Background:
Cytochrome P450 (CYP450) enzymes play an important role in the metabolism of 70-80%
of the currently used medications, including proton pump inhibitors. There are some data analyzing the impact of
gene polymorphisms of CYP450 enzymes on most widely used PPIs, such as omeprazole, however, the data on pantoprazole
are highly lacking.
Objective:
To summarize the most recent publications and studies on the role of polymorphisms of the genes encoding
CYP450 enzyme 2C19 in the metabolism of pantoprazole and pantoprazole based Helicobacter pylori eradication
regimens.
Methods:
We performed a non-systematic search of the available literature on the selected topic.
Results and conclusion:
The data on cytochrome P450 gene polymorphisms and their role in pantoprazole metabolism
and pantoprazole based Helicobacter pylori eradication remain conflicting. Individual differences in pantoprazole
metabolism might be partly related to genetic polymorphisms of CYP450 enzymes. Most of the studies support
the observation that cytochrome 2C19 polymorphisms have an impact on the pharmacokinetics of pantoprazole and
its therapeutic effects: poor metabolizers of PPIs are more likely to have a better response to pantoprazole therapy
and achieve better H. pylori eradication rates compared to rapid metabolizers. The determination of alleles that are
associated with decreased (e.g., *2, *3 alleles) or increased (e.g., *17 allele) cytochrome 2C19 enzyme activity might
be used as predictive factors for the potential of acid suppression and the success of Helicobacter pylori eradication.
Overall, currently available data do not provide robust evidence, therefore, the application of genetic polymorphisms
of cytochrome enzymes in clinical practice still cannot be recommended as routine practice for personalized pantoprazole
prescription strategies.
Frequencies of poor metabolizers of cytochrome P450 2C19 in esophagus cancer, stomach cancer, lung cancer and bladder cancer in Chinese population
