergies and differences D Ghosh, MA Skinner and WA Laing The Horticulture and Food Research Institute of New Zealand Ltd, Auckland, New Zealand The success of the Human Genome Project and the spectacular development of broad genomics tools have catalyzed a new era in both medicine and nutrition. The terms pharmacogenomics and nutrigenomics are relatively new. Both have grown out of their genetic forbears as large-scale genomics technologies have been developed in the last decade. The aim of both disciplines is to individualize or personalize medicine and food and nutrition, and ultimately health, by tailoring the drug or the food to the individual genotype. This review article provides an overview of synergies and differences between these two potentially powerful science areas. Individual genetic variation is the common factor on which both pharmacogenomics and nutrigenomics are based. Each human is genetically (including epigenetics) unique and phenotypically distinct. One of the expectations of both technologies is that a wide range of gene variants and related single-nucleotide polymorphism will be identified as to their importance in health status, validated and incorporated into genotype based strategies for the optimization of health and the prevention of disease. Pharmacogenomics requires rigorous genomic testing that will be regulated and analyzed by professionals and acted on by medical practitioners. As further information is obtained on the importance of the interaction of food and the human genotype in disease prevention and health, pharmacogenomics can provide an opportunity driver for nutrigenomics. As we move from disease treatment to disease prevention, the two disciplines will become more closely aligned. European Journal of Clinical Nutrition (2007) 61, 567–574. doi:10.1038/sj.ejcn.1602590; published online 10 January 2007 Keywords: bioethics; drugs; food; nutrigenomics; pharmacogenomics Introduction new, being first found in the medical literature in the late 1990s. The related term pharmacogenetics was used in the The success of the Human Genome Project and the powerful 1950s (Motulsky, 2002). This early use of the concept is not tools of molecular biology have ushered in a new era in surprising as it was observed from the start that there is a both medicine and nutrition. The pharmaceutical industry genetic basis to the differences in the way people respond to expects to leverage sequence data from the Human Genome drugs. A recent example of a pharmacogenetics medicine is Project to develop new drugs based on knowledge of drug the targeting of BiDil (Taylor et al., 2004), used for treatment targets, taking into account variation in the genetic makeup of heart failure, towards black African Americans, although of individuals. Likewise, the food industry now has an in this case the use of race as a surrogate for genetics is opportunity to position food and nutritional bioactives to debatable. Genetic variation within and between pheno- promote health and prevent disease based on the genetic typically identified populations is relevant to the provision makeup of the individual consumer. of genetic services and population screening. For example, The term pharmacogenomics (Motulsky, 2002; Steele, social group membership can be used clinically as a surrogate 2005; Eichelbaum et al., 2006; Kalow, 2006) is relatively for a high risk of a particular genetic variation in the case of people of Ashkenazi Jewish descent, a population with a high familial risk of breast cancer. However, in general, in such screening programmes, treatment on the basis of self- Correspondence: Dr D Ghosh, Health and Food, The Horticulture and Food Research Institute of New Zealand Ltd, PB 92169, Auckland 1003, New identification is unlikely to be an effective strategy (Bamshad Zealand. et al., 2004; Duster, 2005). In addition, this kind of race and E-mail: [email protected] ethnicity classification for medical treatment can lead to Guarantor: WA Laing. discrimination (Richards, 2006). Contributors: All contributors made an equal contribution. Received 12 April 2006; revised 30 October 2006; accepted 2 November Pharmacogenomics can be described as an approach to 2006; published online 10 January 2007 pharmacology that takes into account the genotype of the Pharmacogenomics and nutrigenomics D Ghosh et al 568 patient (Motulsky, 2002; Guo et al., 2005; Steele, 2005; individual’s genome is ever important in the response to any Eichelbaum et al., 2006; Kalow, 2006; Phillips and Van biologically active substance, such as drugs and nutrients, Bebber, 2006). It uses genomic techniques to study drug and that both fields will benefit greatly by understanding the functionality and discover new drug targets, genetically other areas. based high throughput screens to discover new drugs and large-scale genotyping to characterize and analyze the research and treatment populations. Thus, pharmaco- Background to individualized medicine and food genomics uses genotyping to screen populations in order to determine which drugs would work best in human Inter-individual variation in drug response among patients is subpopulations in curing or preventing a disease, as well as well known and poses a serious problem in medicine. There using various genomic technologies (e.g. gene expression) to is a need for rapid and simple methods to discriminate understand how the drug is interacting with the genotype. between patients on the basis of their response to a drug. The older term pharmacogenetics differs from pharmaco- There are no biomarkers at present that can predict which genomics only in the technologies used and in the breadth group of patients will or will not respond positively and of scope of the genes studied. which will experience adverse reactions for the same Nutrigenomics or nutritional genomics (Muller and medication and dose (Shastry, 2006). Physicians have to Kersten, 2003; Trayhurn, 2003; Kaput and Rodriguez, 2004; optimize a dosage regimen for an individual patient by a Labadarios and Meguid, 2004; Ordovas and Mooser, 2004; trial-and-error method. This kind of approach may cause van Ommen, 2004; Corthesy-Theulaz et al., 2005; Kauwell, adverse drug reactions in some patients. In more than two 2005; Mutch et al., 2005; Ferguson, 2006; Ordovas, 2006) million cases annually in the US, adverse reactions, includ- appears to be a 21st century term, with few references before ing 100 000 deaths (Lazarou et al., 1998; Daniel et al., 2006) the year 2000, although the term nutritional genomics was have been reported to occur. Similarly, according to a used in 1999 to refer to using plant genomics to improve the German study, about 6% of adverse drug reactions are nutritional quality of plants (Della Penna, 1999). Of course, attributed to new hospital admissions (Dormann et al., nutritional genetics, the study of the interaction of nutrition 2004). This inter-individual variability in drug response with human genotypes, is a much older term (Ordovas and could be because of multiple factors such as disease Mooser, 2004). Nutrigenomics is an approach to nutrition determinants, environmental factors and genetic based and human health that takes into account and studies the variability in drug target response (pharmacodynamic re- effect of genetic differences in human response to foods. It sponse) and metabolism or idiosyncratic responses. These also uses technologies from genomics and other related areas factors affect drug absorption, distribution, action, metabo- to study how food has an impact on gene expression, lism and excretion and have a strong genotype basis (Zheng biochemistry, metabolism and promotion of health (Elliott et al., 2004). An understanding of the variability in efficacy and Ong, 2002; Stover, 2006). The use of -omics research to and toxicity of the same doses of medications in the human analyze the influence of nutrients on human health is thus population, therefore, may provide safer and more efficient based on two observations: (1) the nutritional environment drug therapy. modifies the expression of genes, and (2) depending upon It is now clear that nutrients also effect metabolism by the genotype of an individual, the metabolism of nutrients exerting their effects at various genetic levels of biological may vary and ultimately result in a different health status complexity, such as gene transcription, RNA processing, (Corthesy-Theulaz et al., 2005). Thus, nutrigenomics treats mRNA stability and post-translational modifications (Young, food as a major environmental factor in the genetics– 2002) as well as their direct effects on cell metabolism. environment interaction. In parallel with the pharmaco- Nutritional requirements vary between different physiologi- genetics/-genomics split, the extension from nutritional cal groups, including age and gender and also among genetics to nutrigenomics thus lies in the use of genomics apparently similar individuals. Various genetic polymorph- technologies. Like pharmacogenomics, nutrigenomics also isms of importance to nutrition have been identified, for includes the study of the effect of dietary compounds on example folate metabolism, iron homeostasis, bone health, gene expression as a tool to understand how a nutrigenomic lipid metabolism, immune function, phenylketonuria and food acts on