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Phenytoin is one of the most used antiepileptic drugs. Isoniazid, a first-line antitubercular drug, blocks the CYP2C19 enzyme, preventing phenytoin from being metabolised. Concomitant use of phenytoin and isoniazid predisposes to phenytoin toxicity.

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Background: Under standard therapies, the incidence of drug-induced liver injury (DILI) in patients with tuberculosis ranges from 2% to 28%. Numerous studies have identified the risk factors for antituberculosis DILI; however, none have been conducted in a multiethnic real-world setting. The primary outcome of the current study was to identify the risk factors that could be used as the best predictors of DILI in a multiethnic cohort.

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The N-acetyltransferase 2 (NAT2) gene exhibits substantial genetic diversity, leading to distinct acetylator phenotypes among individuals. In this study, we determine NAT2 gene polymorphisms in tuberculosis (TB) patients and analyze serum isoniazid (INH) concentrations across the various genotypes. An observational prospective cohort study involving 217 patients with pulmonary or extrapulmonary TB was carried out.

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Article Synopsis
  • Tuberculosis (TB) patients on treatment can experience serious side effects like liver damage, linked to genetic variations in the NAT2 gene, which affect drug metabolism.
  • This study conducted a meta-analysis of 24 articles to assess the relationship between NAT2 genetic variants and the risk of drug-related liver toxicity in TB treatment.
  • Results indicated that individuals with a slow NAT2 acetylator genotype had over twice the risk of hepatotoxicity compared to others, highlighting the importance of pharmacogenomic testing for personalized treatment.
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Variants in the -acetyltranferase 2 gene, acetylator phenotypes and their association with tuberculosis: Findings in Peruvian patients.

J Clin Tuberc Other Mycobact Dis

December 2024

Centro de Investigación de Genética y Biología Molecular, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru.

Background: Tuberculosis (TB) is a highly prevalent chronic infectious disease in developing countries, with Peru being one of the most affected countries in the world. The variants of the -acetyltransferase 2 () gene are related to xenobiotic metabolism and have potential usefulness in TB studies.

Aim: To determine whether gene variants and acetylator phenotypes are associated with active TB in Peruvian patients.

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