Larisa Cavallari and Edith Nutescu are the clinical directors for the Warfarin Pharmacogenetics Service. vein thrombosis and pulmonary embolism at the Antithrombosis Clinic for the last decade. “As a patient, I appreciate having access to the best and newest technology.”
different forms of sequencing to map the chemical building blocks within the DNA, using technology in her laboratory and the UI Research Resources Center.
Targeting underrepresented patient groups
Using these data, Cavallari was the first to describe an association between a variant of the CYP2C9 gene, which occurs very commonly in AfricanAmericans, and the need for lower warfarin dose requirements. “We are working toward adding this CYP2C9 variant to the hospital’s warfarin genotyping service within the next year,” she says. Cavallari also is researching another gene that could have implications for lower warfarin dosing requirements for Hispanics.
Cavallari also has been instrumental in taking pharmacogenetics research further, by helping the UI Health System become one of the few centers across the country investigating how genotyping affects the warfarin dosage level in African Americans and Hispanics, who have been underrepresented in earlier research. In a 2010 study of more than 200 patients from the university’s Antithrombosis Clinic, Cavallari used buccal cells from mouthwash samples of patients who agreed to be part of the study. DNA from the buccal cells was isolated, and genotype was determined first using biochemical technology called the polymerase chain reaction and then 20
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– Fall 2013 – Catalyst
A team effort With the new Warfarin Pharmacogenetics Service, an estimated 500 patients annually will receive their optimal warfarin dose based on their individual genetic testing. This latest addition to the health system’s approach to personalized
medicine is a team effort involving many disciplines. For example, medical directorship is provided by physicians Thomas Stamos, MD, William Galanter, MD, PhD, and Victor Gordeuk, MD, with laboratory support by Shrihari Kadkol, MD, PhD, a board-certified pathologist, and Carol Dodge, manager of the UI Health Molecular Pathology Laboratory. Two pharmacy fellows, Adam Bress, PharmD, and James Stevenson, PharmD, handle the daily requests for warfarin genotyping and communication with physicians. Galanter has had three roles in the launch of the new pharmacogenetics service — as a practicing physician, as chair of the Pharmacy and Therapeutics Committee where he is responsible for the quality of the drug utilization at the hospital, and as the medical director for clinical information systems. Galanter, with the support of teams from information services and the laboratory, brought the computer technology behind the new warfarin