The Development, Validation and Implementation of a Broad-Based ADME Genotyping Assay into Research and Clinical Trials

In order to better assess the inter-individual variability observed in a patient’s pharmacokinetic response to many medications, we have created a custom genotyping panel that uses unique assay designs to analyze variation present in key genes involved in the absorption, distribution, metabolism and excretion (ADME) of many therapeutic agents. These genes and pathways involved in most pharmacokinetic mechanisms are well known. However, as yet, there has been little effort to develop tools that can interrogate a large number of variations in most known drug metabolizing genes simultaneously within a single experimental tool. Pharmacogenomic research has historically been conducted using two approaches:  targeted studies that screen a small number of specific functional markers to identify known metabolic status phenotypes, and genome-wide studies that identify novel genetic correlations with drug response phenotypes. Thus, a gap currently exists for a targeted ADME research tool that can evaluate a large number of key ADME genes and variants in a format that can be applicable to both types of study designs. As part of this thesis, we have developed a 3000 SNP broad based ADME genotyping panel that can address this need.  Genes and markers for the genotyping panel were selected in collaboration with many groups from both academia and the pharmaceutical industry in an effort to capture all pertinent genes and metabolic pathways that have been implicated in drug metabolism. The final assay design was composed of over 3000 markers in 181 genes. Over three phases of iterative development, the assay conversion rate for the 3000 markers was improved from 83.0% to 97.4% through the incorporation of novel design strategies to overcome areas of genomic interference such as regions of homology and underlying polymorphisms. Accuracy of the assay was validated by screening more than 200 samples of known genotype with a concordance of 99%. Additionally, data from the assay has also been compared to data from different technological platforms and has an overall concordance of 99.5%. The effectiveness of the design strategy was demonstrated in the successful utilization of the assay in the screening of over 1000 samples which identified several novel pharmacogenetic associations between ADME variations and adverse drug reactions in children. Another goal of this thesis was to demonstrate what added benefit/utility the 3000 SNP ADME panel would have when compared to currently available genotyping assays. Using 150 extensively investigated liver samples, the broad based assay was not only able to detect and validate 13 previously reported cis eQTLs in ADME genes  but further identified an additional 13 novel ADME cis eQTLs that had never been observed before, doubling the number previously identified using standard methods on the same samples. Finally, in support of this work, a number of bioinformatic tools had to be developed to help expedite this research. These tools have been further refined and are currently being used to assist with enrichment of genomic targets for next generation sequencing experiments.   In conclusion, this work has led to a better understanding of ADME genetics and the nuances of assaying ADME genes. The content and designs of the developed assay sets it apart from currently available commercial assays that contain only functional markers in a small number of genes or do not have adequate coverage across ADME genes. The assay has the ability to play a significant role in pharmacogenomic studies to identify known and novel pharmacogenomic biomarkers. These will lead to improved biomarkers that will help better stratify pharmaceutical clinical trial populations or assist physicians to select better, more personalized, efficacious and safer therapies for their patients.

Keyphrases: ADME, Pharmacogenomics, pharmacokinetics, genotyping, technology development