What is it about?
Thiopurine drugs, such as azathioprine and 6-mercaptopurine, are commonly used to treat autoimmune diseases, inflammatory bowel disease, and certain cancers. However, their effectiveness and safety depend on the activity of an enzyme called Thiopurine S-Methyl Transferase (TPMT). Low TPMT activity can lead to severe side effects, including life-threatening bone marrow suppression. This study is the first to measure TPMT enzyme levels in a healthy Sudanese population to guide safer use of these drugs. Researchers analyzed blood samples from 177 healthy volunteers using a simple and affordable test called ELISA. They found that TPMT levels varied widely, with most participants (67.2%) falling within the normal range (1.5–3.76 ng/ml). However, 2.3% had very low TPMT activity, and 19.2% had intermediate low activity—higher rates than reported in other populations, such as Caucasians and South Asians. No significant differences were found based on age, sex, or ethnic group. The study highlights the importance of testing TPMT levels before starting thiopurine therapy, especially in Sudan and similar regions, to identify individuals at risk of toxicity. The ELISA method used in this study is a practical and cost-effective tool for pretreatment screening, making it accessible for low-resource settings. These findings provide valuable insights for doctors, particularly immunologists and rheumatologists, to tailor treatments and reduce risks for patients. By incorporating TPMT testing into clinical practice, healthcare providers can improve patient safety and outcomes when using thiopurine drugs.
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Why is it important?
Why is this important? Patient Safety: Thiopurine drugs (e.g., azathioprine) are essential for treating autoimmune diseases and cancers, but they can cause severe, even life-threatening side effects in people with low TPMT enzyme activity. Pretreatment testing helps identify at-risk patients, preventing toxicity. Tailored Treatment: This study provides the first data on TPMT levels in the Sudanese population, showing higher rates of low activity compared to other groups. This knowledge allows doctors to personalize treatment plans, improving outcomes. Accessible Testing: The ELISA method used is affordable and practical, making TPMT screening feasible in low-resource settings like Sudan. Better Healthcare: By adopting TPMT testing, healthcare providers can reduce risks, save lives, and make thiopurine therapy safer and more effective for patients in Sudan and similar regions.
Perspectives
Prospective Impact of the Study This study is the first to assess TPMT enzyme levels in the Sudanese population, providing critical insights into the safe use of thiopurine drugs. The findings highlight the need for pretreatment TPMT screening to prevent severe toxicity, particularly in populations with higher rates of low enzyme activity, like Sudan. By adopting the affordable and practical ELISA method, healthcare systems in low-resource settings can implement this screening, improving patient safety and treatment outcomes. Future Directions: Genotyping Studies: Combining TPMT genotyping with phenotyping will provide a more comprehensive understanding of enzyme variability and genetic factors in the Sudanese population. National Guidelines: These findings can inform the development of national guidelines for thiopurine use, ensuring safer and more effective treatment protocols. Broader Applications: The study sets a foundation for similar research in other African populations, promoting personalized medicine and reducing drug-related risks across the continent. This study not only addresses a critical gap in pharmacogenetic research but also paves the way for safer, more tailored treatments in Sudan and beyond.
Dr. Rayan Khalid
Al-Neelain University
Read the Original
This page is a summary of: Thiopurine S-methyl Transferase (TPMT) Enzyme Level in Healthy Sudanese Population, Sudan Journal of Medical Sciences, September 2024, Knowledge E,
DOI: 10.18502/sjms.v19i3.14194.
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