My lab is interested in all aspects of pharmacogenetics, from basic research to implementation in patient care. Pharmacogenetics refers to the effect of a person's genetic code on their response to a medication. How a person responds to or metabolizes a drug can vary widely in a population. As a trainee, I saw how genetics could help predict or explain some of this variability and wanted to make sure we continue to expand research in this area and use this information in clinical care. We study many different types of medications for many diseases.
One medication I am particularly interested in is methotrexate — used in high doses for treating cancer and low doses for treating autoimmune diseases. I convened and led an international group of experts in creating a consensus guideline for when to use glucarpidase, a medication used to prevent toxicity from methotrexate. We also developed a web tool that shows clinicians how an individual patient is predicted to eliminate methotrexate and whether they are likely to meet the indication criteria for glucarpidase.
We found that pharmacogenetic variants influenced the response, toxicity and dosing of antidepressants (sertraline, citalopram and escitalopram) in children. We then implemented clinical decision support with dosing guidelines through the Genetic Pharmacology Service to optimize dosing and potentially avoid side effects. The Genetic Pharmacology Service is a multidisciplinary team I work with to develop, interpret and implement new pharmacogenetic tests in the electronic medical record. I also educate doctors, pharmacists, genetic counselors and nurses on when and how to use the tests in the clinic.
I am a recipient of the Darrell Abernethy Early Stage Investigator Award (2019) from the American Society for Clinical Pharmacology & Therapeutics. I have more than 11 years of research experience and began working at Cincinnati Children's in 2015.
PhD: University of Minnesota, Minneapolis, MN, 2009.
BS: University of Northern Iowa, Cedar Falls, IA, 2004.
Implementation of CYP2D6-guided opioid therapy at Cincinnati Children's Hospital Medical Center. American Journal of Health-System Pharmacy. 2023; 80:852-859.
Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants. Clinical Pharmacology and Therapeutics. 2023; 114:51-68.
PharmVar GeneFocus: SLCO1B1. Clinical Pharmacology and Therapeutics. 2023; 113:782-793.
MTXPK.org: A Clinical Decision Support Tool Evaluating High-Dose Methotrexate Pharmacokinetics to Inform Post-Infusion Care and Use of Glucarpidase. Clinical Pharmacology and Therapeutics. 2020; 108:635-643.
Gene-Based Dose Optimization in Children. Annual Review of Pharmacology and Toxicology. 2020; 60:311-331.
Pharmacogenetics of treating pediatric anxiety and depression. Pharmacogenomics. 2019; 20:867-870.
CYP2C19-Guided Escitalopram and Sertraline Dosing in Pediatric Patients: A Pharmacokinetic Modeling Study. Journal of Child and Adolescent Psychopharmacology. 2019; 29:340-347.
Pharmacogenetics of Sertraline Tolerability and Response in Pediatric Anxiety and Depressive Disorders. Journal of Child and Adolescent Psychopharmacology. 2019; 29:348-361.
Delayed methotrexate clearance in patients with acute lymphoblastic leukemia concurrently receiving dasatinib. Pediatric Blood and Cancer. 2019; 66:e27618.
Association of SLCO1B1 *14 Allele with Poor Response to Methotrexate in Juvenile Idiopathic Arthritis Patients. ACR Open Rheumatology. 2019; 1:58-62.