Significance and challenges of immunopharmacogenomics

Pharmacogenomics traditionally examines how inherited genetic variations influence drug metabolism, pharmacodynamics, and toxicity. Recent advances have highlighted the immune system as a critical determinant of therapeutic efficacy and safety. Immunopharmacogenomics integrates genetic information, particularly HLA polymorphisms and immune repertoire dynamics of T-cell and B-cell receptors (TCRs and BCRs), to explain interindividual differences in drug responses, immune-related toxicities/diseases. This review summarizes how HLA diversity, immune repertoire heterogeneity, and tolerance mechanisms shape therapeutic outcomes across diverse clinical contexts, including immune-mediated adverse drug reactions, cancer immunotherapy, graft-versus-host disease, autoimmune disorders, food allergy, transplantation, and vaccination. Emerging evidence indicates that immune repertoire sequencing captures dynamic clonal shifts and diversity alterations associated with disease states and treatment responses, providing both mechanistic insight and predictive biomarkers. By integrating genetic and immune repertoire analyses, immunopharmacogenomics establishes a framework for individualized prediction, safer drug design, and more precise immunotherapies, thereby advancing the next phase of precision medicine.