The Great Ear Wax Poll outcome

We don't know the ethnicity of the pollsters (n=47), nor their country of origin, but with the eye of faith, the outcome shows a nice histogram that is consistent with the Hardy-Weinberg Equilibrium (A=0.73, a=0.27). This is assuming the the three categories represents the three genotypes. This assumption may not be true. Nevertheless the outcome is interesting.

The ABC Transporters

For the longest time we all worked on the premise that drug molecules moved across the cell membranes passively, and by virtue of their lipophilicity. In technical terms, this was determined by the water:octanol partition coefficient. But increasingly we are seeing that this is not all there is to the story. It would seem that few drug molecules actually traverse the lipid bilayer by passive diffusion. Few would cross the membrane without engaging the transport process in some way or other.

One important and very fundamental part of this process is mediated by a superfamily of drug transporters called the ABC transporters. The 'ABC' stands for ATP-Binding Cassette. Apart from having at least one ATP-binding domain, these transporters are characterized by a signature sequence of amino acid residues within the nucleotide binding domain - an LSGGQ motif.

In contrast to prokaryotes, the ABC transporters function as efflux pumps, which together with the detoxification enzymes constitute a complex integrated 'chemo-immunological defense' system against drugs and other xenobiotics.

In human beings, this superfamily of transporters comprises 48 members grouped into 7 families. Just how fundamental these transporters is evidenced by the ubiquity in all living systems be they eukaryotes or prokaryotes. Even mitochondria carry at least 4 of their own ABC transporters.

Prokaryotes
Agrobacterium tumefaciens - 135
Fungi/yeast
Saccharomyces cerevisiae - 22
Plasmodium - 15
Mitochondria - 4
Human - 48

The ABC transporters and their SLC (solute carrier) counterparts are fast shaping up to be probably the most important determinants of interindividual differences in drug efficacy/toxicity.

31st Pharmacological and Therapeutic Society of Thailand Meeting

I just spent 3 wonderful days in Khon Kaen, Thailand at the 31st Pharmacological and Therapeutic Society of Thailand Meeting. I was there as the honoured guest of the Society to deliver the 'Chiravat Sadavongvivad Memorial Lecture was on " The ABC Transporters: Their role in determining drug resistance and drug response'. The proceedings are published in the Thai Journal of Pharmacology. For Khon Kaen University, see here.

Apart from enjoying the characteristically warm and wonderful hospitality of the hosts, it was a great time to catch up with old friendships and also on an academic front, to try and understand a bit more about Thai ideas of ethnicity issues.

ABCC11 Transporter

The ABCC11 gene encodes for a little known member of the ABC (ATP binding cassette) superfamily of membrane transporters. The protein is called MRP8 or multi-drug resistance protein 8. Not much is yet known about its function. It became 'famous' largely because of its association with the dry-wet ear wax phenotype. Additionally, it has been shown to transport cyclic nucleotides e.g. cAMP and cGMP, and consequently has been implicated in resistance to a number of nucleotidic anticancer drugs used for breast cancers.

Other interesting associations other than ear wax....is the association with the production of colustrum by nursing mothers (early milk).

The main genetic polymorphism associated with ABCC11 is the 538G-A transition in exon 4 giving rise to a substitution of glycine to arginine. The frequency of this polymorphism is unknown among our local ethnic groups is Singapore.

What's with the Japanese - wet or dry ear wax??

Another interesting bit of trivia I discovered when I visited RIKEN. There is a genetic polymorphism affecting the ABC (ATP-Binding Cassette) transporter ABC11, that determines if your ear wax comes out dry or wet. This was discovered by Yoshiura et al in 2006. See also report in the New York Times. Apparently the Japanese and Koreans (and Northern Chinese) exclusively have the 'dry ear wax' variant while African and West Europeans have the "wet ear wax" phenotype. The rest of the world have mixed proportions of dry and wet waxes. In Southern China and South East Asia, the frequency of wet wax increases. It is thought that the dry wax allele originated in Northern Asia, thus giving rise to an exclusive distribution of the allele in North China, Korea and Japan.

Wet is black, dry is white

The Japanese use the dry wax phenotype to distinguish the Yamato Japanese from the other Japanese arising from Hokkaido (Ainus) and Ryukyu (Okinawans).

Why not take the ear wax poll?

Who are the Japanese, anyway?

The Japanese ethnic group is deceptively homogeneous.The dominant ethnic group however is recognizable as the Yamato people. These are whom we have come to commonly recognize as 'Japanese'. However, some minor ethnic groups do find their home in Japan. Apart from the obvious transplants such as Koreans, Chinese, Taiwanese etc, these are the Ainus, Ryukyuans and the Nivkhs.

The Yamatos are people who derive originally from the North Chinese mainland, having crossed over through the Korean peninsula. Consequently, there is a genetic thread that runs through and links the Northern Han Chinese and Koreans with the Yamato Japanese. By contrast the Ainu and Ryukyuans are earlier peoples who antedate the arrival of the Yamato people. RIKEN has data that show the genetic similarity between the Ainu and the Ryukuans (Okinawans). It is thought that the arrival of Yamato cleaved the distribution of the original Austronesian population to create a northern Ainu group and a southern Okinawan group. The Nivkhs are a small minority who derive from Siberia.

That said, the Japanese are pretty much of the Yamato group (>98% of toal 130 million). The Ryukuans probably account for about 1% and the Ainu even less (0.3%).

From a practical perspective, when one examines Japanese PGx data we should make mental links with data originating from Northern China and Korea. Accordingly, some caution is necessary when we try and connect the dots between Japanese and essentially Southern Chinese and South East Asian data.

The following excerpted from Wikipedia (Japanese_people):

A recent study for the origins of Japanese people is based on the "dual structure model" proposed by Hanihara in 1991. He concludes that modern Japanese lineages consist of the original Jōmon people and immigrants from the Yayoi period. The Jōmon people originated in southeast Asia, moving to the Japanese Archipelago in the Palaeolithic period. In past several decades, the Japanese people was proposed to relate to Yi, Hani and Dai people based on folk customs or genetic evidences.

Another southeast Asian group moved to northeastern Asia. The population of this group increased in the Neolithic period and some moved to the archipelago during the Yayoi period. The miscegenation prevailed in Kyūshū, Shikoku and Honshū islands but not in Okinawa and Hokkaido, respectively represented by the Ryukyuan and Ainu people. This theory was based on the study of the development of human bones and teeth. The comparison of mitochondrial DNA between Jōmon people and medieval Ainu also supports the theory.

Personalized medicine vs Genome-based medicine

I have a very good series of meeting as part of the Health Sciences Authority, Singapore (HSA) team with the Japanese Pharmaceutical and Medical Devices Agency (PMDA), Ministry of Health, Labour and Welfare (MHLW), and the National Institute of Health Sciences (NIHS), as well as the RIKEN Center for Genomics Medicine (CGM).

I learnt a lot just talking the the various agencies. But the highlight for the meeting for me was catching that fleeting comment by Prof Yusuke Nakamura, Director of Riken CGM, that there was a difference between "personalized medicine" and genome-based medicine", and that RIKEN had more of a focus on "genome-based medicine". I thought that was incredibly insightful. So many of the luminaries in PGx toss around the term "personalized medicine" almost as a justification for spending their multimillion $$ budgets but totally missing the point that what they are after really isn't personalizing therapeutics.

In our analogy of the F1 race car driver, it's really no different from developing better and more precise fuel injection systems, or tires that are better suited for the road surface. Technology is great. But after all that we musn't forget that one still needs to navigate and drive fast to get to the finish line, ... with the best time. That is personalized medicine.

See recent editorial: Personalized medicine: are we there yet?