• Nicolas Picard, PharmD, PhD

CV

Nicolas Picard is full professor of pharmacology at the Faculty of Pharmacy, University of Limoges (France), and hospital biologist in the Department of pharmacology, toxicology and pharmacovigilance at Limoges University Hospital. A pharmacist since 2002, he obtained his PhD in Pharmacology in 2005. He heads the Department of physiology and pharmacology at the Faculty of Pharmacy, where he teaches fundamental and clinical pharmacology, and is jointly responsible for the molecular genetics unit of the University Hospital, leading its clinical pharmacogenetics section. His research within the Inserm “Pharmacology & Transplantation” Unit has evolved from in vitro studies of drug metabolism and disposition to clinical research, and now focuses primarily on the implementation of pharmacogenetics in transplantation, psychiatry, and geriatrics. He has authored around 100 peer-reviewed publications and currently serves as President of the Francophone Network of Pharmacogenetics (RNPGx) which brings together experts from France, Belgium, Switzerland, Tunisia, and Quebec.

 

ABSTRACT

Pharmacogenetics in kidney transplantation: from targeted analysis of immunosuppressants to the pharmacogenetic passport

 

Pharmacogenetics has progressively emerged as a robust tool to optimize immunosuppressive therapy in kidney transplantation. Variability in tacrolimus metabolism, driven by polymorphisms in CYP3A enzymes profoundly influences drug exposure, while deficiencies in TPMT or NUDT15 are key determinants of azathioprine toxicity, although this agent is now less frequently used in solid organ transplantation. Targeted pharmacogenetic testing has already demonstrated utility, particularly for tacrolimus, where CYP3A5 expressers require higher initial dosing to achieve therapeutic concentrations, and for preventing azathioprine-related adverse reactions. However, current approaches are often restricted to single gene–drug pairs and fail to encompass the wide range of medications administered before, during, and after transplantation. The concept of a pharmacogenetic passport, integrating multiple germline variants into a pre-emptive and comprehensive panel, offers a transformative paradigm. Such a passport could personalize immunosuppressive regimens, reduce the trial-and-error phase of dose adjustment, and guide therapy for numerous co-administered drugs used in kidney disease, transplant surgery, and the post-transplant setting. This presentation will trace the trajectory from targeted gene–drug testing to the broader pharmacogenetic passport, with concrete examples showing that nearly half of kidney transplant recipients could benefit from pharmacogenetically guided interventions.