Dihydropyrimidine dehydrogenase deficiency

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Dihydropyrimidine dehydrogenase deficiency
Other namesDPD deficiency
Autosomal recessive - en.svg
Dihydropyrimidine dehydrogenase deficiency has an autosomal recessive pattern of inheritance.
Specialty Medical genetics, endocrinology   OOjs UI icon edit-ltr-progressive.svg

Dihydropyrimidine dehydrogenase deficiency is an autosomal recessive [1] metabolic disorder in which there is absent or significantly decreased activity of dihydropyrimidine dehydrogenase, an enzyme involved in the metabolism of uracil and thymine.

Contents

Individuals with this condition may develop life-threatening toxicity following exposure to 5-fluorouracil (5-FU), a chemotherapy drug that is used in the treatment of cancer. [2] [3] Beside 5-FU, widely prescribed oral fluoropyrimidine capecitabine (Xeloda) could put DPD-deficient patients at risk of experiencing severe or lethal toxicities as well. [4] [5]

Genetics

DPD deficiency is inherited in an autosomal recessive manner. [1] This means the defective gene responsible for the disorder is located on an autosome, and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both carry one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder.[ citation needed ]

Diagnosis

Detection

A small number of genetic variants have been repeatedly associated with DPD deficiency, such as IVS14+1G>A mutation in intron 14 coupled with exon 14 deletion (a.k.a. DPYD*2A), 496A>G in exon 6; 2846A>T in exon 22 and T1679G (a.k.a. DPYD*13) in exon 13. Testing patients for these allelic variants usually show high specificity (i.e., bearing the mutation means that severe toxicity will occur indeed) but very low sensitivity (i.e., not bearing the mutation does not mean that there is no risk for severe toxicities). Alternatively, phenotyping DPD using ex-vivo enzymatic assay or surrogate testing (i.e., monitoring physiological dihydrouracil to uracil ratio in plasma) has been presented as a possible upfront strategy to detect DPD deficiency. 5-FU test dose (i.e., preliminary administration of a small dose of 5-FU with pharmacokinetics evaluation) has been proposed as another possible alternative strategy to secure the use of fluoropyrimidine drugs.

Although DPYD pre-treatment screening has been proven to improve drug safety for DPYD*2A carriers by the Food and Drug Administration, the current (version 2016) European Society for Medical Oncology (ESMO) guidelines do not “routinely recommend” upfront genotyping of DPYD*2A before the administration of 5‐FU in metastatic CRC (mCRC) patients. [6] While oncology societies in the United States do not recommend systematic testing. Instead, on April 30, 2020, the European Society for Medical Oncology issued a document recommending genetic testing. [7]

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References

  1. 1 2 Diasio RB, Beavers TL, Carpenter JT (Jan 1988). "Familial deficiency of dihydropyrimidine dehydrogenase: biochemical basis for familial pyrimidinemia and severe 5-fluorouracil-induced toxicity". J Clin Invest. 81 (1): 47–51. doi:10.1172/JCI113308. PMC   442471 . PMID   3335642.
  2. Van Kuilenburg AB (Mar 2006). "Screening for dihydropyrimidine dehydrogenase deficiency: to do or not to do, that's the question". Cancer Investigation. 24 (2): 215–217. doi:10.1080/07357900500524702. PMID   16537192. S2CID   5746790.
  3. Lee A, Ezzeldin H, Fourie J, Diasio R (Aug 2004). "Dihydropyrimidine dehydrogenase deficiency: impact of pharmacogenetics on 5-fluorouracil therapy". Clinical Advances in Hematology & Oncology. 2 (8): 527–532. ISSN   1543-0790. PMID   16163233.
  4. Mercier C, Ciccolini J (Nov 2006). "Profiling dihydropyrimidine dehydrogenase deficiency in patients with cancer undergoing 5-fluorouracil/capecitabine therapy". Clinical Colorectal Cancer. 6 (4): 288–296. doi:10.3816/CCC.2006.n.047. ISSN   1533-0028. PMID   17241513.
  5. Mercier C, Ciccolini J (Dec 2007). "Severe or lethal toxicities upon capecitabine intake: is DPYD genetic polymorphism the ideal culprit?". Trends in Pharmacological Sciences. 28 (12): 597–598. doi:10.1016/j.tips.2007.09.009. PMID   18001850.
  6. Yau, Tung On (October 2019). "Precision treatment in colorectal cancer: Now and the future". JGH Open. 3 (5): 361–369. doi: 10.1002/jgh3.12153 . ISSN   2397-9070. PMC   6788378 . PMID   31633039.
  7. Innocenti, Federico; Mills, Sarah C.; Sanoff, Hanna; Ciccolini, Joseph; Lenz, Heinz-Josef; Milano, Gerard (2020). "All You Need to Know About DPYD Genetic Testing for Patients Treated With Fluorouracil and Capecitabine: A Practitioner-Friendly Guide". JCO Oncology Practice. 16 (12): 793–798. doi:10.1200/OP.20.00553. PMC   8462561 . PMID   33197222.