151
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Fatkin D, Huttner IG, Kovacic JC, Seidman J, Seidman CE. Precision Medicine in the Management of Dilated Cardiomyopathy. J Am Coll Cardiol 2019; 74:2921-2938. [DOI: 10.1016/j.jacc.2019.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/25/2019] [Accepted: 10/10/2019] [Indexed: 01/16/2023]
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152
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Hanania HL, Regalado ES, Guo DC, Xu L, Demo E, Sallee D, Milewicz DM. Do
HCN4
Variants Predispose to Thoracic Aortic Aneurysms and Dissections? CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 12:e002626. [DOI: 10.1161/circgen.119.002626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hannah L. Hanania
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center (H.L.H., E.S.R., D.-c.G., L.X., D.M.M.)
- Program in Biochemistry and Cell Biology, Rice University, Houston, TX (H.L.H.)
| | - Ellen S. Regalado
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center (H.L.H., E.S.R., D.-c.G., L.X., D.M.M.)
| | - Dong-chuan Guo
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center (H.L.H., E.S.R., D.-c.G., L.X., D.M.M.)
| | - Lili Xu
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center (H.L.H., E.S.R., D.-c.G., L.X., D.M.M.)
| | - Erin Demo
- Pediatric Cardiology Division, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (E.D., D.S.)
| | - Denver Sallee
- Pediatric Cardiology Division, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (E.D., D.S.)
| | - Dianna M. Milewicz
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center (H.L.H., E.S.R., D.-c.G., L.X., D.M.M.)
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153
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Genetic Testing in Inherited Heart Diseases. Heart Lung Circ 2019; 29:505-511. [PMID: 31813745 DOI: 10.1016/j.hlc.2019.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 12/19/2022]
Abstract
Inherited heart diseases include numerous conditions, from the more prevalent hypertrophic cardiomyopathy (HCM) and familial hypercholesterolaemia (FH), to the comparatively less common inherited arrhythmia syndromes, such as long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT) and Brugada syndrome (BrS). Genetic testing has evolved rapidly over the last decade and is now considered a mainstream component of clinical management of inherited heart diseases. Cardiac manifestations can also be part of wider syndromes, and genetic testing can play a critical role in clarifying the underlying aetiological basis of disease in some cases. The greatest utility of a genetic diagnosis, however, comes from the ability to elucidate disease risk amongst asymptomatic at-risk family members. Given the nuances and challenges, cardiac genetic testing is best performed in a multidisciplinary specialised clinic with access to cardiac genetic counselling.
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154
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Demo E, Rigelsky C, Rideout AL, Graf M, Pariani M, Regalado E, MacCarrick G. Genetics and Precision Medicine: Heritable Thoracic Aortic Disease. Med Clin North Am 2019; 103:1005-1019. [PMID: 31582001 DOI: 10.1016/j.mcna.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Heritable thoracic aortic disease (HTAD) can have life-threatening consequences if not diagnosed early. Affected individuals and at-risk family members benefit from both cardiology and genetic evaluations, including genetic testing. Important information can be obtained through family history, medical history, and genetic testing to help guide management and assess risk. A genetic diagnosis can guide cardiovascular management (type and frequency of vascular imaging, timing of surgical intervention), risk assessment for arterial aneurysm/dissection, evaluation of nonvascular features, and familial testing.
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Affiliation(s)
- Erin Demo
- Sibley Heart Center Cardiology, 2835 Brandywine Road, Suite 300, Atlanta, GA 30341, USA
| | - Christina Rigelsky
- Genomic Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, NE50, Cleveland, OH 44195, USA
| | - Andrea L Rideout
- IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Madeline Graf
- Stanford Health Care, 900 Blake Wilbur Drive, 3rd floor, Stanford, CA 94305, USA
| | - Mitchel Pariani
- Stanford School of Medicine, 300 Pasteur Drive, 2nd Floor, Room H2157, Stanford, CA 94305, USA
| | | | - Gretchen MacCarrick
- Johns Hopkins School of Medicine, Blalock 1008, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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155
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Takeda N, Komuro I. Genetic basis of hereditary thoracic aortic aneurysms and dissections. J Cardiol 2019; 74:136-143. [DOI: 10.1016/j.jjcc.2019.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 02/01/2023]
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156
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A clinical scoring system for congenital contractural arachnodactyly. Genet Med 2019; 22:124-131. [PMID: 31316167 DOI: 10.1038/s41436-019-0609-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/03/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Congenital contractural arachnodactyly (CCA) is an autosomal dominant connective tissue disorder manifesting joint contractures, arachnodactyly, crumpled ears, and kyphoscoliosis as main features. Due to its rarity, rather aspecific clinical presentation, and overlap with other conditions including Marfan syndrome, the diagnosis is challenging, but important for prognosis and clinical management. CCA is caused by pathogenic variants in FBN2, encoding fibrillin-2, but locus heterogeneity has been suggested. We designed a clinical scoring system and diagnostic criteria to support the diagnostic process and guide molecular genetic testing. METHODS In this retrospective study, we assessed 167 probands referred for FBN2 analysis and classified them into a FBN2-positive (n = 44) and FBN2-negative group (n = 123) following molecular analysis. We developed a 20-point weighted clinical scoring system based on the prevalence of ten main clinical characteristics of CCA in both groups. RESULTS The total score was significantly different between the groups (P < 0.001) and was indicative for classifying patients into unlikely CCA (total score <7) and likely CCA (total score ≥7) groups. CONCLUSIONS Our clinical score is helpful for clinical guidance for patients suspected to have CCA, and provides a quantitative tool for phenotyping in research settings.
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157
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Duan XY, Guo DC, Regalado ES, Shen H, Coselli JS, Estrera AL, Safi HJ, Bamshad MJ, Nickerson DA, LeMaire SA, De Backer J, Milewicz DM. SMAD4 rare variants in individuals and families with thoracic aortic aneurysms and dissections. Eur J Hum Genet 2019; 27:1054-1060. [PMID: 30809044 PMCID: PMC6777456 DOI: 10.1038/s41431-019-0357-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 11/08/2022] Open
Abstract
SMAD4 pathogenic variants cause juvenile polyposis (JPS) and hereditary hemorrhagic telangiectasia (HHT), and 40% of affected individuals also have thoracic aortic disease. At the same time, SMAD4 pathogenic variants have not been reported in thoracic aortic disease families without JPS-HHT. A SMAD4 heterozygous variant, c.290G>T, p.(Arg97Leu), not present in population databases and predicted to be damaging to protein function, was identified in a family with thoracic aortic disease and no evidence of HHT or JPS. Cellular studies revealed that the SMAD4 p.(Arg97Leu) alteration increased SMAD4 ubiquitination and 26S proteasome-mediated protein degradation. Smooth muscle cells (SMCs) infected with lentivirus expressing the SMAD4 p.(Arg97Leu) variant demonstrated reduced contractile protein gene expression when compared to that of wild-type SMAD4. In addition, two rare variants were identified in individuals with early age of onset of thoracic aortic dissection. These results suggest that SMAD4 rare missense variants can lead to thoracic aortic disease in individuals who do not have JPS or HHT.
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Affiliation(s)
- Xue-Yan Duan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
| | - Dong-Chuan Guo
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
| | - Ellen S Regalado
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
| | - Hong Shen
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Joseph S Coselli
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, USA
| | - Anthony L Estrera
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, USA
| | - Hazim J Safi
- Department of Cardiothoracic Vascular Surgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
| | - Michael J Bamshad
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Scott A LeMaire
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, USA
| | - Julie De Backer
- Center for Medical Genetics, Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Dianna M Milewicz
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA.
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158
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De Backer J, Bondue A, Budts W, Evangelista A, Gallego P, Jondeau G, Loeys B, Peña ML, Teixido-Tura G, van de Laar I, Verstraeten A, Roos Hesselink J. Genetic counselling and testing in adults with congenital heart disease: A consensus document of the ESC Working Group of Grown-Up Congenital Heart Disease, the ESC Working Group on Aorta and Peripheral Vascular Disease and the European Society of Human Genetics. Eur J Prev Cardiol 2019; 27:1423-1435. [DOI: 10.1177/2047487319854552] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thanks to a better knowledge of the genetic causes of many diseases and an improvement in genetic testing techniques, genetics has gained an important role in the multidisciplinary approach to diagnosis and management of congenital heart disease and aortic pathology. With the introduction of strategies for precision medicine, it is expected that this will only increase further in the future. Because basic knowledge of the indications, the opportunities as well as the limitations of genetic testing is essential for correct application in clinical practice, this consensus document aims to give guidance to care-providers involved in the follow-up of adults with congenital heart defects and/or with hereditary aortic disease. This paper is the result of a collaboration between the ESC Working Group of Grown-Up Congenital Heart Disease, the ESC Working Group on Aorta and Peripheral Vascular Disease and the European Society of Human Genetics. Throughout the document, the importance of correct counseling in the process of genetic testing is emphasized, indications and timing for genetic studies are discussed as well as the technical modalities of genetic testing. Finally, the most important genetic diseases in adult congenital heart disease and aortic pathology are also discussed.
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Affiliation(s)
- Julie De Backer
- Department of Cardiology and Center for Medical Genetics, Ghent University Hospital, Belgium
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group
| | - Antoine Bondue
- Department of Cardiology, Université Libre de Bruxelles, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Arturo Evangelista
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, VHIR. CIBER-CV, Barcelona, Spain
| | - Pastora Gallego
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Spain
| | - Guillaume Jondeau
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group
- Centre National Maladie Rare pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, France
| | - Bart Loeys
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Belgium
- Department of Human Genetics, Radboud University Medical Center, the Netherlands
| | - Maria L Peña
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Spain
| | - Gisela Teixido-Tura
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, VHIR. CIBER-CV, Barcelona, Spain
| | - Ingrid van de Laar
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group
- Department of Clinical Genetics, Erasmus MC, the Netherlands
| | - Aline Verstraeten
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Belgium
- Department of Human Genetics, Radboud University Medical Center, the Netherlands
| | - Jolien Roos Hesselink
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group
- Department of Cardiology, Erasmus MC, the Netherlands
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159
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Wolford BN, Hornsby WE, Guo D, Zhou W, Lin M, Farhat L, McNamara J, Driscoll A, Wu X, Schmidt EM, Norton EL, Mathis MR, Ganesh SK, Douville NJ, Brummett CM, Kitzman J, Chen YE, Kim K, Deeb GM, Patel H, Eagle KA, Milewicz DM, Willer CJ, Yang B. Clinical Implications of Identifying Pathogenic Variants in Individuals With Thoracic Aortic Dissection. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2019; 12:e002476. [PMID: 31211624 PMCID: PMC6582991 DOI: 10.1161/circgen.118.002476] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thoracic aortic dissection is an emergent life-threatening condition. Routine screening for genetic variants causing thoracic aortic dissection is not currently performed for patients or family members. METHODS We performed whole exome sequencing of 240 patients with thoracic aortic dissection (n=235) or rupture (n=5) and 258 controls matched for age, sex, and ancestry. Blinded to case-control status, we annotated variants in 11 genes for pathogenicity. RESULTS Twenty-four pathogenic variants in 6 genes (COL3A1, FBN1, LOX, PRKG1, SMAD3, and TGFBR2) were identified in 26 individuals, representing 10.8% of aortic cases and 0% of controls. Among dissection cases, we compared those with pathogenic variants to those without and found that pathogenic variant carriers had significantly earlier onset of dissection (41 versus 57 years), higher rates of root aneurysm (54% versus 30%), less hypertension (15% versus 57%), lower rates of smoking (19% versus 45%), and greater incidence of aortic disease in family members. Multivariable logistic regression showed that pathogenic variant carrier status was significantly associated with age <50 (odds ratio [OR], 5.5; 95% CI, 1.6-19.7), no history of hypertension (OR, 5.6; 95% CI, 1.4-22.3), and family history of aortic disease (mother: OR, 5.7; 95% CI, 1.4-22.3, siblings: OR, 5.1; 95% CI, 1.1-23.9, children: OR, 6.0; 95% CI, 1.4-26.7). CONCLUSIONS Clinical genetic testing of known hereditary thoracic aortic dissection genes should be considered in patients with a thoracic aortic dissection, followed by cascade screening of family members, especially in patients with age-of-onset <50 years, family history of thoracic aortic disease, and no history of hypertension.
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Affiliation(s)
- Brooke N. Wolford
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Computational Medicine & Bioinformatics, Univ of Michigan, Ann Arbor, MI
| | - Whitney E. Hornsby
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Internal Medicine, Univ of Michigan, Ann Arbor, MI
| | - Dongchuan Guo
- Dept of Internal Medicine, McGovern Medical School, Univ of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Wei Zhou
- Analytic & Translational Genetics Unit, Massachusetts General Hospital & Harvard Medical School, Boston
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA
- Program in Medical & Population Genetics, Broad Institute of MIT & Harvard, Cambridge, MA
| | - Maoxuan Lin
- Dept of Bioinformatics & Genomics, The Univ of North Carolina at Charlotte, Charlotte, NC
| | - Linda Farhat
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Cardiac Surgery, Univ of Michigan, Ann Arbor, MI
| | - Jennifer McNamara
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Internal Medicine, Univ of Michigan, Ann Arbor, MI
| | - Anisa Driscoll
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Office of Research - Precision Health, Ann Arbor, MI
| | - Xiaoting Wu
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Cardiac Surgery, Univ of Michigan, Ann Arbor, MI
| | | | | | - Michael R. Mathis
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Anesthesiology, Univ of Michigan, Ann Arbor, MI
| | - Santhi K. Ganesh
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Internal Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Human Genetics, Univ of Michigan, Ann Arbor, MI
| | - Nicholas J. Douville
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Anesthesiology, Univ of Michigan, Ann Arbor, MI
| | - Chad M. Brummett
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Anesthesiology, Univ of Michigan, Ann Arbor, MI
| | - Jacob Kitzman
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Internal Medicine, McGovern Medical School, Univ of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Y. Eugene Chen
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Internal Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Pharmacology, Univ of Michigan, Ann Arbor, MI
- Dept of Molecular & Integrative Physiology, Univ of Michigan, Ann Arbor, MI
| | - Karen Kim
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Cardiac Surgery, Univ of Michigan, Ann Arbor, MI
| | - G. Michael Deeb
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Cardiac Surgery, Univ of Michigan, Ann Arbor, MI
| | - Himanshu Patel
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Cardiac Surgery, Univ of Michigan, Ann Arbor, MI
| | - Kim A. Eagle
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Internal Medicine, Univ of Michigan, Ann Arbor, MI
| | - Dianna M. Milewicz
- Dept of Internal Medicine, McGovern Medical School, Univ of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Cristen J. Willer
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Computational Medicine & Bioinformatics, Univ of Michigan, Ann Arbor, MI
- Dept of Internal Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Human Genetics, Univ of Michigan, Ann Arbor, MI
| | - Bo Yang
- Univ of Michigan, Michigan Medicine, Univ of Michigan, Ann Arbor, MI
- Dept of Cardiac Surgery, Univ of Michigan, Ann Arbor, MI
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160
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Schmidtke J, Wittkowski K, Glaubitz R. NGS-Based genetic testing for heritable cardiovascular diseases. Specific requirements for obtaining informed consent. Mol Cell Probes 2019; 45:70-78. [PMID: 31059777 DOI: 10.1016/j.mcp.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
Clinical genetic testing in cardiovascular genetic medicine has undergone rapid changes. Next generation sequencing allows simultaneous testing of all genes associated with any cardiovascular phenotype, and molecular genetic testing for multiple genes has become the standard of practice for cardiovascular medicine. While technical and clinical advantages of multigenic approaches are evident, informed consent procedures have become more complex and challenging to the physician ordering such a test, particularly due to the increased potential for unsolicited findings. Based on the EuroGentest "Guidelines for diagnostic next-generation sequencing" we here propose a set of disease-specific requirements for obtaining informed consent for NGS-based genetic testing in a cardiogenetic clinic. We can show that it is often not feasible to obtain informed consent for every detail and suggest, in such cases, to reach general consent beforehand and discuss specific implications of unsolicited findings after the test results are available.
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Affiliation(s)
- Jörg Schmidtke
- Amedes Genetics, Georgstraße 50, Hannover, Germany; Hannover Medical School, Institute of Human Genetics, Hannover, Germany.
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161
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Grove ME, White S, Fisk DG, Rego S, Dagan-Rosenfeld O, Kohler JN, Reuter CM, Bonner D, Wheeler MT, Bernstein JA, Ormond KE, Hanson-Kahn AK. Developing a genomics rotation: Practical training around variant interpretation for genetic counseling students. J Genet Couns 2019; 28:466-476. [PMID: 30706981 PMCID: PMC6456376 DOI: 10.1002/jgc4.1094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/23/2018] [Accepted: 12/23/2018] [Indexed: 11/11/2022]
Abstract
With the wide adoption of next-generation sequencing (NGS)-based genetic tests, genetic counselors require increased familiarity with NGS technology, variant interpretation concepts, and variant assessment tools. The use of exome and genome sequencing in clinical care has expanded the reach and diversity of genetic testing. Regardless of the setting where genetic counselors are performing variant interpretation or reporting, most of them have learned these skills from colleagues, while on the job. Though traditional, lecture-based learning around these topics is important, there has been growing need for the inclusion of case-based, experiential training of genomics and variant interpretation for genetic counseling students, with the goal of creating a strong foundation in variant interpretation for new genetic counselors, regardless of what area of practice they enter. To address this need, we established a genomics and variant interpretation rotation for Stanford's genetic counseling training program. In response to changes in the genomics landscape, this has now evolved into three unique rotation experiences, each focused on variant interpretation in the context of various genomic settings, including clinical laboratory, research laboratory, and healthy genomic analysis studies. Here, we describe the goals and learning objectives that we have developed for these variant interpretation rotations, and illustrate how these concepts are applied in practice.
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Affiliation(s)
- Megan E Grove
- Stanford Clinical Genomics Program, Stanford Health Care, Stanford, California
| | - Shana White
- Stanford Clinical Genomics Program, Stanford Health Care, Stanford, California
| | - Dianna G Fisk
- Stanford Clinical Genomics Program, Stanford Health Care, Stanford, California
| | - Shannon Rego
- Department of Genetics, Stanford University School of Medicine, Stanford, California
- Institute for Human Genetics, University of California-San Francisco, San Francisco, California
| | - Orit Dagan-Rosenfeld
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Jennefer N Kohler
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
| | - Chloe M Reuter
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
| | - Devon Bonner
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
| | - Matthew T Wheeler
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jonathan A Bernstein
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Andrea K Hanson-Kahn
- Department of Genetics, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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162
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Caspar SM, Dubacher N, Matyas G. More Genes for Thoracic Aortic Aneurysms and Dissections. J Am Coll Cardiol 2019; 73:528-529. [PMID: 30704586 DOI: 10.1016/j.jacc.2018.09.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
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163
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Reply. J Am Coll Cardiol 2019; 73:529-530. [DOI: 10.1016/j.jacc.2018.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
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164
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Arbustini E, Giuliani L, Di Toro A. When Genes, More Than Phenotype, Identify Different Diseases: The Case of Nonsyndromic HTAA/D. J Am Coll Cardiol 2018; 72:616-619. [PMID: 30071990 DOI: 10.1016/j.jacc.2018.03.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/27/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy.
| | - Lorenzo Giuliani
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
| | - Alessandro Di Toro
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
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