Q&A with Vicki Ellingrod, University of Michigan

Vicki L. Ellingrod, Pharm.D., FCCP is The John Gideon Searle Professor of Clinical and Translational Pharmacy in the Clinical Pharmacy Department in the College of Pharmacy, Professor of Psychiatry and Psychology. She obtained her BS and PharmD from the University of Minnesota and then completed a postdoctoral fellowship in psychopharmacology/pharmacogenetics at the University of Iowa. She then joined their faculty and completed a K08 training grant funded by NIMH (National Institute of Mental Health). Read her full bio.

Interview with Vicki Ellingrod, University of Michigan

Q: The prevalence of metabolic syndrome in patients with schizophrenia is much higher compared to the general population. What is the role of folate pharmacogenomics on inflammatory and metabolic complications from atypical antipsychotic use in schizophrenia?

A: The folate hypothesis of schizophrenia is an emerging field of study. Previous research has shown that patients with schizophrenia have altered folate metabolism which is pharamcogenomically regulated. Additionally folate levels in patients with schizophrenia are low and these irregularities have been correlated with the symptoms of schizophrenia as well as functional brain changes. The work done by my group has focused on the cardiovascular complications seen with antipsychotic use as part of one carbon metabolism, where folate is key, hyperhomocysteine can occur. Thus we have been examining the effect of folate on reducing homocysteine as well as inflammatory markers which have also been associated with cardiovascular disease. Work done by our group has found that the methylenetetrahydrfolate reductase (MTHFR) 677 T allele as well as the catechol-o-methyltransferase (COMT) 158 Val alleles are associated with increased risk for cardiovascular complications seen with antipsychotic use in serious mental illness. Furthermore our group has found that folate supplementation helps to reverse some of these effects and that this response to folate is pharmacogenetically regulated.

Q: What are some of the barriers to improving the clinical utility of pharmacogenomics, and what initiatives your Clinical Pharmacogenomics Laboratory at the University of Michigan College of Pharmacy is working on to overcome those barriers?

A: At Michigan we have used an evidence based approach to determine where we can make the greatest impact in implementing pharamcogenomic testing. We have worked to provide a system level approach that is first examining where the testing is currently taking place and how to reduce duplication of testing. AS part of this process we have worked on broad provider education, and are now providing patient education to address any misperceptions that patients may have regarding the testing.

Q: The field of pharmacogenomics and precision pharmacotherapy is evolving rapidly. What role clinical pharmacists can play in this field?

A: Because some of the testing going on comes from outside providers and what is tested can vary from test to test, pharmacists at UM have been key in assuring that the implementation of this testing into patient care is using the most up to date evidence based information and guidelines. We have done this through incorporation of pharmacists in the testing ordering process, as well as assuring they are part of the team responsible for the interpretation of results. Lastly, we have started a system wide consulting service to assess questions from providers as they arise or when patients bring in outside testing results. Through a partnership with the UM genetic counseling service we have created and are currently testing patient educational programs.