Precision Medicine in Pediatric Rehabilitation - Variability in Gabapentin Exposure

项目摘要 虽然加巴喷丁是神经性疼痛患者最常用的处方药，但高剂量的 疼痛减轻的可变性水平限制了疼痛的有效治疗。这项赠款的工作成果将允许 为这种疾病形成一个模型知情的给药策略。这项研究将对 给残疾儿童开药的方式。 需要运输穿过血脑屏障（BBB）的药物经常需要运输以到达 脑脊液（CSF）。基因SLC 7A 5编码轻链蛋白（LAT 1），其形成一个 异二聚体与a重链蛋白CD 98 hc（由SLC 3A 2编码）结合以产生膜转运 L型氨基酸转运蛋白-1（LAT 1）。21先前的体外研究表明， 该转运蛋白是加巴喷丁转运穿过BBB的主要机制之一。这架运输机是 也是其他几种常见处方药的已证实或理论化的转运体， 康复服务提供者提供的。 确定患者血浆中加巴喷丁量的可变性（全身暴露）， 穿过血脑屏障（BBB）的量（中心暴露）对于最佳地确定 最适合每个孩子的剂量（AIM 1）。我的研究策略的总体目标是确定 影响小儿CP患者中心暴露（脑脊液）变异性的因素。要求1 通过测定穿过BBB的加巴喷丁的量来研究中心暴露量。一 AIM 1的第二部分通过执行完整的 外显子组测序以评估SLC 7A 5基因和选定单核苷酸多态性的基因分型 在LAT 1转运蛋白的内含子区域。 目标2采用类似的方法分为两个次级目标。第一个次级目标评估了 使用细胞系模型，同时给予也利用LAT 1转运蛋白的药物， 用SLC 7A 5基因转染，以评价与常用处方药的潜在药物相互作用。 康复医学中的药物，特别是左旋多巴、巴氯芬和普瑞巴林。第二个次级目标 AIM 2涉及LAT 1转运蛋白的遗传变体的转染，以确定编码区的影响。 改变了这个传送器的功能这些变体可以通过全外显子组测序来获知。 在AIM 1中发现的变体。 这两个独立但互补的AIM都允许将数据纳入未来的决策 更适当地预测需要什么剂量的加巴喷丁来达到期望的 暴露和随后的期望水平的临床反应（神经性疼痛减轻）。

PROJECT SUMMARY Although gabapentin is the most commonly prescribed medication for patients with neuropathic pain, the high level of variability in reduction in pain limits effective treatment of pain. Work products from this grant would allow the formation of a model-informed dosing strategy for this disorder. This research will have a lasting impact on the way in which drugs are prescribed to pediatric patients with disabilities. Medications which require transport across the blood-brain barrier (BBB) frequently require transport to reach the cerebrospinal fluid (CSF). The gene SLC7A5 encodes for a light-chain protein (LAT1) that forms a heterodimer with the a heavy chain protein CD98hc (encoded by SLC3A2) to create a membrane transport protein referred to as the L-type amino acid transporter-1 (LAT1). 21 Previous in vitro studies have shown that this transporter is one of the primary mechanisms of gabapentin transport across the BBB. This transporter is also the confirmed or theorized transporter of several other commonly prescribed medications frequently prescribed by rehabilitation providers. Determining the variability in the amount of gabapentin a patient has in their plasma (systemic exposure) and the amount that crosses the blood-brain-barrier (BBB) (central exposure) is significant to optimally determine the most appropriate dose for each individual child (AIM1). The overall goal of my research strategy is to identify factors influencing variability in central exposure (cerebrospinal fluid) in pediatric patients with CP. AIM 1 investigates the amount of central exposure by determining the amount of gabapentin that crosses the BBB. A secondary portion of AIM 1 addresses the impact of the SCL7A5 gene (LAT1 transporter) by performing whole- exome sequencing to evaluate the SLC7A5 gene and genotyping of selected single-nucleotide polymorphisms in the intronic region of the LAT1 transporter. AIM 2 is divided into two sub-aims using similar methodology. The first sub-aim evaluates the impact of concurrently administered medications that also utilize the LAT1 transporter using a cell line model that is transfected with the SLC7A5 gene to evaluate potential drug-drug interactions with commonly prescribed medications in rehabilitation medicine, specifically levodopa, baclofen, and pregabalin. The second sub-aim of AIM 2 involved transfection of genetic variants of the LAT1 transporter to determine the impact of coding region changes to the function of this transporter. These variants may be informed by the whole-exome sequencing variants found in AIM 1. Both of these independent but complementary AIMs allows for data that will be incorporated within future decision support tools to more appropriate anticipate what dose of gabapentin is needed to reach a desired level of exposure and, subsequently, a desired level of clinical response (neuropathic pain reduction).