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feat(cpic): CPIC pharmacogenomics POC on the V3 (part_of:is_a) GUID — ingest + reason + scan#61

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feat(cpic): CPIC pharmacogenomics POC on the V3 (part_of:is_a) GUID — ingest + reason + scan#61
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@AdaWorldAPI AdaWorldAPI commented Jun 24, 2026

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A standalone cpic/ crate (mirrors fma/: isolated [workspace], zero impact on the q2 build) that addresses the CPIC pharmacogenomics database with the V3 canonical NodeGuid and its (part_of : is_a) tile — ingest → reason → scan, all three slices in.

POC over published CPIC rules — NOT clinical decision support (that needs full guideline text + pharmacist review). The disclaimer is in every binary's output.

The thesis held against the real data: CPIC already carries both hierarchies the tile wants — the gene→family partonomy (part_of, high byte) and the functional-status / metabolizer / ATC taxonomies (is_a, low byte) — sitting in its columns. Nothing invented.

Slice 1 — ingest (f405a90e)

Mints the 16-byte NodeGuid (byte-identical to lance_graph_contract::canonical_node::NodeGuid) for every entity. classid = pharmacogenomics domain 0x0C; each HHTL tier an 8:8 (part_of:is_a) tile via the same FNV prefix-cascade the fma converge bin uses; family = gene basin; identity = per-basin golden-ratio multiplicative mint (bijective ⇒ 0 collisions by construction). Edges: part_of, pair, recommends (via lookupkey), targets.

  • 114,410 GUIDs, 0 collisions (110,346 the combinatorial diplotype layer).
  • Both axes route (checked vs data): CYP2C19*2 and CYP2D6*4 (both no-function, both CYP2) share the full path c358-ec6f-f76f, only family differs.
  • A real decision wires end-to-end: HLA-B *57:01 positive ──recommends──▶ [Strong] ──targets──▶ abacavir.

Slice 2 — reason (9f85c67f)

NARS reasoning over the real CPIC graph: {gene, diplotype|phenotype, drug} → phenotype → recommendation, 2-hop deduction (f=f1·f2, c=f1·f2·c1·c2) with authoritative confidence — f from recommendation.classification, c from the pair cpiclevel. Demos:

CYP2C19 *2/*2 + clopidogrel → Poor Metab → "Avoid clopidogrel… use prasugrel/ticagrelor" (f=0.95 c=0.77)
HLA-B *57:01 positive + abacavir → (1-hop) → "Abacavir is not recommended"             (c=0.89)
TPMT *3A/*3A + azathioprine → Poor Metab → "alternative nonthiopurine therapy"  ⚠ MULTI-GENE flag
CYP2C9 *1/*1 + warfarin → refuses to fabricate; surfaces CPIC's "does not follow simple translation" note

The last two matter as much as the first two — the POC flags the guidelines CPIC itself marks complex (warfarin notesonusage, multi-gene lookupkey) instead of auto-deducing a wrong answer.

Slice 3 — scan (9f85c67f)

The scalability headline. 1M-patient cohort, NodeRow = key(16) + value(496) [the canon's 512-byte node]. Query "how many are CYP2C19 Poor Metabolizer?":

key column 16 MB · value column 496 MB
  key-only (prefix-route)   10063 hits   817 M rows/s · 13.1 GB/s   [touched 16 B/row]
  value    (decode slab)    10063 hits     3 M rows/s ·  1.6 GB/s   [touched 496 B/row]
  speedup  251× wall-clock   (31× memory floor: 496/16 = the value column never read)

Both scans return the identical 10,063-patient cohort (asserted) — the canon's "key prerenders with zero value decode," where the value is the bulky consultationtext that genuinely never needs decompressing to answer the cohort question.

Engineering + honest scope

  • src/lib.rs shares the GUID toolkit across all three bins; ingest refactored onto it with verified byte-identical output. All three bins clippy-clean.
  • Reproducible on the 8 committed small CPIC tables (~4 MB); the 21.8 MB diplotype table + 27 MB allele_frequency (the future value column) are gitignored / fetched separately. ingest skips the diplotype layer with a notice when absent.
  • maps_to (diplotype→phenotype) deferredfunctionphenotypeid references a separate function_phenotype table (disjoint id space, verified 0 overlap) not in the dump. reason stands in with a transparent simple allele-function rule; confidence encodes the uncertainty; the authoritative table is a one-line join when it lands.
  • Confidence weights (classification/cpiclevel → f/c) are a defensible, stated mapping — tunable, not a CPIC-published number.

Docs: cpic/docs/{INGEST,REASON,SCAN}.md + SAMPLE_GUIDS.tsv (25 curated rows showing the cascade).

🤖 Generated with Claude Code

https://claude.ai/code/session_01GJ4NVBSjq1w5h7RmTbVafb

First slice of the cpic/ POC (standalone crate, mirrors fma/): mint the
canonical 16-byte NodeGuid for every CPIC entity and wire the reasoning graph.

CPIC carries BOTH hierarchies the V3 tile wants, already in its columns:
- part_of (high byte, WHERE): gene → family → pharmacogenome partonomy.
- is_a   (low byte,  WHAT): allele.clinicalfunctionalstatus ladder, the
  metabolizer ladder, and ATC drug classes — three ready-made taxonomies.

ingest.rs maps each entity to classid (pharmacogenomics domain 0x0C:
gene/allele/diplotype/phenotype/drug/recommendation) + a (part_of:is_a)
cascade. Each HHTL tier is an 8:8 tile: high byte = FNV prefix of the part-of
distinguished name, low byte = FNV prefix of the is-a name (the same prefix
cascade the fma converge bin uses). family = gene basin; identity = per-basin
golden-ratio multiplicative mint (bijective ⇒ 0 collisions by construction).
Layout is byte-identical to lance_graph_contract::canonical_node::NodeGuid.

Edges: part_of (allele/diplotype/phenotype→gene), pair (gene→drug),
recommends (phenotype/allele-status→recommendation via lookupkey), targets
(recommendation→drug). The real abacavir decision wires end-to-end as GUID
nodes: HLA-B *57:01 positive --recommends--> [Strong] --targets--> abacavir.

Both axes route (verified output): all CYP2 alleles share part_of high bytes
c3/ec/f7; no-function alleles share is_a low byte 6f; CYP2C19*2 and CYP2D6*4
(both no-function, both CYP2) share the FULL HEEL/HIP/TWIG path — only the
family basin (gene) differs. Functional classes checked against the data.

Scale (with the diplotype table present locally): 114,410 GUIDs, 0 collisions
— 110,346 of them the combinatorial diplotype layer (N(N+1)/2 per gene), the
natural large-N target for the upcoming key-only cohort scan slice.

Honest gaps:
- diplotype→phenotype (maps_to) is DEFERRED: functionphenotypeid references a
  separate function_phenotype table (disjoint id space from gene_result.id,
  verified 0 overlap) not in this dump. One-line join once it lands.
- The 21.8MB diplotype table + 27MB allele_frequency (the future value column)
  are gitignored / fetched separately; ingest runs reproducibly on the 8
  committed small tables (skips the diplotype layer with a notice).

POC over published CPIC rules — NOT clinical decision support.

Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>
Claude-Session: https://claude.ai/code/session_01GJ4NVBSjq1w5h7RmTbVafb
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ℹ️ Review info
⚙️ Run configuration

Configuration used: Organization UI

Review profile: CHILL

Plan: Pro Plus

Run ID: 6c6cbde9-8d4d-4f77-a26f-539093089680

📥 Commits

Reviewing files that changed from the base of the PR and between f405a90 and bd6d9bf.

⛔ Files ignored due to path filters (1)
  • cpic/Cargo.lock is excluded by !**/*.lock
📒 Files selected for processing (8)
  • cpic/.gitignore
  • cpic/docs/INGEST.md
  • cpic/docs/REASON.md
  • cpic/docs/SCAN.md
  • cpic/src/bin/ingest.rs
  • cpic/src/bin/reason.rs
  • cpic/src/bin/scan.rs
  • cpic/src/lib.rs
📝 Walkthrough

Walkthrough

A new standalone Rust crate cpic/ is introduced. It adds committed CPIC JSON datasets (drugs, guidelines, gene results), a Rust binary ingest.rs that mints deterministic 16-byte NodeGuids via FNV-1a/cascade hashing across three tiers, builds a pharmacogenomic graph, and emits pgx_nodes.tsv and pgx_edges.tsv. Supporting documentation in INGEST.md describes the GUID layout and routing scheme.

Changes

CPIC PGx Ingest Pipeline

Layer / File(s) Summary
Crate scaffold and gitignore
cpic/Cargo.toml, cpic/.gitignore
Defines the isolated cpic Rust package with serde_json and release-profile optimizations; ignores build artifacts and large fetched data files.
Committed CPIC input datasets
cpic/data/guideline.json, cpic/data/gene_result.json, cpic/data/drug.json
Adds the three committed JSON input tables (29 guidelines, 101 gene-result records, 323 drug entries) with standardized schema fields consumed by the ingest binary.
NodeGuid minting foundations and documentation
cpic/docs/INGEST.md, cpic/src/bin/ingest.rs (lines 1–109)
Defines CPIC domain class IDs, FNV-1a hashing, cascade3, basin, the NodeGuid struct with canonical hex and 16-byte key16; INGEST.md documents the full GUID layout, (part_of : is_a) routing, classid domain map, edge types, and data sourcing.
Graph builder, IO, and normalization helpers
cpic/src/bin/ingest.rs (lines 110–237)
Adds NodeSpec, Graph with per-(classid,family) identity counters, Graph::add for minting and collision detection, Graph::edge for TSV rows, load, norm, alpha_prefix, and func_class.
Main ingest: entity minting for all CPIC types
cpic/src/bin/ingest.rs (lines 238–450)
Implements the full main pipeline: CLI arg parsing, then sequential minting of gene, drug, phenotype, allele, diplotype (optional, row-limited), recommendation, and pair nodes; creates part_of, targets, recommends, and pair edges with removal/absence skipping.
TSV output, summary, and routing demo
cpic/src/bin/ingest.rs (lines 452–504)
Writes pgx_nodes.tsv and pgx_edges.tsv with headers; prints minted/collision/edge counts to stderr; emits a "both axes route" demo for fixed CYP allele examples.

Sequence Diagram(s)

sequenceDiagram
  participant CLI
  participant main as ingest binary
  participant JSON as CPIC JSON files
  participant Graph as Graph builder
  participant TSV as pgx_nodes and edges TSV

  CLI->>main: data_dir, out_dir, max_diplo
  main->>JSON: load gene, drug, gene_result, allele JSON
  main->>Graph: mint gene, drug, phenotype, allele nodes via cascade3 and NodeGuid
  Graph-->>main: stored GUIDs keyed by entity id
  main->>JSON: load gene_result_diplotype.json (optional)
  main->>Graph: mint diplotype nodes up to max_diplo
  main->>JSON: load recommendation and pair JSON
  main->>Graph: mint rec nodes and add part_of, targets, recommends, pair edges
  main->>TSV: write pgx_nodes.tsv and pgx_edges.tsv
  main-->>CLI: stderr summary of minted, collisions, edges, recs
Loading

Estimated code review effort

🎯 4 (Complex) | ⏱️ ~50 minutes

Poem

🐇 A rabbit hops through gene and drug,
Minting GUIDs snug as a bug,
FNV-1a spins the hash cascade,
TSV rows in order laid.
Part_of, recommends, the edges align—
This pharmacogenomic graph is fine! 🧬

🚥 Pre-merge checks | ✅ 5
✅ Passed checks (5 passed)
Check name Status Explanation
Docstring Coverage ✅ Passed Docstring coverage is 93.33% which is sufficient. The required threshold is 80.00%.
Linked Issues check ✅ Passed Check skipped because no linked issues were found for this pull request.
Out of Scope Changes check ✅ Passed Check skipped because no linked issues were found for this pull request.
Description Check ✅ Passed Check skipped - CodeRabbit’s high-level summary is enabled.
Title check ✅ Passed The title clearly reflects the CPIC V3 ingest-focused proof of concept and the new workspace/data changes.

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Actionable comments posted: 7

🧹 Nitpick comments (1)
cpic/.gitignore (1)

3-3: 📐 Maintainability & Code Quality | 🔵 Trivial

Commit cpic/Cargo.lock. Keeping the lockfile in version control will keep dependency resolution stable for this application crate.

🤖 Prompt for AI Agents
Verify each finding against current code. Fix only still-valid issues, skip the
rest with a brief reason, keep changes minimal, and validate.

In `@cpic/.gitignore` at line 3, The .gitignore entry is excluding the application
lockfile, but this crate should keep Cargo.lock under version control for stable
dependency resolution. Remove the Cargo.lock ignore rule from the .gitignore so
the lockfile can be committed and maintained alongside the cpic package.
🤖 Prompt for all review comments with AI agents
Verify each finding against current code. Fix only still-valid issues, skip the
rest with a brief reason, keep changes minimal, and validate.

Inline comments:
In `@cpic/data/drug.json`:
- Line 24: The ATC cascade derivation in ingest should ignore placeholder ATC
values like "NA" instead of treating them as real codes. Update the logic around
the ATC branch handling in the ingestion flow, especially the code that reads
each drug’s atcid and builds the cascade, so rows with only placeholder values
are skipped before attaching to the N branch. Use the existing ingest path and
ATC processing symbols in cpic/src/bin/ingest.rs to locate the cascade-building
code and filter invalid atcid entries before classification.

In `@cpic/data/gene_result.json`:
- Around line 1-101: Add the missing phenotype entries to gene_result.json for
the guideline genes ADRA2C, ADRB1, ADRB2, COMT, CYP4F2, GRK4, GRK5, HTR2A,
IFNL3, OPRM1, SLC6A4, and VKORC1 so the downstream recommendation logic can
match them. Use the existing gene_result objects as the template for required
fields and naming conventions, and ensure each gene has the phenotype/result
rows needed by the CPIC guideline branches. Locate this in the gene_result
dataset, since the recomputation of recommends edges depends on these exact
gene/result combinations being present.

In `@cpic/docs/INGEST.md`:
- Line 7: The INGEST.md CLI example is using unsupported key=value syntax for
the ingest binary; update the example to show the actual positional arguments
accepted by the main ingest command so it can be copy-pasted and run correctly.
Use the ingest invocation in the docs snippet and replace the bracketed
`data_dir=...`, `out_dir=...`, and `max_diplotype_rows=...` form with the
positional form that matches the `ingest` CLI behavior, such as the `cargo run
--release --bin ingest -- ...` example.
- Around line 19-27: Add an explicit language to each fenced code block in
INGEST.md so markdownlint MD040 is satisfied; update the unlabeled fences in the
diagrams and other referenced sections to use an appropriate language such as
text or console. Use the existing fenced blocks in the document as the targets
and keep the rendered content unchanged apart from the fence labels.

In `@cpic/src/bin/ingest.rs`:
- Around line 239-242: The zero-argument defaults in the ingest argument parsing
are using repository-root-relative paths instead of the standalone crate’s
paths, causing `ingest` to look in the wrong place when launched from `cpic/`.
Update the defaults in `main` where `std::env::args()` populates `dir` and `out`
so they match the crate layout and docs (`data` and `out`), while keeping the
existing behavior for explicit CLI arguments and `max_diplo` parsing.
- Around line 366-367: The diplotype ingest path in ingest.rs currently hides
malformed gene_result_diplotype.json data by using unwrap_or_default() after
serde_json::from_str, which turns parse failures into an empty layer. Update the
logic around the dipath read/parsing block so a JSON parse error is treated as a
real failure and is surfaced or propagated instead of producing zero rows, while
keeping the successful path that builds rows from serde_json::from_str and the
surrounding fs::read_to_string handling intact.
- Around line 387-395: The diplotype node is being created without using the
returned NodeGuid, so the promised diplotype-to-gene part_of relationship is
never emitted. Update the NodeSpec insertion in the diplotype creation path to
capture the NodeGuid from gr.add and then add the corresponding part_of edge
back to the gene using the existing symbols around the diplotype handling in
ingest.rs. Make sure the linkage is added for each minted diplotype so traversal
and the documented edge contract stay consistent.

---

Nitpick comments:
In `@cpic/.gitignore`:
- Line 3: The .gitignore entry is excluding the application lockfile, but this
crate should keep Cargo.lock under version control for stable dependency
resolution. Remove the Cargo.lock ignore rule from the .gitignore so the
lockfile can be committed and maintained alongside the cpic package.
🪄 Autofix (Beta)

Fix all unresolved CodeRabbit comments on this PR:

  • Push a commit to this branch (recommended)
  • Create a new PR with the fixes

ℹ️ Review info
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Configuration used: Organization UI

Review profile: CHILL

Plan: Pro Plus

Run ID: 138a472a-0651-4f30-ada2-3e23cfb245af

📥 Commits

Reviewing files that changed from the base of the PR and between 6a84309 and f405a90.

⛔ Files ignored due to path filters (1)
  • cpic/docs/SAMPLE_GUIDS.tsv is excluded by !**/*.tsv
📒 Files selected for processing (12)
  • cpic/.gitignore
  • cpic/Cargo.toml
  • cpic/data/allele.json
  • cpic/data/allele_definition.json
  • cpic/data/drug.json
  • cpic/data/gene.json
  • cpic/data/gene_result.json
  • cpic/data/guideline.json
  • cpic/data/pair.json
  • cpic/data/recommendation.json
  • cpic/docs/INGEST.md
  • cpic/src/bin/ingest.rs

Comment thread cpic/data/drug.json
Comment on lines +1 to +101
[{"id":7934352,"genesymbol":"RYR1","result":"Malignant Hyperthermia Susceptibility","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has one copy of a variant [variant] associated with malignant hyperthermia susceptibility. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. Please consult a MHS specialist or contact MHAUS (https://www.mhaus.org/healthcare-professionals/) for further information.","version":2,"frequency":null},
{"id":7902722,"genesymbol":"RYR1","result":"Uncertain Susceptibility","activityscore":"n/a","ehrpriority":"Normal Risk","consultationtext":"Variation in RYR1 and/or CACNA1S genes is associated with increased risk of Malignant hyperthermia after administration of depolarizing muscle relaxants and potent volatile anesthetics. Although listed causative RYR1 variants were NOT detected in this patient, it should be noted that this finding does not absolutely rule out the possibility of malignant hyperthermia. These results should be interpreted in the context of other genetic and clinical findings, family history and other laboratory data.","version":2,"frequency":null},
{"id":7960735,"genesymbol":"SLCO1B1","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has an allele combination with unknown or uncertain function alleles. The expected phenotype for this patient cannot be determined currently based on the SLCO1B1 diplotype result. Please consult a clinical pharmacist for more specific information about how SLCO1B1 function influences drug dosing.","version":3,"frequency":{"American": 0.0, "European": 0.001279436, "Oceanian": 0.0, "East Asian": 0.007855513, "Near Eastern": 0.0, "Central/South Asian": 0.0005580649, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7960705,"genesymbol":"SLCO1B1","result":"Decreased Function","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele (*_) and one copy of a no function allele (*_). Based on the genotype result, this patient is predicted to have decreased SLCO1B1 function. This patient may be at risk for an adverse response to medications that are affected by SLCO1B1. To avoid an untoward drug response, dose adjustments may be necessary for medications affected by SLCO1B1 (i.e. statins). Please consult a clinical pharmacist for more specific information about how SLCO1B1 function influences drug dosing.","version":3,"frequency":{"American": 0.3648, "European": 0.28296122, "Oceanian": 0.0, "East Asian": 0.21842287, "Near Eastern": 0.32000002, "Central/South Asian": 0.12971397, "Sub-Saharan African": 0.054308295, "African American/Afro-Caribbean": 0.0198}},
{"id":7960784,"genesymbol":"SLCO1B1","result":"Poor Function","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a no function allele. Based on the genotype result, this patient is predicted to have low SLCO1B1 function. This patient may be at a high risk for an adverse response to medications that are affected by SLCO1B1 (i.e. statins). To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications affected by SLCO1B1. Please consult a clinical pharmacist for more specific information about how SLCO1B1 function influences drug dosing.","version":3,"frequency":{"American": 0.0576, "European": 0.02916489, "Oceanian": 0.0, "East Asian": 0.015759302, "Near Eastern": 0.040000003, "Central/South Asian": 0.004863923, "Sub-Saharan African": 0.0007803353, "African American/Afro-Caribbean": 0.00010}},
{"id":7862607,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"2.75","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0, "American": 0.0, "European": 0.0, "Oceanian": 0.0, "East Asian": 0.0, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7862713,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"2.5","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0022434974, "American": 0.0005345896, "European": 0.0003203256, "Oceanian": 0.00024761492, "East Asian": 0.00034846712, "Near Eastern": 0.005864233, "Central/South Asian": 0.00006554563, "Sub-Saharan African": 0.015329994, "African American/Afro-Caribbean": 0.01435911}},
{"id":7863151,"genesymbol":"CYP2D6","result":"Normal Metabolizer","activityscore":"1.5","ehrpriority":"Normal/Routine/ Low Risk","consultationtext":"This result signifies that this patient has [1 copy of a normal function allele (*_)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be a normal metabolizer of CYP2D6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.051568672, "American": 0.012521543, "European": 0.010339902, "Oceanian": 0.00143701, "East Asian": 0.017062929, "Near Eastern": 0.045171212, "Central/South Asian": 0.0029989334, "Sub-Saharan African": 0.23161727, "African American/Afro-Caribbean": 0.23827769}},
{"id":7961467,"genesymbol":"TPMT","result":"Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a no function allele OR two copies of a decreased function allele. Based on the genotype result this patient is predicted to be a TPMT intermediate metabolizer. This patient may be at risk for an adverse reactions to medications that are metabolized by TPMT (eg. thiopurines). To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by TPMT. However, thiopurines can be affected by a patient's TPMT and NUDT15 phenotype. Please consult a clinical pharmacist for more information about how TPMT and NUDT15 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.10125442, "European": 0.08729337, "East Asian": 0.039815668, "Near Eastern": 0.06641302, "Central/South Asian": 0.03638162, "Sub-Saharan African": 0.1010342, "African American/Afro-Caribbean": 0.06894094}},
{"id":7961893,"genesymbol":"TPMT","result":"Poor Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a no function allele. Based on the genotype result this patient is predicted to be a TPMT poor metabolizer. This patient may be at a high risk for an adverse reactions to medications that are metabolized by TPMT (eg. thiopurines). To avoid an untoward drug response, dose adjustments or or alternative therapy may be necessary for medications metabolized by TPMT. However, thiopurines can be affected by a patient's TPMT and NUDT15 phenotype. Please consult a clinical pharmacist for more information about how TPMT and NUDT16 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0028794738, "European": 0.0020956735, "East Asian": 0.00041297937, "Near Eastern": 0.0011826118, "Central/South Asian": 0.0003435882, "Sub-Saharan African": 0.002971174, "African American/Afro-Caribbean": 0.0013917874}},
{"id":7962636,"genesymbol":"TPMT","result":"Indeterminate","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of an uncertain or unknown function allele OR one copy of a decreased function allele and one copy of an uncertain or unknown function allele OR two copies of an uncertain or unknown function allele. The expected phenotype for this patient cannot be determined currently based on the TPMT diplotype result. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more specific information about how TPMT function influences drug dosing.","version":3,"frequency":{"Latino": 0.0032013063, "European": 0.0013079308, "East Asian": 0.000104039, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.06207684}},
{"id":7863187,"genesymbol":"CYP2D6","result":"Intermediate Metabolizer","activityscore":"1.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [1 copy of a normal function allele (*_)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an intermediate metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.2278144, "American": 0.21460281, "European": 0.28533316, "Oceanian": 0.077126324, "East Asian": 0.070599586, "Near Eastern": 0.14959782, "Central/South Asian": 0.17827679, "Sub-Saharan African": 0.20079781, "African American/Afro-Caribbean": 0.2080644}},
{"id":7862377,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"≥6.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0000010000001, "American": 0.0000010000001, "European": 0.0000028470035, "Oceanian": 0.0, "East Asian": 0.0000010000001, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.000025000001, "African American/Afro-Caribbean": 0.0}},
{"id":7862382,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"≥5.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.000055729302, "American": 0.00006450697, "European": 0.000058472542, "Oceanian": 0.0, "East Asian": 0.000015887783, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.00025361063, "African American/Afro-Caribbean": 0.0}},
{"id":7962752,"genesymbol":"UGT1A1","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on the UGT1A1 diplotype result. UGT1A1*80 is in very high linkage disequilibrium with *28 and *37. In the rare event that *80 is detected but *28 and *37 are not, there are not enough clinical data to predict metabolizer status with certainty. However, if only *80 is interrogated and the patient is heterozygous or homozygous for *80, an intermediate or poor metabolizer phenotype may be inferred, respectively. Please consult a clinical pharmacist for more specific information about how UGT1A1 function influences drug dosing.","version":2,"frequency":null},
{"id":7962714,"genesymbol":"UGT1A1","result":"Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele (*1) OR one copy of an increased function allele (*36), AND and one copy of a decreased function allele (*_). Based on the genotype result this patient is predicted to be an intermediate metabolizer of UGT1A1 substrates. There is no reason to selectively adjust the dose of most medications that inhibit or are inactivated by UGT1A1. Please consult a clinical pharmacist for more information about how UGT1A1 metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7962707,"genesymbol":"UGT1A1","result":"Normal Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele (*1) OR one copy of a normal function allele (*1) and one copy of an increased function allele (*36) OR two copies of an increased function allele (*36). Based on the genotype result this patient is predicted to be an normal metabolizer of UGT1A1 substrates. There is no reason to selectively adjust the dose of most medications that inhibit or are inactivated by UGT1A1. Please consult a clinical pharmacist for more information about how UGT1A1 metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7962729,"genesymbol":"UGT1A1","result":"Poor Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of decreased function alleles (*_ and *_). Based on the genotype result this patient is predicted to be a poor metabolizer of UGT1A1 substrates. This patient may be at risk for an adverse or poor response to medications that inhibit or are inactivated by UGT1A1. Based on the genotype result, this patient is predicted to have low UGT1A1 function, which is generally indicative of Gilbert syndrome. This patient may be at high risk for toxicity from select medications that inhibit or are inactivated by UGT1A1. Please consult a clinical pharmacist for more information about how UGT1A1 metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7862462,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"≥3.25","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.00018561553, "American": 0.00009731066, "European": 0.00046782166, "Oceanian": 0.0, "East Asian": 0.0009120896, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.000952962, "African American/Afro-Caribbean": 0.0}},
{"id":7862584,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"4.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0007764387, "American": 0.0010402872, "European": 0.0003002313, "Oceanian": 0.014133941, "East Asian": 0.000063105406, "Near Eastern": 0.0041771694, "Central/South Asian": 0.00016144973, "Sub-Saharan African": 0.0006431835, "African American/Afro-Caribbean": 0.0007742127}},
{"id":7862793,"genesymbol":"CYP2D6","result":"Normal Metabolizer","activityscore":"2.25","ehrpriority":"Normal/Routine/ Low Risk","consultationtext":"This result signifies that this patient has two copies of a normal function allele (*_x2) and one copy of decreased function allele with an activity value of 0.25 (*_). Based on the genotype result this patient is predicted to be a normal metabolizer of CYP2D6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.005172111, "American": 0.0031386076, "European": 0.004804125, "Oceanian": 0.021296859, "East Asian": 0.0072455397, "Near Eastern": 0.029094387, "Central/South Asian": 0.005050826, "Sub-Saharan African": 0.0048336256, "African American/Afro-Caribbean": 0.004428509}},
{"id":7862861,"genesymbol":"CYP2D6","result":"Normal Metabolizer","activityscore":"2.0","ehrpriority":"Normal/Routine/ Low Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be a normal metabolizer of CYP2D6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.42007107, "American": 0.57988566, "European": 0.32166475, "Oceanian": 0.48931405, "East Asian": 0.1527359, "Near Eastern": 0.2670007, "Central/South Asian": 0.34187043, "Sub-Saharan African": 0.15406683, "African American/Afro-Caribbean": 0.22171879}},
{"id":7863154,"genesymbol":"CYP2D6","result":"Normal Metabolizer","activityscore":"1.75","ehrpriority":"Normal/Routine/ Low Risk","consultationtext":"This result signifies that this patient has three copies of *41 (*41x3) and one copy of a normal function allele (*_) or [2 copies of a decreased function allele with an activity value of 0.5 (*_x2)]. Based on the genotype result this patient is predicted to be a normal metabolizer of CYP2D6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0, "American": 0.0, "European": 0.0, "Oceanian": 0.0, "East Asian": 0.0, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7863172,"genesymbol":"CYP2D6","result":"Normal Metabolizer","activityscore":"1.25","ehrpriority":"Normal/Routine/ Low Risk","consultationtext":"This result signifies that this patient has [1 copy of a normal function allele (*_)] or [2 copies of a decreased function allele with an activity value of 0.5 (*_x2)] and [1 copy of a decreased function allele with an activity value of 0.25 (*_)] OR *41x3 and [1 copy of a decreased function allele with an activity value of 0.5 (*_)] or [2 copies of a decreased function allele with an activity value of 0.25 (*_x2)]. Based on the genotype result this patient is predicted to be a normal metabolizer of CYP2D6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.11888533, "American": 0.07351474, "European": 0.15507403, "Oceanian": 0.12359433, "East Asian": 0.3547828, "Near Eastern": 0.22410923, "Central/South Asian": 0.23109229, "Sub-Saharan African": 0.073030114, "African American/Afro-Caribbean": 0.07348749}},
{"id":7863200,"genesymbol":"CYP2D6","result":"Intermediate Metabolizer","activityscore":"0.75","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has has three copies of *41 (*41x3) and one copy of a no function allele (*_) OR [1 copy of a decreased function allele with an activity value of 0.25 (*_)] and [1 copy of a decreased function allele with an activity value of 0.5 (*_)] or [2 copies of a decreased function allele with an activity value of 0.25 (*_x2)] . Based on the genotype result this patient is predicted to be an intermediate metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0074723335, "American": 0.00080644403, "European": 0.0025628314, "Oceanian": 0.00018655165, "East Asian": 0.020004882, "Near Eastern": 0.02042247, "Central/South Asian": 0.0010252715, "Sub-Saharan African": 0.05760366, "African American/Afro-Caribbean": 0.041067164}},
{"id":7864778,"genesymbol":"CYP2D6","result":"Intermediate Metabolizer","activityscore":"0.5","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [1 copy of a decreased function allele with an activity value of 0.5 (*_)] or [2 copies of a decreased function allele with an activity value of 0.25 (*_x2)] and one copy of a no function allele (*_) OR two copies for a decreased function allele with an activity value of 0.25 (*_/*_). Based on the genotype result this patient is predicted to be an intermediate metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.022830304, "American": 0.0047207433, "European": 0.023932345, "Oceanian": 0.008138877, "East Asian": 0.21193053, "Near Eastern": 0.06410619, "Central/South Asian": 0.040293686, "Sub-Saharan African": 0.0954133, "African American/Afro-Caribbean": 0.08539959}},
{"id":7866001,"genesymbol":"CYP2D6","result":"Poor Metabolizer","activityscore":"0.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a no function allele (*_/*_). Based on the genotype result this patient is predicted to be a poor metabolizer of CYP2D6 substrates. This patient may be at a high risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by the CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0311798, "American": 0.020160662, "European": 0.065024786, "Oceanian": 0.0031239481, "East Asian": 0.008123729, "Near Eastern": 0.021957064, "Central/South Asian": 0.023507897, "Sub-Saharan African": 0.020398295, "African American/Afro-Caribbean": 0.023474354}},
{"id":7962766,"genesymbol":"HLA-A","result":"*31:01 negative","activityscore":"n/a","ehrpriority":"Routine/Low-Risk","consultationtext":"The HLA-A*31:01 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-A*31:01 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information.","version":1,"frequency":null},
{"id":7962769,"genesymbol":"HLA-A","result":"*31:01 positive","activityscore":"n/a","ehrpriority":"Priority/High-Risk","consultationtext":"This result signifies that the patient has one or two copies of HLA-A*31:01. Patients with this genotype are at increased risk of severe cutaneous adverse reactions, including Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and maculopapular exanthema (MPE), with certain aromatic anticonvulsants (e.g., carbamazepine). Alternative therapy may be warranted. Please consult a clinical pharmacist for more information.","version":1,"frequency":null},
{"id":7960700,"genesymbol":"SLCO1B1","result":"Increased Function","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of an increased function allele. Based on the genotype result, this patient is predicted to have increased SLCO1B1 function. This means that there is no reason to adjust the dose of most medications that are affected by SLCO1B1 on the basis of SLCO1B1 genetic status at this time. Please consult a clinical pharmacist for more specific information about how SLCO1B1 function influences drug dosing.","version":3,"frequency":{"American": 0.0, "European": 0.029916462, "Oceanian": 0.0, "East Asian": 0.0, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7960729,"genesymbol":"SLCO1B1","result":"Normal Function","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele. Based on the genotype result, this patient is predicted to have normal SLCO1B1 function. This means that there is no reason to adjust the dose of most medications that are affected by SLCO1B1 on the basis of SLCO1B1 genetic status. Please consult a clinical pharmacist for more specific information about how SLCO1B1 function influences drug dosing.","version":3,"frequency":{"American": 0.5776, "European": 0.6564144, "Oceanian": 1.0, "East Asian": 0.75683165, "Near Eastern": 0.64000005, "Central/South Asian": 0.8648222, "Sub-Saharan African": 0.94491136, "African American/Afro-Caribbean": 0.98010004}},
{"id":7960879,"genesymbol":"SLCO1B1","result":"Possible Decreased Function","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a uncertain or unknown function allele (*_) and one copy of a no function allele (*_). Based on the genotype result, this patient is predicted to have possible decreased SLCO1B1 function. This patient may be at risk for an adverse response to medications that are affected by SLCO1B1. To avoid an untoward drug response, dose adjustments may be necessary for medications affected by SLCO1B1 (i.e. statins). Please consult a clinical pharmacist for more specific information about how SLCO1B1 function influences drug dosing.","version":3,"frequency":{"American": 0.0, "European": 0.00026362084, "Oceanian": 0.0, "East Asian": 0.0011306308, "Near Eastern": 0.0, "Central/South Asian": 0.0000418451, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7962772,"genesymbol":"HLA-B","result":"*15:02 negative","activityscore":"n/a","ehrpriority":"Routine/Low-Risk","consultationtext":"The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information.","version":1,"frequency":null},
{"id":7962775,"genesymbol":"HLA-B","result":"*15:02 positive","activityscore":"n/a","ehrpriority":"Priority/High-Risk","consultationtext":"This result signifies that the patient has one or two copies of HLA-B*15:02. Patients with this genotype are at increased risk of severe cutaneous adverse reactions, including Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), with certain aromatic anticonvulsants (e.g., carbamazepine, oxcarbazepine, phenytoin/fosphenytoin). Alternative therapy may be warranted. Please consult a clinical pharmacist for more information.","version":1,"frequency":null},
{"id":7962778,"genesymbol":"HLA-B","result":"*57:01 negative","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"The HLA-B*57:01 allele, associated with abacavir hypersensitivity, was not detected in this patient. The patient may be prescribed abacavir. Please refer to the hospital formulary guidelines for specific dosing information. It should be noted that a negative HLA-B*57:01 result does not absolutely rule out the possibility of some form of abacavir hypersensitivity. Administration of abacavir therapy requires close observation including immediate discontinuation of therapy should any signs or symptoms of hypersensitivity develop.","version":1,"frequency":null},
{"id":7962781,"genesymbol":"HLA-B","result":"*57:01 positive","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"The HLA-B*57:01 allele, associated with abacavir hypersensitivity, was detected in this patient. HLA-B*5701 positive patients should NOT be prescribed abacavir.","version":1,"frequency":null},
{"id":7962784,"genesymbol":"HLA-B","result":"*58:01 negative","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"The HLA-B*58:01 allele, associated with allopurinol hypersensitivity, was not detected in this patient. Allopurinol can be used per standard dosing guidelines. Patients should be monitored closely for any signs of sensitivity reactions, especially those patients receiving allopurinol (of >300 mg/day), concomitant medications (i.e. thiazide diuretics or penicillin/cephalosporin) or with medical conditions (i.e. chronic kidney disease) that increase the non-genetic risk for allopurinol-related hypersensitivity reactions.","version":1,"frequency":null},
{"id":7962787,"genesymbol":"HLA-B","result":"*58:01 positive","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"The HLA-B*58:01 allele, associated with allopurinol hypersensitivity, was detected in this patient. Allopurinol is contraindicated.","version":1,"frequency":null},
{"id":7961462,"genesymbol":"TPMT","result":"Normal Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele OR one copy of a normal function allele and one copy of a decreased function allele. Based on the genotype result this patient is predicted to be a TPMT normal metabolizer. There is no reason to selectively adjust the dose of most medications that are metabolized by TPMT. However, thiopurines can be affected by a patient's TPMT and NUDT15 phenotype. Please consult a clinical pharmacist for more information about how TPMT and NUDT15 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.8923553, "European": 0.90923065, "East Asian": 0.9596651, "Near Eastern": 0.93240434, "Central/South Asian": 0.96327126, "Sub-Saharan African": 0.8933782, "African American/Afro-Caribbean": 0.8646596}},
{"id":7961509,"genesymbol":"TPMT","result":"Possible Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of an uncertain or unknown function allele and one copy of a no function allele OR one copy of a no function allele and one copy of a decreased function allele. Based on the genotype result this patient has a priority result (TPMT possible intermediate metabolizer) because their activity is not likely to be any higher than that of an intermediate metabolizer; if the uncertain/unknown function allele is also low, activity may be even lower than that of an intermediate metabolizer. This patient may be at risk for an adverse reactions to medications that are metabolized by TPMT (eg. thiopurines). To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by TPMT. However, thiopurines can be affected by a patient's TPMT and NUDT15 phenotype. Please consult a clinical pharmacist for more information about how TPMT and NUDT15metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0003095076, "European": 0.00007234227, "East Asian": 0.0000021581852, "Near Eastern": 0.0, "Central/South Asian": 0.0000034757581, "Sub-Saharan African": 0.0026164071, "African American/Afro-Caribbean": 0.0029308118}},
{"id":7859105,"genesymbol":"CYP2C19","result":"Poor Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a no function allele. Based on the genotype result this patient is predicted to be a poor metabolizer of CYP2C19 substrates. This patient may be at a high risk for an adverse or poor response to medications that are metabolized by CYP2C19. To avoid an untoward drug response, dose adjustments or or alternative therapy may be necessary for medications metabolized by the CYP2C19. Please consult a clinical pharmacist for more information about how CYP2C19 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.011408395, "American": 0.014819587, "European": 0.02387743, "Oceanian": 0.5713864, "East Asian": 0.12978691, "Near Eastern": 0.018584846, "Central/South Asian": 0.08156806, "Sub-Saharan African": 0.036714304, "African American/Afro-Caribbean": 0.040512204}},
{"id":7852135,"genesymbol":"ABCG2","result":"Poor Function","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a decreased function allele. Based on the genotype result, this patient is predicted to have poor ABCG2 function. This patient may be at a high risk for an adverse response to medications that are affected by ABCG2 (i.e. statins). To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications affected by ABCG2. Please consult a clinical pharmacist for more specific information about how ABCG2 function influences drug dosing.","version":3,"frequency":{"Latino": 0.05035536, "American": 0.040000003, "European": 0.010732961, "Oceanian": 0.0419122, "East Asian": 0.09431041, "Near Eastern": 0.00426409, "Central/South Asian": 0.00868624, "Sub-Saharan African": 0.000034175762, "African American/Afro-Caribbean": 0.0012156549}},
{"id":7852138,"genesymbol":"ABCG2","result":"Decreased Function","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a no decreased allele . Based on the genotype result, this patient is predicted to have decreased ABCG2 function. This patient may be at risk for an adverse response to medications that are affected by ABCG2. To avoid an untoward drug response, dose adjustments may be necessary for medications affected by ABCG2 (i.e. statins). Please consult a clinical pharmacist for more specific information about how ABCG2 function influences drug dosing.","version":3,"frequency":{"Latino": 0.34808928, "American": 0.32000002, "European": 0.18573408, "Oceanian": 0.32562497, "East Asian": 0.4255792, "Near Eastern": 0.122071825, "Central/South Asian": 0.1690275, "Sub-Saharan African": 0.011623656, "African American/Afro-Caribbean": 0.06730118}},
{"id":7852141,"genesymbol":"ABCG2","result":"Normal Function","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele. Based on the genotype result, this patient is predicted to have normal ABCG2 function. This means that there is no reason to adjust the dose of most medications that are affected by ABCG2 on the basis of ABCG2 genetic status. Please consult a clinical pharmacist for more specific information about how ABCG2 function influences drug dosing.","version":3,"frequency":{"Latino": 0.6015554, "American": 0.64000005, "European": 0.8035329, "Oceanian": 0.63246274, "East Asian": 0.4801104, "Near Eastern": 0.87366414, "Central/South Asian": 0.8222862, "Sub-Saharan African": 0.9883421, "African American/Afro-Caribbean": 0.9314832}},
{"id":7852144,"genesymbol":"CACNA1S","result":"Malignant Hyperthermia Susceptibility","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has one copy of a variant [variant] associated with malignant hyperthermia susceptibility. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. Please consult a MHS specialist or contact MHAUS (https://www.mhaus.org/healthcare-professionals/) for further information.","version":2,"frequency":null},
{"id":7852152,"genesymbol":"CACNA1S","result":"Uncertain Susceptibility","activityscore":"n/a","ehrpriority":"Normal Risk","consultationtext":"Variation in RYR1 and/or CACNA1S genes is associated with increased risk of Malignant hyperthermia after administration of depolarizing muscle relaxants and potent volatile anesthetics. Although listed causative CACNA1S variants were NOT detected in this patient, it should be noted that this finding does not absolutely rule out the possibility of malignant hyperthermia. These results should be interpreted in the context of other genetic and clinical findings, family history and other laboratory data.","version":2,"frequency":null},
{"id":7852155,"genesymbol":"CFTR","result":"ivacaftor responsive in CF patients","activityscore":"n/a","ehrpriority":null,"consultationtext":null,"version":1,"frequency":null},
{"id":7857617,"genesymbol":"CFTR","result":"ivacaftor non-responsive in CF patients","activityscore":"n/a","ehrpriority":null,"consultationtext":null,"version":1,"frequency":null},
{"id":7857813,"genesymbol":"CYP2B6","result":"Poor Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a no function allele OR two copies of a decreased function allele OR one copy of a no function allele and one copy of a decreased function allele. Based on the genotype result this patient is predicted to be a poor metabolizer of CYP2B6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2B6. To avoid an untoward drug response, dose adjustments or or alternative therapy may be necessary for medications metabolized by CYP2B6. Please consult a clinical pharmacist for more information about how CYP2B6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.09452413, "European": 0.07428478, "Oceanian": 0.4096, "East Asian": 0.0436291, "Near Eastern": 0.127449, "Central/South Asian": 0.059536003, "Sub-Saharan African": 0.23673655, "African American/Afro-Caribbean": 0.15714757}},
{"id":7858070,"genesymbol":"CYP2B6","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on the CYP2B6 diplotype result. Please consult a clinical pharmacist for more specific information about how CYP2B6 function influences drug dosing.","version":3,"frequency":{"Latino": 0.013596146, "European": 0.06145065, "Oceanian": 0.0, "East Asian": 0.020025712, "Near Eastern": 0.0, "Central/South Asian": 0.014973663, "Sub-Saharan African": 0.25210795, "African American/Afro-Caribbean": 0.031204166}},
{"id":7857620,"genesymbol":"CYP2B6","result":"Ultrarapid Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of increased function alleles. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2B6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2B6. Please consult a clinical pharmacist for more information about how CYP2B6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.011284955, "European": 0.0016704409, "Oceanian": 0.0, "East Asian": 0.007088209, "Near Eastern": 0.010816, "Central/South Asian": 0.009801, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.000106068765}},
{"id":7857623,"genesymbol":"CYP2B6","result":"Rapid Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of an increased function allele. Based on the genotype result this patient is predicted to be a rapid metabolizer of CYP2B6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2B6. Please consult a clinical pharmacist for more information about how CYP2B6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.1231214, "European": 0.05357082, "Oceanian": 0.0, "East Asian": 0.11734093, "Near Eastern": 0.112112, "Central/South Asian": 0.12859802, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.011896482}},
{"id":7857631,"genesymbol":"CYP2B6","result":"Normal Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of normal function alleles. Based on the genotype result this patient is predicted to be an normal metabolizer of CYP2B6 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2B6. Please consult a clinical pharmacist for more information about how CYP2B6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.33582056, "European": 0.42950228, "Oceanian": 0.12960002, "East Asian": 0.48562673, "Near Eastern": 0.29052103, "Central/South Asian": 0.42183065, "Sub-Saharan African": 0.14307445, "African American/Afro-Caribbean": 0.333572}},
{"id":7857654,"genesymbol":"CYP2B6","result":"Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a no function allele OR one copy of a normal function allele and one copy of a decreased function allele OR one copy of an increased function allele and one copy of a no function allele OR one copy of an increased function allele and one copy of a decreased function allele. Based on the genotype result this patient is predicted to be an intermediate metabolizer of CYP2B6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2B6. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by CYP2B6. Please consult a clinical pharmacist for more information about how CYP2B6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.42165288, "European": 0.37952113, "Oceanian": 0.46080005, "East Asian": 0.32628936, "Near Eastern": 0.459102, "Central/South Asian": 0.36526063, "Sub-Saharan African": 0.36808127, "African American/Afro-Caribbean": 0.4660738}},
{"id":7859031,"genesymbol":"CYP2C19","result":"Likely Poor Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a decreased function allele and one copy of a no function allele. Based on the genotype result this patient MAY be a poor metabolizer of CYP2C19 substrates. This patient may be at a high risk for an adverse or poor response to medications that are metabolized by CYP2C19. To avoid an untoward drug response, dose adjustments or or alternative therapy may be necessary for medications metabolized by the CYP2C19. Please consult a clinical pharmacist for more information about how CYP2C19 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0004440685, "American": 0.0, "European": 0.00020405183, "Oceanian": 0.0, "East Asian": 0.0004349198, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.010332189, "African American/Afro-Caribbean": 0.007090685}},
{"id":7858932,"genesymbol":"CYP2C19","result":"Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a no function allele OR one copy of an increased function and one copy of a no function allele. Based on the genotype result this patient is predicted to be an intermediate metabolizer of CYP2C19 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2C19. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by CYP2C19. Please consult a clinical pharmacist for more information about how CYP2C19 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.19035932, "American": 0.21383229, "European": 0.26108757, "Oceanian": 0.36902928, "East Asian": 0.45928204, "Near Eastern": 0.2354828, "Central/South Asian": 0.40806636, "Sub-Saharan African": 0.29945874, "African American/Afro-Caribbean": 0.31398684}},
{"id":7859185,"genesymbol":"CYP2C19","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on the CYP2C19 diplotype result. Please consult a clinical pharmacist for more specific information about how CYP2C19 function influences drug dosing.","version":3,"frequency":{"Latino": 0.0, "American": 0.0, "European": 0.0, "Oceanian": 0.0, "East Asian": 0.0034064606, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0022393465}},
{"id":7858829,"genesymbol":"CYP2C19","result":"Normal Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele. Based on the genotype result this patient is predicted to be an normal metabolizer of CYP2C19 substrates. There is no reason to selectively adjust the dose of most medications that are metabolized by CYP2C19. Please consult a clinical pharmacist for more information about how CYP2C19 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.5249766, "American": 0.62755567, "European": 0.39611652, "Oceanian": 0.035006005, "East Asian": 0.38055435, "Near Eastern": 0.45192146, "Central/South Asian": 0.29552925, "Sub-Saharan African": 0.36977687, "African American/Afro-Caribbean": 0.32805592}},
{"id":7858859,"genesymbol":"CYP2C19","result":"Likely Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a decreased function allele OR one copy of an increased function allele and one copy of a decreased function allele OR two copies of a decreased function allele. Based on the genotype result this patient MAY be an intermediate metabolizer of CYP2C19 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2C19. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by CYP2C19. Please consult a clinical pharmacist for more information about how CYP2C19 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.003709162, "American": 0.0, "European": 0.0011160374, "Oceanian": 0.0, "East Asian": 0.00076989824, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.042863965, "African American/Afro-Caribbean": 0.027788177}},
{"id":7858817,"genesymbol":"CYP2C19","result":"Ultrarapid Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of an increased function allele. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2C19 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2C19. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by CYP2C19. Please consult a clinical pharmacist for more information about how CYP2C19 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.02774172, "American": 0.0074097984, "European": 0.04641379, "Oceanian": 0.003249, "East Asian": 0.00042194634, "Near Eastern": 0.036642652, "Central/South Asian": 0.029163336, "Sub-Saharan African": 0.030045323, "African American/Afro-Caribbean": 0.042943195}},
{"id":7858820,"genesymbol":"CYP2C19","result":"Rapid Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of an increased function allele. Based on the genotype result this patient is predicted to be a rapid metabolizer of CYP2C19 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2C19. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by CYP2C19. Please consult a clinical pharmacist for more information about how CYP2C19 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.24136075, "American": 0.13638271, "European": 0.2711846, "Oceanian": 0.021329276, "East Asian": 0.025343522, "Near Eastern": 0.2573682, "Central/South Asian": 0.18567303, "Sub-Saharan African": 0.21080859, "African American/Afro-Caribbean": 0.2373838}},
{"id":7860183,"genesymbol":"CYP2C9","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on the CYP2C9 diplotype result. Please consult a clinical pharmacist for more specific information about how CYP2C9 function influences drug dosing.","version":3,"frequency":{"Latino": 0.0009997501, "American": 0.0, "European": 0.00059991, "Oceanian": 0.0, "East Asian": 0.0046076896, "Near Eastern": 0.0, "Central/South Asian": 0.0037963898, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7859506,"genesymbol":"CYP2C9","result":"Normal Metabolizer","activityscore":"2.0","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele. Based on the genotype result, this patient is predicted to be a CYP2C9 Normal metabolizer. Based only on the CYP2C9 genotype, there is no reason to adjust the dose of most medications that are affected by CYP2C9. Please consult a clinical pharmacist for more specific information about how CYP2C9 function influences drug dosing.","version":3,"frequency":{"Latino": 0.74342215, "American": 0.83149743, "European": 0.62845254, "Oceanian": 0.9122409, "East Asian": 0.8378542, "Near Eastern": 0.61125296, "Central/South Asian": 0.5961676, "Sub-Saharan African": 0.73114437, "African American/Afro-Caribbean": 0.75866354}},
{"id":7859511,"genesymbol":"CYP2C9","result":"Intermediate Metabolizer","activityscore":"1.5","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a decreased function allele. Based on the genotype result, this patient is predicted to be a CYP2C9 intermediate metabolizer (activity score of 1.5). This patient may be at risk for an adverse response to medications that are affected by CYP2C9. Please consult a clinical pharmacist for more specific information about how CYP2C9 intermediate metabolizer status influences drug dosing.","version":3,"frequency":{"Latino": 0.1647683, "American": 0.10592343, "European": 0.20758142, "Oceanian": 0.05599055, "East Asian": 0.052658077, "Near Eastern": 0.2097067, "Central/South Asian": 0.17885593, "Sub-Saharan African": 0.21372117, "African American/Afro-Caribbean": 0.1863267}},
{"id":7859555,"genesymbol":"CYP2C9","result":"Intermediate Metabolizer","activityscore":"1.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a no function allele OR two copies of decreased function alleles. Based on the genotype result, this patient is predicted to be a CYP2C9 intermediate metabolizer (activity score of 1). This patient may be at risk for an adverse response to medications that are affected by CYP2C9. Please consult a clinical pharmacist for more specific information about how CYP2C9 intermediate metabolizer status influences drug dosing.","version":3,"frequency":{"Latino": 0.08109343, "American": 0.05818467, "European": 0.13767911, "Oceanian": 0.03061276, "East Asian": 0.098925985, "Near Eastern": 0.1494271, "Central/South Asian": 0.18352722, "Sub-Saharan African": 0.049747862, "African American/Afro-Caribbean": 0.049812526}},
{"id":7859815,"genesymbol":"CYP2C9","result":"Poor Metabolizer","activityscore":"0.5","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a decreased function allele and one copy of a no function allele. Based on the genotype result, this patient is predicted to be a CYP2C9 poor metabolizer. This patient may be at high risk for an adverse response to medications that are affected by CYP2C9. Please consult a clinical pharmacist for more specific information about how CYP2C9 intermediate metabolizer status influences drug dosing.","version":3,"frequency":{"Latino": 0.007974847, "American": 0.0034911723, "European": 0.019907156, "Oceanian": 0.0009130932, "East Asian": 0.0030826868, "Near Eastern": 0.022547128, "Central/South Asian": 0.025517693, "Sub-Saharan African": 0.0049882242, "African American/Afro-Caribbean": 0.004712071}},
{"id":7860090,"genesymbol":"CYP2C9","result":"Poor Metabolizer","activityscore":"0.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of no function alleles. Based on the genotype result, this patient is predicted to be a CYP2C9 poor metabolizer. This patient may be at high risk for an adverse response to medications that are affected by CYP2C9. Please consult a clinical pharmacist for more specific information about how CYP2C9 intermediate metabolizer status influences drug dosing.","version":3,"frequency":{"Latino": 0.0017415384, "American": 0.00090327376, "European": 0.0057798154, "Oceanian": 0.00024261088, "East Asian": 0.0028714235, "Near Eastern": 0.007066085, "Central/South Asian": 0.012135133, "Sub-Saharan African": 0.0003982905, "African American/Afro-Caribbean": 0.00048520204}},
{"id":7862400,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"≥4.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0012809848, "American": 0.0015109289, "European": 0.0018874556, "Oceanian": 0.0, "East Asian": 0.0007779561, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0038317435, "African American/Afro-Caribbean": 0.0}},
{"id":7862396,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"≥3.75","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0, "American": 0.0, "European": 0.0, "Oceanian": 0.0, "East Asian": 0.0, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7862434,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"≥3.5","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.00008051411, "American": 0.00001657463, "European": 0.000031193038, "Oceanian": 0.0, "East Asian": 0.00004386605, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0030223487, "African American/Afro-Caribbean": 0.0}},
{"id":7862486,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"≥3.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.00035315607, "American": 0.0002839765, "European": 0.0008605249, "Oceanian": 0.0, "East Asian": 0.00018026348, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.001428226, "African American/Afro-Caribbean": 0.0}},
{"id":7867179,"genesymbol":"CYP2D6","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on the CYP2D6 diplotype result. Please consult a clinical pharmacist for more specific information about how CYP2D6 function influences drug dosing.","version":3,"frequency":{"Latino": 0.041558996, "American": 0.02454997, "European": 0.03725156, "Oceanian": 0.087338224, "East Asian": 0.066782884, "Near Eastern": 0.03744279, "Central/South Asian": 0.09993659, "Sub-Saharan African": 0.09009597, "African American/Afro-Caribbean": 0.038868744}},
{"id":7862615,"genesymbol":"CYP2D6","result":"Ultrarapid Metabolizer","activityscore":"3.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has [X copies of a normal function allele (*_xN)] [X copies of a decreased function allele (*_)] [X copies of a no function allele (*_)]. Based on the genotype result this patient is predicted to be an ultrarapid metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.035694193, "American": 0.048732717, "European": 0.019382542, "Oceanian": 0.16405001, "East Asian": 0.006179998, "Near Eastern": 0.06435209, "Central/South Asian": 0.014773737, "Sub-Saharan African": 0.019435417, "African American/Afro-Caribbean": 0.025694855}},
{"id":7865471,"genesymbol":"CYP2D6","result":"Intermediate Metabolizer","activityscore":"0.25","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that this patient has one copy of a decreased function allele with an activity value of 0.25 (*_) and one copy of a no function allele (*_). Based on the genotype result this patient is predicted to be an intermediate metabolizer of CYP2D6 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by CYP2D6. To avoid an untoward drug response, dose adjustments may be necessary for medications metabolized by CYP2D6. Please consult a clinical pharmacist for more information about how CYP2D6 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.03277562, "American": 0.0138169695, "European": 0.07070104, "Oceanian": 0.010012345, "East Asian": 0.08220821, "Near Eastern": 0.06670452, "Central/South Asian": 0.060946763, "Sub-Saharan African": 0.027220901, "African American/Afro-Caribbean": 0.024385082}},
{"id":7879280,"genesymbol":"CYP3A5","result":"Normal Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele. Patients with this genotype are expected to require higher starting tacrolimus dosing (1.5 times to 2 times the standard dose-maximum starting dose not to exceed 0.3mg/kg/day). Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function). Please consult a clinical pharmacist for more specific dosing information.","version":3,"frequency":{"Latino": 0.029857205, "European": 0.005491413, "East Asian": 0.064288594, "Near Eastern": 0.014869832, "Central/South Asian": 0.106746115, "Sub-Saharan African": 0.22983262, "African American/Afro-Caribbean": 0.20507748}},
{"id":7879283,"genesymbol":"CYP3A5","result":"Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a no function allele. Patients with this genotype are expected to require higher starting tacrolimus dosing (1.5 times to 2 times the standard dose-maximum starting dose not to exceed 0.3mg/kg/day). Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function). Please consult a clinical pharmacist for more specific dosing information.","version":3,"frequency":{"Latino": 0.28587034, "European": 0.13722531, "East Asian": 0.37852672, "Near Eastern": 0.21414419, "Central/South Asian": 0.43994826, "Sub-Saharan African": 0.499152, "African American/Afro-Caribbean": 0.4955547}},
{"id":7879288,"genesymbol":"CYP3A5","result":"Poor Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a no function allele. Patients with this genotype are expected to require standard tacrolimus dosing. Please consult a clinical pharmacist for more specific dosing information.","version":3,"frequency":{"Latino": 0.68427247, "European": 0.85728335, "East Asian": 0.5571847, "Near Eastern": 0.770986, "Central/South Asian": 0.45330563, "Sub-Saharan African": 0.2710154, "African American/Afro-Caribbean": 0.2993679}},
{"id":7879296,"genesymbol":"CYP3A5","result":"Possible Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of an uncertain or unknown function allele. Patients with this genotype are expected to require higher starting tacrolimus dosing (1.5 times to 2 times the standard dose-maximum starting dose not to exceed 0.3mg/kg/day). Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function). Please consult a clinical pharmacist for more specific dosing information.","version":3,"frequency":{"Latino": 0.0, "European": 0.0, "East Asian": 0.0, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7879300,"genesymbol":"CYP3A5","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on the CYP3A5 diplotype result. Please consult a clinical pharmacist for more specific information about how CYP3A5 function influences drug dosing.","version":3,"frequency":{"Latino": 0.0, "European": 0.0, "East Asian": 0.0, "Near Eastern": 0.0, "Central/South Asian": 0.0, "Sub-Saharan African": 0.0, "African American/Afro-Caribbean": 0.0}},
{"id":7879312,"genesymbol":"DPYD","result":"Normal Metabolizer","activityscore":"2.0","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of normal function DPYD alleles. Based on the genotype result this patient is predicted to be DPYD Normal Metabolizer with a DPYD activity score of 2. For this genotype, no selective dose adjustment is indicated for medications that are metabolized by DPD. Please consult a clinical pharmacist for more information about how DPD metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7880910,"genesymbol":"DPYD","result":"Intermediate Metabolizer","activityscore":"1.5","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a decreased function allele of the DPYD gene. Based on the genotype result this patient is predicted to be a DPYD Intermediate Metabolizer with a DPYD activity score of 1.5. This patient may be at risk for adverse drug reactions to medications that are metabolized by DPD (i.e. 5-fluorouracil, capecitabine, and tegafur) and a dose adjustment may be indicated. Please consult a clinical pharmacist for more information about how DPD metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7881304,"genesymbol":"DPYD","result":"Intermediate Metabolizer","activityscore":"1.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has either one copy of a normal function allele and one copy of a no function allele of the DPYD gene OR two copies of decreased function alleles of the DPYD gene. Based on the genotype result this patient is predicted to be a DPYD Intermediate Metabolizer with a DPYD activity score of 1. This patient may be at risk for adverse drug reactions to medications that are metabolized by DPD (i.e. 5-fluorouracil, capecitabine, and tegafur) and a dose adjustment may be indicated. Please consult a clinical pharmacist for more information about how DPD metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7882511,"genesymbol":"DPYD","result":"Poor Metabolizer","activityscore":"0.5","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a decreased function allele and one copy of a no function allele of the DPYD gene. Based on the genotype result this patient is predicted to be a DPYD Poor Metabolizer with a DPYD activity score of 0.5. This patient may be at risk for adverse drug reactions to medications that are metabolized by DPD (i.e. 5-fluorouracil, capecitabine, and tegafur) and a dose adjustment or alternative therapeutic agents may be indicated. Please consult a clinical pharmacist for more information about how DPD metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7882660,"genesymbol":"DPYD","result":"Poor Metabolizer","activityscore":"0.0","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of no function alleles of the DPYD gene. Based on the genotype result this patient is predicted to be a DPYD Poor Metabolizer with a DPYD activity score of 0. This patient may be at risk for adverse drug reactions to medications that are metabolized by DPD (i.e. 5-fluorouracil, capecitabine, and tegafur) and alternative therapeutic agents may be indicated. Please consult a clinical pharmacist for more information about how DPD metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7882900,"genesymbol":"G6PD","result":"Deficient","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"Based on the genotype result, this patient is predicted to be G6PD deficient and is at risk for developing hemolytic anemia when exposed to certain medications (such as dapsone, methylene blue, pegloticase, primaquine (at certain doses), rasburicase, tafenoquine, toluidine blue) or foods (such as fava beans). Please consult a clinical pharmacist for more information.","version":2,"frequency":null},
{"id":7882993,"genesymbol":"G6PD","result":"Deficient with CNSHA","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"Based on the genotype result, this patient is predicted to be G6PD deficient with CNSHA and is at risk for developing or worsening hemolytic anemia when exposed to certain medications (such as dapsone, methylene blue, pegloticase, primaquine (at certain doses), rasburicase, tafenoquine, toluidine blue) or foods (such as fava beans). Please consult a clinical pharmacist for more information.","version":2,"frequency":null},
{"id":7899563,"genesymbol":"G6PD","result":"Indeterminate","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on genotype alone. A G6PD enzyme activity test is recommended to assess for G6PD deficiency. Please consult a clinical pharmacist for more specific information about how G6PD function influences drug dosing.","version":2,"frequency":null},
{"id":7882893,"genesymbol":"G6PD","result":"Normal","activityscore":"n/a","ehrpriority":"Normal Risk","consultationtext":"Based on the genotype result, this patient is predicted to have normal G6PD enzyme activity. This means there is no reason to selectively avoid G6PD associated medications based on the G6PD status alone. Please consult a clinical pharmacist for more information.","version":2,"frequency":null},
{"id":7883097,"genesymbol":"G6PD","result":"Variable","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This patient carries one copy of a deficient G6PD allele and one copy of a normal G6PD allele. Due to X inactivation, patients who are heterozygous with one deficient allele and one normal allele may exhibit G6PD activity ranging from normal to deficient. A G6PD enzyme activity test is recommended to assess for G6PD deficiency. Please consult a clinical pharmacist for more information.","version":2,"frequency":null},
{"id":7900683,"genesymbol":"MT-RNR1","result":"increased risk of aminoglycoside-induced hearing loss","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has a copy of the MT-RNR1 [variant]. Based on this genotype result, the patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. This means that the patient is likely to develop irreversible hearing loss if aminoglycosides (e.g. amikacin, gentamicin, tobramycin) are prescribed. Please consult a clinical pharmacist or Infectious Diseases Service for help selecting alternative therapies.","version":2,"frequency":null},
{"id":7900688,"genesymbol":"MT-RNR1","result":"normal risk of aminoglycoside-induced hearing loss","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that MT-RNR1 variants associated with aminoglycoside-induced hearing loss were not detected in this patient. Based on this genotype result, no change in aminoglycoside therapy is warranted. It should be noted that this result does not absolutely rule out the possibility of the patient developing ototoxicity with aminoglycoside use.","version":2,"frequency":null},
{"id":7900691,"genesymbol":"MT-RNR1","result":"uncertain risk of aminoglycoside-induced hearing loss","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has a copy of MT-RNR1 [variant]. At this time, the association of this allele with aminoglycoside-induced hearing loss is unknown/uncertain. Based on this genotype result, no change in aminoglycoside therapy is warranted. It should be noted that this result does not absolutely rule out the possibility of the patient developing ototoxicity with aminoglycoside use.","version":2,"frequency":null},
{"id":7900713,"genesymbol":"NAT2","result":"Rapid Metabolizer","activityscore":"n/a","ehrpriority":"Priority/High Risk","consultationtext":"This result signifies that the patient has inherited two increased function alleles. Based on the genotype result this patient is predicted to be a rapid metabolizer of NAT2 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by NAT2. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by NAT2. Please consult a clinical pharmacist for more information about how NAT2 metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7900718,"genesymbol":"NAT2","result":"Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Priority/High Risk","consultationtext":"This result signifies that the patient has inherited one increased function allele and one decreased function allele. Based on the genotype result this patient is predicted to be an intermediate metabolizer of NAT2 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by NAT2. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by NAT2. Please consult a clinical pharmacist for more information about how NAT2 metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7900800,"genesymbol":"NAT2","result":"Poor Metabolizer","activityscore":"n/a","ehrpriority":"Priority/High Risk","consultationtext":"This result signifies that the patient has inherited two decreased function alleles. Based on the genotype result this patient is predicted to be a poor metabolizer of NAT2 substrates. This patient may be at risk for an adverse or poor response to medications that are metabolized by NAT2. To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by NAT2. Please consult a clinical pharmacist for more information about how NAT2 metabolic status influences drug selection and dosing.","version":2,"frequency":null},
{"id":7901622,"genesymbol":"NAT2","result":"Indeterminate","activityscore":"n/a","ehrpriority":"none","consultationtext":"This result signifies that the patient has inhertied an allele combination with uncertain and/or unknown function alleles. The expected phenotype for this patient cannot be determined currently based on the NAT2 diplotype result. Please consult a clinical pharmacist for more specific information about how NAT2 function influences drug dosing.","version":2,"frequency":null},
{"id":7902497,"genesymbol":"NUDT15","result":"Normal Metabolizer","activityscore":"n/a","ehrpriority":"Normal/Routine/Low Risk","consultationtext":"This result signifies that the patient has two copies of a normal function allele OR one copy of a normal function allele and one copy of a decreased function allele. Based on the genotype result this patient is predicted to be a NUDT15 normal metabolizer. There is no reason to selectively adjust the dose of most medications that are metabolized by NUDT15. Please consult a clinical pharmacist for more information about how NUDT15 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.94649667, "European": 0.98632336, "East Asian": 0.8551724, "Central/South Asian": 0.8657786}},
{"id":7902503,"genesymbol":"NUDT15","result":"Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of a no function allele OR two copies of a decreased function allele. Based on the genotype result this patient is predicted to be a NUDT15 intermediate metabolizer. This patient may be at risk for an adverse reactions to medications that are metabolized by NUDT15 (eg thiopurines). To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by NUDT15. Please consult a clinical pharmacist for more information about how NUDT15 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0527679, "European": 0.013629507, "East Asian": 0.13750981, "Central/South Asian": 0.12932494}},
{"id":7902520,"genesymbol":"NUDT15","result":"Possible Intermediate Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of an uncertain function allele and one copy of a no function allele. Based on the genotype result this patient is predicted to be a NUDT15 possible intermediate metabolizer. This patient may be at risk for an adverse reactions to medications that are metabolized by NUDT15 (eg thiopurines). To avoid an untoward drug response, dose adjustments or alternative therapeutic agents may be necessary for medications metabolized by NUDT15. Please consult a clinical pharmacist for more information about how NUDT15 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.0, "European": 0.0, "East Asian": 0.0, "Central/South Asian": 0.0}},
{"id":7902588,"genesymbol":"NUDT15","result":"Poor Metabolizer","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has two copies of a no function allele OR one copy of a no function allele and one copy of a decreased function allele. Based on the genotype result this patient is predicted to be a NUDT15 poor metabolizer. This patient may be at a high risk for an adverse reactions to medications that are metabolized by NUDT15 (eg. thiopurines). To avoid an untoward drug response, dose adjustments or or alternative therapy may be necessary for medications metabolized by NUDT15. Please consult a clinical pharmacist for more information about how NUDT15 metabolic status influences drug selection and dosing.","version":3,"frequency":{"Latino": 0.00073546247, "European": 0.000047192545, "East Asian": 0.0073177223, "Central/South Asian": 0.004896416}},
{"id":7902679,"genesymbol":"NUDT15","result":"Indeterminate","activityscore":"n/a","ehrpriority":"Abnormal/Priority/High Risk","consultationtext":"This result signifies that the patient has one copy of a normal function allele and one copy of an uncertain function allele OR one copy of a decreased function allele and one copy of an uncertain function allele OR two copies of an uncertain function allele. The expected phenotype for this patient cannot be determined currently based on the NUDT15 diplotype result. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more specific information about how NUDT15 function influences drug dosing.","version":3,"frequency":{"Latino": 0.0, "European": 0.0, "East Asian": 0.0, "Central/South Asian": 0.0}}] No newline at end of file

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🗄️ Data Integrity & Integration | 🟠 Major

🧩 Analysis chain

🏁 Script executed:

#!/bin/bash
python - <<'PY'
import json
from pathlib import Path

guidelines = json.loads(Path("cpic/data/guideline.json").read_text())
gene_results = json.loads(Path("cpic/data/gene_result.json").read_text())

guideline_genes = sorted({g for row in guidelines for g in row.get("genes", [])})
result_genes = sorted({row["genesymbol"] for row in gene_results})
missing = sorted(set(guideline_genes) - set(result_genes))

print("guideline genes:", guideline_genes)
print("gene_result genes:", result_genes)
print("missing from gene_result:", missing)
PY

Repository: AdaWorldAPI/q2

Length of output: 793


🏁 Script executed:

#!/bin/bash
set -euo pipefail

# Inspect the ingestion logic that links guideline genes to phenotype entries.
grep -n "pheno_by_gr\|recommends\|genesymbol\|gene_result" -n cpic/src/bin/ingest.rs
sed -n '405,450p' cpic/src/bin/ingest.rs

# Show the guideline gene list shape to confirm the gene names are taken directly from guideline.json.
python3 - <<'PY'
import json
from pathlib import Path
guidelines = json.loads(Path("cpic/data/guideline.json").read_text())
print("rows:", len(guidelines))
print("sample row keys:", sorted(guidelines[0].keys()))
print("sample genes field type:", type(guidelines[0].get("genes")).__name__)
print("sample genes:", guidelines[0].get("genes"))
PY

Repository: AdaWorldAPI/q2

Length of output: 3182


🏁 Script executed:

#!/bin/bash
set -euo pipefail

# Inspect the ingestion logic that links guideline genes to phenotype entries.
grep -n "pheno_by_gr\|recommends\|genesymbol\|gene_result" -n cpic/src/bin/ingest.rs
sed -n '405,450p' cpic/src/bin/ingest.rs

# Show the guideline gene list shape to confirm the gene names are taken directly from guideline.json.
python3 - <<'PY'
import json
from pathlib import Path
guidelines = json.loads(Path("cpic/data/guideline.json").read_text())
print("rows:", len(guidelines))
print("sample row keys:", sorted(guidelines[0].keys()))
print("sample genes field type:", type(guidelines[0].get("genes")).__name__)
print("sample genes:", guidelines[0].get("genes"))
PY

Repository: AdaWorldAPI/q2

Length of output: 3182


🏁 Script executed:

#!/bin/bash
set -euo pipefail

grep -n "pheno_by_gr\|recommends\|genesymbol\|gene_result" cpic/src/bin/ingest.rs
sed -n '405,450p' cpic/src/bin/ingest.rs

python3 - <<'PY'
import json
from pathlib import Path
guidelines = json.loads(Path("cpic/data/guideline.json").read_text())
print("rows:", len(guidelines))
print("sample row keys:", sorted(guidelines[0].keys()))
print("sample genes field type:", type(guidelines[0].get("genes")).__name__)
print("sample genes:", guidelines[0].get("genes"))
PY

Repository: AdaWorldAPI/q2

Length of output: 3182


Add phenotype rows for the missing guideline genes. cpic/data/gene_result.json has no entries for ADRA2C, ADRB1, ADRB2, COMT, CYP4F2, GRK4, GRK5, HTR2A, IFNL3, OPRM1, SLC6A4, or VKORC1. Those guideline branches won’t emit recommends edges unless matching gene/result rows exist.

🤖 Prompt for AI Agents
Verify each finding against current code. Fix only still-valid issues, skip the
rest with a brief reason, keep changes minimal, and validate.

In `@cpic/data/gene_result.json` around lines 1 - 101, Add the missing phenotype
entries to gene_result.json for the guideline genes ADRA2C, ADRB1, ADRB2, COMT,
CYP4F2, GRK4, GRK5, HTR2A, IFNL3, OPRM1, SLC6A4, and VKORC1 so the downstream
recommendation logic can match them. Use the existing gene_result objects as the
template for required fields and naming conventions, and ensure each gene has
the phenotype/result rows needed by the CPIC guideline branches. Locate this in
the gene_result dataset, since the recomputation of recommends edges depends on
these exact gene/result combinations being present.

Comment thread cpic/docs/INGEST.md Outdated
Comment thread cpic/docs/INGEST.md Outdated
Comment thread cpic/src/bin/ingest.rs
Comment thread cpic/src/bin/ingest.rs Outdated
Comment thread cpic/src/bin/ingest.rs Outdated
The two proposed follow-ons to the ingest slice, both on the (part_of:is_a) GUID.

- src/lib.rs: extract the shared GUID toolkit (NodeGuid, classid consts,
  cascade/basin/mint, gene_part_of/func_class/norm) so all three bins mint
  identically. ingest refactored onto it — verified byte-identical output
  (114,410 GUIDs, 0 collisions, same demo hexes).

- reason: NARS reasoning over the REAL CPIC graph. {gene, diplotype|phenotype,
  drug} → phenotype → recommendation, 2-hop deduction (f=f1·f2, c=f1·f2·c1·c2)
  with CPIC-authoritative confidence: f from recommendation.classification
  (Strong/Moderate/Optional), c from the pair cpiclevel (A/B/C/D). The lookupkey
  join is real; the routable GUID prefix of each chain node is printed. Demos:
  CYP2C19 *2/*2 + clopidogrel → "Avoid clopidogrel..." (f=0.95 c=0.77);
  HLA-B *57:01 positive + abacavir → "not recommended" (1-hop, c=0.89);
  TPMT *3A/*3A + azathioprine → flags MULTI-GENE; CYP2C9 *1/*1 + warfarin →
  refuses to fabricate, surfaces CPIC's own "does not follow simple translation"
  note. diplotype→phenotype uses a transparent simple allele-function rule (the
  authoritative function_phenotype table is deferred); confidence weights are
  stated in docs for tuning.

- scan: the scalability headline. 1M-patient cohort, NodeRow = key(16)+value(496).
  Query "how many are CYP2C19 Poor Metabolizer?" key-only prefix-route (16MB key
  column, cache-resident) vs value-decode (496MB consult-text column, RAM-bound).
  Measured: 817 vs 3 M rows/s = 251x wall-clock (31x memory floor), both finding
  the identical 10,063-patient cohort (asserted). The canon's "key prerenders with
  zero value decode" with a genuinely skippable value.

docs/REASON.md + docs/SCAN.md. POC over published CPIC rules — NOT clinical
decision support.

Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>
Claude-Session: https://claude.ai/code/session_01GJ4NVBSjq1w5h7RmTbVafb
@AdaWorldAPI AdaWorldAPI changed the title feat(cpic): CPIC pharmacogenomics POC on the V3 (part_of:is_a) GUID feat(cpic): CPIC pharmacogenomics POC on the V3 (part_of:is_a) GUID — ingest + reason + scan Jun 24, 2026
CodeRabbit review on PR #61 — applied the 6 valid findings, skipped 1 (verified
each against current code first).

- Cargo.lock: commit it (bin crate ⇒ stable dependency resolution); removed
  from .gitignore.
- ingest drug ATC: validate the ATC code shape (letter + 2 digits) before
  building the is_a cascade, so 8 drugs with placeholder atcid ["NA"] (methylene
  blue, dabrafenib, trametinib, …) are no longer mis-filed under ATC main
  group "N".
- ingest defaults: auto-detect crate-relative (data/out) vs repo-relative
  (cpic/data, cpic/out) like the reason/scan bins already do, so `ingest` with
  no args works when launched from cpic/.
- ingest diplotype parse: propagate a JSON parse error (panic with path) instead
  of unwrap_or_default() silently producing an empty layer.
- ingest diplotype edge: emit the documented diplotype→gene part_of edge for
  recorded diplotypes (was minted but the NodeGuid discarded). part_of edges
  1450 → 5450; total edges 6000 → 10000. Docs updated.
- docs: positional-arg CLI example; `text` language on every fenced block
  (markdownlint MD040) across INGEST/REASON/SCAN.

SKIPPED (would fabricate clinical data): CodeRabbit asked to add phenotype rows
to gene_result.json for 12 guideline genes (ADRA2C/ADRB1/…/VKORC1). Those are
modifier / allele-status / non-phenotype-lookup genes with no gene_result rows
in the CPIC dump; inventing phenotype data is exactly what this POC must not do.
Their recommendations correctly get no recommends edge.

Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>
Claude-Session: https://claude.ai/code/session_01GJ4NVBSjq1w5h7RmTbVafb

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Addressed the CodeRabbit review in bd6d9bfb — verified each finding against current code first.

Applied (6):

  • Commit Cargo.lock (bin crate → stable resolution); removed from .gitignore.
  • Drug ATC validation — 8 drugs carry placeholder atcid:["NA"] (methylene blue, dabrafenib, trametinib, …) that were being mis-filed under ATC main group "N". Now gated on a real ATC shape (letter + 2 digits).
  • Default pathsingest now auto-detects crate-relative vs repo-relative dirs (matching reason/scan), so a no-arg run from cpic/ works.
  • Diplotype parse — propagate a JSON parse error instead of unwrap_or_default() silently emptying the layer.
  • Diplotype part_of edge — the documented diplotype→gene edge is now emitted for recorded diplotypes (part_of 1450 → 5450; edges 6000 → 10000).
  • Docs — positional-arg CLI example + text language on all fenced blocks (MD040), across INGEST/REASON/SCAN.

Skipped (1), deliberately: the suggestion to add phenotype rows to gene_result.json for ADRA2C/ADRB1/ADRB2/COMT/CYP4F2/GRK4/GRK5/HTR2A/IFNL3/OPRM1/SLC6A4/VKORC1. Those are modifier / allele-status / non-phenotype-lookup genes that genuinely have no gene_result rows in the CPIC dump — inventing phenotype data for them is exactly what this POC must not do (it's a reasoning POC over published CPIC rules, not a data-authoring tool). Their recommendations correctly receive no recommends edge; the absence is faithful to the source.


Generated by Claude Code

@AdaWorldAPI AdaWorldAPI merged commit 7f06700 into main Jun 24, 2026
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