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Irinotecan is a cytotoxic agent used widely for the treatment of solid tumors, particularly for metastatic colorectal cancers. Treatment with this drug frequently results in severe neutropenia and diarrhea that can markedly impact the course of treatment and patients' quality of life. Pharmacogenomic tailoring of irinotecan-based chemotherapy has been the subject of several investigations, but with limited data on ATP-binding cassette (ABC) and solute carrier (SLC) transporter genes.In this study, we aimed to discover toxicity-associated markers in seven transporter genes participating in irinotecan pharmacokinetics involving the ABC transporter genes ABCB1, ABCC1, ABCC2, ABCC5, ABCG1, and ABCG2 and the solute carrier organic anion transporter gene SLCO1B1 and using a haplotype-tagging single-nucleotide polymorphisms (n=210 htSNPs) strategy. The profiles of 167 metastatic colorectal cancer Canadian patients treated with FOLFIRI-based regimens were examined and the findings were replicated in an independent cohort of 250 Italian patients.In combined cohorts, a two-marker ABCC5 rs3749438 and rs10937158 haplotype (T-C) predicted lower risk of severe diarrhea [odds ratio (OR) of 0.43; P=0.001]. The co-occurrence of ABCG1 rs225440T and ABCC5 rs2292997A predicted the risk of severe neutropenia (OR=5.93; P=0.0002), which was further improved when incorporating the well-known risk marker UGT1A1*28 rs8175347 (OR=7.68; P0.0001). In contrast, carriers of one protective marker (UGT1 rs11563250G) but none of these risk alleles experienced significantly less severe neutropenia (8.2 vs. 34.0%; P0.0001).This combination of predictive genetic markers could potentially lead to better risk assessment and may thus improve personalized treatment.

BACKGROUND AND AIMS: UGT2B4 is a member of the UDP-glucuronosyltransferase (UGT) superfamily, a major detoxifying system in humans. UGT2B4 is involved in bile acids metabolism and highly expressed in liver and extrahepatic tissues. The aim of this study was to uncover new molecular mechanisms underlying interindividual variability in the UGT2B4 pathway. METHODS: We carried out a comprehensive scan for additional exons at this locus and discovered multiple alternative splicing events. We then assessed the expression profile of alternatively spliced transcripts in human tissues and the activity of the corresponding overexpressed proteins toward bile acids. RESULTS: We discovered three previously unidentified UGT2B4 exons, increasing the total known gene length to 46 kb. Molecular analyses revealed at least eight distinct mRNAs produced by (i) alternative promoter usage, (ii) complete and partial exon skipping, and (iii) use of alternative 3' splice sites. These splice variants were predominantly expressed in liver, gastrointestinal tract, and other extrahepatic tissues. Quantitative analyses of splicing events further sustain their prevalence in the liver. UGT2B4 proteins produced from these mRNA variants had undetectable transferase activity in human cells. However, when stably co-expressed with the active UGT2B4 isoform 1, three newly identified UGT2B4 isoforms (i2, i3, and i5) were found to negatively regulate glucuronidation. CONCLUSION: In addition to heritable genetic mutations and control of gene expression, the newly discovered diversity of UGT2B4 mRNAs may introduce variability in this glucuronidation pathway.