Clinical Pharmacokinetics

, Volume 57, Issue 7, pp 817–829 | Cite as

Effects of PON1 Gene Promoter DNA Methylation and Genetic Variations on the Clinical Outcomes of Dual Antiplatelet Therapy for Patients Undergoing Percutaneous Coronary Intervention

  • He-Ping Lei
  • Xi-Yong Yu
  • Hong Wu
  • Yan-Hong Kang
  • Wan-Ping Zhong
  • Li-Yun Cai
  • Meng-Zhen Zhang
  • Ji-Yan Chen
  • Li-Ping Mai
  • Qing-Shan Ding
  • Min Yang
  • Shi-Long ZhongEmail author
Original Research Article


Introduction and Objective

The relationship between either paraoxonase 1 (PON1) gene promoter DNA methylation or genetic variations and bleeding or major adverse cardiac events after dual antiplatelet therapy has been incompletely characterized. We aimed to systematically investigate the role of genetic variations and DNA methylation of the PON1 CpG island promoter on the clinical outcomes of dual antiplatelet therapy for patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI).


This study included 653 patients with CAD undergoing PCI and receiving dual antiplatelet therapy. Genomic DNAs were isolated from whole blood and were genotyped for the three single nucleotide polymorphisms (SNPs) of the PON1 gene. The DNA methylation levels in the PON1 promoter region were determined by bisulfite sequencing or pyrosequencing at five CpG sites (positions −142, −161, −163, −170, and −184 from the transcription start site). Clopidogrel and its metabolites in plasma were examined using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and platelet function analysis was performed using the VerifyNow assay.


Statistically significant associations between methylation levels at five PON1 CpG sites and bleeding were observed: −184 [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.96–1.00, p = 0.028]; −170 (OR 0.99, 95% CI 0.97–1.00, p = 0.048); −163 (OR 0.98, 95% CI 0.96–1.00, p = 0.029); −161 (OR 0.98, 95% CI 0.97–1.00, p = 0.026); and −142 (OR 0.98, 95% CI 0.97–1.00, p = 0.042) at a false discovery rate of <5%. Statistical analysis also revealed that aspirin reaction units (ARUs) were significantly associated with PON1 methylation level at CpG site −163 (p = 0.0342). The ARUs of patients with the PON1 126 CC genotype was 527 ± 94, which was higher than the ARUs (473 ± 89) of patients with the 126 CG genotype (p = 0.0163). Multivariate logistic regression analysis indicated that the PON1 methylation level at CpG site −161 (OR 0.95, 95% CI 0.92–0.98, p = 0.002) and the use of angiotensin-converting enzyme inhibitors (OR 0.48, 95% CI 0.26–0.89, p = 0.021) were associated with a decreased risk of bleeding events.


Hypomethylation of CpGs in the PON1 promoter may be a weak, albeit statistically significant, risk factor of bleeding after dual antiplatelet therapy. Further large-scale studies are needed to verify our results.


Compliance with Ethical Standards


This work was supported by the National Nature Science Foundation of China (Nos. 81373486, 81673514, 81330007, 81202602, U1601227), Science and Technology Development Projects of Guangdong Province, China (Nos. 2016B090918114, 2013B021800157), and Science and Technology Development Projects of Guangzhou, Guangdong, China (201510010236, 201604020096).

Conflict of interest

He-Ping Lei, Xi-Yong Yu, Hong Wu, Yan-Hong Kang, Wan-Ping Zhong, Li-Yun Cai, Meng-Zhen Zhang, Ji-Yan Chen, Li-Ping Mai, Qing-Shan Ding, Min-Yang, and Shi-Long Zhong declare that they have no conflicts of interest that might be relevant to the contents of this article.

Ethical Approval

This study was performed in compliance with the Declaration of Helsinki and was approved by the Medical Ethical Review Committee of the Guangdong General Hospital.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

40262_2017_595_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 28 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • He-Ping Lei
    • 1
    • 2
  • Xi-Yong Yu
    • 1
    • 3
  • Hong Wu
    • 4
  • Yan-Hong Kang
    • 1
  • Wan-Ping Zhong
    • 1
    • 2
  • Li-Yun Cai
    • 1
    • 2
  • Meng-Zhen Zhang
    • 1
    • 2
  • Ji-Yan Chen
    • 1
    • 2
  • Li-Ping Mai
    • 1
    • 2
  • Qing-Shan Ding
    • 1
    • 2
  • Min Yang
    • 1
    • 2
  • Shi-Long Zhong
    • 1
    • 2
    Email author
  1. 1.Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouPeople’s Republic of China
  2. 2.School of MedicineSouth China University of TechnologyGuangzhouPeople’s Republic of China
  3. 3.School of Pharmaceutical SciencesGuangzhou Medical UniversityGuangzhouPeople’s Republic of China
  4. 4.Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhouPeople’s Republic of China

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