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Faculty Detail    
Name NITA A LIMDI
 
Campus Address JT 1235 Zip 6830
Phone 205-934-4385
E-mail nlimdi@uab.edu
Other websites http://medicine.uab.edu/neurology/faculty/Limdi/
     


Faculty Appointment(s)
Appointment Type Department Division Rank
Primary  Neurology   Neurology Chair Office Associate Professor
Secondary  Medicine  Med - Nephrology Associate Professor
Secondary  Pharmacology/Toxicology   Pharmacology/Toxicology Chair's Office Associate Professor
Center  Center for Aging  COMPREHENSIVE CTR FOR HEALTHY AGING Associate Professor
Center  General Clinical Research Center  Center for Outcomes & Effectiveness Res & Educ Associate Professor
Center  General Clinical Research Center  Comprehensive Neuroscience Center Associate Professor
Center  General Clinical Research Center  Ctr for Clinical & Translational Sci Associate Professor

Graduate Biomedical Sciences Affiliations
Biochemistry and Structural Biology 
Genetics and Genomic Sciences 
Pathobiology and Molecular Medicine 

Biographical Sketch 
Dr. Limdi graduated from Samford University obtaining a Pharm.D degree in 1994. She joined the Department of Hospital Pharmacy as a Pharmacy Specialist in Neurosciences. She continued her training obtaining an MSPH in Clinical Research in 2005 and PhD in Epidemiology in 2007. Dr. Limdi’s primary research focus is on pharmacogenetics/genomics of anticoagulation therapy and pharmacoepidemiology in cardiovascular phenotypes.

Research/Clinical Interest
Title
Pharmacogenetics of drug response
Description
Drug response is a complex phenotype depicting an intricate and complex interplay of genetic and environmental factors. Although overall response patterns among participants in clinical studies guides clinical practice, it is often difficult to predict individual patients’ response to medications. The emergence of pharmacogenetics offers hope to improve prediction of medication response with the potential benefit of increasing medication efficacy and safety. My work is focused on understanding genetic and environmental factors that influence drug response determine their relative contribution and understand the interplay between genes and environment. Anticoagulants, specifically warfarin is of particular interest. Warfarin, the most widely used oral anticoagulant, is limited by the capricious nature of patients’ response to any given dose. Warfarin’s narrow therapeutic index makes this variation potentially hazardous perhaps explaining warfarin’s consistent rank among the top 10 drugs associated with serious adverse events. With a network of collaborators in UAB and at other national and international institutions we are defining the genetic and environmental factors that influence warfarin dose and risk of hemorrhagic complications. Our approach is to use complementary approaches: candidate-gene and genome-wide association study in a prospective racially diverse cohort. The long-term goals are to use genetic and environmental predictors to tailor dosage and to predict individual risk of hemorrhage and to use this information to enable informed and personalized clinical decisions.

Selected Publications 
Publication PUBMEDID
Limdi NA and Veenstra DL. Expectations, validity and reality in pharmacogenomics. Journal of Clinical Epidemiology. 2010 (in press)   19995676 
Limdi NA, Goldstein JA, Blaisdell JA, Beasley TM, Rivers CA, Acton RT. Influence of CYP2C9 Genotype on warfarin dose among African American and European Americans. Personalized Medicine. 2007;4(2): 157-169  19802360 
Knowlton RC, Razdan S, Limdi NA, Elgavish RA, Killen J, Blount J, Burneo JG, Ver Hoef L; Paige L, Faught E, Kankirawatana P, Riley K, Kuzniecky, R. Effect of magnetic source imaging on intracranial electrode placement for epilepsy surgery. Ann Neurol. 2009; 65(6):716-723.   19557860 
Cavallari LH, Limdi NA. Warfarin Pharmacogenomics. Curr Opin Mol Ther. 2009;11(3):243-51.  19479657 
DeWolfe JL, Knowlton RK, Beasley MT, Cofield S, Faught E, Limdi NA. Hyperammonemia intravenous valproate loading. Epilepsy Research 2009; 85(1):65-71.  19299111  
The International Warfarin Pharmacogenetics Consortium. Estimation of the Warfarin Dose with Clinical and Pharmacogenetic Data. New England Journal of Medicine 2009;360:753-64.   19228618  
NA Limdi, Goldstein, TM Beasley, G McGwin, DK Arnett, MF Baird, RT Acton, M Allon. Kidney Function Influences Warfarin Responsiveness and Hemorrhagic Complications. Journal of American Society of Nephrology 2009;20: 912-921  19225037  
NA Limdi, TM Beasley, MR Crowley, JA Goldstein, MJ Rieder, DA Flockhart, DK Arnett, N Liu. I Influence of VKORC1 polymorphisms, haplotypes and haplotype groups on warfarin dose among African Americans and European Americans. Pharmacogenomics 2008; 9(10):1445-1458.  18855533 
Hedi Schelleman, Nita A. Limdi, Stephen E. Kimmel. Ethnic differences in warfarin maintenance dose requirement. Pharmacogenomics 2008; 9(9):1331-1346.  18781859 
NA Limdi, DL Veenstra. Invited review: Warfarin Pharmacogenetics. Pharmacotherapy 2008;28(9):1084–1097. PMCID: 2756787  18752379  
Knowlton RC, Elgavish RA, Bartolucci A, Howell J, Limdi NA, Ojha B, Blount J, Burneo JG, Ver Hoef L, Paige LA, Faught E, Kankirawatana P, Riley K, Kuzniecky, R. Functional imaging: II. Prediction of epilepsy surgery outcome. Annals of Neurology 2008;64:35–41.

 
18570291  
NA Limdi, G McGwin, JA Goldstein, TM Beasley, BK Adler, RT Acton DK Arnett. Influence of CYP2C9 and VKORC1 on Warfarin Dose and Anticoagulation Maintenance among European American and African Americans. Pharmacogenomics 2008;9(5):511-526.   18466099 
Knowlton RC, Elgavish RA, Limdi NA, Bartolucci A, Howell J, Ojha B, Blount J, Burneo JG, Ver Hoef L, Paige LA, Faught E, Kankirawatana P, Riley K, Kuzniecky, R. Functional imaging: I. Relative predictive value of intracranial electroencphalography. Annals of Neurology 2008;64: 25–34.  18412264 
Limdi NA, Lemons NV, Gomez CR. Superiority of fixed-dose warfarin for chronic anticoagulation. Journal of Stroke & Cerebrovascular Diseases. 2003; 13(3): 118-121.  17903962 
NA Limdi , G McGwin , JA Goldstein, TM Beasley, DK Arnett, BK Adler, MF Baird, RT Acton. Influence of CYP2C9 and VKORC1 1173C/T Genotype on the Risk of Hemorrhagic Complications in African American and European American patients on warfarin. Clinical Pharmacology & Therapeutics. 2008; 83(2): 312-321.   17653141 
S. Dutta, E. Faught, N. A. Limdi. Valproate protein binding following rapid intravenous administration of high doses of valproic acid in patients with epilepsy. Journal of Clinical Pharmacy and Therapeutics. 2007; 32, 1–7.   17635338 
Limdi NA, Knowlton RK, Cofield S, Ver Hoef L, Paige L, Dutta S, Faught E. Safety of rapid intravenous loading of valproate. Epilepsia 2007; 48(3):478–483.  17319914 
Limdi NA, Beasley T M, Allison DB, Rivers CA, Acton RT. Racial differences in the prevalence of Factor V Leiden mutation among patients on chronic warfarin therapy. Blood Cells, Molecules and Diseases 2006; 37:100-106.   16889993 
Steffany Haaz, Kevin R. Fontaine, Gary Cutter, Nita Limdi, Suzanne Perumean-Chaney, David B. Allison Citrus Aurantium and Synephrine Alkaloids in the Treatment of Overweight and Obesity: An Update. Obesity Reviews 2006; 7:79-88.   16436104 
Limdi NA, Shimpi AV, Faught E, Gomez CR, Burneo JG. Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology 2005; 64:354-355.   15668440  
Burneo JG, Limdi NA, Kuzniecky RI, et al. Neurotoxicity following the addition of intravenous valproate to lamotrigine therapy. Neurology 2003; 60:1991-1992.  12821749  
Counce, D, Limdi NA, Kuzniecky R. Rasmussens Encephalitis. Current Treatment Options in Neurology. 2001;3(6):162-170.   11581532 
JA Goldstein, Blaisdell JA, NA Limdi. A potentially deleterious new CYP2C9 polymorphism identified in an African American patient with major hemorrhage on warfarin therapy. Blood Cells Molecules and Disease 2009;42:155–158.   19083245  
Limdi NA, Faught E. Safety of rapid valproic acid infusion. Epilepsia. 41(10): 1342-45.2000.   11051132  
Limdi NA, Wadelius M, Cavallari L, Eriksson N, Crawford DC, Lee MM, Chen C, Motsinger-Reif A, Sagreiya H, Liu N, Wu A, Gage B, Jorgensen A, Pirmohamed M, Shin J, Suarez-Kurtz G, Kimmel SE, Johnson JA, Klein TE, Wagner MJ. Warfarin Pharmacogenetics: A single VKORC1 polymorphism is predictive of dose across three racial groups. Blood 2010 (in press).   
P. Lenzini, M. Wadelius, S. Kimmel, J. Anderson, A.L Jorgensen, M. Pirmohamed, M. Caldwell, N. Limdi, J. Burmester, M.B. Dowd, P. Angchaisuksiri, A. Bass, J. Chen, N. Eriksson, A. Rane, J.D. Lindh, J.F. Carlquist, B.D. Horne, G. Grice, P. Milligan , C. Eby, R.L. Berg, P. Deloukas, B. Gage. Integration of genetic, clinical, and laboratory data to improve accuracy of warfarin dose-refinement. Clinical Pharmacology & Therapeutics. 2010 (in press).    

Keywords
Pharmacogenetics, Pharmacogenomics, Pharmacoepidemiology, Warfarin , Antiplatelet drugs, Antithrombotic, comparative effectiveness