Proton Pump Research Articles

Comprehensive Analysis of the Gradient Porous Transport Layer for the Proton-Exchange Membrane Electrolyzer.

A reasonable porous transport layer (PTL) is crucial to decreasing the mass-transfer loss in proton-exchange membrane water electrolyzers (PEMWEs). In this study, it was experimentally demonstrated that the gradient porosity PTL is beneficial in improving the performance of electrolyzers. The research comprehensively investigates the impact of gradient porosity PTL structures on the performance of the PEMWE, considering mass transfer and interfacial contact. It offers insights into the two-phase (oxygen-water) flow transport mechanisms within the PTLs using a 2D numerical model based on the actual PTL geometry. At the microscopic level, it analyzes how the interfacial contact impacts proton and electron transport mechanisms, affecting not only the contact resistance but also the number of effective catalytic sites for the oxygen evolution reaction. Experimental results demonstrate that the cis-gradient porosity PTL leads to a performance enhancement of 9.3% at 2.2 A/cm2. Numerical simulations reveal that the drivers of oxygen transport include the surface tension of the fibers and the pressure drop influenced by the local PTL porosity. Further analysis indicates that the lower oxygen saturation in the bottom region of the PTL with cis-gradient porosity favors a lower oxygen coverage area in the catalyst layers (CL) since the narrower pore space and higher capillary pressure increase the number of water flow paths into the CL. Overall, this study provides valuable insights for designing high-performance PTLs for use in electrolyzers.

Big1 is a newly identified autophagy regulator that is critical for a fully functional V-ATPase.

The vacuolar H+-translocating ATPase (V-ATPase) is the major proton pump for intra-organellar acidification. Therefore, the integrity of the V-ATPase is closely associated with cellular homeostasis, and mutations in genes encoding V-ATPase components and assembly factors have been reported in certain types of diseases. For instance, the recurrent mutations of ATP6AP1, a gene encoding a V-ATPase accessory protein, have been associated with cancers and immunodeficiency. With the aim of studying V-ATPase-related mutations using the yeast model system, we report that Big1 is another homolog of ATP6AP1 in yeast cells, and we characterize the role of Big1 in maintaining a fully functional V-ATPase. In addition to its role in acidifying the vacuole or lysosome, our data support the concept that the V-ATPase may function as part of a signaling pathway to regulate macroautophagy/autophagy through a mechanism that is independent from Tor/MTOR.

Impact of proton pump inhibitors on pathologic response rates following fluoropyrimidine-based neoadjuvant chemotherapy in pancreatic cancer patients.

Proton pump inhibitors (PPIs) negatively impact fluoropyrimidine-based chemotherapy efficacy in colorectal cancer. This study assessed PPI impact on major pathologic response (mPR) rates of pancreatic adenocarcinoma (PDAC) patients receiving fluoropyrimidine-based chemotherapy. An institutional retrospective review of resected PDAC patients receiving neoadjuvant fluoropyrimidine-based chemotherapy (98% FOLFIRINOX) from 2011 to 2021 was conducted. Outcomes were stratified by use or nonuse of PPIs within 6 months of neoadjuvant chemotherapy initiation. Primary outcome was mPR defined as complete or near complete response. Among 540 patients included, the median age was 64 (IQR: 60-70) years, 297 (55%) were male, and 202 (37%) were PPI users. 170 (31%) patients had mPR with similar rates among PPI users and nonusers (29% vs. 33%, p = 0.38). No difference in mPR was seen between PPI users and nonusers receiving chemoradiation (35% vs. 36%, p = 0.89) or ≥8 cycles of NAC (33% vs. 36%, p = 0.55). Median OS for PPI users was 30.9 versus 31.7 months for nonusers (p = 0.62). On multivariable analysis, PPI therapy was not associated with decreased survival. PPI usage did not significantly influence mPR or OS following neoadjuvant fluoropyrimidine-based chemotherapy in resected PDAC patients. Further analysis of all patients, not just those who underwent resection, is required.

Efficacy and safety of Vonoprazan-based treatment of Helicobacter pylori infection: a systematic review and network meta-analysis

ObjectiveThe aim of this study was to evaluate the effectiveness and safety of the nine most widely studied Vonoprazan (VPZ)-based treatment regimens along with traditional Proton pump inhibitor (PPI)-based treatment regimens in eradicating Helicobacter pylori (H. pylori) infection.DesignThrough searching PubMed, Embase, Cochrane Library, Web of Science, we exclusively included randomized controlled trials (RCTs) to investigate the efficacy of VPZ-based and PPI-based therapies for H. pylori infection. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool, and the data analysis software was used to analyze the data accordingly.ResultsThe RCTs were collected from the earliest available date up to August 2023. Twenty-one RCTs were included, with a total sample size of 5481. The results of the network meta-analysis showed that the eradication rate of the VPZ-based quadruple 14-day (VPZ-Q14) treatment regimen in Intention-to-treat (ITT) analysis was the highest (SUCRA: 0.874); The eradication rate of the VPZ-based quadruple 10-day (VPZ-Q10) treatment plan in Per-protocol (PP) analysis was the highest (SUCRA: 0.849). All regimens were well tolerated without significant differences. According to the probability ranking of safety, high-dose VPZ-based dual 14-day therapy (H-VPZ-D14) ranked first in SUCRA, reaching 0.952. This indicates that H-VPZ-D14 treatment is the safest with a relatively low incidence of adverse effect. Therefore, VPZ-based therapies not only have a higher eradication rate, but also possess satisfactory safety.ConclusionCompared with traditional PPI-based therapies, VPZ-based therapies have shown superior eradication effects. Based on the Ranking Plot of the Network, the VPZ-Q14 or VPZ-Q10 treatment regimen for H. pylori has a higher eradication rate and acceptable differences compared to other treatment regimens. In addition, for regions with high antibiotic resistance rates, we recommend a 14-day quadruple therapy with bismuth based on VPZ.

Proton Transport Scenarios in Sulfuric Acid Explored via Ab Initio Molecular Dynamics Simulations.

Sulfuric acid (H2SO4), a highly reactive reagent containing intrinsic protonic charge carriers, has been studied via ab initio molecular dynamics simulations. Specifically, we explore the solvation shell structure of the protonic defects, H1SO4- and H3SO4+, as well as the underlying proton transport mechanisms in both the neat and hydrated H2SO4 solutions. Our findings reveal a significant contraction of the dynamic hydrogen-bonded network around the protonic defects, which resembles features seen in water. The simulations provide estimates of the structural relaxation time scales for proton release from both the covalent O-H bonds (∼23 ps) and the hydrogen bonds (∼0.4 ps). In contrast to water, our analysis of the proton transfer scenarios in sulfuric acid reveals correlated events mediated by the formation of longer (up to four) hydrogen-bonded Grotthuss chains.

Electrochemical CO2 Reduction in Acidic Electrolytes: Spectroscopic Evidence for Local pH Gradients.

Inspired by recent advances in electrochemical CO2 reduction (CO2R) under acidic conditions, herein we leverage in situ spectroscopy to inform the optimization of CO2R at low pH. Using attenuated total reflection surface-enhanced infrared absorption spectroscopy (ATR-SEIRAS) and fluorescent confocal laser scanning microscopy, we investigate the role that alkali cations (M+) play on electrochemical CO2R. This study hence provides important information related to the local electrode surface pH under bulk acidic conditions for CO2R, both in the presence and absence of an organic film layer, at variable [M+]. We show that in an acidic electrolyte, an appropriate current density can enable CO2R in the absence of metal cations. In situ local pH measurements suggest the local [H+] must be sufficiently depleted to promote H2O reduction as the competing reaction with CO2R. Incrementally incorporating [K+] leads to increases in the local pH that promotes CO2R but only at proton consumption rates sufficient to drive the pH up dramatically. Stark tuning measurements and analysis of surface water structure reveal no change in the electric field with [M+] and a desorption of interfacial water, indicating that improved CO2R performance is driven by suppression of H+ mass transport and modification of the interfacial solvation structure. In situ pH measurements confirm increasing local pH, and therefore decreased local [CO2], with [M+], motivating alternate means of modulating proton transport. We show that an organic film formed via in situ electrodeposition of an organic additive provides a means to achieve selective CO2R (FECO2R ∼ 65%) over hydrogen evolution reaction in the presence of strong acid (pH 1) and low cation concentrations (≤0.1 M) at both low and high current densities.

Classification of Gastric Neuroendocrine Tumors and Associations With Survival.

Not all gastric neuroendocrine tumors (GNETs) may be classified into one of the three described clinicopathologic subtypes. The purpose of this study was to better characterize GNET subtypes and associated outcomes. Patients treated for GNET at our institution (1995-2021) were identified. Pathologic specimens of tumors that could not be classified as type 1, 2, or 3 were further reviewed. GNETs were categorized as proton pump inhibitor (PPI)-associated based on changes in the background gastric mucosa consistent with PPI use. Distant metastasis at presentation (DM) and disease-specific survival (DSS) were evaluated. Among 246 patients, there were 164 (67%) type 1, 5 (2%) type 2, 52 (21%) type 3, and 18 (7%) PPI-associated GNETs. Seven (3%) tumors remained unclassified. DM was more frequent with type 3 GNETs (38%) than type 1 (1%), type 2 (20%), or PPI-associated tumors (11%, p < 0.001). Ten-year DSS rates were 100% for type 1, 53% (95% confidence interval [CI], 38%-75%) for type 3, and 80% (95% CI, 58%-100%) for PPI-associated tumors (p < 0.001). GNET subtype, race, and DM were independently associated with DSS. PPI-associated tumors may represent a distinct GNET subtype with intermediate outcomes. Other factors should also be considered in overall prognosis.

Emerging Two-Dimensional Materials for Proton-Based Energy Storage.

The rapid diffusion kinetics and smallest ion radius make protons the ideal cations toward the ultimate energy storage technology combining the ultrafast charging capabilities of supercapacitors and the high energy densities of batteries. Despite the concept existing for centuries, the lack of satisfactory electrode materials hinders its practical development. Recently, the rapid advancement of the emerging two-dimensional (2D) materials, characterized by their ultrathin morphology, interlayer van der Waals gaps, and distinctive electrochemical properties, injects promises into future proton-based energy storage systems. In this perspective, we comprehensively summarize the current advances in proton-based energy storage based on 2D materials. We begin by providing an overview of proton-based energy storage systems, including proton batteries, pseudocapacitors and electrical double layer capacitors. We then elucidate the fundamental knowledge about proton transport characteristics, including in electrolytes, at electrolyte/electrode interfaces, and within electrode materials, particularly in 2D material systems. We comprehensively summarize specific cases of 2D materials as proton electrodes, detailing their design concepts, proton transport mechanism and electrochemical performance. Finally, we provide insights into the prospects of proton-based energy storage systems, emphasizing the importance of rational design of 2D electrode materials and matching electrolyte systems.

Groove pancreatitis – an unusual case of pancreatitis, case report

Groove pancreatitis is a rare form of chronic pancreatitis affecting the pancreaticoduodenal groove, leading to ductal stenosis and symptoms like abdominal pain, vomiting, and jaundice. It often coexists with cystic dystrophy of the duodenal wall (CDDW), marked by duodenal wall thickening and cyst formation. We report a case of a 36-year-old male with persistent abdominal pain and a history of acute pancreatitis, diagnosed with CDDW via MRI. Despite multiple endoscopic interventions, ductal access was challenging due to inflammation and conservative management with proton pump inhibitors and pancreatic enzymes provided symptom relief. Diagnostic tools include MRI, endoscopy, and EUS were administered. Management of groove pancreatitis still remains a challenge consisting of treatment ranging from conservative methods to surgical intervention for refractory cases, emphasizing a cautious, stepwise approach and lifestyle changes.

ThP6.9 - Endoluminal vacuum-assisted closure (EndoVAC) therapy in spontaneous duodenal perforation: a novel approach to an undertreated problem

Abstract Introduction Duodenal perforation is a rare but critical condition, with management ranging from conservative to surgical depending on timing of presentation, patient status, and clinician preference. In recent years, minimally invasive techniques have been emerging alternatives for their safety and efficacy. Notably, there have been cases promoting endoluminal vacuum-assisted closure (EndoVAC) therapy as a viable alternative for use among patients with iatrogenic oesophageal perforations. To our knowledge, there has been no reported use of this novel approach specifically in spontaneous duodenal perforations. Case presentation A 55-year-old female with no history of trauma, surgery, NSAID use, or gastrointestinal conditions presented with epigastric pain and vomiting. A CT scan revealed a contained duodenal perforation at the D2/3 junction, accompanied by a complex retroperitoneal collection unsuitable for imaging-guided drainage. Initial management was conservative with intravenous hydration, antibiotics, proton pump inhibitors, and nasogastric tube decompression. She underwent oesophagoduodenoscopy and EndoVAC therapy resulting in complete resolution of collection and a small diverticulum on repeat CT. Discussion Current standard of care for duodenal perforations would be conservative management, though this carries the risk of deterioration due to biliopancreatic leakage and slow resolution of sepsis. Surgical management, when needed, is often technically challenging with high morbidity. EndoVAC gives the benefit of providing targeted drainage and negative pressure therapy to the site of perforation, reducing ongoing contamination, and promoting wound granulation. Conclusion EndoVAC therapy offers a minimally invasive alternative to treatment of duodenal perforations and has the potential for broader application in specialist and tertiary healthcare settings.

Gastrointestinal dysmotility is associated with proton pump inhibitor refractory esophagitis in patients with systemic sclerosis.

Patients with systemic sclerosis present with severe gastroesophageal reflux disease, often refractory to proton-pump inhibitors (PPI) treatment. The aim of the present study was to identify factors associated with PPI-refractory esophagitis. We performed a cross-sectional study in a single-center cohort of patients diagnosed with systemic sclerosis. We included patients who underwent an esophagogastroduodenoscopy while on PPI treatment. Patients with PPI-refractory erosive esophagitis were compared with those with endoscopically normal esophageal mucosa. A total of 69 patients were included, from these, 23 patients (33%) had PPI-refractory esophagitis (Grade A, n = 11; Grade B, n = 7; Grade C, n = 2; Grade D, n = 3) and 46 (67%) had an endoscopically normal esophageal mucosa. On univariate analysis, patients with PPI-refractory esophagitis were more frequently diffuse SSc subset (43% vs 17%; p= 0.041). Evaluating gastrointestinal motility tests, neither absent esophageal contractility (39% vs 25%, p= 0.292) nor hypotensive lower esophageal sphincter (47% vs 44%, p= 0.980) were significantly associated with PPI-refractory esophagitis. Gastrointestinal dysmotility, defined as abnormal gastric emptying and/or small bowel dilated loops, was significantly associated with PPI-refractory esophagitis (66 vs 8%, p = <0.001). On a multivariate regression model to evaluate the association between motility test results adjusted for the diffuse subset, gastrointestinal dysmotility (β = 0.751, p= 0.010) was independently associated with PPI-refractory esophagitis, while absent esophageal contractility (β = 0.044, p= 0.886) or a hypotensive LES were not (β=-0.131, p= 0.663). Our findings suggest that gastric and small intestinal motor dysfunction may be an important contributor to the development of PPI-refractory esophagitis in patients with systemic sclerosis.

In Situ Analysis of Binder Degradation during Catalyst-Accelerated Stress Test of Polymer Electrolyte Membrane Fuel Cells.

High-oxygen-permeability ionomers (HOPIs) are being actively developed to enhance the performance and durability of high-power polymer electrolyte membrane fuel cells (PEMFCs). While methods for evaluating binder performance are well-established, techniques for assessing binder durability and measuring its degradation in situ during the AST process remain limited. This study examines the distribution of relaxation times (DRT) and Warburg-like response (WLR) methods as in situ analysis techniques during the catalyst-accelerated stress test (AST) process. We conducted catalyst-ASTs (0.6-0.95 V cycling) for 20,000 cycles, monitoring changes using cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), and linear sweep voltammetry (LSV). Contrary to expectations, during the catalyst-AST, the ion transport resistance of the binder decreased, indicating no binder degradation. Scanning electron microscopy/energy dispersive spectrometer (SEM/EDS) analysis revealed that the degradation rate of the catalyst and the support was relatively higher than that of the binder, leading to a reduction in catalyst layer thickness and improved binder network formation. By applying the DRT method during the catalyst-AST process, we were able to measure the increase in oxygen reduction reaction (ORR) resistance and the decrease in proton transport resistance in situ. This allowed for the real-time detection of the reduction in catalyst layer thickness and improvements in ionomer networks due to catalyst and support degradation. These findings provide new insights into the complex interplay between catalyst degradation and binder performance, contributing to the development of more durable PEMFC components.

Gating elements for carvacrol activation of the OTOP1 proton channel

Otopetrin 1 (OTOP1) is a proton-activated channel crucial for animals’ perception of sour taste. Despite its significance, the gating mechanism of OTOP1 remains poorly understood. Here, we demonstrate that carvacrol activates the mouse OTOP1 (mOTOP1) channel under neutral and acidic conditions. Functional analysis showed that carvacrol enhances pH fluorescence signals in OTOP1-expressing cells, with reduced efficacy at lower pH levels. Carvacrol selectively activates mOTOP1, while mOTOP2, mOTOP3, and Chelonia mydas OTOP1 (CmOTOP1) are insensitive to carvacrol activation under neutral pH. Through chimera and point mutation experiments, swapping S134 in transmembrane segment 3 (TM3) and T247 in the TM5-6 linker abolished carvacrol activation of mOTOP1 and conferred activation on CmOTOP1, suggesting these two residues are critical for carvacrol sensitivity. These findings highlight TM3 and TM5-6 linker as pivotal gating apparatus of OTOP1 channels and potential docking sites for drug design.

Long-Term Use of Proton Pump Inhibitors Increases the Risk of Renal Diseases

Long-Term Use of Proton Pump Inhibitors Increases the Risk of Renal Diseases

Study of Intestinal Fatty Acid Binding Protein-2 in Cirrhotic Patients and its Relation to Chronic Use of Proton Pump Inhibitors in Decompensated Cirrhosis

Study of Intestinal Fatty Acid Binding Protein-2 in Cirrhotic Patients and its Relation to Chronic Use of Proton Pump Inhibitors in Decompensated Cirrhosis

Postoperative ileus in obstetric and gynecological practice: a prospective solution to the problem

Proton pump inhibitors (PPIs) are the undisputed leaders in the treatment of acid-related diseases. In actual clinical practice, the use of PPIs has been growing exponentially in recent decades. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines and reviews and meta-analyses of the current decade on the safety of PPI use note that when prescribing PPIs in large doses for a long period, the possibility of developing numerous side effects should be taken into account. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to 12/01/2023. The review addresses issues of drug interactions between PPIs and chemotherapeutic drugs, which should certainly be taken into account in real clinical practice. In addition, recent reviews and meta-analyses have examined side effects of long-term PPI use, such as increased risk of infection (Clostridium difficile infection, community-acquired pneumonia), electrolyte disturbances, kidney damage, increased risk of hip, wrist and spine fractures; increased cardiovascular risk and a number of others, which can also have an adverse effect on the prognosis of cancer patients. The risk of developing gastric cancer with long-term PPI therapy can be considered as a likely side effect, since their association with PPI use is not denied or questioned in recent reviews and meta-analyses. There is still uncertainty regarding the increased risk of other cancers, since there are publications that do not confirm their association with PPI use. However, the presented review, despite a number of contradictions, allows us to conclude that the increased cancer risk with long-term use of PPIs is real and must be taken into account when prescribing PPIs for a long term.

Oxidative Phosphorylation Does Not Violate the Second Law of Thermodynamics.

In a recent series of papers, James W. Lee reported that mitochondrial oxidative phosphorylation violates the second law of thermodynamics and that it is allowed to do so because it is a "Type-B" process that features lateral and longitudinal membrane asymmetry. We show here that these contentions are based on problematic interpretations of the literature. More reliable values of ΔGredox and ΔGATPsynthesis show that the second law is not violated. More recent reports on the structures of the redox-driven proton pumps (Complexes I, III, and IV) suggest that longitudinal membrane asymmetry does not exist. Finally, Lee's predictions for the concentration of protons localized at the P-side surface of the bioenergetic membrane are likely to be much too high due to several errors; thus, his predicted high values of ΔpHsurface that violate the second law are likely to be wrong. There is currently no strong experimental or theoretical evidence to support the contention that oxidative phosphorylation violates the second law of thermodynamics.

Influence of compression effect on the MEA structure and performance based on M−N–C electrocatalysts for PEMFC

The single-atom dispersed active sites and the thicker catalytic layer of metal-nitrogen-carbon (M-N-C) electrocatalysts based membrane electrode assembly (MEA) exhibit notable distinctions from Pt-based MEA, necessitating targeted optimization. This study systematically investigates the influence of compression on both structure and performance of the M-N-C electrocatalysts based MEA. Four compression ratios, ranging from 11.5% to 39.3%, were examined across diverse operational conditions. The variations in impedance across different electrochemical regions are observed, resulting from the superposition of distinct impedance components. It is found that the insufficient compression leads to higher porosity and the formation of cracks between catalytic layer and membrane, adversely impacting internal resistance and proton transport. Increasing compression first acts the catalytic layer, and then gradually acts on the interface, membrane and gas diffusion layer, thereby reducing internal resistance, charge transfer resistances, albeit at the expense of heightened mass transfer resistance. Among these factors, the influence of internal resistance affects significance to total performance. Furthermore, compression influenced mass transfer differently in various layers. For the catalyst layer, the effect was uniform and sustained, while for the gas diffusion layer, it initially remained constant and then experienced a sudden deterioration over a certain extent. Optimal MEA performance is achieved when the compression ratio attains 40 %, which 2.1 times higher than the low compression MEA. This finding emphasizes the necessity for higher compression on M-N-C electrocatalysts based MEA compared to Pt-based MEA.

Current status and influencing factors of prophylactic use of proton pump inhibitors in internal medicine inpatients receiving glucocorticoid therapy.

The actual situation and influencing factors of prophylactic use of proton pump inhibitors (PPIs) in internal medicine inpatients receiving glucocorticoid therapy are rarely reported. This study aimed to investigate the current status and influencing factors of prophylactic use of PPIs in internal medicine inpatients receiving glucocorticoid therapy to provide a basis for rational prophylactic use of PPIs. Internal medicine inpatients receiving glucocorticoid therapy from February 2023 to September 2023 were included. Information on the prophylactic use of PPIs was collected and analyzed by clinical pharmacists. Associated factors with prophylactic use of PPIs were analyzed by univariable and multivariable logistic regression. 980 inpatients were finally included in our study, of which 271 (27.7%) inpatients received prophylactic use of PPIs. Among the inpatients prescribed PPIs, 90 inpatients received a standard dose of PPIs twice a day. Multiple logistic regression analysis showed that age ≥80years [OR = 7.009, 95% CI (1.424, 34.495), p = 0.017], history of gastroesophageal reflux disease (GERD) [OR = 2.047, 95% CI (1.338, 3.133), p = 0.001], low platelet count [OR = 0.997, 95% CI (0.994, 0.999), p = 0.004], number of concomitant diseases [OR = 1.104, 95% CI (1.056, 1.153), p < 0.001], junior doctors [OR = 1.755, 95% CI (1.248, 2.468), p = 0.001], glucocorticoid dose (higher than 50mg, measured by methylprednisolone) [OR = 2.455, 95% CI (1.371, 4.395), p = 0.003], antiplatelet agents [OR = 2.567, 95% CI (1.456, 4.524), p = 0.001], immunosuppressants [OR = 1.477, 95% CI (1.014, 2.153), p = 0.042], and betahistine [OR = 5.503, 95% CI (1.124, 26.950), p = 0.035] were associated with more prophylactic use of PPIs. The prophylactic use of PPIs in internal medicine inpatients receiving glucocorticoid therapy is common in China. Clinical pharmacists will take targeted measures to promote the rational use of PPIs according to the results of this study.

Association of Polymorphic Cytochrome P450 Enzyme Pathways with Falls in Multimedicated Older Adults

ObjectivesDose exposure is considered relevant for drug-associated falls in older adults, pointing to an importance of drug metabolism. Aim was to analyze individual factors altering drug metabolism such as enzyme saturation by drug exposure and pharmacogenetics in the context of drug-associated falls. DesignProspective population-based study (ActiFE-Ulm study). Setting and ParticipantsCommunity-dwelling older adults. MethodsFocus was laid on the metabolism by polymorphic cytochrome P450 (CYP) enzymes CYP2C19, 2C9, and 2D6. Relevant variants of pharmacogenes were analyzed. Logistic binary regression analysis was used to calculate odds ratios (ORs) and 95% CIs for falls observed prospectively over a 1-year period with drug metabolism characteristics. ResultsIn total, 1377 participants were included in the analysis. Although the phenotype predicted by the genotype was not, the use of drugs metabolized by CYP2C19 was associated with falls. Drugs not known as fall risk–increasing drugs (FRIDs; ie, non-FRIDs), but metabolized by CYP2C19, showed an OR of 1.46 (1.11-1.93) in adjusted analysis. Significant effect modification was observed for a reduced CYP2C19 activity phenotype with non-FRIDs metabolized by CYP2C19. Conclusions and ImplicationsThis study suggests an association between the occurrence of falls in older adults and the metabolic capacity of CYP2C19. Thus, an important step toward prevention of falls might be to personalize dosage and treatment length of the main drug classes known to be CYP2C19 substrates, such as many antidepressants, opioids, and sedatives, but also proton pump inhibitors in particular in poor and intermediate metabolizers.