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Catapulting clopidogrel pharmacogenomics forward

Nature Medicine volume 17, pages 40–41 (2011)Cite this article

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The antiplatelet drug clopidogrel helps prevent stent-associated thrombosis, but the antiplatelet effects are quite variable and the clinical consequences can be serious. New findings show that the variability in clopidogrel efficacy is affected by the enzyme paraoxonase-1 (PON1), which is required for clopidogrel bioactivation (pages 110–116).

Each year more than 2 million individuals undergo coronary stenting1, a procedure in which a bare or drug-coated metal stent is placed in an atherosclerotic plaque to improve myocardial blood flow. This foreign body deployment in an arterial circuit subject to high shear stress increases risk of platelet-mediated thrombosis. To counter the chance of such an occurrence, people subjected to this procedure receive a combination antiplatelet therapy with aspirin and clopidogrel. This routine adjunct pharmacologic regimen, for one of the most commonly performed medical procedures, has contributed to making clopidogrel the second most prescribed drug in the world, with over $9 billion in sales in 2010 (ref. 2).

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Figure 1: There are two major steps in the metabolism of clopidogrel.

Marina Corral

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Authors and Affiliations

  1. Eric J. Topol and Nicholas J. Schork are at the Scripps Translational Science Institute, the Scripps Research Institute, Scripps Genomic Medicine and Scripps Health, La Jolla, California, USA.,

    Eric J Topol & Nicholas J Schork

  2. Eric J. Topol is also at the Scripps Clinic, La Jolla, California, USA.,

    Eric J Topol

Authors
  1. Eric J Topol
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  2. Nicholas J Schork
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Correspondence to Eric J Topol.

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Competing interests

E.J.T. is a consultant/advisor to Sanofi-Aventis, Daiichi and Quest Diagnostics.

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Topol, E., Schork, N. Catapulting clopidogrel pharmacogenomics forward. Nat Med 17, 40–41 (2011). https://doi.org/10.1038/nm0111-40

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