Implementation of Cell Samples as Controls in National Proficiency Testing for Clopidogrel Therapy-Related CYP2C19 Genotyping in China: A Novel Approach

PLoS One. 2015 Jul 28;10(7):e0134174. doi: 10.1371/journal.pone.0134174. eCollection 2015.

Abstract

Laboratories are increasingly requested to perform CYP2C19 genetic testing when managing clopidogrel therapy, especially in patients with acute coronary syndrome undergoing percutaneous coronary intervention. To ensure high quality molecular testing and ascertain that the referring clinician has the correct information for CYP2C19 genotype-directed antiplatelet therapy, a proficiency testing scheme was set up to evaluate the laboratory performance for the entire testing process. Proficiency panels of 10 cell samples encompassing the common CYP2C19 genetic polymorphisms were distributed to 62 participating laboratories for routine molecular testing and the responses were analyzed for accuracy of genotyping and the reporting of results. Data including the number of samples tested, the accreditation/certification status, and test methodology of each individual laboratory were also reviewed. Fifty-seven of the 62 participants correctly identified the CYP2C19 variants in all samples. There were six genotyping errors, with a corresponding analytical sensitivity of 98.5% (333/338 challenges; 95% confidence interval: 96.5-99.5%) and an analytic specificity of 99.6% (281/282; 95% confidence interval: 98.0-99.9%). Reports of the CYP2C19 genotyping results often lacked essential information. In conclusion, clinical laboratories demonstrated good analytical sensitivity and specificity; however, the pharmacogenetic testing community requires additional education regarding the correct reporting of CYP2C19 genetic test results.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / drug therapy
  • Acute Coronary Syndrome / genetics*
  • Alleles
  • Cells, Cultured
  • China
  • Clopidogrel
  • Cytochrome P-450 CYP2C19 / genetics*
  • Genetic Testing / methods
  • Genotype
  • Health Plan Implementation*
  • Humans
  • Laboratory Proficiency Testing / methods*
  • Percutaneous Coronary Intervention
  • Pharmacogenetics*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Polymerase Chain Reaction
  • Polymorphism, Genetic / genetics*
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Cytochrome P-450 CYP2C19
  • Ticlopidine

Grants and funding

This work was supported by the capital development fund from the Beijing Municipal Public Health Bureau (No. 2011-4011-02) (JL) and the Special Fund for Health-scientific Research in the Public Interest from National Population and Family Planning Commission of the P R China (No. 201402018) (JL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.