In Caucasians the most frequent null alleles are the CYP2D6*4 alleles,which all harbor a consensus splice site mutation (1846G>A)that leads to absence of detectable protein in the liver. The collectiveCYP2D6*4 allele frequency among Caucasians is about 20 to 25%, accountingfor 70 to 90% of genetically determined PMs (Sachse et al.,1997; Griese et al., 1998). The virtual absence of the *4 allele inAsian, African, and South American populations explains the low incidenceof the PM phenotype in these populations, whereas African-Americans have an intermediate frequency. The CYP2D6 gene deletionallele *5 is present at a frequency of 3 to 5% in most populations.The null alleles *3 and *6 are present at frequencies of ~1–3% in Caucasianswhereas most other null alleles are even rarer. Nevertheless,collectively the low frequency alleles make a significant contributionto phenotype. Heterozygous carriers of one defective and one normalallele of CYP2D6 tend to have a lower median enzyme activity, whichis overlapping with that of carriers of two functional alleles (Fig. 2).A separate phenotype model has been termed intermediatemetabolizer (IM), which occurs in all major races, but interestinglythe causative mutations are different. About 10 to 15% of Caucasiansare carriers of one partially defective allele (e.g. *41, *9, *10) in combinationwith another partially defective or null allele such as *4,resulting in a distinct phenotypic subgroup with compromised sparteine
oxidation capacity (Fig. 2). The mechanism of the *41 allele,
which is more common among Caucasians, has been studied in detail
and an intron 6 SNP that leads to erroneous splicing resulting in only
a fraction of correctly spliced mRNA has been shown to be responsible
for the low activity in vitro and in vivo (Toscano et al., 2006). In
Africans and Asians other partially defective alleles termed *17 and
*10, respectively, are prevalent. The *17 allele is present at frequencies
of up to 30% in Africans (Wennerholm et al., 2002) and the *10
variant occurs at up to 50% in Asians (Sakuyama et al., 2008). Due
to their high frequencies, the partial activity conferred by these alleles
leads to a shift of the metabolic drug oxidation capacity towards
lower values which has clinical relevance (Kitada, 2003).
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