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The MDR1 (ABCB1) Gene Polymorphism and its Clinical Implications

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Abstract

There has been an increasing appreciation of the role of drug transporters in the pharmacokinetic and pharmacodynamic profiles of certain drugs. Among various drug transporters, P-glycoprotein, the MDR1 gene product, is one of the best studied and characterised. P-glycoprotein is expressed in normal human tissues such as liver, kidney, intestine and the endothelial cells of the blood-brain barrier. Apical (or luminal) expression of P-glycoprotein in these tissues results in reduced drug absorption from the gastrointestinal tract, enhanced drug elimination into bile and urine, and impeded entry of certain drugs into the central nervous system. The clinical relevance of P-glycoprotein depends on the localisation in human tissues (i.e. vectorial or directional movement), the therapeutic index of the substrate drug and the inherent inter- and intra-individual variability.

With regard to the variability, polymorphisms of the MDR1 gene have recently been reported to be associated with alterations in disposition kinetics and interaction profiles of clinically useful drugs, including digoxin, fexofenadine, Ciclosporin and talinolol. In addition, polymorphism may play a role in patients who do not respond to drug treatment. Moreover, P-glycoprotein is an important prognostic factor in malignant diseases, such as tumours of the gastrointestinal tract.

A growing number of preclinical and clinical studies have demonstrated that polymorphism of the MDR1 gene may be a factor in the overall outcome of pharmacotherapy for numerous diseases. We believe that further understanding the physiology and biochemistry of P-glycoprotein with respect to its genetic variations will be important to establish individualised pharmacotherapy with various clinically used drugs.

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Acknowledgements

This paper was supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan (no. 13357020 to I.I.). The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Hospital Pharmacy, Faculty of Medicine, Tottori University, Nishi-machi 36-1, Yonago, 683-8504, Japan

    Ichiro Ieiri, Hiroshi Takane & Kenji Otsubo

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  1. Ichiro Ieiri
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Correspondence to Ichiro Ieiri.

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Ieiri, I., Takane, H. & Otsubo, K. The MDR1 (ABCB1) Gene Polymorphism and its Clinical Implications. Clin Pharmacokinet 43, 553–576 (2004). https://doi.org/10.2165/00003088-200443090-00001

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