Rapid and portable, lab-on-chip, point-of-care genotyping for evaluating clopidogrel metabolism.

Nicola Marziliano (Lead / Corresponding author), Maria Francesca Notarangelo, Marco Cereda, Vittoria Caporale, Lucia Coppini, Maria Antonietta Demola, Angela Guidorossi, Antonio Crocamo, Filippo Pigazzani, Francesca Boffetti, Federica del Giudice, Francesco Orsini, Danilo Pirola, Alessandro Cocci, Chiara Manzalini, Gavino Casu, Marco Bianchessi, Diego Ardissino, Piera Angelica Merlini

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

Background: Dual antiplatelet therapy with aspirin and a platelet P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) is a cornerstone of antithrombotic treatment in patients with acute coronary syndromes (ACS). Clopidogrel has been the standard of care for nearly a decade; however, its clinical efficacy is influenced by a considerable inter-patient variability in response, clearly associated to cytochrome P (CYP) enzyme genetic variations. We used a novel point-of-care lab-on-chip instrument to genotype ACS patients in order to identify carriers of the ATB-binding cassette ABCB1 3435, CYP2C19*2 and CYPC2C19*17 alleles and adjust the pharmacological approach accordingly.

Methods and results: Between October 2012 and January 2013, 160 ACS patients were enrolled at the Cardiology Unit of the Ospedale Niguarda Cà Granda and genotyped at the patients' point-of-care using the newly developed Q3 portable real-time PCR instrument, which remarkably scored the CYP2C19*2, CYP2C19*17, and ABCB1 3435 alleles in a time of 70 min from DNA extraction to final genotype calls; concordance with the other gold-standard genotyping techniques was 100%.

Conclusions: The Q3 instrument proved to be as reliable as the current conventional techniques. As genotyping in the ACS setting cannot be delegated to centralised clinical laboratories for reasons of time, genotyping at the patients' bedside provides an opportunity to conduct large-scale randomised trials in order to assess whether adding genotype data to clinical variables improves clinical outcomes.
Original languageEnglish
Pages (from-to)240-246
Number of pages7
JournalClinica chimica acta; international journal of clinical chemistry
Volume45
Issue numberPart B
Early online date8 Oct 2015
DOIs
Publication statusPublished - 7 Dec 2015

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