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•Many adults do not consume the recommended 25 to 30 g of dietary fiber per day.•Clinical trials have shown that 10 to 21 g of psyllium daily improves blood lipids.•Clinical trials have demonstrated that 6 to 8 g of oat bran β-glucan daily improves blood lipids.•Clinical trials have found that 10 to 15 g of PolyGlycopleX daily improves blood lipids.•Effects of these fibers on weight, hypertension, and blood glucose need clarification. The persistent obesity crisis, with its increased risk for the metabolic syndrome (MetS), type 2 diabetes, and cardiovascular disease (CVD), continues to damage the health of populations globally, including children. Diets rich in the fiber provided by fruit and vegetables support good metabolic health, although few adults and children achieve the recommended daily target. Daily fiber supplementation, particularly with soluble fiber products, such as psyllium, oat bran, or a newer product such as PolyGlycopleX, may provide a convenient solution. Literature searches were conducted to identify original research articles, systematic reviews, and meta-analyses with the search terms psyllium, oat bran, PolyGlycopleX, and PGX, AND adults and children AND overweight, obesity, and metabolic syndrome. Data source was Embase and PubMed from 1980 to 2017. The results show that the addition of a soluble fiber product, most notably psyllium, improves blood lipid profiles, particularly total and low-density lipoprotein cholesterol, as well as glycemic response, and increases satiety, and by thus improving MetS and CVD risk factors, may augment the processes initiated by weight reduction diets. Although less studied than psyllium, the available evidence has shown that β-glucan present in oat bran has a beneficial effect on MetS and CVD risk factors, particularly blood lipids and glycemia. Early research has found PolyGlycopleX to provide similar benefits to other soluble fiber products, and suggest it may also assist with weight loss. This critical review demonstrates that soluble fiber supplements used as an adjunct to dietary and lifestyle modifications may assist with the treatment of CVD and MetS risk factors. More research is needed to further clarify the benefits of PolyGlycopleX in particular, as well as to develop safe and efficacious recommendations for fiber supplementation of all types for children in general.

Background: The HLA-B is the most polymorphic gene, play a crucial role in drug-induced hypersensitivity reactions. There is a lot of evidence associating several risk alleles to life-threatening adverse drug reactions, and a few of them have been approved as valid biomarkers for predicting life-threatening hypersensitivity reactions. Objectives: The objective of this present study is to present the progression of HLA-B pharmacogenomics (PGx) testing in the Thai population during a 10‐year period, from 2011 to 2020. Methods: This was a retrospective observational cohort study conducted at the Faculty of Medicine Ramathibodi Hospital. Overall, 13,985 eligible patients who were tested for HLA-B risk alleles between periods of 2011–2020 at the study site were included in this study. Results: The HLA PGx testing has been increasing year by year tremendously, 94 HLA-B testing was done in 2011; this has been raised to 2,880 in 2020. Carbamazepine ( n = 4,069, 33%), allopurinol ( n = 4,675, 38%), and abacavir ( n = 3,246, 26%) were the most common drugs for which the HLA-B genotyping was performed. HLA-B*13:01, HLA-B*15:02 and HLA-B*58:01 are highly frequent, HLA-B*51:01 and HLA-B*57:01 are moderately frequent alleles that are being associated with drug induced hypersensitivity. HLA-B*59:01 and HLA-B*38:01 theses alleles are rare but has been reported with drug induced toxicity. Most of the samples were from state hospital (50%), 36% from private clinical laboratories and 14% from private hospitals. Conclusion: According to this study, HLA-B PGx testing is increasing substantially in Thailand year after year. The advancement of research in this field, increased physician awareness of PGx, and government and insurance scheme reimbursement assistance could all be factors. Incorporating PGx data, along with other clinical and non-clinical data, into clinical decision support systems (CDS) and national formularies, on the other hand, would assist prescribers in prioritizing therapy for their patients. This will also aid in the prediction and prevention of serious adverse drug reactions.

Evaluating the knowledge in pharmacogenomics (PGx) is the first step toward the implementation of PGx testing in clinical practice. This survey aimed to evaluate the knowledge of PGx testing among healthcare providing students at the top-ranked university in the West Bank of Palestine.First an online questionnaire consisting of 30 questions regarding the demographic, knowledge, and attitude toward pharmacogenomics testing was structured and validated. Then the questionnaire was distributed to 1,000 current students from different fields.696 responses was received. The results showed that almost half of the participants (n=355, 51.1%) have never took any courses about PGx during their university training. Only 81 (11.7%) of the students who took the PGx course stated that it helped them understanding how genetic variations affect drug response. The majority of the students were uncertain (n=352, 50.6%) or disagreed (n=143, 20.6%) that the lectures during university education described the effects of genetic variants on drug response. Although most of the students (70–80%) answered that genetic variants can indeed affect the drug’s response, only 162 students (23.3%) responded that VKORC1 and CYP2C9 genotypes influence the response to warfarin. In addition, only 94 (13.5%) students were aware that many medicine labels include clinical information about PGx testing provided by the FDA.It is concluded from the results of this survey that there is a lack of exposure to PGx education associated with poor knowledge of PGx testing among the healthcare providing students in the West Bank of Palestine. It is recommended to include and improve the lectures and courses regarding PGx as this will have a major impact on precision medicine.

[This corrects the article DOI: 10.3389/fvets.2025.1658765.].

Clopidogrel is an antiplatelet agent widely utilized in cardiology. It is a prodrug activated in the liver by the cytochrome P450 isoform CYP2C19. Variability in the CYPC2C19 gene influences the activation and efficacy of clopidogrel. This is covered in guidelines from the Clinical Pharmacogenetics Implementation Consortium, the Dutch Pharmacogenetics Working Group, and more recently the UK Centre of Excellence in Regulatory Science and Innovation in Pharmacogenomics. Despite this extensive guidance, pharmacogenetic information is rarely used to guide clopidogrel prescription in cardiology patients. The present study assesses the visibility of the pharmacogenetic guidelines in the cardiology literature. We analyzed citations of the clopidogrel pharmacogenetic guidelines in the cardiology literature and in the cardiology guidelines/position statements on the treatment of acute coronary syndromes and stable coronary artery disease. Citations of these guidelines were found to be limited in the cardiology literature. Only 3 out of 19 cardiology guidelines/position statements refer to the pharmacogenetic guidelines. 58% of the cardiology guidelines/position statements mention clopidogrel pharmacogenetics but suggest that the use of pre‐emptive genotyping for CYP2C19 variants to guide clopidogrel prescription is of limited clinical relevance. Genetically determined variation in clopidogrel efficacy has poor visibility in the cardiology literature and clinical guidelines. It is perceived to have limited benefits for clinical practice despite mounting evidence from randomized controlled trials and systematic reviews/meta‐analyses. Study Highlights What is the current knowledge on the topic? ○Clopidogrel is an antiplatelet agent which requires a liver cytochrome P450 enzyme, CYP2C19, for metabolic activation. CYP2C19, the encoding gene, is polymorphic, with allelic variants that lead to reduced or no enzymatic activity with an impact on clopidogrel efficacy. Various pharmacogenetic guidelines have been developed to guide clopidogrel prescription based on genotype. Pharmacogenetics is included in clopidogrel drug labels by different regulators, although pre‐emptive CYP2C19 pharmacogenetic testing is not mandated. In 2010, the FDA also included a warning box recommending to consider alternative treatments in CYP2C19 poor metabolisers. What question did this study address? ○To address the extent to which pharmacogenetic prescribing guidelines are visible in the cardiology literature and in the major cardiology guidelines. What does this study add to our knowledge? ○Pharmacogenetic guidelines for clopidogrel prescription are not visible to cardiologists through the international literature. Despite the high volume of publications related to clopidogrel in cardiovascular journals, citations of international pharmacogenetics guidelines are limited. We found no citations in major cardiology guidelines, and when reported, the pharmacogenetics of clopidogrel is perceived to be of limited usefulness. How might this change clinical pharmacology or translational science? ○We suggest that to facilitate the implementation of pharmacogenetics in clinical cardiology, there is a need for greater pharmacogenetic education amongst cardiologists. This can be supported by identifying clinical champions and conducting feasibility studies. We also believe that regulators may play an important role by updating drug labels and/or issuing clear guidance (e.g., NICE recommendations on CYP2C19 genotyping to guide clopidogrel prescription in stroke).

The field of pharmacogenomics (PGx) is gradually shifting from the reactive testing of single genes toward the proactive testing of multiple genes to improve treatment outcomes, reduce adverse events, and decrease the burden of unnecessary costs for healthcare systems. Despite the progress in the field of pharmacogenomics, its implementation into routine care has been slow due to several barriers. However, in recent years, the number of studies on the implementation of PGx has increased, all providing a wealth of knowledge on different solutions for overcoming the obstacles that have been emphasized over the past years. This review focuses on some of the challenges faced by these initiatives, the solutions and different approaches for testing that they suggest, and the evidence that they provide regarding the benefits of preemptive PGx testing.

The identification of pharmacogenetic factors that increase the susceptibility to clozapine-induced agranulocytosis or granulocytopenia (CIAG) has received increasing interest. The SLCO1B3-SCLO1B7 variant (rs149104283) and single amino acid changes in human leukocyte antigen (HLA) HLA-DQB1 (126Q) and HLA-B (158T) were associated with an increased risk of CIAG. In this study, we evaluated the effectiveness and cost-effectiveness of adding the SLCO1B3-SCLO1B7 to HLA variants as a new pharmacogenomic (PGx) approach and explored the evolution of a cohort of schizophrenic patients taking long-term clozapine as a third-line antipsychotic medication. The decision model included probabilistic and deterministic sensitivity analyses to assess the expected costs and quality-adjusted life-years (QALYs). The current monitoring scheme was compared with the PGx-guided strategy, where all patients underwent pre-emptively a genetic test before taking clozapine, over 10 years. By adding the SLCO1B3-SCLO1B7 variant into HLA variants, CIAG sensitivity increased from 36.0% to 43.0%, the specificity decreased from 89.0% to 86.9%, and the probability of cost-effectiveness improved from 74.1% to 87.8%. The incremental cost-effectiveness ratio was £16,215 per QALY and remained below the conventional decision threshold (£30,000 or US$50,000 per QALY). Therefore, the SLCO1B3-SCLO1B7 variant, as an additional risk allele to HLA variants, increases preemptive test sensitivity and improves the effectiveness and cost-effectiveness of PGx-guided clozapine administration.

SCARs are rare and life-threatening hypersensitivity reactions. In general, the increased duration of hospital stays and the associated cost burden are common issues, and in the worst-case scenario, they can result in mortality. SCARs are delayed T cell-mediated hypersensitivity reactions. Recovery can take from 2 weeks to many months after dechallenging the culprit drugs. Genetic polymorphism of the HLA genes may change the selection and presentation of antigens, allowing toxic drug metabolites to initiate immunological reactions. However, each SCARs has a different onset latency period, clinical features, or morphological pattern. This explains that, other than HLA mutations, other immuno-pathogenesis may be involved in drug-induced severe cutaneous reactions. This review will discuss the clinical morphology of various SCARs, various immune pathogenesis models, diagnostic criteria, treatments, the association of various drug-induced reactions and susceptible alleles in different populations, and the successful implementation of pharmacogenomics in Thailand for the prevention of SCARs.

Anna Bollinger,1 Céline K Stäuble,1,2 Isabelle O Urdieux,1 Henriette E Meyer zu Schwabedissen,1 Samuel S Allemann1 1Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; 2Institute of Hospital Pharmacy, Stadtspital Zürich, Zürich, SwitzerlandCorrespondence: Anna Bollinger, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland, Tel +41612076631, Email a.bollinger@unibas.chBackground: Chronic pain is a prevalent and complex condition that often results in inadequate pharmacotherapy due to interindividual variability in drug response. Pharmacogenetics (PGx) offers a promising approach to personalize pain management, particularly since many analgesic drugs are PGx actionable. However, knowledge about the clinical relevance and patient perspective on PGx in Swiss chronic pain care remains limited.Methods: We conducted a cross-sectional online survey among chronic pain patients in the German-speaking regions of Switzerland. The questionnaire was developed to (1) assess the proportion of patients currently or previously treated with PGx actionable drugs, (2) evaluate therapy satisfaction and the perception of being taken seriously by healthcare professionals (HCPs), and (3) explore patients’ awareness of PGx and their interest in genetic pain predisposition.Results: Among the 725 participants who completed the survey, most reported current or past use of PGx actionable drugs: 85% non-steroidal anti-inflammatory drugs (NSAIDs), 54% opioids, 38% co-analgesics (antidepressants), and 73% proton-pump-inhibitors (PPIs) used as adjunctive therapy. Over one-third of participants reported no use of any analgesic drug. Therapy dissatisfaction was reported by 33%, and 28% felt not taken seriously by HCPs. Notably, 97% had never been offered PGx testing by an HCP. Despite this, 60% expressed interest in knowing their genetic pain predisposition, even if it would not affect their treatment. This interest was significantly higher among younger participants and those who were dissatisfied or felt not taken seriously by HCPs.Conclusion: This study provides the first large-scale, representative insights into the use of PGx actionable drugs and treatment patterns in Swiss chronic pain care. In particular, the high prevalence of PGx actionable drug use and the strong patient interest in genetic information support not only the clinical, but also the biopsychosocial potential of PGx for chronic pain management.Keywords: pharmacogenetics, PGx testing, pain sensitivity, therapy satisfaction, chronic pain care, Switzerland