1. North Carolina DNA Day ON DEMAND Pharmacogenomics

2. What is Pharmacogenomics? R X

3. Pharma = drug or medicine Genomics = the study of genes R X What is Pharmacogenomics?

4. Personalized medicine tailored to your genes Pharma = drug or medicine Genomics = the study of genes R X What is Pharmacogenomics?

5. Case Study – Breast Cancer Patients

6. Tumoricide

7. 7 Case Study – Breast Cancer Patients

8. 8 30%

9. 9 HelpedNo Effect/Hurt Tumoricide

10. HelpedNo Effect/Hurt Tumoricide Why?

11. YouYour cells Your DNA Picture credit: adapted from Riken Research: http://www.rikenresearch.riken.jp/eng/frontline/5514 How do scientists make personalized medicine?

12. YouYour cells Your DNA Picture credit: adapted from Riken Research: http://www.rikenresearch.riken.jp/eng/frontline/5514 How do scientists make personalized medicine? It’s all about what makes YOUR genetic code UNIQUE

13. Genetic Code: DNA DeoxyriboNucleic Acid (DNA) contains all the information necessary to make a complete organism DNA is composed of a combination of 4 nucleotides

14. Genetic Code: DNA DeoxyriboNucleic Acid (DNA) contains all the information necessary to make a complete organism DNA is composed of a combination of 4 nucleotides A Adenine

15. Genetic Code: DNA DeoxyriboNucleic Acid (DNA) contains all the information necessary to make a complete organism DNA is composed of a combination of 4 nucleotides A T Adenine Thymine

16. Genetic Code: DNA DeoxyriboNucleic Acid (DNA) contains all the information necessary to make a complete organism DNA is composed of a combination of 4 nucleotides A T C Adenine Thymine Cytosine

17. Genetic Code: DNA DeoxyriboNucleic Acid (DNA) contains all the information necessary to make a complete organism DNA is composed of a combination of 4 nucleotides A T C G Adenine Thymine CytosineGuanine

18. DNA: A long double-stranded string of nucleotides that encode for many genes. Gene The Central Dogma: DNA  RNA  Protein

19. DNA: A long double-stranded string of nucleotides that encode for many genes. Gene RNA: A single-stranded copy of one gene. RNA The Central Dogma: DNA  RNA  Protein

20. DNA: A long double-stranded string of nucleotides that encode for many genes. Gene Protein: Proteins are composed of amino acids. Amino acids are made from triplets of nucleotides called codons. RNA: A single-stranded copy of one gene. The Central Dogma: DNA  RNA  Protein RNA

21. DNA: A long double-stranded string of nucleotides that encode for many genes. Gene Protein: Proteins are composed amino acids. Amino acids are made from triplets of nucleotides called codons. RNA: A single-stranded copy of one gene. The Central Dogma: DNA  RNA  Protein Codon 1

22. DNA: A long double-stranded string of nucleotides that encode for many genes. Gene Protein: Proteins are composed amino acids. Amino acids are made from triplets of nucleotides called codons. RNA: A single-stranded copy of one gene. The Central Dogma: DNA  RNA  Protein Codon 1 Codon 2

23. DNA: A long double-stranded string of nucleotides that encode for many genes. Gene Protein: Proteins are composed amino acids. Amino acids are made from triplets of nucleotides called codons. Amino acid 1 Amino acid 2 RNA: A single-stranded copy of one gene. The Central Dogma: DNA  RNA  Protein Codon 1 Codon 2

24. DNA: A long double-stranded string of nucleotides that encode for many genes. Gene Protein: Proteins are composed amino acids. Amino acids are made from triplets of nucleotides called codons. Amino acid 1 Amino acid 2 Protein! RNA: A single-stranded copy of one gene. The Central Dogma: DNA  RNA  Protein Codon 1 Codon 2

25. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCTDNA:

26. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT Met DNA: Amino Acids/Protein:

27. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT Met DNA: Amino Acids/Protein: Val

28. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeu DNA: Amino Acids/Protein: Val

29. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSer DNA: Amino Acids/Protein: Val

30. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSerPro DNA: Amino Acids/Protein: Val

31. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSerPro DNA: Amino Acids/Protein: Val

32. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSerPro DNA: Amino Acids/Protein: Val ATG GTG CTG TCT ACTDNA:

33. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSerPro DNA: Amino Acids/Protein: Val ATG GTG CTG TCT ACT MetLeuSerThr DNA: Amino Acids/Protein: Val

34. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSerPro DNA: Amino Acids/Protein: Val Words: Tom and Sam are bad ATG GTG CTG TCT ACT MetLeuSerThr DNA: Amino Acids/Protein: Val

35. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSerPro DNA: Amino Acids/Protein: Val Words: Tom and Sam are bad ATG GTG CTG TCT ACT MetLeuSerThr DNA: Amino Acids/Protein: Val Tom and Sam are sad Words:

36. A small change in the gene sequence can result in a very different protein ATG GTG CTG TCT CCT MetLeuSerPro DNA: Amino Acids/Protein: Val Words: Tom and Sam are bad ATG GTG CTG TCT ACT MetLeuSerThr DNA: Amino Acids/Protein: Val Tom and Sam are sad Words: Changes in DNA are called variations or mutations Variations in the DNA (genotype) can cause observable changes (phenotype) in individuals

37. Variations in our DNA make us UNIQUE!

38. HelpedNo Effect/Hurt Tumoricide Why does Tumoricide work on some patients but not on others?

39. What are the reasons a person would react differently to drugs? 1.Having the receptor (protein) to recognize the drug 2.Other physiological traits that enable you to respond to a drug 3.How your body processes the drugs after receiving it

40. Drugs and Receptors Cell

41. Drugs and Receptors Cell Receptor (Protein)

42. Drugs and Receptors Cell Receptor (Protein)

43. Drugs and Receptors Cell Drug (Ligand) Receptor (Protein)

44. Drugs and Receptors Cell Drug (Ligand) Receptor (Protein)

45. Your DNA and Drugs Variation in genes can cause variation in receptors Cell

46. Your DNA and Drugs Variation in genes can cause variation in receptors Cell

47. Your DNA and Drugs Variation in genes can cause variation in receptors Cell

48. Your DNA and Drugs Variation in genes can cause variation in receptors Cell

49. Your DNA and Drugs Variation in genes can cause variation in receptors Cell Too Many (hypersensitive) Cell

50. Your DNA and Drugs Variation in genes can cause variation in receptors Cell Too Many (hypersensitive) Too Few (hyposensitive) Cell

51. Your DNA and Drugs Variation in genes can cause variation in receptors Cell Too Many (hypersensitive) Too Few (hyposensitive) Mutated (insensitive)

52. Where Drugs “Fit” In Lock = Receptor Key = Drug

53. Let’s do a class case study!

54. Taste the PTC strip (This won’t hurt you - not a toxic chemical) What do you taste?

55. Let’s do a class case study! Taste the PTC strip (This won’t hurt you - not a toxic chemical) What do you taste? Why does the strip taste bitter to some and have no taste for others? What is your hypothesis?

56. Taste cell “This tastes bitter!” PTC- Receptor PTC Why can some people taste PTC and others can’t?

57. Taste cell “This tastes bitter!” PTC- Receptor PTC Why can some people taste PTC and others can’t? Taste cell “I don’t taste anything!” Non-binding PTC- Receptor PTC

58. Where does tasting PTC come from? You have two copies of every gene: one from Mom and one from Dad

59. Where does tasting PTC come from? You have two copies of every gene: one from Mom and one from Dad

60. Where does tasting PTC come from? You have two copies of every gene: one from Mom and one from Dad

61. Your two genes are the genotype You have two copies of every gene: one from Mom and one from Dad Where does tasting PTC come from?

62. Your two genes are the genotype A gene can be dominant or recessive You have two copies of every gene: one from Mom and one from Dad Where does tasting PTC come from?

63. Your two genes are the genotype A gene can be dominant or recessive The expressed trait is a phenotype You have two copies of every gene: one from Mom and one from Dad Where does tasting PTC come from?

64. Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) TTTttt

65. Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) TTTttt

66. Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) TTTttt

67. Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) TTTttt

68. Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) TTTttt For individuals with these genotypes, what would their phenotypes be?

69. TT “This tastes REALLY bitter!” SUPERTASTER Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) Tttt

70. “This tastes bitter!” TASTER TT “This tastes REALLY bitter!” SUPERTASTER Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) Tttt

71. “This tastes bitter!” TASTER TT Tasting PTC is dominant (T) over inability taste PTC which is recessive (t) Tttt “I don’t taste anything!” NON-TASTER “This tastes REALLY bitter!” SUPERTASTER

72. Drug receptor summary Ability to taste PTC has a very strong genetic component PTC = chemical and Drugs = chemical Differences in ability to taste PTC is similar to differences in reactions to drugs PTC

73. HelpedNo Effect/Hurt Tumoricide Why?

74. Two Types of Breast Cancer Tumoricide is a personalized medication Tumoricide only works for Her2+ breast tumors Y Y Y Her2- Her2+

75. 75 HelpedNo Effect/Hurt Tumoricide Her2- Her2+

76. Screening for Her2+ Cells American Journal of Clinical Pathology. 2008;129(2):263-273 Her2-Her2+

77. Screening for Her2+ Cells American Journal of Clinical Pathology. 2008;129(2):263-273 + Tumoricide = ?

78. Screening for Her2+ Cells American Journal of Clinical Pathology. 2008;129(2):263-273 + Tumoricide = ✓

79. Breast Cancer 1990 Surgery Radiation Chemotherapy (drugs) 2011 Surgery Radiation Chemotherapy Specialized treatments (for certain types of breast cancer) http://www.ucdmc.ucdavis.edu/welcome/features/20080709_cancer_sweeney/index.html

80. What are the reasons a person would react differently to drugs? 1.Having the receptor (protein) to recognize the drug 2.Other physiological traits that enable you to respond to a drug 3.How your body processes the drugs after receiving it

81. Y The presence of receptors influence how we react to drugs like Tumoricide or chemicals like PTC Tumoricide Works! Tumoricide Does Not Work Y Her2- Her2+ Y

82. TT Tt tt “This tastes REALLY bitter!” SUPERTASTER “This tastes bitter!” TASTER “I don’t taste anything!” NON-TASTER The presence of receptors influence how we react to drugs like Tumoricide or chemicals like PTC

83. Where are the PTC receptors?

84. They are on your taste buds! Yummy!

85. What are taste buds? Taste buds are found on papillae on your tongue

86. What are taste buds? Taste buds are found on papillae on your tongue Papillae bumps on your tongue

87. What are taste buds? Taste buds are found on papillae on your tongue Taste buds cells are found on the papilla Papillae bumps on your tongue

88. What are taste buds? Taste buds are found on papillae on your tongue Taste buds cells are found on the papilla PTC receptors are found on the taste buds Papillae bumps on your tongue

89. What are taste buds? Taste buds are found on papillae on your tongue PTC receptors are found on the taste buds Papillae bumps on your tongue Nerve Cell Transmits signal to brain Taste buds cells are found on the papilla

90. What are taste buds? Taste buds are found on papillae on your tongue PTC receptors are found on the taste buds Papillae bumps on your tongue Nerve Cell Transmits signal to brain Brain Wow! This tastes really bitter Taste buds cells are found on the papilla

91. Are there other traits that can allow a person to more strongly taste PTC?

92. If a person has more taste buds, then he/she may be able to taste the PTC more strongly. Are there other traits that can allow a person to more strongly taste PTC?

93. 1)Lollipop time! Lick your lollipop such that the blue gets all over your tongue…especially the tip of your tongue. 2)Once your tongue is really blue, place one hole reinforcer on the tip of your tongue—so it looks like the picture on the bottom on this slide. 3)Have your partner count the bumps or papillae on your tongue…these will not stain blue. * Remember that your taste buds are on your papillae. Therefore the number of papillae correlates to the amount of taste buds on your tongue. *

94. Counting the number of tongue papillae 5 papillae20 papillae35 papillae

95. Counting the number of tongue papillae Come to the front of the class to report your PTC phenotype (taster, super-taster and non-taster) and the number of papillae on your tongue 5 papillae20 papillae35 papillae

96. Please PAUSE and take a moment to count your taste buds and report your results on the spreadsheet at the front of the classroom

97. Ideal graph representing the number of tongue papillae related to the phenotype of PTC taste These results support our hypothesis that the super-taster has more papillae!

98. Ideal graph representing the number of tongue papillae related to the phenotype of PTC taste The number of papillae in the non-taster is variable. Why would the number of papillae be variable in a non-taster?

99. Please PAUSE and discuss why you think being a PTC non-taster does not correlate with number of taste buds.

100. What does it take to be a PTC Taster? Two traits are important for determining PTC taste sensitivity 1) PTC receptor genotype—Do you have the receptors that enable you to taste PTC

101. What does it take to be a PTC Taster? Two traits are important for determining PTC taste sensitivity 1) PTC receptor genotype—Do you have the receptors that enable you to taste PTC 2) The density of papillae on your tongue correlates to the sensitivity of tasting PTC tastersuper-taster

102. What are the reasons a person would react differently to drugs? 1.Having the receptor (protein) to recognize the drug 2.Other physiological traits that enable you to respond to a drug 3.How your body processes the drugs after receiving it

103. http://publications.nigms.nih.gov/medbydesign/chapter1.html ADME Absorption Distribution Metabolism Excretion A drug’s life

104. Metabolic enzymes Liver DNA variations in special proteins in the liver called enzymes can influence a person’s ability to metabolize certain drugs Drug Metabolites Enzymes

105. Adverse Drug Reactions (ADR) Definition- unwanted, negative response to a prescribed drug at normal doses and during normal use –Examples?

106. Adverse Drug Reactions (ADR) Definition- unwanted, negative response to a prescribed drug at normal doses and during normal use –Examples? There are multiple causes for ADRs –environmental basis –genetic basis

107. Adverse Drug Reactions (ADR) Definition- unwanted, negative response to a prescribed drug at normal doses and during normal use –Examples? There are multiple causes for ADRs –environmental basis –genetic basis Poor metabolizers can experience ADRs at normally therapeutic drug doses

108. Case study: Nortriptyline metabolism Three women of the same height, weight, age, and racial background are depressed and go to the doctor. The doctor prescribes an antidepressant, Nortriptyline, at a dose of 100 mg. Person A has an adverse reaction Person B nothing happens Person C gets better… ABC

109. Case study: Nortriptyline metabolism Three women of the same height, weight, age, and racial background are depressed and go to the doctor. The doctor prescribes an antidepressant, Nortriptyline, at a dose of 100 mg. Person A has an adverse reaction Person B nothing happens Person C gets better… ABC Why?

110. ADME of Nortriptyline 100mg Nortriptyline Adverse reactionNothing happensGets better ABC How much active drug in blood?

111. ADME of Nortriptyline 100mg Nortriptyline Adverse reactionNothing happensGets better ABC 95mg5mg50mg

112. DNA variation influence drug metabolism Liver Drug Metabolites Enzymes A Poor Metabolizer 95mg

113. DNA variation influence drug metabolism Liver Drug Metabolites Enzymes B Ultrarapid Metabolizer 5mg

114. DNA variation influence drug metabolism Liver Drug Metabolites Enzymes C Intermediate Metabolizer 50mg

115. 2011 - What do doctors do? ABC Decrease DoseIncrease Dose Or change drug Poor MetabolizerUltrarapid Metabolizer

116. Today One-size-fits-all drugs Current drug development system develops drugs for the average patient No simple way to determine who will respond well and who will respond poorly One size does NOT fit all! What’s the solution?

117. Today One-size-fits-all drugs Current drug development system develops drugs for the average patient No simple way to determine who will respond well and who will respond poorly One size does NOT fit all! What’s the solution? Pharmacogenomics (PGx) Personalized Medicine

118. April, 2050 You wake up feeling terrible, and you know it's time to see a doctor. In the office, the physician looks you over, listens to your symptoms, and decides to prescribe you a drug. But first, the doctor takes a look at your DNA. TODAY vs. FUTURE Today = Drugs are One-Size-Fits-All Future = Drugs Specific for You! More effective & minimizes side effects

119. Summary Genetic variation leads to phenotypic differences and differences in how we all react to drugs.

120. Summary Genetic variation leads to phenotypic differences and differences in how we all react to drugs. 1.Having the receptor (protein) to recognize the drug PTC and HER2 receptors

121. Summary Genetic variation leads to phenotypic differences and differences in how we all react to drugs. 1.Having the receptor (protein) to recognize the drug PTC and HER2 receptors 2. Other physiological traits that enable you to respond to a drug Number of taste buds on tongue

122. Summary Genetic variation leads to phenotypic differences and differences in how we all react to drugs. 1.Having the receptor (protein) to recognize the drug PTC and HER2 receptors 2. Other physiological traits that enable you to respond to a drug Number of taste buds on tongue 3. How drugs are processed in the body Enzymes in liver metabolize drugs

123. Pharamcogenomics Using people’s genetic information for the right drug at the right dose at the right time! R X

124. Presenters: - Sarah Bortvedt - Jessica Sullivan-Brown, PhD - Jet Aiken - Amanda Marvelle, PhD Produced by: - UNC-TV Filmed on location at: - Carolina Center for Educational Excellence, UNC School of Education CREDITS: NC DNA Day ON DEMAND Project Director: - Joshua Hall, PhD Assistant Director: - Jessica Harrell, PhD Project funded by: - National Human Genome Research Institute (NHGRI), National Institutes of Health (NIH)