Meta-analysis of the population and phenotypic expression of CYP2C9/2C19 polymorphism on drug metabolism in different ethnicities

The term "pharmacogenetics" has been defined as the scientific study of inherited factors that affect the human drug response. Many pharmacogenetie studies have been published since 1995 and have focussed on the principal enzyme family involved in drug metabolism, the cytochrome P450 family, particularly cytochrome P4502C9 and 2C19. In order to investigate the pharmacogenetic aspect of pharmacotherapy, the relevant studies describing the association of pharmacogenetic factor(s) in drug responses must be retrieved from existing literature using a systematic review approach. In addition, the estimation of variant allele prevalence for the gene under study between different ethnic populations is important for pharmacogenetic studies. In this thesis, the prevalence of CYP2C9/2C19 alleles between different ethnicities has been estimated through meta-analysis and the population genetic principle. The clinical outcome of CYP2C9/2C19 allelic variation on the pharmacotherapy of epilepsy has been investigated; although many new antiepileptic drugs have been launched into the market, carbamazepine, phenobarbital and phenytoin are still the major agents in the pharmacotherapy of epilepsy. Therefore, phenytoin was chosen as a model AED and the effect of CYP2C9/2C19 genetic polymorphism on phenytoin metabolism was further examined.An estimation of the allele prevalence was undertaken for three CYP2C9/2C19 alleles respectively using a meta-analysis of studies that fit the Hardy-Weinberg equilibrium. The prevalence of CYP2C9*1 is approximately 81%, 96%, 97% and 94% in Caucasian, Chinese, Japanese, African populations respectively; the pooled prevalence of CYP2C19*1 is about 86%, 57%, 58% and 85% in these ethnic populations respectively. However, the studies of association between CYP2C9/2C19 polymorphism and phenytoin metabolism failed to achieve any qualitative or quantitative conclusion. Therefore, mephenytoin metabolism was examined as a probe drug for association between CYP2C19 polymorphism and mephenytoin metabolic ratio. Similarly, analysis of association between CYP2C9 polymorphism and warfarin dose requirement was undertaken.It was confirmed that subjects carrying two mutated CYP2C19 alleles have higher S/R mephenytoin ratio due to deficient CYP2C19 enzyme activity. The studies of warfarin and CYP2C9 polymorphism did not provide a conclusive result due to poor comparability between studies.The genetic polymorphism of drug metabolism enzymes has been studied extensively, however other genetic factors, such as multiple drug resistance genes (MDR) and genes encoding ion channels, which may contribute to variability in function of drug transporters and targets, require more attention in future pharmacogenetic studies of antiepileptic drugs.

Nonlinear signalling networks and cell-to-cell variability transform external signals into broadly distributed or bimodal responses

We show theoretically and experimentally a mechanismbehind the emergence of wide or bimodal protein distributions in biochemical networks with nonlinear input-output characteristics (the dose-response curve) and variability in protein abundance. Large cell-to-cell variation in the nonlinear dose-response characteristics can be beneficial to facilitate two distinct groups of response levels as opposed to a graded response. Under the circumstances that we quantify mathematically, the two distinct responses can coexist within a cellular population, leading to the emergence of a bimodal protein distribution. Using flow cytometry, we demonstrate the appearance of wide distributions in the hypoxia-inducible factor-mediated response network in HCT116 cells. With help of our theoretical framework, we perform a novel calculation of the magnitude of cell-to-cell heterogeneity in the dose-response obtained experimentally. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

An empirical examination of emotional and cognitive responses to threat appeals

Advertising and other forms of communications are often used by government bodies, non-government organisations, and other institutions to try to influence the population to either a) reduce some form of harmful behaviour (e.g. smoking, drunk- driving) or b) increase some more healthy behaviour (e.g. eating healthily). It is common for these messages to be predicated on the chances of some negative event occurring if the individual does not either a) stop the harmful behaviour, or b) start / increase the healthy behaviour. This design of communication is referred to by many names in the relevant literature, but for the purposes of this thesis, will be termed a ‘threat appeal’. Despite their widespread use in the public sphere, and concerted academic interest since the 1950s, the effectiveness of threat appeals in delivering their objective remains unclear in many ways. In a detailed, chronological and thematic examination of the literature, two assumptions are uncovered that have either been upheld despite little evidence to support them, or received limited attention at all, in the literature. Specifically, a) that threat appeal characteristics can be conflated with their intended responses, and b) that a threat appeal always and necessarily evokes a fear response in the subject. A detailed examination of these assumptions underpins this thesis. The intention is to take as a point of departure the equivocality of empirical results, and deliver a novel approach with the objective of reducing the confusion that is evident in existing work. More specifically, the present thesis frames cognitive and emotional responses to threat appeals as part of a decision about future behaviour. To further develop theory, a conceptual framework is presented that outlines the role of anticipated and anticipatory emotions, alongside subjective probabilities, elaboration and immediate visceral emotions, resultant from manipulation of the intrinsic message characteristics of a threat appeal (namely, message direction, message frame and graphic image). In doing so, the spectrum of relevant literature is surveyed, and used to develop a theoretical model which serves to integrate key strands of theory into a coherent model. In particular, the emotional and cognitive responses to the threat appeal manipulations are hypothesised to influence behaviour intentions and expectations pertaining to future behaviour. Using data from a randomised experiment with a sample of 681 participants, the conceptual model was tested using analysis of covariance. The results for the conceptual framework were encouraging overall, and also with regard to the individual hypotheses. In particular, empirical results showed clearly that emotional responses to the intrinsic message characteristics are not restricted to fear, and that different responses to threat appeals were clearly attributed to specific intrinsic message characteristics. In addition, the inclusion of anticipated emotions alongside cognitive appraisals in the framework generated interesting results. Specifically, immediate emotions did not influence key response variables related to future behaviour, in support of questioning the assumption of the prominent role of fear in the response process that is so prevalent in existing literature. The findings, theoretical and practical implications, limitations and directions for future research are discussed.