L’objectif de cette thèse a été d’explorer l’association entre des variants génétiques impliqués dans la variabilité interindividuelle de la réponse au traitement par les opioïdes et la survenue d’effets secondaires. Nous avons recherché si des facteurs génétiques influençaient la réponse à la morphine dans le traitement de la douleur aigüe. L’allèle T du polymorphisme c.3435C>T d’ABCB1 est significativement associé aux doses de morphine et à la survenue de nausées dans une étude pilote chez des patients libanais en post-opératoire. Ensuite, l’étude de la réponse à la morphine chez des patients présentant une obésité morbide a montré que la fréquence de l’allèle 118G d’OPRM1 et le seuil de sensibilité à la douleur sont plus élevés que chez les patients à poids normal. La recherche des facteurs influençant la variabilité de la réponse à la méthadone chez des patients toxicomanes traités pour substitution a mis en évidence deux polymorphismes (TaqIA de DRD2/ANKK1 et c.118A>G d’OPRM1) significativement associés à la dose maximale de méthadone administrée. Trois facteurs sont associés au phénotype CYP3A, impliqué dans le métabolisme de la méthadone: la prise de benzodiazépines, l’infection par le VIH et un polymorphisme de POR, gène qui code une oxydoréductase. De plus, le travail mené sur les effets secondaires cardiaques de la méthadone a permis de mettre en évidence trois facteurs corrélés à l’allongement de l’espace QT : la dose, l’infection par le VIH et le polymorphisme p.Lys897Thr de KCNH2 codant pour le canal potassique hERG. Ces travaux contribuent à démontrer l’intérêt d’intégrer des données cliniques et génétiques dans la prescription personnalisée des opioïdes. / The main objective of this thesis was to explore the association between genetic variants potentially involved in inter-individual variability of opioids’ response and side effects in the treatment of pain and opiate substitution treatment. Initially, we investigated whether genetic factors influence the response to morphine in the treatment of acute pain. The T allele of the polymorphism ABCB1 c.3435C>T was significantly associated with doses of morphine and the outcome of nausea in a pilot study in Lebanese postoperative patients. Next, we examined the response to morphine in patients with morbid obesity (BMI>40); in these patients, the frequency of the 118G OPRM1 allele and the pain threshold appeared to be higher than in patients with normal BMI. The search for factors influencing the variability in response to methadone in patients treated for drug substitution showed that two polymorphisms (DRD2/ANKK1 TaqIA and OPRM1 c.118A>G) were significantly associated with the maximum doses of methadone. In addition, three factors were associated with the CYP3A phenotype, involved in the metabolism of methadone: the use of benzodiazepines, HIV infection and a polymorphism in POR gene, which encodes an oxidoreductase. Finally, the exploration of the cardiac side effects of methadone has highlighted three factors significantly correlated with QT prolongation: methadone doses, HIV infection and the polymorphism p.Lys897Thr in KCNH2 encoding a cardiac potassium ion channel. This work demonstrates the importance of integrating both clinical and genetic data in the personalized prescription of opioids.

>Magister Scientiae - MSc / Genetic variability in genes encoding drug metabolizing enzymes, transporters and targets are known to be the main factors of inter-individual differences in therapeutic outcome. Genetic factors are estimated to be responsible for about 15-30% of inter-individual variation in drug disposition and response. Single-nucleotide polymorphisms (SNPs) are the most prevalent class of genetic variation that could explain the variability in drug efficacy and undesired side effects for patients. The aims of this study were to develop and evaluate the performance of robust and high throughput techniques for genotyping ten polymorphisms related to anticancer drugs and ten polymorphisms related to cholesterol lowering drugs. SNaPshot minisequencing and high resolution melt analysis (HRM) genotyping panels were developed, optimized, and their performances were evaluated and compared. SNaPshot minisequencing systems were developed and successfully optimized for the genotyping of ten SNPs associated with anticancer drug therapy, and ten SNPs associated with cholesterol lowering drugs. These systems were used to genotype the selected SNPs in 130 healthy Cape Admixed participants residing in Cape Town, South Africa. Population genetics data obtained for the studied SNPs were analysed using several statistical analysis software tools. Important population genetic parameters were calculated. Among others, allelic and genotypic frequencies were determined and compared with other populations in the world. High resolution melt analysis (HRM) genotyping panels were developed, optimized and their performance were evaluated and compared to the SNaPshot assays. HRM was explored as an alternative inexpensive and rapid methodology to genotype five SNPs related to anticancer therapy and five SNPs related to cholesterol lowering therapy (statins). Unlike the SNaPshot assays, rigorous optimization was required for the detection heterozygous genotypes via HRM. Both assays were validated using direct sequencing and compared to each other. The HRM system is a closed tube, cheap and (theoretically) rapid method for identifying genetic variations. HRM was however found to be more time consuming, needed further optimization, primer redesigning and more evaluation. The developed genotyping systems could be further validated using clinical samples from patients. This could help in optimizing drug therapy for cancer and cholesterol treatment.

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Martina Kobrlová Supervisor: prof. PharmDr. Petr Pávek, Ph.D. Title of diploma thesis: Pharmacogenetics in rheumatoid arthritis Based on scientific progress in the research of human genome and the discovery of polymorphisms, which are involved in the interindividual differences in human population, there is also a growing interest in pharmacogenetics. It is a field combining pharmacology and genetics with the aim of identifying specific features that could explain the different responses of patients to treatment by clinically used drugs. Applying this knowledge could contribute to a simpler choice of medication for a particular patient and it could reduce the risk of side effects or poor response. In this diploma thesis I dealt with the latest scientific knowledge on pharmacogenetics in rheumatology, in particular the rheumatoid arthritis. From available studies, reviews, and meta-analyzes that have been published, I summarized current data on the relationship between polymorphisms and disease modifying drugs (DMARDs) used for the treatment of this disease. The largest amount of data was found on the most commonly used methotrexate. Further, the work examines the leflunomide and other...

La médecine personnalisée représente une grande attente et un grand espoir dans la lutte contre le cancer. Cette approche vise à adapter les traitements aux caractéristiques personnelles du patient, principalement des biomarqueurs génétiques. Dans notre premier travail, nous avons analysé l'ensemble des médicaments approuvés par la FDA avec un biomarqueur pharmacogénétique dans leur label et montré (1) que l'oncologie représentait un tiers des médicaments avec un biomarqueur dans leur notice et (2) qu'une part importante des médicaments en oncologie mentionnaient le biomarqueur pour requérir un test avant la prescription du médicament contrairement aux autres domaines thérapeutiques. Notre deuxième travail a analysé les essais cliniques soumis à la FDA en vue de la mise sur le marché des thérapies ciblées pour lesquelles il existait une indication restreinte aux patients présentant un certain biomarqueur. Nous concluons que dans deux tiers des cas, l'utilisation du biomarqueur pour sélectionner les patients à traiter était basée sur les résultats des essais cliniques restreints aux patients biomarqueur-positifs et, qu'ainsi, il n'existait aucune donnée clinique permettant de conclure à une différence d'effet traitement selon les valeurs du biomarqueur. Pour notre troisième travail, nous avons réalisé une cartographie de l'ensemble des essais enregistrés sur le registre américain des essais cliniques pour les médicaments anti-cancéreux avec la mention d'un biomarqueur dans leur label. Nous avons mis en évidence des variations très importantes entre les médicaments quant au recours à des essais enrichis et au fait de tester un médicament dans plusieurs indications ou avec plusieurs biomarqueurs prédictifs. Dans notre quatrième travail, nous avons étudié la question du bénéfice apporté par les médicaments anti-cancéreux dans un contexte d'augmentation très importante des prix et grâce à la publication récente de deux échelles par les sociétés européenne et américaine d'oncologie (ESMO et ASCO). Nous avons analysé le bénéfice de tous les médicaments anti-cancéreux approuvés entre 2000 et 2015 pour le traitement d'une tumeur solide. Nous avons montré (1) la faible valeur des récents médicaments anti-cancéreux, (2) l'absence de relation entre le prix et la valeur de ces médicaments et (3) l'absence de différence de bénéfice entre médicaments de médecine personnalisée et médicaments classiques. En conclusion, la présence de biomarqueurs prédictifs dans le label des médicaments---souvent citée comme critère de succès de la médecine personnalisée---est pour l'instant restreinte en grande partie à l'oncologie. Le niveau de preuve pour l'utilité clinique est souvent inconnu car les études sont restreintes à un sous-groupe de patients positifs pour le biomarqueur dès les phases initiales du développement du médicament. Enfin, seul un tiers des médicaments anti-cancéreux approuvés par la FDA entre 2000 et 2015 ont un bénéfice cliniquement pertinent, sans différence de bénéfice clinique entre les médicaments avec et sans biomarqueur et sans relation entre le prix et le bénéfice de ces médicaments. / Personalized medicine represents great expectations and hopes in oncology. This approach aims to adapt treatments to the personal characteristics of the patient, mainly genetic biomarkers. In our first work, we analyzed all the FDA-approved drugs with a pharmacogenetic biomarker in their label and showed (1) that oncology represented one-third of the drugs with a biomarker in their label and (2) a significant portion of oncology drugs mentioned the biomarker to require a biomarker test, contrary to other therapeutic areas. Our second work analyzed the clinical trials submitted to the FDA for the approval of targeted therapies for which there was a indication restricted to biomarker-positive patients. We conclude that in two-thirds of the cases, the use of the biomarker to select the patients to be treated was based on the results of the clinical trials restricted to the biomarker-positive patients. Thus, in these cases, there was no clinical evidence to conclude to a treatment-by-biomarker interaction. For our third work, we mapped all the trials recorded on the US ClinicalTrials.gov registry for anti-cancer drugs with a biomarker labeling. We found very important variations between drugs in the use of enriched trials and in testing of the drug in several indications or with several predictive biomarkers. In our last work, we examined the benefit of anti-cancer drugs in a context of very significant price increases and the recent publication of two scales by the European and American oncology societies (ESMO and ASCO). We analyzed the benefit of all anti-cancer drugs approved between 2000 and 2015 for the treatment of a solid tumor. We have shown (1) the low value of recent anti-cancer drugs, (2) the lack of relationship between the price and the value of these drugs, and (3) the lack of difference of benefice between personalized and “classical” medicines. In conclusion, the presence of predictive biomarkers in the label of drugs --- often cited as a criterion of success of personalized medicine --- is, at least for now, being restricted in large part to oncology. The level of evidence for clinical utility is often unknown because studies are restricted to the subgroup of biomarker-positive patients from the initial stages of the drug development. Finally, only one third of the anti-cancer drugs approved by the FDA between 2000 and 2015 have meaningful clinical benefit and there is no difference in clinical benefit between drugs with and without biomarkers and no relation between the price and the benefit of anti-cancer drugs.

Background: Gastric cancer is often diagnosed in the metastatic stage, and only 10% of patients survive for as long as 2 years. Current chemotherapy regimens show significant treatment-related toxicities. It is crucial to identify the patients that will benefit most from certain chemotherapy regimens in order to avoid unnecessary side effects. Patients and Methods: 2 patients with advanced gastric cancer repeatedly received 5-FU/cisplatin combination chemotherapy. Genomic DNA was extracted from tumor tissue and mononuclear blood cells. Genotype analysis of genes of metabolizing and DNA repair enzymes was carried out using a PCR-RFLP technique. Direct sequencing was used to identify mutations of the gene dihydropyrimidine dehydrogenase (DPD). Results: Prolonged survival of 51 and 29 months, respectively were observed in our 2 patients. Both patients were positive for genotypes of thymidylate synthase - the target enzyme of 5-FU - that are associated with improved drug response. DPD variants connected with increased toxicity were not observed. However, both patients also showed genotypes in cisplatin metabolizing enzymes which enhance the effect of the drug. Conclusion: Genotype analysis in drug metabolizing enzymes of 5-FU and cisplatin provide a possible explanation for extraordinary therapy effects observed in 2 patients with advanced gastric cancer. / Hintergrund: Das Magenkarzinom wird häufig im fortgeschrittenen Stadium diagnostiziert, und nur etwa 10% der Patienten überleben 2 Jahre. Aktuelle Chemotherapien zeigen eine hohe therapiebedingte Toxizität. Es ist daher von großer Bedeutung, diejenigen Patienten zu identifizieren, die von einer bestimmten Therapie profitieren, um anderen Patienten die Nebenwirkungen einer solchen Therapie zu ersparen. Patienten und Methoden: 2 Patienten mit fortgeschrittenem Magenkarzinom erhielten wiederholt eine Kombinationschemotherapie aus 5-FU/Cisplatin. Genomische DNS wurde aus Tumorgewebe und Leukozyten isoliert. Genotypanalysen von Genen, die am Metabolismus der Substanzen und am DNS-Reparaturprozess beteiligt sind, wurden mithilfe einer PCRRFLP-Methode durchgeführt. Das Gen der Dihydropyrimidindehydrogenase (DPD) wurde direkt sequenziert. Ergebnisse: Beide Patienten zeigten ein deutlich verlängertes Überleben von 51 bzw. 29 Monaten. Genotypen des 5-FU-Zielenzyms Thymidylatsynthase, die mit einem verbesserten Ansprechen assoziiert sind, konnten in beiden Patienten nachgewiesen werden. DPD-Varianten, die mit einer erhöhten Toxizität verbunden sind, wurden nicht beobachtet. Zusätzlich konnten bei beiden Patienten Genotypen in Cisplatin metabolisierenden Genen gefunden werden, die eine prolongierte Wirkung der Substanz bedingen. Schlussfolgerungen: Durch Genotypanalysen in Genen des 5-FU- und Cisplatin-Metabolismus konnte ein spezifisches pharmakogenetisches Profil identifiziert werden, das möglicherweise die Ursache eines außergewöhnlich guten Therapieeffektes in 2 Patienten mit fortgeschrittenem Magenkarzinom ist. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Objective: The FKBP5-gene influences the HPA-system by modulating the sensitivity of the glucocorticoid receptor (GR). The polymorphism rs1360780 has been associated with response in studies with heterogeneous antidepressant treatment. In contrast, several antidepressant studies with standardized antidepressant treatment could not detect this effect. We therefore compared patients with standardized vs naturalistic antidepressant treatment to (a) investigate a possible interaction between FKBP5-genotype and treatment mode and (b) replicate the effect of the FKBP5-genotype on antidepressant treatment outcome. Methods: A total of 298 major depressive disorder (MDD) inpatients from the multicentred German project and the Zurich Algorithm Project were genotyped for their FKBP5 status. Patients were treated as usual (n=127) or according to a standardized algorithm (n=171). Main outcome criteria was remission (Hamilton Depression Rating Scale-21<10). Results: We detected an interaction of treatment as usual (TAU) treatment and C-allele with the worst outcome for patients combining those two factors (HR=0.46; p=0.000). Even though C-allele patients did better when treated in the structured, stepwise treatment algorithm (SSTR) group, we still could confirm the influence of the FKBP5-genotype in the whole sample (HR=0.52; p=0.01). Conclusions: This is the first study to show an interaction between a genetic polymorphism and treatment mode. Patients with the C-allele of the rs1360780 polymorphism seem to benefit from a standardized antidepressant treatment.

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Tesis por compendio / [EN] The determination of genetic biomarkers is progressively becoming more extended and popular, being commercialized even in kits for personalized medicine. Establishing specific genotype variations for each patient, such as single nucleotide polymorphisms (SNPs), could be a fundamental tool in the field of diagnosis, prognosis and therapy selection. However, the use of DNA testing is not fully implemented in general healthcare, mainly due to technical and economic barriers associated to the current technologies, which are limited only to specialized centers and large hospitals. In this thesis, the main goal was to overcome these obstacles by developing simpler, faster and more affordable point-of-care (POC) genotyping systems. Allele discrimination was achieved by employing isothermal enzymatic reactions, like recombinase polymerase amplification (RPA), ligation of oligonucleotides and loop-mediated isothermal amplification (LAMP). These processes were integrated to colorimetric indicators and immunoenzymatic assays, in a microarray format. Using compact discs and polycarbonate chips as platforms, the detection was achieved through widespread electronics, like disc-reader, flatbed scanner and smartphone. To demonstrate their capacities, the resulting systems were applied for identifying SNPs in human samples, associated to therapies for tobacco smoking cessation, major depression disorder and blood clotting-related diseases. After selecting the proper conditions, all studied strategies discriminated SNPs in samples containing as low as 100 copies of genomic DNA, with an error rate below 15%. Most importantly, the developed methods have reduced assays times varying between 70 and 140 minutes, at a cost similar to a conventional PCR-based analog, but maintaining or raising amplification efficiency and eliminating the need of specialized temperature cyclers and fluorescence scanners. In conclusion, the biosensors based in isothermal reactions and consumer electronics devices greatly improve the competitivity of POC DNA analysis. It was demonstrated that the technologies developed in this thesis could support genotyping assays in low-resource areas, such as primary healthcare centers and emerging countries. Through this democratization of genetic testing and by performing adequate association studies, molecular diagnostics and personalized medicine practices could have their application extended to the clinical routine. / [ES] La determinación de biomarcadores genéticos es cada vez más extensa y popular, estando incluso comercializándose kits para medicina personalizada. Establecer las variaciones específicas en el genotipo de cada paciente, como los polimorfismos de un solo nucleótido (SNP) podría ser una herramienta fundamental en el campo del diagnóstico, pronóstico y selección de la terapia. Sin embargo, el uso de pruebas de ADN no se encuentra completamente implementado en la atención médica general, principalmente debido a las barreras técnicas y económicas asociadas a las tecnologías actuales, limitadas solamente a centros especializados y grandes hospitales. En esta tesis, el objetivo principal fue superar estos obstáculos mediante el desarrollo de sistemas de genotipado point-of-care (POC), más simples, rápidos y asequibles. La discriminación alélica se logró mediante el uso de reacciones enzimáticas isotermas, como la amplificación de la recombinasa polimerasa (RPA), la ligación de oligonucleótidos y la amplificación isotérmica mediada por bucle (LAMP). Estos procesos se integraron a indicadores colorimétricos y ensayos inmunoenzimáticos en formato de micromatriz. Utilizando discos compactos y chips de policarbonato como plataforma de ensayo, se ha logrado la detección mediante dispositivos electrónicos de consumo, como un lector de discos, escáner documental y teléfono móvil. Para demostrar sus capacidades, los sistemas resultantes se aplicaron a la identificación de SNPs en muestras humanas, asociados a terapias antitabaquismo, para depresión y enfermedades relacionadas con la coagulación de la sangre. Tras seleccionar las condiciones adecuadas, todas las estrategias estudiadas discriminaron SNPs en muestras conteniendo tan solo 100 copias de ADN genómico, con una tasa de error inferior al 15%. Más importante, los métodos desarrollados han reducido los tiempos de ensayo a valores entre 70 y 140 minutos, a un coste similar a un análogo convencional basado en la reacción en cadena de la polimerasa (PCR), pero manteniendo o aumentando la eficiencia de amplificación y eliminando la necesidad de termocicladores y escáneres de fluorescencia. En conclusión, los biosensores basados en reacciones isotérmicas y dispositivos de electrónica de consumo mejoran en gran medida la competitividad del análisis POC de ADN. Se ha demostrado que las tecnologías desarrolladas en esta tesis podrían apoyar los ensayos de genotipado en áreas de recursos escasos, como centros de atención primaria y países emergentes. A través de esta democratización de las pruebas genéticas y realización estudios de asociación adecuados, el diagnóstico molecular y las prácticas en medicina personalizada podrían extender su aplicación a la rutina clínica. / [CA] La determinació de biomarcadors genètics és cada vegada més extensa i popular, estant fins i tot comercialitzant-se kits per a medicina personalitzada. Establir les variacions específiques en el genotip de cada pacient, com els polimorfismes d'un sol nucleòtid (SNP) podria ser una eina fonamental en el camp del diagnòstic, pronòstic i selecció de la teràpia. No obstant això, l'ús de proves d'ADN no es troba completament implementat en l'atenció mèdica general, principalment a causa de les barreres tècniques i econòmiques associades a les tecnologies actuals, limitades solament a centres especialitzats i grans hospitals. En aquesta tesi, l'objectiu principal va ser superar aquests obstacles mitjançant el desenvolupament de sistemes de genotipat point-of-care (POC), més simples, ràpids i assequibles. La discriminació al·lèlica es va aconseguir mitjançant l'ús de reaccions enzimàtiques isotermes, com l'amplificació de la recombinasa polimerasa (RPA), la lligació de oligonucleòtids i l'amplificació isotèrmica mediada per bucle (LAMP). Aquests processos es van integrar a indicadors colorimètrics i assajos inmunoenzimàtics en format de micromatriu. Utilitzant discos compactes i xips de policarbonat com a plataforma d'assaig, s'ha conseguit la detecció mitjançant dispositius electrònics de consum, com un lector de discos, escàner documental i telèfon mòbil. Per a demostrar les seues capacitats, els sistemes resultants es van aplicar a la identificació de polimorfismes en mostres humanes, associats a teràpies antitabaquisme, per a depressió i malalties relacionades amb la coagulació de la sang. Després de seleccionar les condicions adequades, totes les estratègies estudiades van ser capaces de discriminar SNPs en mostres contenint tan sols 100 còpies d'ADN genòmic, amb una taxa d'error inferior al 15%. Més important, els mètodes desenvolupats han reduït els temps d'assaig a valors entre 70 i 140 minuts, a un cost similar a un anàleg convencional basat en la reacció en cadena de la polimerasa (PCR), però mantenint o augmentant l'eficiència d'amplificació i eliminant la necessitat de termocicladors i escàners de fluorescència. En conclusió, els biosensors basats en reaccions isotèrmiques i dispositius d'electrònica de consum milloren en gran manera la competitivitat de l'anàlisi POC del ADN. S'ha demostrat que les tecnologies desenvolupades en aquesta tesi podrien donar suport als assajos de genotipat en àrees de recursos escassos, com a centres d'atenció primària i països emergents. A través d'aquesta democratització de les proves genètiques i realització estudis d'associació adequats, el diagnòstic molecular i les pràctiques en medicina personalitzada podrien estendre la seua aplicació a la rutina clínica. / [PT] A determinação de biomarcadores genéticos está tornando-se cada vez mais extensa e popular, sendo comercializada até em kits para medicina personalizada. O estabelecimento de variações específicas de genotipo para cada paciente, tais como os polimorfismo de nucleotídeo único, pode ser uma ferramenta fundamental no campo do diagnóstico, prognóstico e seleção de terapias. No entanto, o uso de testes de DNA ainda não encontra-se totalmente implementado na área de saúde geral, principalmente devido às barreiras técnicas e econômicas associadas às tecnologias atuais, limitadas apenas a centros especializados e grandes hospitais. Nesta tese, o principal objetivo foi superar esses obstáculos desenvolvendo sistemas de genotipagem point-of-care (POC) de DNA, mais simples, rápidos e acessíveis. A discriminação de alelos foi alcançada empregando reações enzimáticas isotérmicas, como amplificação por recombinase polimerase (RPA), ligação de oligonucleotídeos e amplificação isotérmica mediada por loop (LAMP). Tais processos foram integrados a indicadores colorimétricos e ensaios imunoenzimáticos, em formato micromatriz. Usando discos compactos e chips de policarbonato como plataforma de ensaio, os analitos foram detectados através de dispositivos eletrônicos de consumo, como leitor de disco, scanner de mesa e smartphone. Para demonstrar suas capacidades, os sistemas resultantes foram aplicados para identificação de polimorfismos em amostras de DNA humano, associados a terapias antitabagismo, para depressão e doenças relacionadas à coagulação do sangue. Após a seleção das condições adequadas, todas as estratégias estudadas foram capazes de discriminar SNPs em amostras contendo até 100 cópias de DNA genômico, com uma taxa de erro inferior a 15%. Mais importante, os métodos desenvolvidos reduziram o tempo de ensaio a valores entre 70 e 140 minutos, com um custo similar a um método análogo baseado em reação em cadeia da polimerase (PCR), mas mantendo ou aumentando a eficiência da amplificação e eliminando a necessidade de cicladores de temperatura e scanners de fluorescência especializados. Em conclusão, os biosensores baseados em reações enzimáticas isotérmicas e dispositivos eletrônicos de consumo incrementam grandemente a competitividade da análise POC de DNA. Foi demonstrado que as tecnologias desenvolvidas nesta tese poderiam dar suporte a ensaios de genotipagem em lugares com poucos recursos, como centros de atenção primária e países emergentes. Através desta democratização dos testes genéticos e com a realização de estudos de associação adequados, o diagnóstico molecular e as práticas de medicina personalizada poderiam ter sua aplicação extendida à rotina clínica. / The authors acknowledge the financial support received from the Generalitat Valenciana (GVA-PROMETEOII/2014/040 Project and GRISOLIA/2014/024 PhD grant) and the Spanish Ministry of Economy and Competitiveness (MINECO CTQ2013-45875-R project) / Yamanaka, ES. (2020). Isothermal-based DNA biosensors for application in pharmacogenetics [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/148366 / TESIS / Compendio

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