ABCMdb

PMID: 20627697

Sia AT, Sng BL, Lim EC, Law H, Tan EC
The influence of ATP-binding cassette sub-family B member -1 (ABCB1) genetic polymorphisms on acute and chronic pain after intrathecal morphine for caesarean section: a prospective cohort study.
Int J Obstet Anesth. 2010 Jul;19(3):254-60. Epub 2010 Jun 2., [PubMed]

Sentences

No. Mutations Sentence Comment

87 ABCB1 p.Thr1236Cys Table 1 Personal characteristics Age (yr) Weight (kg) Height (cm) Previous caesarean section Duration of surgery (min) Pain scores in recovery (0-10 VAS) SNP C3435T CC (n = 190, 31%) 32.2 (4.6) 69.2 (10) 158 (5.5) 70 (37) 51.9 (16) 0 [0-3] CT (n = 319, 51%) 32.5 (4.8) 69.3 (11) 158 (5.5) 112 (35) 52.2 (16) 0 [0-2] TT (n = 111, 18%) 32.5 (4.6) 68.9 (10) 159 (5.6) 43 (39) 54.8 (15) 0 [0-4] SNP T1236C TT (n = 288, 47%) 32.6 (4.6) 69.1 (10) 158 (5.9) 108 (37) 52.6 (17) 0 [0-4] TC (n = 263, 42%) 32.3 (4.6) 69.2 (9.2) 159 (5.3) 96 (37) 53.2 (16) 0 [0-3] CC (n = 61, 11%) 32.9 (5.0) 70.0 (14) 158 (5.8) 21 (34) 51.5 (11) 0 [0-3] SNP 2677 Homozygous T (n = 100, 16%) 32.0 (4.7) 70.0 (11) 159 (5.2) 38 (38) 53.2 (15) 0 [0-3] Heterozygous T (n = 308, 50%) 32.6 (4.5) 69.0 (11) 158 (5.6) 111 (36) 52.5 (17) 0 [0-4] No allele T (n = 205, 34%) 32.4 (4.7) 68.5 (9.1) 160 (3.8) 76 (37) 53.2 (16) 0 [0-3] SNP 2677 Homozygous G (n = 130, 21%) 32.3 (4.7) 68.8 (9.0) 159 (5.4) 51 (39) 54.6 (16) 0 [0-2] Heterozygous G (n = 327, 53%) 32.5 (4.5) 70.0 (11) 158 (5.6) 113 (35) 51.7 (16) 0 [0-2] No allele G (n = 156, 26%) 32.4 (4.7) 67.6 (10) 159 (5.3) 61 (40) 53.1 (15) 0 [0-3] SNP 2677 Homozygous A (n = 7, 1%) 32.5 (4.7) 67.8 (10) 158 (5.5) 3 (43) 54.0 (9) 0 [0-0] Heterozygous A (n = 117, 19%) 32.8 (4.6) 70.0 (11) 159 (5.6) 42 (36) 52.4 (15) 0 [0-3] No allele A (n = 489, 80%) 32.4 (5.2) 68.8 (9.8) 158 (5.3) 180 (37) 52.7 (16) 0 [0-4] The frequency of each SNP is expressed as absolute numbers (n), percentage of total (%); Data are mean (SD) except parturients with previous cesarean section, which are n (%) and pain scores which are median [range]; No statistically significant differences were found among the genotypes. Login to comment 88 ABCB1 p.Thr1236Cys ABCB1 p.Thr1236Cys Table 2 Data in the first 24 h after caesarean section Total morphine consumption (mg) Total pain scores (0-10 VAS) Total pruritus (0-3 severity score) Total nausea (0-3 severity score) Total episodes of vomiting SNP C3435T CC (n = 190) 6.9 (7.3) 2 [0-24] 0 [0-10] 0 [0-6] 0 [0-4] CT (n = 319) 7.3 (8.4) 2 [0-17] 0 [0-12] 0 [0-2] 0 [0-8] TT (n = 111) 7.6 (8.0) 2 [0-14] 0 [0-11] 0 [0-3] 0 [0-3] SNP T1236C TT (n = 288) 7.3 (8.5) 2 [0-24] 0 [0-12] 0 [0-3] 0 [0-3] TC (n = 263) 6.9 (7.7) 2 [0-17] 0 [0-12] 0 [0-6] 0 [0-8] CC (n = 61) 8.4 (8.7) 2 [0-13] 0 [0-12] 0 [0-6] 0 [0-3] SNP 2677 Homozygous T (n = 100) 8.0 (9.3) 2 [0-24] 2 [0-11] 0 [0-3] 0 [0-3] Heterozygous T (n = 308) 6.8 (7.6) 2 [0-14] 0 [0-12] 0 [0-3] 0 [0-8] No allele T (n = 205) 7.7 (8.5) 2 [0-14] 0 [0-11] 0 [0-6] 0 [0-4] SNP 2677 Homozygous G (n = 130) 7.2 (7.8) 2 [0-14] 0.5 [0-11] 0 [0-6] 0 [0-8] Heterozygous G (n = 327) 7.2 (8.1) 2 [0-14] 0 [0-12] 0 [0-3] 0 [0-4] No allele G (n = 156) 7.5 (8.6) 2 [0-24] 1 [0-1]) 0 [0-3] 0 [0-3] SNP 2677 Homozygous A (n = 7) 3.0 (2.4) 0 [0-8] 0 [0-9] 0 [0-0] 0 [0-0] Heterozygous A (n = 117) 8.2 (8.9) 4 [0-14] 0 [0-12] 0 [0-3] 0 [0-8] No allele A (n = 489) 7.1 (8.0) 2 [0-24] 0 [0-12] 0 [0-6] 0 [0-3] Data are median [range] except nausea and morphine consumption which are actual number of episodes and mean (SD), respectively; No statistically significant differences were found among the genotypes. Login to comment 89 ABCB1 p.Thr1236Cys Table 2 Data in the first 24 h after caesarean section Total morphine consumption (mg) Total pain scores (0-10 VAS) Total pruritus (0-3 severity score) Total nausea (0-3 severity score) Total episodes of vomiting SNP C3435T CC (n = 190) 6.9 (7.3) 2 [0-24] 0 [0-10] 0 [0-6] 0 [0-4] CT (n = 319) 7.3 (8.4) 2 [0-17] 0 [0-12] 0 [0-2] 0 [0-8] TT (n = 111) 7.6 (8.0) 2 [0-14] 0 [0-11] 0 [0-3] 0 [0-3] SNP T1236C TT (n = 288) 7.3 (8.5) 2 [0-24] 0 [0-12] 0 [0-3] 0 [0-3] TC (n = 263) 6.9 (7.7) 2 [0-17] 0 [0-12] 0 [0-6] 0 [0-8] CC (n = 61) 8.4 (8.7) 2 [0-13] 0 [0-12] 0 [0-6] 0 [0-3] SNP 2677 Homozygous T (n = 100) 8.0 (9.3) 2 [0-24] 2 [0-11] 0 [0-3] 0 [0-3] Heterozygous T (n = 308) 6.8 (7.6) 2 [0-14] 0 [0-12] 0 [0-3] 0 [0-8] No allele T (n = 205) 7.7 (8.5) 2 [0-14] 0 [0-11] 0 [0-6] 0 [0-4] SNP 2677 Homozygous G (n = 130) 7.2 (7.8) 2 [0-14] 0.5 [0-11] 0 [0-6] 0 [0-8] Heterozygous G (n = 327) 7.2 (8.1) 2 [0-14] 0 [0-12] 0 [0-3] 0 [0-4] No allele G (n = 156) 7.5 (8.6) 2 [0-24] 1 [0-1]) 0 [0-3] 0 [0-3] SNP 2677 Homozygous A (n = 7) 3.0 (2.4) 0 [0-8] 0 [0-9] 0 [0-0] 0 [0-0] Heterozygous A (n = 117) 8.2 (8.9) 4 [0-14] 0 [0-12] 0 [0-3] 0 [0-8] No allele A (n = 489) 7.1 (8.0) 2 [0-24] 0 [0-12] 0 [0-6] 0 [0-3] Data are median [range] except nausea and morphine consumption which are actual number of episodes and mean (SD), respectively; No statistically significant differences were found among the genotypes. Login to comment 113 ABCB1 p.Thr1236Cys 0.18 for CC, CT and TT, respectively (with an allelic frequency of 0.56 for C); our results were not dissimilar to the Chinese population in a previous study.10 Also, the presence of the T allele at position 2677, which was found to be closely linked to C3435T SNP in a previous study, has been shown to result in a reduced expression of Table 3 Data on persistent pain after caesarean section Incidence of persistent pain for 3 months or longer [n (%)] Survival time of post operative pain (months) SNP C3435T CC (n = 164) 9 (5.5) 1.43 (0.06) CT (n = 248) 17 (6.9) 1.42 (0.05) TT (n = 89) 12 (13.5)a 1.72 (0.11)b SNP T1236C TT (n = 233) 24 (10.3) 1.50 (0.06) TC (n = 209) 8 (3.8) 1.33 (0.05) CC (n = 54) 6 (11) 1.40 (0.13) SNP 2677 Homozygous T (n = 100) 8. Login to comment 114 ABCB1 p.Thr1236Cys 0.18 for CC, CT and TT, respectively (with an allelic frequency of 0.56 for C); our results were not dissimilar to the Chinese population in a previous study.10 Also, the presence of the T allele at position 2677, which was found to be closely linked to C3435T SNP in a previous study, has been shown to result in a reduced expression of Table 3 Data on persistent pain after caesarean section Incidence of persistent pain for 3 months or longer [n (%)] Survival time of post operative pain (months) SNP C3435T CC (n = 164) 9 (5.5) 1.43 (0.06) CT (n = 248) 17 (6.9) 1.42 (0.05) TT (n = 89) 12 (13.5)a 1.72 (0.11)b SNP T1236C TT (n = 233) 24 (10.3) 1.50 (0.06) TC (n = 209) 8 (3.8) 1.33 (0.05) CC (n = 54) 6 (11) 1.40 (0.13) SNP 2677 Homozygous T (n = 100) 8. Login to comment 116 ABCB1 p.Thr1236Cys P-glycoprotein in the placenta.11 SNP T1236C has also been found to have an impact on methadone dose requirements in chronic opioid users even though its impact on the effectiveness of morphine is undetermined.12 However, while the blood brain barrier could be an important site for modulation of morphine in mice,2 there is to date, no evidence of an association between the SNP which we investigated in this study, and any clinically relevant differences in the quality of analgesia rendered by morphine in postoperative patients. Login to comment 117 ABCB1 p.Thr1236Cys P-glycoprotein in the placenta.11 SNP T1236C has also been found to have an impact on methadone dose requirements in chronic opioid users even though its impact on the effectiveness of morphine is undetermined.12 However, while the blood brain barrier could be an important site for modulation of morphine in mice,2 there is to date, no evidence of an association between the SNP which we investigated in this study, and any clinically relevant differences in the quality of analgesia rendered by morphine in postoperative patients. Login to comment