Glaucoma is a leading cause of irreversible optic nerve damage,with a significant proportion of patients(approximately 10%)suffering from blindness or severe visual field damage during their lifetime.^([1])The number of patients suffering from glaucoma worldwide is estimated to be 76 million in 2020 and is expected to rise to 111.8 million by 2040.^([2])The estimated global prevalence of primary open-angle glaucoma(POAG)is 3.05%and primary angle-closure glaucoma is 0.50%in those aged 40 to 80 years,and the prevalence increases with age,^([2])which imposes a significant economic burden.Elevated intraocular pressure(IOP)is a well-recognized risk factor for glaucoma progression;although some natural products such as citicoline and coenzyme q10 have been shown to possess neuroprotective properties for delaying the progression of glaucoma,^([3,4])IOP-lowering medications are currently the mainstay in its medical management.
In recent years,pharmacogenetics has emerged as an important tool for choosing the right immunosuppressant drug and its appropriate dose.Indeed,pharmacogenetics may exert its action on immunosuppressant drugs at three levels.Pharmacogenetics identifies and studies the genes involved in encoding the proteins involved in drug pharmacokinetics and in encoding the enzymes involved in drug degradation.Pharmacogenetics is also relevant in encoding the enzymes and proteins involved in codifying the transmembrane proteins involved in transmembrane passage favoring the absorption and intracellular action of several immunosuppressants.Pharmacogenetics concern the variability of genes encoding the proteins involved as immunosuppressant triggers in the pharmacodynamic pathways.Of course,not all genes have been discovered and studied,but some of them have been clearly examined and their relevance together with other factors such as age and race has been defined.Other genes on the basis of relevant studies have been proposed as good candidates for future studies.Unfortunately,to date,clear conclusions may be drawn only for those drugs that are metabolized by CYP3A5 and its genotyping before kidney,heart and lung transplantation is recommended.The conclusions of the studies on the recommended candidate genes,together with the development of omics techniques could in the future allow us to choose the right dose of the right immunosuppressant for the right patient.
Pharmacogenetics and pharmacogenomics have expanded rapidly over the past years and represent one of the bases of precision medicine.The application of pharmacogenetic and pharmacogenomic approaches and tools for the selection of medications and their dosage to improve patient care is nowadays substantially increased[1,2].Prescription drug information sheets in several therapeutic areas(psychiatric,cardiovascular,analgesic,antiviral,and anticancer drugs)provide current information on pharmacogenetic and pharmacogenomic biomarkers for over 200 medicines including mandatory or recommended biomarker testing prior to initiating therapy[3].
