Abstract
Rifampin (RF) is metabolized in the liver into an active metabolite 25-desacetylrifampin and excreted almost equally via biliary and renal routes. Various influx and efflux transporters influence RF disposition during hepatic uptake and biliary excretion. Evidence has also shown that Vitamin D deficiency (VDD) and Vitamin D receptor (VDR) polymorphisms are associated with tuberculosis (TB). Hence, genetic polymorphisms of metabolizing enzymes, drug transporters and/or their transcriptional regulators and VDR and its pathway regulators may affect the pharmacokinetics of RF. In this narrative review, we aim to identify literature that has explored the influence of single nucleotide polymorphisms (SNPs) of genes encoding drug transporters and their transcriptional regulators (SLCO1B1, ABCB1, PXR and CAR), metabolizing enzymes (CES1, CES2 and AADAC) and VDR and its pathway regulators (VDR, CYP27B1 and CYP24A1) on plasma RF concentrations in TB patients on antitubercular therapy. Available reports to date have shown that there is a lack of any association of ABCB1, PXR, CAR, CES1 and AADAC genetic variants with plasma concentrations of RF. Further evidence is required from a more comprehensive exploration of the association of SLCO1B1, CES2 and Vitamin D pathway gene variants with RF pharmacokinetics in distinct ethnic groups and a larger population to reach conclusive information.
Highlights
Rifampin (RF) was introduced as a part of the combinational chemotherapy regimen for tuberculosis (TB) during the 1960s
The primary mechanism of RF resistance is due to the mutations in the rpoB gene that encode for the β-subunit of RNA polymerase
The following Medical Subject Headings (MeSH) words were used as part of our search strategy: antitubercular agents, antitubercular drugs, rifampin, rifampicin, genetic polymorphism, genetic susceptibility, pharmacogenetics, pharmacogenomics, genetic association study, genetic association analysis, tuberculosis, single nucleotide polymorphisms, pharmacokinetics, population pharmacokinetics, SLCO1B1, ABCB1, Pregnane X receptor (PXR), constitutive androstane receptor (CAR), carboxylesterase 1 (CES1), carboxylesterase
Summary
Rifampin (RF) was introduced as a part of the combinational chemotherapy regimen for tuberculosis (TB) during the 1960s. Multiple studies have reported the association of various genetic polymorphisms with significant variances in plasma RF levels in TB patients. This provides us with an exciting opportunity to review for assessing the potential impact of SNPs as an important driver for plasma RF exposure variability in TB patients. The genetic polymorphisms of these metabolizing enzymes, drug transporters and/or their transcriptional regulators and VDR gene and its pathway regulators may influence the RF pharmacokinetics. The following Medical Subject Headings (MeSH) words were used as part of our search strategy: antitubercular agents, antitubercular drugs, rifampin, rifampicin, genetic polymorphism, genetic susceptibility, pharmacogenetics, pharmacogenomics, genetic association study, genetic association analysis, tuberculosis, single nucleotide polymorphisms, pharmacokinetics, population pharmacokinetics, SLCO1B1, ABCB1, PXR, CAR, carboxylesterase 1 (CES1), carboxylesterase.
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