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Malgré des avancées techniques et médicales, la transplantation rénale reste risquée et le phénomène de rejet reste fréquent. L'usage d'immunosuppresseurs comme le tacrolimus reste à ce jour le meilleur moyen d'assurer la survie du greffon et d'ainsi récupérer une fonction rénale satisfaisante. Malheureusement, la néphrotoxicité ainsi que la grande variabilité pharmacocinétique et pharmacodynamique du tacrolimus représente un frein au bon déroulement du traitement. Objectif : L'objectif de ce travail est d'illustrer l'intérêt de la pharmacogénétique dans le cadre d'un traitement par tacrolimus en transplantation rénale à travers différents cas cliniques et études.Résultats : L'identification des métaboliseurs rapides ( CYP3A5*1/*J et CYP3A5*1/*3) ou lents (CYP3A5*3/*3), permet une adaptation de la dose de départ avant même l'administration de celle-ci, ce qui permet d'atteindre la concentration cible plus rapidement. On évite ainsi une néphrotoxicité liée à un surdosage. De plus, le suivi par monitoring thérapeutique n'est plus nécessaire durant la première semaine de traitement. Néanmoins, l'impact du polymorphisme du CYP3A5 au niveau de l'incidence du rejet de greffe et au niveau de la néphrotoxicité n'est pas encore complétement démontrée. Cependant, plusieurs études concordent à dire que les patients expresseurs du CYPA3A5 ont un risque plus élevé de rejet aigu et de néphrotoxicité chronique. Conclusion : La pharmacogénétique est un outil fiable et prometteur permettant de prédire la dose de départ du tacrolimus dans le cadre d'une transplantation rénale. De nombreuses applications cliniques sont déjà d'applications en routine et il faut s'attendre à de nombreuses autres dans le futur. Despite the evolution of technics kidney transplantation is still risky and acute rejection is common. The use of immunosuppressive drugs like tacrolimus is the best way to assure the graft survival and get a normal renal function. However, tacrolimus’s nephrotoxicity and pharmacokinetics variability delay the treatment efficiency. The objective of this work is to evaluate and illustrate the interest of the use of pharmacogenetics in renal transplantation. The identification of intensive metabolizers (CYP3A5*/1*1 and CYP3A5*1/*3) or slow metabolizers (CYP3A5*3/*3) allows the adaptation of starting dose of tacrolimus before the first administration. The result is that the target concentration is reached faster. Thanks that, nephrotoxicity can be avoided and the use of therapeutic drug monitoring before the first week is not necessary anymore. However, the impact of CYP3A5 polymorphisms on acute graft rejection and on nephrotoxicity is still not fully documented. But several studies show that CYP3A5 expressors present a higher risk of acute graft rejection and chronic nephrotoxicity. Pharmacogenetics is a reliable and promising tool for tacrolimus starting dose prediction in renal transplantation. There are already some clinical applications and we can except new ones in the future.

Pharmacogenetics --- Tacrolimus --- Kidney Transplantation --- CYP3A5 protein, human

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This Special Issue focuses on the current state of pharmacogenomics (PGx) and the extensive translational process, including the identification of functionally important PGx variation; the characterization of PGx haplotypes and metabolizer statuses, their clinical interpretation, clinical decision support, and the incorporation of PGx into clinical care.

Medicine --- Pharmacology --- pharmacogenomics --- return of results --- genetic counseling --- qualitative --- pharmacogenetics --- implementation --- pharmacogenetics service --- screening --- pre-emptive --- personalized medicine --- precision medicine --- community pharmacy --- pharmacogenomic testing --- genetic privacy --- pharmaco-economics --- polymorphisms --- pharmacogenes --- pharmacogenomic --- machine learning --- adaptation --- human evolution --- US Food and Drug Administration --- clinical actionability --- clinical translation --- chronic kidney disease --- CYP3A5 --- polymorphism --- progression --- pharmacogenomics (PGx) --- pediatrics --- best practice alerts (BPAs) --- electronic health records (EHR) --- genomic indicators --- clinical decision support (CDS) --- phenotype --- genotype --- polypharmacy --- chronic disease --- medication management --- electronic medical record --- artificial intelligence --- n/a

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This colligated Special Issue of Pharmaceutics on Precision Medicine: Applied Concepts of Pharmacogenomics in Patients with Various Diseases and Polypharmacy offers to the reader a series of articles that describe the concept of Precision Medicine, discuss its implementation process and limitations, demonstrate its value by illustrating some clinical cases, and open the door to new and more sophisticated techniques and applications.

Medicine --- Clinical & internal medicine --- fibromyalgia (FM) --- myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) --- microRNA --- miRNome --- pharmacogenomics --- pharmacoepigenomics --- SM2miR --- Pharmaco-miR --- repoDB --- ME/CFS Common Data Elements (CDEs) --- dihydropyrimidine dehydrogenase --- DPYD --- 5-fluorouracil --- fluoropyrimidine --- therapeutic drug monitoring --- orthotopic liver transplant --- busulfan --- glutathione S-transferase --- genetic polymorphism --- limited sampling strategy --- pharmacokinetics --- clinical pharmacogenetics --- pharmacogenetic testing --- adverse drug reactions --- genotype --- phenotype --- pharmacogene --- barriers to pharmacogenetics implementation --- Sub-Saharan Africa --- chronic low back pain (cLBP) --- genetics --- personalized treatment --- polymorphism --- CYP450 --- tacrolimus --- CYP3A5 --- liver transplant --- pharmacogenomic --- minority --- data collection --- drug --- biomarker --- pharmacogenetics --- pharmacogenetic test --- personalized medicine --- gene expression --- infliximab --- adalimumab --- ulcerative colitis --- Crohn disease --- inflammatory bowel disease --- n/a

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This colligated Special Issue of Pharmaceutics on Precision Medicine: Applied Concepts of Pharmacogenomics in Patients with Various Diseases and Polypharmacy offers to the reader a series of articles that describe the concept of Precision Medicine, discuss its implementation process and limitations, demonstrate its value by illustrating some clinical cases, and open the door to new and more sophisticated techniques and applications.

Medicine --- Clinical & internal medicine --- fibromyalgia (FM) --- myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) --- microRNA --- miRNome --- pharmacogenomics --- pharmacoepigenomics --- SM2miR --- Pharmaco-miR --- repoDB --- ME/CFS Common Data Elements (CDEs) --- dihydropyrimidine dehydrogenase --- DPYD --- 5-fluorouracil --- fluoropyrimidine --- therapeutic drug monitoring --- orthotopic liver transplant --- busulfan --- glutathione S-transferase --- genetic polymorphism --- limited sampling strategy --- pharmacokinetics --- clinical pharmacogenetics --- pharmacogenetic testing --- adverse drug reactions --- genotype --- phenotype --- pharmacogene --- barriers to pharmacogenetics implementation --- Sub-Saharan Africa --- chronic low back pain (cLBP) --- genetics --- personalized treatment --- polymorphism --- CYP450 --- tacrolimus --- CYP3A5 --- liver transplant --- pharmacogenomic --- minority --- data collection --- drug --- biomarker --- pharmacogenetics --- pharmacogenetic test --- personalized medicine --- gene expression --- infliximab --- adalimumab --- ulcerative colitis --- Crohn disease --- inflammatory bowel disease --- fibromyalgia (FM) --- myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) --- microRNA --- miRNome --- pharmacogenomics --- pharmacoepigenomics --- SM2miR --- Pharmaco-miR --- repoDB --- ME/CFS Common Data Elements (CDEs) --- dihydropyrimidine dehydrogenase --- DPYD --- 5-fluorouracil --- fluoropyrimidine --- therapeutic drug monitoring --- orthotopic liver transplant --- busulfan --- glutathione S-transferase --- genetic polymorphism --- limited sampling strategy --- pharmacokinetics --- clinical pharmacogenetics --- pharmacogenetic testing --- adverse drug reactions --- genotype --- phenotype --- pharmacogene --- barriers to pharmacogenetics implementation --- Sub-Saharan Africa --- chronic low back pain (cLBP) --- genetics --- personalized treatment --- polymorphism --- CYP450 --- tacrolimus --- CYP3A5 --- liver transplant --- pharmacogenomic --- minority --- data collection --- drug --- biomarker --- pharmacogenetics --- pharmacogenetic test --- personalized medicine --- gene expression --- infliximab --- adalimumab --- ulcerative colitis --- Crohn disease --- inflammatory bowel disease