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McCarthy-Leo C, Baughan S, Dlugas H, Abraham P, Gibbons J, Baldwin C, Chung S, Feldman GL, Dyson G, Finley RL, Tainsky MA. Germline variant profiling of CHEK2 sequencing variants in breast cancer patients. Cancer Genet 2024; 288-289:10-19. [PMID: 39208550 DOI: 10.1016/j.cancergen.2024.08.081] [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: 05/06/2024] [Revised: 07/17/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
The cell cycle checkpoint kinase 2 (CHEK2) is a tumor suppressor gene coding for a protein kinase with a role in the cell cycle and DNA repair pathways. Variants within CHEK2 are associated with an increased risk of developing breast, colorectal, prostate and several other types of cancer. Comprehensive genetic risk assessment leads to early detection of hereditary cancer and provides an opportunity for better survival. Multigene panel screening can identify the presence of pathogenic variants in hereditary cancer predisposition genes (HCPG), including CHEK2. Multigene panels, however, also result in large quantities of genetic data some of which cannot be interpreted and are classified as variants of uncertain significance (VUS). A VUS provides no information for use in medical management and leads to ambiguity in genetic counseling. In the absence of variant segregation data, in vitro functional analyses can be used to clarify variant annotations, aiding in accurate clinical management of patient risk and treatment plans. In this study, we performed whole exome sequencing (WES) to investigate the prevalence of germline variants in 210 breast cancer (BC) patients and conspicuously among the many variants in HCPGs that we found, we identified 16 individuals with non-synonymous or frameshift CHEK2 variants, sometimes along with additional variants within other BC susceptibility genes. Using this data, we investigated the prevalence of these CHEK2 variants in African American (AA) and Caucasian (CA) populations identifying the presence of two novel frameshift variants, c.1350delA (p.Val451Serfs*18) and c.1528delC (p.Gln510Argfs*3) and a novel missense variant, c262C>T (p.Pro88Ser). Along with the current clinical classifications, we assembled available experimental data and computational predictions of function for these CHEK2 variants, as well as explored the role these variants may play in polygenic risk assessment.
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Affiliation(s)
- Claire McCarthy-Leo
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Scott Baughan
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Hunter Dlugas
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Detroit, MI, United States
| | - Prisca Abraham
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Janice Gibbons
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Carolyn Baldwin
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Sarah Chung
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Gerald L Feldman
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Gregory Dyson
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Detroit, MI, United States; Department of Oncology, Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Russell L Finley
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Michael A Tainsky
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States; Department of Oncology, Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States.
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2
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Reches A, Ofen Glassner V, Goldstein N, Yeshaya J, Delmar G, Portugali E, Hallas T, Weinstein A, Kurolap A, Berkenstadt M, Mantsour T, Abu-Gutstein L, Ries-Levavi L, Reznik-Wolf H, Behar DM, Yaron Y, Pras E, Baris Feldman H. Expanded targeted preconception screening panel in Israel: findings and insights. J Med Genet 2024; 61:783-787. [PMID: 38719349 DOI: 10.1136/jmg-2023-109629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/25/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND We aimed to analyse the efficacy and added value of a targeted Israeli expanded carrier screening panel (IL-ECSP), beyond the first-tier test covered by the Israeli Ministry of Health (IMOH) and the second-tier covered by the Health Maintenance Organisations (HMOs). METHODS A curated variant-based IL-ECSP, tailored to the uniquely diverse Israeli population, was offered at two tertiary hospitals and a major genetics laboratory. The panel includes 1487 variants in 357 autosomal recessive and X-linked genes. RESULTS We analysed 10 115 Israeli samples during an 18-month period. Of these, 6036 (59.7%) were tested as couples and 4079 (40.3%) were singles. Carriers were most frequently identified with mutations in the following genes: GJB2/GJB6 (1:22 allele frequency), CFTR (1:28), GBA (1:34), TYR (1:39), PAH (1:50), SMN1 (1:52) and HEXA (1:56). Of 3018 couples tested, 753 (25%) had no findings, in 1464 (48.5%) only one partner was a carrier, and in 733 (24.3%) both were carriers of different diseases. We identified 79 (2.6%) at-risk couples, where both partners are carriers of the same autosomal recessive condition, or the female carries an X-linked disease. Importantly, 48.1% of these would not have been detected by ethnically-based screening tests currently provided by the IMOH and HMOs, for example, variants in GBA, TYR, PAH and GJB2/GJB6. CONCLUSION This is the largest cohort of targeted ECSP testing, tailored to the diverse Israeli population. The IL-ECSP expands the identification of couples at risk and empowers their reproductive choices. We recommend endorsing an expanded targeted panel to the National Genetic Carrier Screening programme.
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Affiliation(s)
- Adi Reches
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Vered Ofen Glassner
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nurit Goldstein
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Josepha Yeshaya
- American Medical Genetics (AMG) Laboratory, Herzliya, Israel
| | | | | | | | - Amit Weinstein
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Berkenstadt
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tal Mantsour
- American Medical Genetics (AMG) Laboratory, Herzliya, Israel
| | - Liat Abu-Gutstein
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Liat Ries-Levavi
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Haike Reznik-Wolf
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Yuval Yaron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elon Pras
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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3
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Liu S, Huang S, Zhang VW, Cao L, Liu H, Wei X, Luo Y, Li Y, Zhou L, Li F, Zhu Q, Liu H. Customizing carrier screening in the Chinese population: Insights from a 334-gene panel. Prenat Diagn 2024. [PMID: 39030774 DOI: 10.1002/pd.6635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE This study aimed to evaluate the yield and applicability of expanded carrier screening and propose carrier rate screening thresholds suitable for the Chinese population by comparing the current screening panel with the American College of Medical Genetics and Genomics recommended panel of 113 genes. METHODS Using targeted next-generation sequencing, a customized panel with 334 genes was performed on 2168 individuals without clinical phenotypes for expanded carrier screening purpose. Variant interpretation followed the American College of Medical Genetics and Genomics guidelines. Carrier rates were calculated for each identified variant and each gene. At-risk couple rates were also assessed. The yield of expanded carrier screening was evaluated through calculating cumulative carrier rate. RESULTS Overall, 65.87% of the individuals were found to be carriers of at least 1 disease causing variants. The overall at-risk couple rate was 11.76%, of which the GJB2:c.109G > A related at-risk couple rate was 5.78%. The cumulative carrier rate of 334-panel was 65.53%. When screened genes with gene carrier rate ≥1/1000, the expanded carrier screening can cover over 90% of the cumulative carrier rate and at-risk couples. A total of 86 genes overlapped with American College of Medical Genetics and Genomics Tier-3 genes and were attributed to the cumulative carrier rate of 47.33%. CONCLUSION Expanded carrier screening using the 334-gene panel showed high screening efficiency. A threshold of gene carrier rate ≥1/1000 is recommended for selecting carrier screening genes in the Chinese Han population. This study highlights the importance of customizing screening panels based on the ACMG Tier-3 genes in conjunction with population-specific carrier frequencies to improve the accuracy and effectiveness of expanded carrier screening.
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Affiliation(s)
- Sha Liu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Shuang Huang
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | | | - Liyuan Cao
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Haipeng Liu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Xiang Wei
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yuan Luo
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yue Li
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Lin Zhou
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Fuping Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- Department of Reproductive Andrology/Human Sperm Bank, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qian Zhu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hongqian Liu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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4
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Grønbæk-Thygesen M, Hartmann-Petersen R. Cellular and molecular mechanisms of aspartoacylase and its role in Canavan disease. Cell Biosci 2024; 14:45. [PMID: 38582917 PMCID: PMC10998430 DOI: 10.1186/s13578-024-01224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/24/2024] [Indexed: 04/08/2024] Open
Abstract
Canavan disease is an autosomal recessive and lethal neurological disorder, characterized by the spongy degeneration of the white matter in the brain. The disease is caused by a deficiency of the cytosolic aspartoacylase (ASPA) enzyme, which catalyzes the hydrolysis of N-acetyl-aspartate (NAA), an abundant brain metabolite, into aspartate and acetate. On the physiological level, the mechanism of pathogenicity remains somewhat obscure, with multiple, not mutually exclusive, suggested hypotheses. At the molecular level, recent studies have shown that most disease linked ASPA gene variants lead to a structural destabilization and subsequent proteasomal degradation of the ASPA protein variants, and accordingly Canavan disease should in general be considered a protein misfolding disorder. Here, we comprehensively summarize the molecular and cell biology of ASPA, with a particular focus on disease-linked gene variants and the pathophysiology of Canavan disease. We highlight the importance of high-throughput technologies and computational prediction tools for making genotype-phenotype predictions as we await the results of ongoing trials with gene therapy for Canavan disease.
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Affiliation(s)
- Martin Grønbæk-Thygesen
- The Linderstrøm-Lang Centre for Protein Science, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, 2200N, Copenhagen, Denmark.
| | - Rasmus Hartmann-Petersen
- The Linderstrøm-Lang Centre for Protein Science, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, 2200N, Copenhagen, Denmark.
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5
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Chen SC, Zhou XY, Li SY, Zhao MM, Huang HF, Jia J, Xu CM. Carrier burden of over 300 diseases in Han Chinese identified by expanded carrier testing of 300 couples using assisted reproductive technology. J Assist Reprod Genet 2023; 40:2157-2173. [PMID: 37450097 PMCID: PMC10440320 DOI: 10.1007/s10815-023-02876-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Expanded carrier screening (ECS) has become a common practice for identifying carriers of monogenic diseases. However, existing large gene panels are not well-tailored to Chinese populations. In this study, ECS testing for pathogenic variants of both single-nucleotide variants (SNVs) and copy number variants (CNVs) in 330 genes implicated in 342 autosomal recessive (AR) or X-linked diseases was carried out. We assessed the differences in allele frequencies specific to the Chinese population who have used assisted reproductive technology (ART) and the important genes to screen for in this population. METHODOLOGY A total of 300 heterosexual couples were screened by our ECS panel using next-generation sequencing. A customed bioinformatic algorithm was used to analyze SNVs and CNVs. Guidelines from the American College of Medical Genetics and Genomics and the Association for Molecular Pathology were adapted for variant interpretation. Pathogenic or likely pathogenic (P/LP) SNVs located in high homology regions/deletions and duplications of one or more exons in length were independently verified with other methods. RESULTS 64.83% of the patients were identified to be carriers of at least one of 342 hereditary conditions. We identified 622 P/LP variants, 4.18% of which were flagged as CNVs. The rate of at-risk couples was 3%. A total of 149 AR diseases accounted for 64.05% of the cumulative carrier rate, and 48 diseases had a carrier rate above 1/200 in the test. CONCLUSION An expanded screening of inherited diseases by incorporating different variant types, especially CNVs, has the potential to reduce the occurrence of severe monogenic diseases in the offspring of patients using ART in China.
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Affiliation(s)
- Song-Chang Chen
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, 566 Fangxie Road, Huangpu District, Shanghai, 200001, China
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Xuan-You Zhou
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, 566 Fangxie Road, Huangpu District, Shanghai, 200001, China
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Shu-Yuan Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Ming-Min Zhao
- Fujungenetics Biotechnology Co., Ltd., No. 70 of Tongchuan Road, Putuo District, Shanghai, 200333, China
| | - He-Feng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, 566 Fangxie Road, Huangpu District, Shanghai, 200001, China
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
| | - Jia Jia
- Fujungenetics Biotechnology Co., Ltd., No. 70 of Tongchuan Road, Putuo District, Shanghai, 200333, China.
| | - Chen-Ming Xu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, 566 Fangxie Road, Huangpu District, Shanghai, 200001, China.
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
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6
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Deignan JL, Gregg AR, Grody WW, Guo MH, Kearney H, Monaghan KG, Raraigh KS, Taylor J, Zepeda-Mendoza CJ, Ziats C. Updated recommendations for CFTR carrier screening: A position statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100867. [PMID: 37310422 DOI: 10.1016/j.gim.2023.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 06/14/2023] Open
Affiliation(s)
- Joshua L Deignan
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Anthony R Gregg
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health, Columbia, SC
| | - Wayne W Grody
- Departments of Pathology and Laboratory Medicine, Pediatrics, and Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Michael H Guo
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hutton Kearney
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN
| | | | - Karen S Raraigh
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Taylor
- American College of Medical Genetics and Genomics, Bethesda, MD
| | | | - Catherine Ziats
- Division of Genetics, Department of Pediatrics, Dell Medical School, University of Texas, Austin, TX
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7
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Wall JD, Sathirapongsasuti JF, Gupta R, Rasheed A, Venkatesan R, Belsare S, Menon R, Phalke S, Mittal A, Fang J, Tanneeru D, Deshmukh M, Bassi A, Robinson J, Chaudhary R, Murugan S, Ul-Asar Z, Saleem I, Ishtiaq U, Fatima A, Sheikh SS, Hameed S, Ishaq M, Rasheed SZ, Memon FUR, Jalal A, Abbas S, Frossard P, Fuchsberger C, Forer L, Schoenherr S, Bei Q, Bhangale T, Tom J, Gadde SGK, B V P, Naik NK, Wang M, Kwok PY, Khera AV, Lakshmi BR, Butterworth AS, Chowdhury R, Danesh J, di Angelantonio E, Naheed A, Goyal V, Kandadai RM, Kumar H, Borgohain R, Mukherjee A, Wadia PM, Yadav R, Desai S, Kumar N, Biswas A, Pal PK, Muthane UB, Das SK, Ramprasad VL, Kukkle PL, Seshagiri S, Kathiresan S, Ghosh A, Mohan V, Saleheen D, Stawiski EW, Peterson AS. South Asian medical cohorts reveal strong founder effects and high rates of homozygosity. Nat Commun 2023; 14:3377. [PMID: 37291107 PMCID: PMC10250394 DOI: 10.1038/s41467-023-38766-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
The benefits of large-scale genetic studies for healthcare of the populations studied are well documented, but these genetic studies have traditionally ignored people from some parts of the world, such as South Asia. Here we describe whole genome sequence (WGS) data from 4806 individuals recruited from the healthcare delivery systems of Pakistan, India and Bangladesh, combined with WGS from 927 individuals from isolated South Asian populations. We characterize population structure in South Asia and describe a genotyping array (SARGAM) and imputation reference panel that are optimized for South Asian genomes. We find evidence for high rates of reproductive isolation, endogamy and consanguinity that vary across the subcontinent and that lead to levels of rare homozygotes that reach 100 times that seen in outbred populations. Founder effects increase the power to associate functional variants with disease processes and make South Asia a uniquely powerful place for population-scale genetic studies.
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Affiliation(s)
- Jeffrey D Wall
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA.
- Dept of Ornithology and Mammology, California Academy of Sciences, San Francisco, CA, 94118, USA.
| | - J Fah Sathirapongsasuti
- MedGenome Inc., Foster City, CA, 94404, USA
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA
| | - Ravi Gupta
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | - Asif Rasheed
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Radha Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, 600086, India
| | - Saurabh Belsare
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA
| | - Ramesh Menon
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | - Sameer Phalke
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | | | - John Fang
- Thermo Fisher Scientific, Santa Clara, CA, 95051, USA
| | - Deepak Tanneeru
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | | | - Akshi Bassi
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | - Jacqueline Robinson
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA
| | | | | | - Zameer Ul-Asar
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Imran Saleem
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Unzila Ishtiaq
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Areej Fatima
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | | | | | | | | | | | - Anjum Jalal
- Faisalabad Institute of Cardiology, Faisalabad, Pakistan
| | - Shahid Abbas
- Faisalabad Institute of Cardiology, Faisalabad, Pakistan
| | - Philippe Frossard
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Christian Fuchsberger
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48109, USA
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Forer
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Schoenherr
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Qixin Bei
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA
| | - Tushar Bhangale
- Department of Human Genetics, Genentech, South San Francisco, CA, 94080, USA
| | - Jennifer Tom
- Product Development Data Sciences, Genentech, South San Francisco, CA, 94080, USA
| | | | - Priya B V
- Narayana Nethralaya Foundation, Bengaluru, Karnataka, 560010, India
| | | | - Minxian Wang
- Program in Medical and Population Genetics & Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Pui-Yan Kwok
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA
- Cardiovascular Research Institute and Department of Dermatology, University of California San Francisco, San Francisco, CA, 94143, USA
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Amit V Khera
- Harvard Medical School, Boston, MA, 02115, USA
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, MA, 02115, Boston, USA
- Verve Therapeutics, Cambridge, MA, 02139, USA
| | - B R Lakshmi
- MDCRC, Royal Care Super Speciality Hospital 1/520, Neelambur, Coimbatore, Tamil Nadu, 641062, India
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Rajiv Chowdhury
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Emanuele di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Aliya Naheed
- Initiative for Non Communicable Diseases, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Vinay Goyal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
- Medanta Hospital, New Delhi, India
- Medanta, The Medicity, Gurgaon, India
| | | | | | - Rupam Borgohain
- Nizams Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Adreesh Mukherjee
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | | | - Ravi Yadav
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Soaham Desai
- Shree Krishna Hospital and Pramukhaswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
| | - Niraj Kumar
- All India Institute of Medical Sciences, Rishikesh, India
| | - Atanu Biswas
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | - Pramod Kumar Pal
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Uday B Muthane
- Parkinson and Ageing Research Foundation, Bengaluru, India
| | - Shymal K Das
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | | | - Prashanth L Kukkle
- All India Institute of Medical Sciences, Rishikesh, India
- Manipal Hospital, Miller Road, Bengaluru, India
- Parkinson's Disease and Movement Disorders Clinic, Bengaluru, India
| | - Somasekar Seshagiri
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA
| | - Sekar Kathiresan
- Program in Medical and Population Genetics & Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Verve Therapeutics, Cambridge, MA, 02139, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Arkasubhra Ghosh
- Narayana Nethralaya Foundation, Bengaluru, Karnataka, 560010, India
| | - V Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, 600086, India
| | - Danish Saleheen
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
- Seymour, Paul and Gloria Milstein Division of Cardiology at Columbia University, New York, NY, 10032, USA
| | - Eric W Stawiski
- MedGenome Inc., Foster City, CA, 94404, USA
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA
- Caribou Biosciences, Berkeley, CA, 94710, USA
| | - Andrew S Peterson
- MedGenome Inc., Foster City, CA, 94404, USA.
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA.
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA.
- Broadwing Bio, South San Francisco, CA, 94080, USA.
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8
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Matalon DR, Zepeda-Mendoza CJ, Aarabi M, Brown K, Fullerton SM, Kaur S, Quintero-Rivera F, Vatta M. Clinical, technical, and environmental biases influencing equitable access to clinical genetics/genomics testing: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100812. [PMID: 37058144 DOI: 10.1016/j.gim.2023.100812] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 04/15/2023] Open
Affiliation(s)
- Dena R Matalon
- Division of Medical Genetics, Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, CA
| | - Cinthya J Zepeda-Mendoza
- Divisions of Hematopathology and Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Mahmoud Aarabi
- UPMC Medical Genetics and Genomics Laboratories, UPMC Magee-Womens Hospital, Pittsburgh, PA; Departments of Pathology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Stephanie M Fullerton
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA
| | - Shagun Kaur
- Department of Child Health, Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Fabiola Quintero-Rivera
- Division of Genetic and Genomic Medicine, Departments of Pathology, Laboratory Medicine, and Pediatrics, University of California Irvine, Irvine, CA
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9
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Reid MM, Davis SP, Henry ON, Mathew AA, McCallister S, Nero TT, Rabheru SA, Sampson SH, Vanderslice TF, Williams DT. Demographic diversity of US-based participants in GSK-sponsored interventional clinical trials. Clin Trials 2023; 20:133-144. [PMID: 36744680 PMCID: PMC10021118 DOI: 10.1177/17407745221149118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Demographic diversity among clinical trials is required for representing the real-world populations intended for treatment and disease prevention. Moreover, genetic and environmental differences between ethnic and racial groups necessitate appropriately powered trials for relevant subgroups. We investigate the racial and ethnic demographic diversity of US-based participants in GSK-sponsored interventional trials. We also assess the evaluation of demographic diversity against US Census and epidemiologic data. METHODS GSK-sponsored interventional phase I-IV clinical trials conducted from 2002 to 2019 across three areas were analyzed: pharmaceutical (includes therapeutic medicines except for vaccines and human immunodeficiency virus (HIV)), vaccine (includes prophylactic and therapeutic vaccines), and ViiV (includes HIV therapies). A total of 1005 global trials encompassing 460,707 global participants were identified, of which 495 had US-based sites with a total of 108,261 (23.5% of global) US participants (pharmaceutical, n = 357 trials; vaccine, n = 45 trials; and ViiV, n = 93 trials). We evaluated how GSK US-based trial recruitment compares with US Census (in line with previously published studies from other groups) and with epidemiologic data. RESULTS GSK participant data for race and ethnicity combined across areas were generally similar to US Census levels (e.g. GSK versus census: White, 76.5% versus 76.3%; Black or African American, 15.1% versus 13.4%; Asian, 1.8% versus 5.9%; Hispanic or Latino, 14.0% versus 18.5%; Non-Hispanic White, 63.5% versus 60.1%). However, this was not the case for the individual pharmaceutical, vaccine, and ViiV data sets; least represented groups were Asian individuals for pharmaceutical and ViiV trials and American Indian or Alaskan Native individuals for vaccine trials (6.2%, 11.8%, and 11.1% of trials met/exceeded census level representation, respectively). The percentage of trials reaching/exceeding census levels also varied per trial phase for race and ethnicity. Furthermore, disparities in the percentage of trials reaching/exceeding census levels versus epidemiology-based prevalence levels have revealed opportunities to improve industry success metrics; in HIV trials, the proportion of Black or African American individuals (35.1%) exceeded census (13.4%) but not epidemiologic levels (55.3%). CONCLUSION Further work is required to achieve demographic diversity across clinical trials. We conclude that US Census data are an inappropriate universal benchmark. A shift to epidemiology benchmarking will enable the consideration of global participants into US analyses for highly intrinsic (i.e. influenced by ancestry) diseases and more firm requirements for US-based participants into US analyses for extrinsic (i.e. influenced by location or culture) diseases. Benchmarking in line with epidemiologic data will allow us to set better trial enrollment goals, with the aim of conducting more demographically balanced, diverse, and representative clinical trials and enabling a better understanding of drug safety and efficacy per demographic group.
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Affiliation(s)
| | | | - Ouzama N Henry
- GSK, Rockville, MD, USA.,Dynavax Technologies, Emeryville, CA, USA
| | | | | | | | | | - Shani H Sampson
- GSK, Collegeville, PA, USA.,Independent Project Management Consultant for the Pharmaceutical Industry, Philadelphia, PA, USA
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10
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Ibrahim DMA, Ali OSM, Nasr H, Fateen E, AbdelAleem A. Biochemical and mutational analyses of HEXA in a cohort of Egyptian patients with infantile Tay-Sachs disease. Expansion of the mutation spectrum. Orphanet J Rare Dis 2023; 18:52. [PMID: 36907859 PMCID: PMC10009996 DOI: 10.1186/s13023-023-02637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Tay-Sachs disease (TSD), an autosomal recessively inherited neurodegenerative lysosomal storage disease, reported worldwide with a high incidence among population of Eastern European and Ashkenazi Jewish descent. Mutations in the alpha subunit of HEXA that encodes for the β-hexosaminidase-A lead to deficient enzyme activity and TSD phenotype. This study is the first to highlight the HEXA sequence variations spectrum in a cohort of Egyptian patients with infantile TSD. RESULTS This study involved 13 Egyptian infant/children patients presented with the infantile form of TSD, ten of the 13 patients were born to consanguineous marriages. β-hexosaminidase-A enzyme activity was markedly reduced in the 13 patients with a mean activity of 3 µmol/L/h ± 1.56. Sanger sequencing of the HEXA' coding regions and splicing junctions enabled a detection rate of ~ 62% (8/13) in our patients revealing the molecular defects in eight patients; six homozygous-mutant children (five of them were the product of consanguineous marriages) and two patients showed their mutant alleles in heterozygous genotypes, while no disease-causing mutation was identified in the remaining patients. Regulatory intragenic mutations or del/dup may underlie the molecular defect in those patients showing no relevant pathogenic sequencing variants or in the two patients with a heterozygous genotype of the mutant allele. This research identified three novel, likely pathogenic variants in association with the TSD phenotype; two missense, c.920A > C (E307A) and c.952C > G (H318D) in exon 8, and a single base deletion c.484delG causing a frameshift E162Rfs*37 (p.Glu162ArgfsTer37) in exon 5. Three recurrent disease-causing missense mutations; c.1495C > T (R499C), c.1511G > A(R504H), and c.1510C > T(R504C) in exon 13 were identified in five of the eight patients. None of the variants was detected in 50 healthy Egyptians' DNA. Five variants, likely benign or of uncertain significance, S3T, I436V, E506E, and T2T, in exons 1, 11,13, & 1 were detected in our study. CONCLUSIONS For the proper diagnostics, genetic counseling, and primary prevention, our study stresses the important role of Next Generation Sequencing approaches in delineating the molecular defect in TSD-candidate patients that showed negative Sanger sequencing or a heterozygous mutant allele in their genetic testing results. Interestingly, the three recurrent TSD associated mutations were clustered on chromosome 13 and accounted for 38% of the HEXA mutations detected in this study. This suggested exon 13 as the first candidate for sequencing screening in Egyptian patients with infantile TSD. Larger studies involving our regional population are recommended, hence unique disease associated pathogenic variations could be identified.
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Affiliation(s)
- Doaa M A Ibrahim
- Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Ola S M Ali
- Department of Biochemistry, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Hala Nasr
- Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Ekram Fateen
- Department of Biochemical Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt.
| | - Alice AbdelAleem
- Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt.
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11
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Genome-wide data from medieval German Jews show that the Ashkenazi founder event pre-dated the 14 th century. Cell 2022; 185:4703-4716.e16. [PMID: 36455558 PMCID: PMC9793425 DOI: 10.1016/j.cell.2022.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/26/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022]
Abstract
We report genome-wide data from 33 Ashkenazi Jews (AJ), dated to the 14th century, obtained following a salvage excavation at the medieval Jewish cemetery of Erfurt, Germany. The Erfurt individuals are genetically similar to modern AJ, but they show more variability in Eastern European-related ancestry than modern AJ. A third of the Erfurt individuals carried a mitochondrial lineage common in modern AJ and eight carried pathogenic variants known to affect AJ today. These observations, together with high levels of runs of homozygosity, suggest that the Erfurt community had already experienced the major reduction in size that affected modern AJ. The Erfurt bottleneck was more severe, implying substructure in medieval AJ. Overall, our results suggest that the AJ founder event and the acquisition of the main sources of ancestry pre-dated the 14th century and highlight late medieval genetic heterogeneity no longer present in modern AJ.
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12
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Hubbel A, Hogan E, Matthews A, Goldenberg A. North American genetic counselors' approach to collecting and using ancestry in clinical practice. J Genet Couns 2022; 32:462-474. [PMID: 36445952 DOI: 10.1002/jgc4.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022]
Abstract
Current guidelines from the National Society of Genetic Counselors (NSGC) recommend that patients' ancestry be obtained when taking a family history. However, no study has explored how consistently genetic counselors obtain or utilize this information. The goals of this study included assessing how genetic counselors collect their patients' ancestry, what factors influence this decision, and how they view the utility of this information. Genetic counselors working in a direct patient care setting in the US or Canada were recruited to participate in an anonymous survey via an NSGC email blast. Most participants (n = 115) obtain information about their patients' ancestry (96.5%), with the most common methods being directly asking the patient (91%) and utilizing intake forms (43.2%). Of participants who ask about ancestry directly, 50.5% always ask about the presence of Ashkenazi Jewish ancestry and 70.3% always ask about additional ancestries, suggesting that for most genetic counselors' collection of ancestry is standard practice. However, the clinical utility of ancestry information is highly variable, with the impact on genetic testing choice being particularly low. A slight majority of participants support a reevaluation of current ancestry guidelines (51.3%), with many participants suggesting that the varying utility of ancestry in different clinical indications/specialties should be incorporated into guidelines. Despite being standard practice for most genetic counselors, no unified approach or standard for how ancestral information should be used in genetic counseling practice was identified.
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Affiliation(s)
- Alexandra Hubbel
- Department of Genetics and Genome Sciences Case Western Reserve University Cleveland Ohio USA
| | - Elizabeth Hogan
- Department of Genetics and Genome Sciences Case Western Reserve University Cleveland Ohio USA
- Division of Genetics and Genomics The MetroHealth System Cleveland Ohio USA
| | - Anne Matthews
- Department of Genetics and Genome Sciences Case Western Reserve University Cleveland Ohio USA
| | - Aaron Goldenberg
- Department of Bioethics Case Western Reserve University Cleveland Ohio USA
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13
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Rudnik-Schöneborn S, Zerres K. Preconception carrier screening as an alternative reproductive option prior to newborn screening for severe recessive disorders. MED GENET-BERLIN 2022; 34:157-161. [PMID: 38835902 PMCID: PMC11006357 DOI: 10.1515/medgen-2022-2123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Sabine Rudnik-Schöneborn
- Institute of Human Genetics, Medical University Innsbruck, Peter-Mayr-Str. 1, 6020 Innsbruck, Austria
| | - Klaus Zerres
- Institute of Human Genetics and Genomic Medicine, RWTH Aachen University, Aachen, Germany
- LADR Laborzentrum Recklinghausen, Recklinghausen, Germany
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14
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Ramdaney A, Lichten L, Propst L, Mann C, Lazarin GA, Jones M, Taylor A, Malinowski J. Expanded carrier screening in the United States: A systematic evidence review exploring client and provider experiences. J Genet Couns 2022; 31:937-948. [PMID: 35212439 DOI: 10.1002/jgc4.1566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/08/2022]
Abstract
The aim of carrier screening is to identify prospective parents at risk of having a pregnancy affected with an autosomal recessive or X-linked disorder. Though minimal guideline-based screening is available, expanded carrier screening (ECS) is quickly becoming a feasible option for the general population due to its growing availability and affordability. However, the impact of ECS on clients and providers remains relatively unexplored. We performed a systematic evidence review to identify publications describing client-, provider-, and test-related outcomes. We searched several biomedical databases for articles published between January 1, 2003 and May 31, 2021. Studies were eligible for inclusion if they described genetic counseling and/or genetic testing for carrier screening (minimal guideline-based or ECS) in a prenatal or preconception setting in the United States. Title and abstract screening were performed using the Raayan web application or customized Google Forms. Full-text review and data extraction of included articles were performed using custom Google Forms. Two researchers performed a multistep selection process independently for validation purposes. Of 5413 unique articles screened, 36 studies were included with several studies contributing to multiple outcomes. Twenty described outcomes relating to patients/clients, 10 described provider-based outcomes, and 16 described test-based outcomes. Findings suggest that client and provider perceptions of ECS and minimal guideline-based carrier screening are multifaceted. Though clients have expressed desire for ECS, clinical uptake and impact on reproductive decision-making varies. Additionally, though genetic counselors seem to be comfortable with ECS, most other reproductive care providers seem to prefer minimal guideline or ancestry-based screening due to perceived barriers, such as time needed for ECS results disclosure and follow-up, as well as the desire to have panels set by professional societies/recommendations. There are limitations within the gathered literature, leading to potential uncertainty in the generalizability of our review. We outline several recommendations for future studies, including the need to examine variant interpretation and use of next-generation sequencing.
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Affiliation(s)
- Aarti Ramdaney
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lauren Lichten
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Caitlin Mann
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Malorie Jones
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amy Taylor
- Houston Methodist Hospital, Houston, Texas, USA
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15
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Addressing Reproductive Healthcare Disparities through Equitable Carrier Screening: Medical Racism and Genetic Discrimination in United States’ History Highlights the Needs for Change in Obstetrical Genetics Care. SOCIETIES 2022. [DOI: 10.3390/soc12020033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Carrier screening, a nearly half-century old practice, aims to provide individuals and couples with information about their risk of having children with serious genetic conditions. Traditionally, the conditions for which individuals were offered screening depended on their self-reported race or ethnicity and which conditions were seen commonly in that population. This process has led to disparities and inequities in care as the multi-racial population in the U.S. has grown exponentially, yet databases used to determine clinical practice guidelines are made up of primarily White cohorts. Technological advancements now allow for pan-ethnic expanded carrier screening (ECS), which screens for many conditions regardless of self-reported race or ethnicity. ECS presents a unique opportunity to promote equitable genetic testing practices in reproductive medicine. However, this goal can only be achieved if we acknowledge and appreciate the innumerable inequities evidenced in reproductive medicine and other socio-legal practices in the United States, and if we intentionally work in concert with healthcare providers, policy makers, advocates, and community health champions to reduce current and future reproductive health disparities. Herein, we provide a brief review of the way that US medical racism and genetic discrimination has shaped the current landscape of carrier screening.
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16
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Aleissa M, Aloraini T, Alsubaie LF, Hassoun M, Abdulrahman G, Swaid A, Eyaid WA, Mutairi FA, Ababneh F, Alfadhel M, Alfares A. Common disease-associated gene variants in a Saudi Arabian population. Ann Saudi Med 2022; 42:29-35. [PMID: 35112591 PMCID: PMC8812157 DOI: 10.5144/0256-4947.2022.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Screening programs for the most prevalent conditions occurring in a country is an evidence-based prevention strategy. The burden of autosomal recessive disease variations in Saudi Arabia is high because of the highly consanguineous population. The optimal solution for estimating the carrier frequency of the most prevalent diseases is carrier screening. OBJECTIVES Identify the most influential recessive alleles associated with disease in the Saudi population. DESIGN We used clinical whole-exome sequencing data from an in-house familial database to evaluate the most prevalent genetic variations associated with disease in a Saudi population. SETTINGS King Abdullah International Medical Research Center (KAIMRC) and King Abdulaziz Medical City. METHODS Whole exome sequencing data obtained from clinical studies of family members, a cohort of 1314 affected and unaffected individuals, were filtered using the in-house pipeline to extract the most prevalent variant in the dataset. MAIN OUTCOME MEASURES Most prevalent genetic variations associated with disease in the Saudi population. SAMPLE SIZE 1314 affected and unaffected individuals. RESULTS We identified 37 autosomal recessive variants and two heterozygous X-linked variants in 35 genes associated with the most prevalent disorders, which included hematologic (32%), endocrine (21%), metabolic (11%) and immunological (10%) diseases. CONCLUSION This study provides an update of the most frequently occurring alleles, which support future carrier screening programs. LIMITATIONS Single center that might represent the different regions but may be biased. In addition, most of the families included in the database are part of the proband's genetic identification for specific phenotypes. CONFLICT OF INTEREST None.
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Affiliation(s)
- Mariam Aleissa
- From the Division of Translational Pathology, Department of Laboratory Medicine, King Abdulaziz Medical City.,From the Department of Molecular Genetics, Public Health Laboratory, Public Health Authority, Riyadh.,From the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Taghrid Aloraini
- From the Division of Translational Pathology, Department of Laboratory Medicine, King Abdulaziz Medical City.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Lamia Fahad Alsubaie
- From the Department of Genetics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Madawi Hassoun
- From the Division of Translational Pathology, Department of Laboratory Medicine, King Abdulaziz Medical City.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Ghada Abdulrahman
- From the Division of Translational Pathology, Department of Laboratory Medicine, King Abdulaziz Medical City.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Abdulrahman Swaid
- From the Department of Genetics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Wafa Al Eyaid
- From the Department of Genetics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Fuad Al Mutairi
- From the Department of Genetics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Faroug Ababneh
- From the Department of Genetics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Majid Alfadhel
- From the Department of Genetics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences
| | - Ahmed Alfares
- From the Division of Translational Pathology, Department of Laboratory Medicine, King Abdulaziz Medical City.,From the King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences.,From the Department of Pediatrics, College of Medicine, Qassim University, Qassim
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17
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Diagnostic Tips from a Video Series and Literature Review of Patients with Late-Onset Tay-Sachs Disease. Tremor Other Hyperkinet Mov (N Y) 2022; 12:34. [PMID: 36618998 PMCID: PMC9801838 DOI: 10.5334/tohm.726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background Late-Onset Tay-Sachs (LOTS) disease is a rare, progressive neurological condition that can dramatically affect the life of these patients. The diagnosis of LOTS is easily missed because of the multifaced presentation of these patients, who can initially be assessed by neuromuscular or movement disorder specialists, or psychiatrists. Clinical trials are now becoming available for LOTS. Therefore, early diagnosis can be detrimental for these patients and for insuring informative research outcomes. Methods We characterized a cohort of nine patients with LOTS through a detailed clinical and video description. We then reviewed the available literature regarding the clinical description of patients with LOTS. Our findings were summarized based on the predominant phenotype of presentation to highlight diagnostic clues to guide the diagnosis of LOTS for different neurology specialists (neuromuscular, movement disorders) and psychiatrist. Results We described a cohort of 9 new patients with LOTS seen at our clinic. Our literature review identified 76 patients mainly presenting with a neuromuscular, cerebellar, psychiatric, stuttering, or movement disorder phenotype. Diagnostic tips, such as the triceps sign, distinct speech patterns, early psychiatric presentation and impulsivity, as well as neurological symptoms (cerebellar or neuromuscular) in patients with a prominent psychiatric presentation, are described. Discussion Specific diagnostics clues can help neurologists and psychiatrists in the early diagnosis of LOTS disease. Our work also represent the first video presentation of a cohort of patients with LOTS that can help different specialists to familiarize with these features and improve diagnostic outcomes. Highlights Late-Onset Tay-Sachs (LOTS) disease, a severe progressive neurological condition, has multifaced presentations causing diagnostic delays that can significantly affect research outcomes now that clinical trials are available. We highlight useful diagnostic clues from our cohort (including the first video representation of a LOTS cohort) and comprehensive literature review.
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18
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Barlow-Stewart K, Bardsley K, Elan E, Fleming J, Berman Y, Fleischer R, Recsei K, Goldberg D, Tucker J, Burnett L. Evaluating the model of offering expanded genetic carrier screening to high school students within the Sydney Jewish community. J Community Genet 2021; 13:121-131. [PMID: 34846685 PMCID: PMC8799788 DOI: 10.1007/s12687-021-00567-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/15/2021] [Indexed: 10/31/2022] Open
Abstract
Programs offering reproductive genetic carrier screening (RGCS) to high school students within the Ashkenazi Jewish community in several countries including Canada and Australia have demonstrated high uptake and retention of educational messages over time. This study was undertaken to evaluate whether testing for an expanded number of conditions in a high school setting would impact the effectiveness of education. In this questionnaire-based study, genetic carrier testing for nine conditions was offered to 322 year 11 students from five high schools, with students attending a compulsory 1-h education session prior to voluntary testing. Comparison of pre- and post-education measures demonstrated a significant increase in knowledge, positive attitudes, and reduced concern immediately after the education session. Retention of knowledge, measures of positive attitude, and low concern over a 12-month period were significantly higher than baseline, although there was some reduction over time. In total, 77% of students exhibited informed choice regarding their intention to test. A significant increase in baseline knowledge scores and positive attitude was also demonstrated between our original 1995 evaluation (with testing for only one condition) and 2014 (testing for nine conditions) suggesting community awareness and attitudes to RGCS have increased. These findings validate the implementation of effective education programs as a key component of RGCS and are relevant as gene panels expand with the introduction of genomic technologies.
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Affiliation(s)
- Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, 2065, Australia.,Community Genetics Program (NSW), Wolper Jewish Hospital, Woollahra, NSW, 2025, Australia
| | - Kayley Bardsley
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, 2065, Australia.,Department of Genetic Medicine, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Elle Elan
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, 2065, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Jane Fleming
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, 2065, Australia
| | - Yemima Berman
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, 2065, Australia.,Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ron Fleischer
- Community Genetics Program (NSW), Wolper Jewish Hospital, Woollahra, NSW, 2025, Australia.,Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, 2010, Australia
| | - Krista Recsei
- Pangolin Consulting, The Entrance, NSW, 2261, Australia
| | - Daniel Goldberg
- Community Genetics Program (NSW), Wolper Jewish Hospital, Woollahra, NSW, 2025, Australia
| | - John Tucker
- Community Genetics Program (NSW), Wolper Jewish Hospital, Woollahra, NSW, 2025, Australia
| | - Leslie Burnett
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW, 2065, Australia. .,Community Genetics Program (NSW), Wolper Jewish Hospital, Woollahra, NSW, 2025, Australia. .,Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia. .,St Vincent's Clinical School, UNSW Sydney, Darlinghurst, NSW, 2010, Australia.
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19
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Morgenstern-Kaplan D, Raijman-Policar J, Majzner-Aronovich S, Aradhya S, Pineda-Alvarez DE, Aguinaga M, García-Vences EE. Carrier screening in the Mexican Jewish community using a pan-ethnic expanded carrier screening NGS panel. Genet Med 2021; 24:821-830. [PMID: 34961661 DOI: 10.1016/j.gim.2021.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The Mexican Jewish community (MJC) is a previously uncharacterized, genetically isolated group composed of Ashkenazi and Sephardi-Mizrahi Jews who migrated in the early 1900s. We aimed to determine the heterozygote frequency of disease-causing variants in 302 genes in this population. METHODS We conducted a cross-sectional study of the MJC involving individuals representing Ashkenazi Jews, Sephardi-Mizrahi Jews, or mixed-ancestry Jews. We offered saliva-based preconception pan-ethnic expanded carrier screening, which examined 302 genes. We analyzed heterozygote frequencies of pathogenic/likely pathogenic variants and compared them with those in the Genome Aggregation Database (gnomAD). RESULTS We recruited 208 participants. The carrier screening results showed that 72.1% were heterozygous for at least 1 severe disease-causing variant in 1 of the genes analyzed. The most common genes with severe disease-causing variants were CFTR (16.8% of participants), MEFV (11.5%), WNT10A (6.7%), and GBA (6.7%). The allele frequencies were compared with those in the gnomAD; 85% of variant frequencies were statistically different from those found in gnomAD (P <.05). Finally, 6% of couples were at risk of having a child with a severe disorder. CONCLUSION The heterozygote frequency of at least 1 severe disease-causing variant in the MJC was 72.1%. The use of carrier screening in the MJC and other understudied populations could help parents make more informed decisions.
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Affiliation(s)
- Dan Morgenstern-Kaplan
- Centro de Investigación en Ciencias de la Salud (CICSA), Health Sciences Faculty, Anahuac University, Mexico City, Mexico.
| | - Jaime Raijman-Policar
- Centro de Investigación en Ciencias de la Salud (CICSA), Health Sciences Faculty, Anahuac University, Mexico City, Mexico
| | - Sore Majzner-Aronovich
- Centro de Investigación en Ciencias de la Salud (CICSA), Health Sciences Faculty, Anahuac University, Mexico City, Mexico
| | | | | | - Mónica Aguinaga
- Centro de Investigación en Ciencias de la Salud (CICSA), Health Sciences Faculty, Anahuac University, Mexico City, Mexico; Sexual and Reproductive Health Department, National Institute of Perinatology, Mexico City, Mexico
| | - Edna Elisa García-Vences
- Centro de Investigación en Ciencias de la Salud (CICSA), Health Sciences Faculty, Anahuac University, Mexico City, Mexico
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20
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Johansen Taber K, Ben-Shachar R, Torres R, Arjunan A, Muzzey D, Kaseniit KE, Goldberg J, Brown H. A guidelines-consistent carrier screening panel that supports equity across diverse populations. Genet Med 2021; 24:201-213. [PMID: 34906503 DOI: 10.1016/j.gim.2021.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/25/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The American College of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics and Genomics (ACMG) suggest carrier screening panel design criteria intended to ensure meaningful results. This study used a data-driven approach to interpret the criteria to identify guidelines-consistent panels. METHODS Carrier frequencies in >460,000 individuals across 11 races/ethnicities were used to assess carrier frequency. Other criteria were interpreted on the basis of published data. A total of 176 conditions were then evaluated. Stringency thresholds were set as suggested by ACOG and/or ACMG or by evaluating conditions already recommended by ACOG and ACMG. RESULTS Forty and 75 conditions had carrier frequencies of ≥1 in 100 and ≥1 in 200, respectively; 175 had a well-defined phenotype; and 165 met at least 1 severity criterion and had an onset early in life. Thirty-seven conditions met conservative thresholds, including a carrier frequency of ≥1 in 100, and 74 conditions met permissive thresholds, including a carrier frequency of ≥1 in 200; thus, both were identified as guidelines-consistent panels. CONCLUSION Clear panel design criteria are needed to ensure quality and consistency among carrier screening panels. Evidence-based analyses of criteria resulted in the identification of guidelines-consistent panels of 37 and 74 conditions.
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Affiliation(s)
| | - Rotem Ben-Shachar
- Department of Clinical Development, Myriad Genetics, Inc, Salt Lake City, UT
| | - Raul Torres
- Department of Clinical Development, Myriad Genetics, Inc, Salt Lake City, UT
| | - Aishwarya Arjunan
- Department of Medical Affairs, Myriad Women's Health, Inc, South San Francisco, CA
| | - Dale Muzzey
- Department of Research and Development, Myriad Genetics, Inc, Salt Lake City, UT
| | - Kristjan E Kaseniit
- Department of Clinical Development, Myriad Genetics, Inc, Salt Lake City, UT
| | - James Goldberg
- Department of Medical Affairs, Myriad Women's Health, Inc, South San Francisco, CA
| | - Haywood Brown
- Department of Obstetrics & Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL
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21
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Gregg AR, Aarabi M, Klugman S, Leach NT, Bashford MT, Goldwaser T, Chen E, Sparks TN, Reddi HV, Rajkovic A, Dungan JS. Screening for autosomal recessive and X-linked conditions during pregnancy and preconception: a practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2021; 23:1793-1806. [PMID: 34285390 PMCID: PMC8488021 DOI: 10.1038/s41436-021-01203-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
Carrier screening began 50 years ago with screening for conditions that have a high prevalence in defined racial/ethnic groups (e.g., Tay-Sachs disease in the Ashkenazi Jewish population; sickle cell disease in Black individuals). Cystic fibrosis was the first medical condition for which panethnic screening was recommended, followed by spinal muscular atrophy. Next-generation sequencing allows low cost and high throughput identification of sequence variants across many genes simultaneously. Since the phrase "expanded carrier screening" is nonspecific, there is a need to define carrier screening processes in a way that will allow equitable opportunity for patients to learn their reproductive risks using next-generation sequencing technology. An improved understanding of this risk allows patients to make informed reproductive decisions. Reproductive decision making is the established metric for clinical utility of population-based carrier screening. Furthermore, standardization of the screening approach will facilitate testing consistency. This practice resource reviews the current status of carrier screening, provides answers to some of the emerging questions, and recommends a consistent and equitable approach for offering carrier screening to all individuals during pregnancy or preconception.
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Affiliation(s)
- Anthony R Gregg
- Department of Obstetrics and Gynecology, Prisma Health, Columbia, SC, USA
| | - Mahmoud Aarabi
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Genetics Program, North York General Hospital, Toronto, ON, Canada
| | - Susan Klugman
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Michael T Bashford
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tamar Goldwaser
- Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, NY, USA
- Mount Sinai Hospital, New York, NY, USA
| | - Emily Chen
- Department of Genetics, Kaiser Permanente Medical Center, San Francisco, CA, USA
| | - Teresa N Sparks
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, CA, USA
| | - Honey V Reddi
- Department of Pathology and Laboratory Medicine and Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aleksandar Rajkovic
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Jeffrey S Dungan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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Abu-Much A, Nof E, Bragazzi NL, Younis A, Hochstein D, Younis A, Shlomo N, Fardman A, Goldenberg I, Klempfner R, Beinart R. Ethnic Disparity in Mortality Among Ischemic Heart Disease Patients. A-20 Years Outcome Study From Israel. Front Cardiovasc Med 2021; 8:661390. [PMID: 34277726 PMCID: PMC8277917 DOI: 10.3389/fcvm.2021.661390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Long-term morbidity and mortality data among ischemic heart disease (IHD) patients of different ethnicities are conflicting. We sought to determine the independent association of ethnicity and all-cause mortality over two decades of follow-up of Israeli patients. Methods: Our study comprised 15,524 patients including 958 (6%) Arab patients who had been previously enrolled in the Bezafibrate Infarction Prevention (BIP) registry between February 1, 1990, and October 31, 1992, and subsequently followed-up for long-term mortality. We compared clinical characteristics and outcomes of Israeli Arabs and Jews. Propensity score matching (PSM) (1:2 ratios) was used for validation. Results: Arab patients were significantly younger (56 ± 7 years vs. 60 ± 7 years; p < 0.001; respectively), and had more cardiovascular disease (CVD) risk factors. Kaplan-Meier survival analysis showed that all-cause mortality was significantly higher among Arab patients (67 vs. 61%; log-rank p < 0.001). Multivariate adjusted analysis showed that mortality risk was 49% greater (HR 1.49; 95% CI: 1.37–1.62; p < 0.001) among Arabs. Conclusions: Arab ethnicity is independently associated with an increased 20-year all-cause mortality among patients with established IHD.
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Affiliation(s)
- Arsalan Abu-Much
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, Centre for Disease Modelling, York University, Toronto, ON, Canada
| | - Anan Younis
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hochstein
- St George's Hospital Medical School, University of London, London, United Kingdom
| | - Arwa Younis
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Shlomo
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Fardman
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, United States
| | - Robert Klempfner
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
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23
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Xiao Q, Lauschke VM. The prevalence, genetic complexity and population-specific founder effects of human autosomal recessive disorders. NPJ Genom Med 2021; 6:41. [PMID: 34078906 PMCID: PMC8172936 DOI: 10.1038/s41525-021-00203-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Autosomal recessive (AR) disorders pose a significant burden for public health. However, despite their clinical importance, epidemiology and molecular genetics of many AR diseases remain poorly characterized. Here, we analyzed the genetic variability of 508 genes associated with AR disorders based on sequencing data from 141,456 individuals across seven ethnogeographic groups by integrating variants with documented pathogenicity from ClinVar, with stringent functionality predictions for variants with unknown pathogenicity. We first validated our model using 85 diseases for which population-specific prevalence data were available and found that our estimates strongly correlated with the respective clinically observed disease frequencies (r = 0.68; p < 0.0001). We found striking differences in population-specific disease prevalence with 101 AR diseases (27%) being limited to specific populations, while an additional 305 diseases (68%) differed more than tenfold across major ethnogeographic groups. Furthermore, by analyzing genetic AR disease complexity, we confirm founder effects for cystic fibrosis and Stargardt disease, and provide strong evidences for >25 additional population-specific founder mutations. The presented analyses reveal the molecular genetics of AR diseases with unprecedented resolution and provide insights into epidemiology, complexity, and population-specific founder effects. These data can serve as a powerful resource for clinical geneticists to inform population-adjusted genetic screening programs, particularly in otherwise understudied ethnogeographic groups.
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Affiliation(s)
- Qingyang Xiao
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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24
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Lisi EC, Ali N. Opinions of adults affected with later-onset lysosomal storage diseases regarding newborn screening: A qualitative study. J Genet Couns 2021; 30:1544-1558. [PMID: 33938615 DOI: 10.1002/jgc4.1421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 12/23/2022]
Abstract
Lysosomal storage diseases (LSDs) are a heterogeneous group of conditions causing substrate accumulation leading to progressive organ damage. Newborn screening (NBS) for several LSDs has become available in recent years due to advances in technology and treatment availability. While early initiation of treatment is lifesaving for those with infantile presentations, controversy continues regarding diagnosis of milder, later-onset diseases in infancy, including creation of pre-symptomatic populations of 'patients-in-waiting', the potential for medicalization, stigmatization, and/or discrimination. In-depth interviews were conducted with 36 adults [11 with Fabry disease (FD), 8 with Gaucher disease (GD), and 17 with late-onset Pompe disease (LOPD)], to determine their perspectives on NBS for their respective conditions. Thirty-four of 36 participants were in favor of NBS; both participants not in favor had GD1. Emergent themes influencing participants favorably toward NBS included earlier age of onset, a long diagnostic odyssey, less efficacious treatment, and the desire to have made different life decisions (e.g., relationships, career, or lifestyle) with the knowledge of their diagnosis. Concerns about insurance discrimination and psychological or physical burdens were associated with less favorable opinions of NBS. The ability for parents to make future reproductive decisions based their child's NBS result was considered favorably by some participants and unfavorably by others. Participants' specific condition (GD1, FD, or LOPD) contributed to these experiences differently. Participants with LOPD and FD favored NBS to initiate earlier treatment and prevent irreversible organ damage, whereas fewer patients with GD1 mentioned this benefit. Participants with LOPD had the longest diagnostic odyssey, while those with FD were more likely to report feeling misunderstood and experiencing accusations of malingering, both contributing to favorable views of NBS. Results expand prior quantitative findings by illuminating how participants' lived experiences can shape opinions about NBS. By understanding how currently affected individuals perceive the lifelong impact of a NBS result, genetic counselors can provide better anticipatory guidance to the parents of individuals diagnosed with a later-onset LSD by NBS.
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Affiliation(s)
- Emily C Lisi
- Department of Human Genetics, Emory University, Atlanta, GA, USA.,Graduate School for Arts and Sciences- Biomedical Sciences Division, Wake Forest University, Winston-Salem, NC, USA
| | - Nadia Ali
- Department of Human Genetics, Emory University, Atlanta, GA, USA
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25
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Clinical Implementation of Expanded Carrier Screening in Pregnant Women at Early Gestational Weeks: A Chinese Cohort Study. Genes (Basel) 2021; 12:genes12040496. [PMID: 33805278 PMCID: PMC8066122 DOI: 10.3390/genes12040496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
Demands for expanded carrier screening (ECS) are growing and ECS is becoming an important part of obstetrics practice and reproductive planning. The aim of this study is to evaluate the feasibility of a small-size ECS panel in clinical implementation and investigate Chinese couples’ attitudes towards ECS. An ECS panel containing 11 recessive conditions was offered to Chinese pregnant women below 16 gestational weeks. Sequential testing of their partners was recommended for women with a positive carrier status. The reproductive decision and pregnancy outcome were surveyed for at-risk couples. A total of 1321 women performed ECS successfully and the overall carrier rate was 19.23%. The estimated at-risk couple rate was 0.83%. Sequential testing was performed in less than half of male partners. Eight at-risk couples were identified and four of them performed prenatal diagnosis. Our study demonstrated that a small-size ECS panel could yield comparable clinical value to a larger-size panel when the carrier rate of the individual condition is equal or greater than 1%. In addition, more than half of male partners whose wives were carriers declined any types of sequential testing possibly due to a lack of awareness and knowledge of genetic disorders. Genetic education is warranted for the better implementation of ECS.
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26
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Wilf-Yarkoni A, Shor O, Fellner A, Hellmann MA, Pras E, Yonath H, Shkedi-Rafid S, Basel-Salmon L, Bazak L, Eliahou R, Greenbaum L, Stiebel-Kalish H, Benninger F, Goldberg Y. Mild Phenotype of Wolfram Syndrome Associated With a Common Pathogenic Variant Is Predicted by a Structural Model of Wolframin. NEUROLOGY-GENETICS 2021; 7:e578. [PMID: 33763535 PMCID: PMC7983365 DOI: 10.1212/nxg.0000000000000578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/27/2021] [Indexed: 11/15/2022]
Abstract
Objective To describe the WFS1 c.1672C>T; p.R558C missense variant, found in 1.34% of Ashkenazi Jews, that has a relatively mild phenotype and to use computational normal mode analysis (NMA) to explain the genotype-phenotype relationship. Methods The clinical, laboratory, and genetic features of 8 homozygotes were collected. A model of the wolframin protein was constructed, and NMA was used to simulate the effect of the variant on protein thermodynamics. Results Mean age at Wolfram syndrome (WS) diagnosis among homozygotes was 30 years; diabetes (7/8) was diagnosed at mean age 19 years (15–21 years), and bilateral optic atrophy (with MRI evidence of optic/chiasm atrophy) (6/8) at mean age 29 years (15–48 years). The oldest patient (62 years) also had gait difficulties, memory problems, parietal and cerebellar atrophy, and white matter hyperintense lesions. All retained functional vision with independent ambulation and self-care; none had diabetes insipidus or hearing loss. The p.R558C variant caused less impairment of protein entropy than WFS1 variants associated with a more severe phenotype. Conclusions The p.R558C variant causes a milder, late-onset phenotype of WS. We report a structural model of wolframin protein based on empirical functional studies and use NMA modeling to show a genotype-phenotype correlation across all homozygotes. Clinicians should be alert to this condition in patients with juvenile diabetes and patients of any age with a combination of diabetes and optic atrophy. Computational NMA has potential benefit for prediction of the genotype-phenotype relationship.
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Affiliation(s)
- Adi Wilf-Yarkoni
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Oded Shor
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Avi Fellner
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Mark Andrew Hellmann
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Elon Pras
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Hagit Yonath
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Shiri Shkedi-Rafid
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Lina Basel-Salmon
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Lili Bazak
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Ruth Eliahou
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Lior Greenbaum
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Hadas Stiebel-Kalish
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Felix Benninger
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
| | - Yael Goldberg
- Neuro-Immunology Unit (A.W-.Y., M.A.H.), Department of Neurology (O.S., A.F., F.B.), Department of Radiology (R.E.), and Neuro-Ophthalmology Unit, Department of Ophthalmology (H.S.K.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine (O.S., E.P., H.Y., L.B.-S., L.G., H.S.-K., F.B., Y.G.), Tel Aviv University, Tel Aviv, Israel; The Raphael Recanati Genetic Institute (A.F., Y.G., L.B.-S., L.B.), Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; The Danek Gertner Institute of Human Genetics (E.P., H.Y., L.G.), Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center (E.P., L.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A (H.Y.), Sheba Medical Center, Tel Hashomer, Israel; Department of Genetics and Faculty of Medicine (S.S.-R.), Hadassah-Hebrew University Hospital, Jerusalem, Israel; Felsenstein Medical Research Center (O.S., L.B.-S., F.B.), Petach Tikva, Israel
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27
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Rabin R, Hirsch Y, Johansson MM, Ekstein J, Ekstein A, Pappas J. Severe epileptic encephalopathy associated with compound heterozygosity of THG1L variants in the Ashkenazi Jewish population. Am J Med Genet A 2021; 185:1589-1597. [PMID: 33682303 DOI: 10.1002/ajmg.a.62147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/10/2022]
Abstract
THG1L-associated autosomal recessive ataxia belongs to a group of disorders that occur due to abnormal mitochondrial tRNA modification. The product of THG1L is the tRNA-histidine guanylyltransferase 1-like enzyme that catalyzes the 3'-5"addition of guanine to the 5"-end of tRNA-histidine in the mitochondrion. To date, five individuals with homozygosity for p.(Val55Ala) in THG1L have been reported and presented with mild delays or normal development and cerebellar dysfunction. We present seven individuals with biallelic variants in THG1L. Three individuals were compound heterozygous for the p.(Cys51Trp) and p.(Val55Ala) variants and presented with profound developmental delays, microcephaly, intractable epilepsy, and cerebellar hypoplasia. Four siblings were homozygous for the p.(Val55Ala) variant and presented with cerebellar ataxia with cerebellar vermis hypoplasia, dysarthria, mild developmental delays, and normal/near-normal cognition. All seven patients were of Ashkenazi Jewish descent. Carrier rates for the two variants were calculated in a cohort of 26,731 Ashkenazi Jewish individuals tested by the Dor Yeshorim screening program. The p.(Cys51Trp) variant is novel and was found in 40 of the Ashkenazi Jewish individuals tested, with a carrier rate of 1 in 668 (0.15%). The p.(Val55Ala) variant was found in 229 of the Ashkenazi Jewish individuals tested, with a carrier rate of 1 in 117 (0.85%). The individuals with compound heterozygosity of the p.(Val55Ala) and p.(Cys51Trp) variants expand the phenotypic spectrum of THG1L-related disorders to include severe epileptic encephalopathy. The individuals with homozygosity of the p.(V55A) variant further establish the associated mild and slowly progressive or nonprogressive neurodevelopmental phenotype.
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Affiliation(s)
- Rachel Rabin
- Clinical Genetic Services, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York, USA
| | - Yoel Hirsch
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases, Brooklyn, New York, USA
| | - Martin M Johansson
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases, Brooklyn, New York, USA
| | - Joseph Ekstein
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases, Brooklyn, New York, USA
| | - Ahron Ekstein
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases, Jerusalem, Israel
| | - John Pappas
- Clinical Genetic Services, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York, USA.,Clinical Genetics, NYU Langone Orthopedic Hospital, New York, New York, USA
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28
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de Wert G, van der Hout S, Goddijn M, Vassena R, Frith L, Vermeulen N, Eichenlaub-Ritter U. The ethics of preconception expanded carrier screening in patients seeking assisted reproduction. Hum Reprod Open 2021; 2021:hoaa063. [PMID: 33604456 PMCID: PMC7880037 DOI: 10.1093/hropen/hoaa063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/30/2020] [Indexed: 02/02/2023] Open
Abstract
Expanded carrier screening (ECS) entails a screening offer for carrier status for multiple recessive disorders simultaneously and allows testing of couples or individuals regardless of ancestry or geographic origin. Although universal ECS—referring to a screening offer for the general population—has generated considerable ethical debate, little attention has been given to the ethics of preconception ECS for patients applying for assisted reproduction using their own gametes. There are several reasons why it is time for a systematic reflection on this practice. Firstly, various European fertility clinics already offer preconception ECS on a routine basis, and others are considering such a screening offer. Professionals involved in assisted reproduction have indicated a need for ethical guidance for ECS. Secondly, it is expected that patients seeking assisted reproduction will be particularly interested in preconception ECS, as they are already undertaking the physical, emotional and economic burdens of such reproduction. Thirdly, an offer of preconception ECS to patients seeking assisted reproduction raises particular ethical questions that do not arise in the context of universal ECS: the professional’s involvement in the conception implies that both parental and professional responsibilities should be taken into account. This paper reflects on and provides ethical guidance for a responsible implementation of preconception ECS to patients seeking assisted reproduction using their own gametes by assessing the proportionality of such a screening offer: do the possible benefits clearly outweigh the possible harms and disadvantages? If so, for what kinds of disorders and under what conditions?
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Affiliation(s)
- Guido de Wert
- Department of Health, Ethics and Society; CAPHRI School for Public Health and Primary Care, Maastricht University; and GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Sanne van der Hout
- Department of Health, Ethics and Society; CAPHRI School for Public Health and Primary Care, Maastricht University; and GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Mariëtte Goddijn
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Rita Vassena
- Clinica EUGIN, Carrer de Balmes 236, Barcelona 08006, Spain
| | - Lucy Frith
- Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
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29
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Leung ML, McAdoo S, Watson D, Stumm K, Harr M, Wang X, Chung CH, Mafra F, Nesbitt AI, Hakonarson H, Santani A. A Transparent Approach to Calculate Detection Rate and Residual Risk for Carrier Screening. J Mol Diagn 2021; 23:91-102. [PMID: 33349347 DOI: 10.1016/j.jmoldx.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 01/25/2023] Open
Abstract
Carrier screening involves detection of carrier status for genes associated with recessive conditions. A negative carrier screening test result bears a nonzero residual risk (RR) for the individual to have an affected child. The RR depends on the prevalence of specific conditions and the detection rate (DR) of the test itself. Herein, we provide a detailed approach for calculating DR and RR. DR was calculated on the basis of the sum of disease allele frequencies (DAFs) of pathogenic variants found in published literature. As a proof of concept, DAF data for cystic fibrosis were compared with society guidelines. The DAF data calculated by this method were consistent with the published cystic fibrosis guideline. In addition, we compared DAF for four genes (ABCC8, ASPA, GAA, and MMUT) across three laboratories, and outlined the likely reasons for discrepancies between these laboratories. The utility of carrier screening is to support couples with information while making reproductive choices. Accurate development of DR and RR is therefore critical. The method described herein provides an unbiased and transparent process to collect, calculate, and report these data.
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Affiliation(s)
- Marco L Leung
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
| | | | - Deborah Watson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kallyn Stumm
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret Harr
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Xiang Wang
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christine H Chung
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Fernanda Mafra
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Addie I Nesbitt
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Avni Santani
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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30
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Dolitsky S, Mitra A, Khan S, Ashkinadze E, Sauer MV. Beyond the "Jewish panel": the importance of offering expanded carrier screening to the Ashkenazi Jewish population. F S Rep 2020; 1:294-298. [PMID: 34223259 PMCID: PMC8244264 DOI: 10.1016/j.xfre.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/12/2020] [Accepted: 08/02/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To assess whether or not the current American College of Obstetricians and Gynecologists (ACOG) recommendations regarding carrier screening are sufficiently robust in detecting mutations in the Ashkenazi Jewish (AJ) population. Design Cross-sectional study. Setting Outreach program at university community center. Patient(s) Self-identified Jewish students, 18–24 years of age, interested in genetic carrier testing. Intervention(s) Expanded carrier screening (ECS) with the use of a commercially available targeted genotyping panel including >700 mutations in 180 genes. Main Outcome Measure(s) Gene mutations found in this population were grouped into three categories based on ACOG’s 2017 committee opinion regarding carrier screening: category 1: the four commonly recommended genetic conditions known to be a risk for this population; category 2: 14 genetic disorders that should be considered for more comprehensive screening, including those of category 1; and category 3: the ECS panel, which includes category 2. Result(s) A total of 81 students underwent screening and 36 (44.4%) were ascertained to be carriers of at least one mutation. A total of 45 mutations were identified, as 8 students were carriers for more than one condition. If testing were limited to category 1, 84% of the mutations would not have been identified, and if limited to category 2, 55% of mutations would have gone undetected. Conclusion(s) Individuals of Ashkenazi Jewish descent are at significant risk for carrying a variety of single-gene mutations and therefore they should be offered panethnic ECS to increase the likelihood of detecting preventable disorders.
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Affiliation(s)
- Shelley Dolitsky
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anjali Mitra
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shama Khan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Elena Ashkinadze
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mark V Sauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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31
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Westemeyer M, Saucier J, Wallace J, Prins SA, Shetty A, Malhotra M, Demko ZP, Eng CM, Weckstein L, Boostanfar R, Rabinowitz M, Benn P, Keen-Kim D, Billings P. Clinical experience with carrier screening in a general population: support for a comprehensive pan-ethnic approach. Genet Med 2020; 22:1320-1328. [PMID: 32366966 PMCID: PMC7394882 DOI: 10.1038/s41436-020-0807-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To present results from a large cohort of individuals receiving expanded carrier screening (CS) in the United States. METHODS Single-gene disorder carrier status for 381,014 individuals was determined using next-generation sequencing (NGS) based CS for up to 274 genes. Detection rates were compared with literature-reported values derived from disease prevalence and carrier frequencies. Combined theoretical affected pregnancy rates for the 274 screened disorders were calculated. RESULTS For Ashkenazi Jewish (AJ) diseases, 81.6% (4434/5435) of carriers identified did not report AJ ancestry. For cystic fibrosis, 44.0% (6260/14,229) of carriers identified had a variant not on the standard genotyping panel. Individuals at risk of being a silent spinal muscular atrophy carrier, not detectable by standard screening, comprised 1/39 (8763/344,407) individuals. For fragile X syndrome, compared with standard premutation screening, AGG interruption analysis modified risk in 83.2% (1128/1356) premutation carriers. Assuming random pairing across the study population, approximately 1/175 pregnancies would be affected by a disorder in the 274-gene screening panel. CONCLUSION Compared with standard screening, NGS-based CS provides additional information that may impact reproductive choices. Pan-ethnic CS leads to substantially increased identification of at-risk couples. These data support offering NGS-based CS to all reproductive-aged women.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Louis Weckstein
- Reproductive Science Center of the San Francisco Bay Area, San Ramon, CA, USA
| | | | | | - Peter Benn
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, CT, USA
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32
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Thomsen AJ, Matthews AL, Mitchell AL, Cohen L. Practices in synagogues regarding Jewish genetic disease education. J Genet Couns 2020; 29:1041-1049. [PMID: 32091143 DOI: 10.1002/jgc4.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/05/2020] [Indexed: 11/07/2022]
Abstract
Approximately one in three Ashkenazi Jews are carriers for an autosomal recessive Jewish genetic disease (JGD). However, studies indicate that most Jews are uneducated on this topic and obstetricians do not routinely offer carrier screening to Jewish patients. Both the Reform and Conservative movements of Judaism call for JGD education to take place within the synagogue; however, little is known about the extent of this education occurring today. An online survey was created for Reform and Conservative rabbis to assess the types of JGD education taking place within the synagogue. Additionally, the survey included questions to assess JGD knowledge and possible factors that could predict counseling activity and knowledge level. Of the 94 participants, 91% had provided education about JGDs to congregants, with 98.8% providing this education during premarital counseling sessions. For most respondents, explaining recessive inheritance pattern and carrier screening was the extent of the discussion. Additionally, the majority of rabbis scored below 50% on the knowledge portion of the survey, with an average score of 1.9/4. There were no statistically significant differences between JGD education in Reform vs. Conservative synagogues, and there were no statistically significant predictors of knowledge score or JGD education frequency. In conclusion, while the number of rabbis discussing this topic is encouraging, discussion topics were found to be limited and their knowledge of JGDs was found to be poor.
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Affiliation(s)
- Allison J Thomsen
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA.,Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anne L Matthews
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Anna L Mitchell
- Department of Genetics and Genome Sciences, Case Western Reserve University and Center for Human Genetics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Leslie Cohen
- Department of Genetics and Genome Sciences, Case Western Reserve University and Center for Human Genetics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Sema4 Genomics, Stamford, CT, USA
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33
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Akler G, Birch AH, Schreiber-Agus N, Cai X, Cai G, Shi L, Yu C, Larmore AM, Mendiratta-Vij G, Elkhoury L, Dillon MW, Zhu J, Mclellan AS, Suer FE, Webb BD, Schadt EE, Kornreich R, Edelmann L. Lessons learned from expanded reproductive carrier screening in self-reported Ashkenazi, Sephardi, and Mizrahi Jewish patients. Mol Genet Genomic Med 2019; 8:e1053. [PMID: 31880409 PMCID: PMC7005669 DOI: 10.1002/mgg3.1053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 09/15/2019] [Accepted: 10/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background Next‐generation sequencing (NGS)‐based panels have gained traction as a strategy for reproductive carrier screening. Their value for screening Ashkenazi Jewish (AJ) individuals, who have benefited greatly from population‐wide targeted testing, as well as Sephardi/Mizrahi Jewish (SMJ) individuals (an underserved population), has not been fully explored. Methods The clinical utilization by 6,805 self‐reported Jewish individuals of an expanded NGS panel, along with several ancillary assays, was assessed retrospectively. Data were extracted for a subset of 96 diseases that, during the panel design phase, were classified as being AJ‐, SMJ‐, or pan‐Jewish/pan‐ethnic‐relevant. Results 64.6% of individuals were identified as carriers of one or more of these 96 diseases. Over 80% of the reported variants would have been missed by following recommended AJ screening guidelines. 10.7% of variants reported for AJs were in “SMJ‐relevant genes,” and 31.2% reported for SMJs were in “AJ‐relevant genes.” Roughly 2.5% of individuals carried a novel, likely pathogenic variant. One in 16 linked cohort couples was identified as a carrier couple for at least one of these 96 diseases. Conclusion For maximal carrier identification, this study supports using expanded NGS panels for individuals of all Jewish backgrounds. This approach can better empower at‐risk couples for reproductive decision making.
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Affiliation(s)
- Gidon Akler
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,TOVANA Health, Houston, TX, USA.,Precision Medicine Insights, P.C., Great Neck, NY, USA
| | - Ashley H Birch
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | | | - Xiaoqiang Cai
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Guiqing Cai
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Lisong Shi
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Chunli Yu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Anastasia M Larmore
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Geetu Mendiratta-Vij
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Lama Elkhoury
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Mitchell W Dillon
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Zhu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Andrew S Mclellan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Funda E Suer
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Bryn D Webb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Ruth Kornreich
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Lisa Edelmann
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
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Rowe CA, Wright CF. Expanded universal carrier screening and its implementation within a publicly funded healthcare service. J Community Genet 2019; 11:21-38. [PMID: 31828606 PMCID: PMC6962405 DOI: 10.1007/s12687-019-00443-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Carrier screening, a well-established clinical initiative, has been slow to take advantage of the new possibilities offered by high-throughput next generation sequencing technologies. There is evidence of significant benefit in expanding carrier screening to include multiple autosomal recessive conditions and offering a ‘universal’ carrier screen that could be used for a pan-ethnic population. However, the challenges of implementing such a programme and the difficulties of demonstrating efficacy worthy of public health investment are significant barriers. In order for such a programme to be successful, it would need to be applicable and acceptable to the population, which may be ethnically and culturally diverse. There are significant practical and ethical implications associated with determining which variants, genes and conditions to include whilst maintaining adequate sensitivity and accuracy. Although preconception screening would maximise the potential benefits from universal carrier screening, the resource implications of different modes of delivery need to be carefully evaluated and balanced against maximising reproductive autonomy and ensuring equity of access. Currently, although a number of existing initiatives are increasing access to carrier screening, there is insufficient evidence to inform the development of a publicly funded, expanded, universal carrier screening programme that would justify investment over other healthcare interventions.
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Affiliation(s)
- Charlotte A Rowe
- University of Exeter, St Luke's Campus, 79 Heavitree Rd, Exeter, EX1 1TX, UK. .,Post Graduate Centre, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, TR1 3LQ, UK.
| | - Caroline F Wright
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, RILD Building, RD&E, Barrack Road, Exeter, EX2 5DW, UK.
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Giles Choates M, Stevens BK, Wagner C, Murphy L, Singletary CN, Wittman AT. It takes two: uptake of carrier screening among male reproductive partners. Prenat Diagn 2019; 40:311-316. [PMID: 31793013 DOI: 10.1002/pd.5588] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/23/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe uptake of carrier screening by male reproductive partners of prenatal and preconception patients. METHODS A retrospective database review of all prenatal and preconception patients seen for genetic counseling in Maternal Fetal Medicine clinics was performed. Descriptive statistics and chi-square analysis were used on the data set. RESULTS Within the study period, 6087 patients were seen for genetic counseling, of whom 661 were identified as a carrier of an autosomal recessive disorder by their referring provider or genetic counselor. Despite guidelines recommending partner testing for risk clarification when a woman is known to be a carrier of an autosomal recessive condition, only 41.5% male partners elected carrier screening to clarify the couple's reproductive risk, with a majority of males (75%) having screening consecutively. Of all assessed variables, the only significant predictors of male carrier screening uptake were female parity and earlier gestational age (p < .0001, and p = .001, respectively). CONCLUSION With less than half of male partners pursuing carrier screening when indicated, its utility becomes severely diminished. More research is needed to explore reasons why males elect or decline carrier screening.
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Affiliation(s)
- Meagan Giles Choates
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Blair K Stevens
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Chelsea Wagner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Lauren Murphy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Claire N Singletary
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
| | - A Theresa Wittman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, USA.,UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
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Delatycki MB, Alkuraya F, Archibald A, Castellani C, Cornel M, Grody WW, Henneman L, Ioannides AS, Kirk E, Laing N, Lucassen A, Massie J, Schuurmans J, Thong M, Langen I, Zlotogora J. International perspectives on the implementation of reproductive carrier screening. Prenat Diagn 2019; 40:301-310. [DOI: 10.1002/pd.5611] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/22/2019] [Accepted: 11/07/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Martin B. Delatycki
- Victorian Clinical Genetics Services Parkville Victoria Australia
- Murdoch Children's Research Institute Parkville Victoria Australia
- Department of PaediatricsUniversity of Melbourne Parkville Victoria Australia
| | - Fowzan Alkuraya
- Department of GeneticsKing Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia
- Saudi Human Genome ProgramKing Abdulaziz City for Science and Technology Riyadh Saudi Arabia
- College of MedicineAlfaisal University Riyadh Saudi Arabia
| | - Alison Archibald
- Victorian Clinical Genetics Services Parkville Victoria Australia
- Murdoch Children's Research Institute Parkville Victoria Australia
- Department of PaediatricsUniversity of Melbourne Parkville Victoria Australia
| | - Carlo Castellani
- Cystic Fibrosis CentreIRCCS Istituto Giannina Gaslini Genoa Italy
| | - Martina Cornel
- Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Amsterdam Reproduction and Development Research Institute Amsterdam The Netherlands
| | - Wayne W. Grody
- Divisions of Medical Genetics and Molecular Diagnostics, Departments of Pathology and Laboratory Medicine, Pediatrics, and Human GeneticsUCLA School of Medicine Los Angeles California USA
- UCLA Institute for Society and Genetics, Molecular Diagnostic Laboratories and Clinical Genomics CenterUCLA Medical Center Los Angeles California USA
| | - Lidewij Henneman
- Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Amsterdam Reproduction and Development Research Institute Amsterdam The Netherlands
| | | | - Edwin Kirk
- Sydney Children's Hospital Randwick New South Wales Australia
- New South Wales Health Pathology Randwick New South Wales Australia
- School of Women's and Children's HealthUniversity of New South Wales Randwick New South Wales Australia
| | - Nigel Laing
- University of Western Australia Centre for Medical Research and Harry Perkins Institute of Medical ResearchQEII Medical Centre Nedlands Western Australia Australia
- Neurogenetic Unit, Department of Diagnostic Genomics, PathWest Laboratory MedicineQEII Medical Centre Nedlands Western Australia Australia
| | - Anneke Lucassen
- Faculty of Medicine, Southampton Medical SchoolUniversity of Southampton Southampton UK
| | - John Massie
- Murdoch Children's Research Institute Parkville Victoria Australia
- Department of PaediatricsUniversity of Melbourne Parkville Victoria Australia
- Department of Respiratory MedicineRoyal Children's Hospital Parkville Victoria Australia
| | - Juliette Schuurmans
- Faculty of Medicine, Southampton Medical SchoolUniversity of Southampton Southampton UK
- Department of Genetics, University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
| | - Meow‐Keong Thong
- Genetics and Metabolism Unit, Department of Paediatrics, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Irene Langen
- Department of Genetics, University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
| | - Joël Zlotogora
- Hadassah‐Hebrew University Medical School Jerusalem Israel
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Rosenblum LS, Zhu H, Zhou Z, Teicher J, Heim RA, Leach NT. Comparison of pan-ethnic and ethnic-based carrier screening panels for individuals of Ashkenazi Jewish descent. J Genet Couns 2019; 29:56-66. [PMID: 31663226 DOI: 10.1002/jgc4.1180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/26/2022]
Abstract
The intent of carrier screening is to identify individuals at risk for having a child with a genetic disorder. American College of Medical Genetics and Genomics (ACMG) guidelines currently recommend that individuals of Ashkenazi Jewish (AJ) descent be screened for carrier status for nine disorders. However, a joint statement from five professional organizations acknowledges benefits of expanded carrier screening and this is becoming common practice. To better understand the impact of expanded carrier screening for the AJ population, we performed a retrospective analysis comparing detection rates for AJ individuals screened by two targeted panels: a pan-ethnic panel comprising 87 disorders and an AJ panel comprising an 18-disorder subset of the pan-ethnic panel. We also extrapolated the detection rates for the 18 AJ disorders from the pan-ethnic panel data and for the nine ACMG-recommended disorders using data from both panels. We found that with the pan-ethnic panel 431/1150 (37.5%) individuals were carriers of at least one disorder, compared to 319/1248 (25.6%) individuals with the AJ panel. If the pan-ethnic panel cohort were tested in the AJ panel or for the nine ACMG-recommended disorders, the detection rates would have been 280/1150 (24.3%) and 207/1150 (18.0%) respectively. Therefore, the pan-ethnic expanded carrier screening panel of 87 disorders increased the carrier detection rate in AJ individuals by approximately 50% and 100%, respectively, compared with a panel of 18 disorders considered relevant to the AJ population and the ACMG-recommended disorders. Twenty disorders accounted for the difference in carrier detection rates between the pan-ethnic and AJ panels. Of these, three were among the 10 most commonly identified disorders. Our findings reinforce published data that targeted AJ panels are less effective than a pan-ethnic panel in carrier detection among AJ individuals and provide metrics to address the impact of expanded carrier screening in this population.
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Affiliation(s)
- Lynne S Rosenblum
- Integrated Genetics, Laboratory Corporation of America® Holdings, Westborough, MA, USA
| | - Hui Zhu
- Integrated Genetics, Laboratory Corporation of America® Holdings, Westborough, MA, USA
| | - Zhaoqing Zhou
- Integrated Genetics, Laboratory Corporation of America® Holdings, Westborough, MA, USA
| | - Jennifer Teicher
- Integrated Genetics, Laboratory Corporation of America® Holdings, Westborough, MA, USA
| | - Ruth A Heim
- Integrated Genetics, Laboratory Corporation of America® Holdings, Westborough, MA, USA
| | - Natalia T Leach
- Integrated Genetics, Laboratory Corporation of America® Holdings, Westborough, MA, USA
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A founder deletion in the TRPM1 gene associated with congenital stationary night blindness and myopia is highly prevalent in Ashkenazi Jews. Hum Genome Var 2019; 6:45. [PMID: 31645983 PMCID: PMC6804618 DOI: 10.1038/s41439-019-0076-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023] Open
Abstract
Congenital stationary night blindness (CSNB) is a disease affecting the night vision of individuals. Previous studies identified TRPM1 as a gene involved in reduced night vision. Homozygous deletion of TRPM1 was the cause of CSNB in several children in 6 Ashkenazi Jewish families, thereby prompting further investigation of the carrier status within the families as well as in large cohorts of unrelated Ashkenazi and Sephardi individuals. Affected children were tested with a CSNB next-generation (NextGen) sequencing panel. A deletion of TRPM1 exons 2 through 7 was detected and confirmed by PCR and sequence analysis. A TaqMan-based assay was used to assess the frequency of this deletion in 18266 individuals of Jewish descent. High-throughput amplicon sequencing was performed on 380 samples to determine the putative deletion-flanking founder haplotype. Heterozygous TRPM1 deletions were found in 2.75% (1/36) of Ashkenazi subjects and in 1.22% (1/82) individuals of mixed Ashkenazi/Sephardic origin. The homozygous deletion frequency in our data was 0.03% (1/4025) and was only found in Ashkenazi Jewish individuals. Homozygous deletion of exons 2–7 in TRPM1 is a common cause of CSNB and myopia in many Ashkenazi Jewish patients. This deletion is a founder Ashkenazi Jewish deletion. A genetic mutation found in Ashkenazi Jewish population causes an eye disease that leads to poor vision in dim light. Yoel Hirsch and Martin M. Johansson from Dor Yeshorim, together with colleagues determined the genetic etiology of congenital stationary night blindness (CSNB) in children from six Ashkenazi families. Each affected child harbored two mutant versions of TRPM1, a gene involved in the transmission of light-elicited signals within the retina of the eye. Notably, all the children had the same large chunk of DNA missing from the gene. The researchers next screened for this genetic deletion in >18,000 individuals of Jewish descent, finding single copies of the mutation in 2.75% of Ashkenazi subjects. The findings should help doctors better diagnose CSNB and care for Jewish patients with eyesight problems.
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Cecchi AC, Vengoechea ES, Kaseniit KE, Hardy MW, Kiger LA, Mehta N, Haque IS, Moyer K, Page PZ, Muzzey D, Grinzaid KA. Screening for Tay-Sachs disease carriers by full-exon sequencing with novel variant interpretation outperforms enzyme testing in a pan-ethnic cohort. Mol Genet Genomic Med 2019; 7:e836. [PMID: 31293106 PMCID: PMC6687860 DOI: 10.1002/mgg3.836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/22/2019] [Accepted: 05/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background Pathogenic variants in HEXA that impair β‐hexosaminidase A (Hex A) enzyme activity cause Tay‐Sachs Disease (TSD), a severe autosomal‐recessive neurodegenerative disorder. Hex A enzyme analysis demonstrates near‐zero activity in patients affected with TSD and can also identify carriers, whose single functional copy of HEXA results in reduced enzyme activity relative to noncarriers. Although enzyme testing has been optimized and widely used for carrier screening in Ashkenazi Jewish (AJ) individuals, it has unproven sensitivity and specificity in a pan‐ethnic population. The ability to detect HEXA variants via DNA analysis has evolved from limited targeting of a few ethnicity‐specific variants to next‐generation sequencing (NGS) of the entire coding region coupled with interpretation of any discovered novel variants. Methods We combined results of enzyme testing, retrospective computational analysis, and variant reclassification to estimate the respective clinical performance of TSD screening via enzyme analysis and NGS. We maximized NGS accuracy by reclassifying variants of uncertain significance and compared to the maximum performance of enzyme analysis estimated by calculating ethnicity‐specific frequencies of variants known to yield false‐positive or false‐negative enzyme results (e.g., pseudodeficiency and B1 alleles). Results In both AJ and non‐AJ populations, the estimated clinical sensitivity, specificity, and positive predictive value were higher by NGS than by enzyme testing. The differences were significant for all comparisons except for AJ clinical sensitivity, where NGS exceeded enzyme testing, but not significantly. Conclusions Our results suggest that performance of an NGS‐based TSD carrier screen that interrogates the entire coding region and employs novel variant interpretation exceeds that of Hex A enzyme testing, warranting a reconsideration of existing guidelines.
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Affiliation(s)
| | | | | | - Melanie W Hardy
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Laura A Kiger
- Myriad Women's Health, South San Francisco, California
| | - Nikita Mehta
- Myriad Women's Health, South San Francisco, California
| | - Imran S Haque
- Myriad Women's Health, South San Francisco, California
| | - Krista Moyer
- Myriad Women's Health, South San Francisco, California
| | - Patricia Z Page
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Dale Muzzey
- Myriad Women's Health, South San Francisco, California
| | - Karen A Grinzaid
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
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Rabin R, Hirsch Y, Johansson MM, Ekstein J, Zeevi DA, Keena B, Zackai EH, Pappas J. Study of carrier frequency of Warsaw breakage syndrome in the Ashkenazi Jewish population and presentation of two cases. Am J Med Genet A 2019; 179:2144-2151. [DOI: 10.1002/ajmg.a.61284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Rachel Rabin
- Clinical Genetic Services, Department of PediatricsNYU School of Medicine New York New York
| | - Yoel Hirsch
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases Brooklyn New York
| | - Martin M. Johansson
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases Brooklyn New York
| | - Joseph Ekstein
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases Brooklyn New York
| | - David A. Zeevi
- Dor Yeshorim, Committee for Prevention Jewish Genetic Diseases Jerusalem Israel
| | - Beth Keena
- Division of Human GeneticsChildren's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Elaine H. Zackai
- Division of Human GeneticsChildren's Hospital of Philadelphia Philadelphia Pennsylvania
| | - John Pappas
- Clinical Genetic Services, Department of PediatricsNYU School of Medicine New York New York
- Clinical GeneticsNYU Orthopedic Hospital New York New York
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Beyond the Brochure: Innovations in Clinical Counseling Practices for Prenatal Genetic Testing Options. J Perinat Neonatal Nurs 2019; 33:12-25. [PMID: 30676459 DOI: 10.1097/jpn.0000000000000374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Remarkable advancements related to preconception and prenatal genetic screening have emerged in recent years. While technology and testing options are more numerous and complex; fundamental genetic counseling issues remain the same. It is essential that with any prenatal genetic testing, women have an opportunity to make informed and autonomous decisions that are consistent with their personal needs and values. Opportunities to discuss testing options, including potential benefits and limitations, are often limited in obstetric visits due to time constraints or lack of sufficient provider education. As genetic testing is not considered a routine component of antepartum care, review of information regarding testing options is imperative so women can decide which, if any, testing to pursue. Developing new strategies to address the growing complexity of prenatal testing while ensuring provider education is accurate is crucial in imparting evidence-based care. This article will arm providers with the knowledge needed to educate women about currently available prenatal genetic screening and diagnostic tests along with guidance on the essential elements and importance of genetic counseling.
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Hardy MW, Kener HJ, Grinzaid KA. Implementation of a Carrier Screening Program in a High-Risk Undergraduate Student Population Using Digital Marketing, Online Education, and Telehealth. Public Health Genomics 2018; 21:67-76. [PMID: 30408784 DOI: 10.1159/000493971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 09/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Access to preconception carrier screening, which provides at-risk couples with more reproductive options, is critically important. To address this need in the Jewish community, genetic counselors at Emory University launched JScreen (www.jscreen.org), a national online genetic disease education and carrier screening program. To reach the preconception demographic, JScreen initiated a study evaluating the impact of marketing and education on knowledge and screening activity on college campuses. METHODS Students at 10 universities were targeted with a marketing campaign designed for this initiative. Those who elected screening were provided pre-test video education designed for the study. Success was assessed through enrollment in testing, comparison of pre- and post-education knowledge quizzes, and patient satisfaction surveys evaluating genetic counseling and the JScreen process. RESULTS A total of 1,794 participants were enrolled. Over 99% of those screened were not pregnant. Knowledge quiz scores improved significantly post-education, and patient satisfaction was over 98%. CONCLUSIONS Findings suggested that the use of targeted marketing helped promote preconception screening in this population. The study demonstrated that video education was effective in educating participants about benefits and limitations of testing. Also, the use of telehealth technology facilitated access to professional genetic counseling services. This study serves as a model for future public health initiatives.
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Affiliation(s)
| | - Hillary J Kener
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
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Coco R. Genetic counseling prior to Assisted Reproductive Technology procedures in the era of cytogenomics. JBRA Assist Reprod 2018; 22:375-380. [PMID: 30106543 PMCID: PMC6210621 DOI: 10.5935/1518-0557.20180050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The possibility of sequencing hundreds of genes simultaneously and performing
molecular karyotyping thanks to the introduction of novel genetic tools has
expanded the use of preconception screening for blastocyst recessive mutations
and aneuploidies before embryo transfer, with the ultimate purpose of increasing
the proportion of normal healthy newborns. Since medically-assisted reproduction
procedures are increasingly required to be eugenic, and the aforementioned
genetic tests cover only half of the potential genetic diseases occurring at
birth, it seems reasonable to incorporate genetic counseling in the practice of
assisted reproduction to avoid prosecution for malpractice.
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Affiliation(s)
- Roberto Coco
- UBA de Argentina Instituto de Medicina Reproductiva Fecunditas - Instituto de Medicina Reproductiva afiliado a la UBA de Argentina
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Peyser A, Singer T, Mullin C, Bristow SL, Gamma A, Onel K, Hershlag A. Comparing ethnicity-based and expanded carrier screening methods at a single fertility center reveals significant differences in carrier rates and carrier couple rates. Genet Med 2018; 21:1400-1406. [PMID: 30327537 DOI: 10.1038/s41436-018-0331-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/26/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficiency of expanded carrier screening (ECS) compared with ethnicity-based screening in identifying carriers. METHODS A total of 4232 infertility patients underwent ECS from a single genetic testing laboratory at our center between June 2013 and July 2015. Self-reported ethnicity was recorded. Carrier rates based on ECS were calculated. In addition, carrier status was determined for two other screening panels: ethnicity-based guidelines or the ECS panel recommended by the American College of Obstetricians and Gynecologists (ACOG) using ECS results. Carrier rate and carrier couple rates were compared in the overall study population and in each self-reported ethnicity. RESULTS The ECS panel used to screen the patient population identified 1243 carriers (29.4%). For the same population, ethnicity-based screening and the ACOG panel would have identified 359 (8.5%) and 659 carriers (15.6%), respectively, representing statistically significant differences. Differences in identifying carriers across self-reported ethnicities varied. In 15 couples (1.2%), both partners carried pathogenic variants for the same genes, 47% of whom would have been missed had screening been ethnicity-based. CONCLUSION We propose that all reproductive-aged women should be offered ECS. Carrier couple rates would likely increase further with expansion of the panel, playing a pivotal role in preventing genetic disease in fertility clinics.
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Affiliation(s)
- Alexandra Peyser
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Tomer Singer
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Christine Mullin
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sara L Bristow
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Amber Gamma
- Department of Pediatrics, Northwell Health, Division of Human Genetics and Genomics, Great Neck, NY, USA
| | - Kenan Onel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Northwell Health, Division of Human Genetics and Genomics, Great Neck, NY, USA.,Robert S Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Avner Hershlag
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA. .,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Bansal V, Boehm BO, Darvasi A. Identification of a missense variant in the WFS1 gene that causes a mild form of Wolfram syndrome and is associated with risk for type 2 diabetes in Ashkenazi Jewish individuals. Diabetologia 2018; 61:2180-2188. [PMID: 30014265 DOI: 10.1007/s00125-018-4690-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS Wolfram syndrome is a rare, autosomal recessive syndrome characterised by juvenile-onset diabetes and optic atrophy and is caused by bi-allelic mutations in the WFS1 gene. In a recent sequencing study, an individual with juvenile-onset diabetes was observed to be homozygous for a rare missense variant (c.1672C>T, p.R558C) in the WFS1 gene. The aim of this study was to perform the genetic characterisation of this variant and to determine whether it is causal for young-onset diabetes and Wolfram syndrome. METHODS We analysed the allele frequency of the missense variant in multiple variant databases. We genotyped the variant in 475 individuals with type 1 diabetes and 2237 control individuals of Ashkenazi Jewish ancestry and analysed the phenotypes of homozygotes. We also investigated the association of this variant with risk for type 2 diabetes using genotype and sequence data for type 2 diabetes cases and controls. RESULTS The missense variant demonstrated an allele frequency of 1.4% in individuals of Ashkenazi Jewish ancestry, 60-fold higher than in other populations. Genotyping of this variant in 475 individuals diagnosed with type 1 diabetes identified eight homozygotes compared with none in 2237 control individuals (genotype relative risk 135.3, p = 3.4 × 10-15). The age at diagnosis of diabetes for these eight individuals (17.8 ± 8.3 years) was several times greater than for typical Wolfram syndrome (5 ± 4 years). Further, optic atrophy was observed in only one of the eight individuals, while another individual had the Wolfram syndrome-relevant phenotype of neurogenic bladder. Analysis of sequence and genotype data in two case-control cohorts of Ashkenazi ancestry demonstrated that this variant is also associated with an increased risk of type 2 diabetes in heterozygotes (OR 1.81, p = 0.004). CONCLUSIONS/INTERPRETATION We have identified a low-frequency coding variant in the WFS1 gene that is enriched in Ashkenazi Jewish individuals and causes a mild form of Wolfram syndrome characterised by young-onset diabetes and reduced penetrance for optic atrophy. This variant should be considered for genetic testing in individuals of Ashkenazi ancestry diagnosed with young-onset non-autoimmune diabetes and should be included in Ashkenazi carrier screening panels.
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Affiliation(s)
- Vikas Bansal
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Bernhard O Boehm
- Department of Internal Medicine I, Ulm University Medical Centre, Ulm, Germany
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Imperial College London, London, UK
| | - Ariel Darvasi
- Department of Genetics, The Institute of Life Sciences, The Hebrew University of Jerusalem, Givat Ram, Jerusalem, Israel
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Zhou Y, Lauschke VM. Comprehensive overview of the pharmacogenetic diversity in Ashkenazi Jews. J Med Genet 2018; 55:617-627. [PMID: 29970487 DOI: 10.1136/jmedgenet-2018-105429] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/28/2018] [Accepted: 06/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adverse drug reactions are a major concern in drug development and clinical therapy. Genetic polymorphisms in genes involved in drug metabolism and transport are major determinants of treatment efficacy and adverse reactions, and constitute important biomarkers for drug dosing, efficacy and safety. Importantly, human populations and subgroups differ substantially in their pharmacogenetic variability profiles, with important consequences for personalised medicine strategies and precision public health approaches. Despite their long migration history, Ashkenazi Jews constitute a rather isolated population with a unique genetic signature that is distinctly different from other populations. OBJECTIVE To provide a comprehensive overview of the pharmacogenetic profile in Ashkenazim. METHODS We analysed next-generation sequencing data from 5076 Ashkenazim individuals and used sequence data from 117 425 non-Jewish individuals as reference. RESULTS We derived frequencies of 164 alleles in 17 clinically relevant pharmacogenes and derived profiles of putative functional consequences, providing the most comprehensive data set of Jewish pharmacogenetic diversity published to date. Furthermore, we detected 127 variants with an aggregated frequency of 20.7% that were specifically found in Ashkenazim, of which 55 variants were putatively deleterious (aggregated frequency of 9.4%). CONCLUSION The revealed pattern of pharmacogenetic variability in Ashkenazi Jews is distinctly different from other populations and is expected to translate into unique functional consequences, especially for the metabolism of CYP2A6, CYP2C9, NAT2 and VKORC1 substrates. We anticipate that the presented data will serve as a powerful resource for the guidance of pharmacogenetic treatment decisions and the optimisation of population-specific genotyping strategies in the Ashkenazi diaspora.
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Affiliation(s)
- Yitian Zhou
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, Stockholm, Sweden
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Section of Pharmacogenetics, Karolinska Institutet, Stockholm, Sweden
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Sandler S, Alfino L, Saleem M. The importance of preventative medicine in conjunction with modern day genetic studies. Genes Dis 2018; 5:107-111. [PMID: 30258938 PMCID: PMC6146230 DOI: 10.1016/j.gendis.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/08/2018] [Indexed: 02/08/2023] Open
Abstract
Genetic screening in the primary care setting is the future of preventative medicine. Genetic testing is an important medical tool for assessing various inheritable diseases, conditions, and cancers. The ability to diagnose patients before symptoms surface can help lessen the severity of symptoms and promote quality of life. However, genetic screening can cause psychological distress from the knowledge of test results, in some cases only serving to increase the risk of developing a condition due to stress. Genetic testing can be conducted anytime in life, even before birth. In this review, a compilation of genetic testing's definitions and boundaries, factors influencing an individual's test outcomes, and an overview of a wide variety of diseases, conditions and cancers were collected.
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Affiliation(s)
| | | | - Mir Saleem
- NOVA Southeastern University, United States
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48
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Rivas MA, Avila BE, Koskela J, Huang H, Stevens C, Pirinen M, Haritunians T, Neale BM, Kurki M, Ganna A, Graham D, Glaser B, Peter I, Atzmon G, Barzilai N, Levine AP, Schiff E, Pontikos N, Weisburd B, Lek M, Karczewski KJ, Bloom J, Minikel EV, Petersen BS, Beaugerie L, Seksik P, Cosnes J, Schreiber S, Bokemeyer B, Bethge J, Heap G, Ahmad T, Plagnol V, Segal AW, Targan S, Turner D, Saavalainen P, Farkkila M, Kontula K, Palotie A, Brant SR, Duerr RH, Silverberg MS, Rioux JD, Weersma RK, Franke A, Jostins L, Anderson CA, Barrett JC, MacArthur DG, Jalas C, Sokol H, Xavier RJ, Pulver A, Cho JH, McGovern DPB, Daly MJ. Insights into the genetic epidemiology of Crohn's and rare diseases in the Ashkenazi Jewish population. PLoS Genet 2018; 14:e1007329. [PMID: 29795570 PMCID: PMC5967709 DOI: 10.1371/journal.pgen.1007329] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/22/2018] [Indexed: 02/05/2023] Open
Abstract
As part of a broader collaborative network of exome sequencing studies, we developed a jointly called data set of 5,685 Ashkenazi Jewish exomes. We make publicly available a resource of site and allele frequencies, which should serve as a reference for medical genetics in the Ashkenazim (hosted in part at https://ibd.broadinstitute.org, also available in gnomAD at http://gnomad.broadinstitute.org). We estimate that 34% of protein-coding alleles present in the Ashkenazi Jewish population at frequencies greater than 0.2% are significantly more frequent (mean 15-fold) than their maximum frequency observed in other reference populations. Arising via a well-described founder effect approximately 30 generations ago, this catalog of enriched alleles can contribute to differences in genetic risk and overall prevalence of diseases between populations. As validation we document 148 AJ enriched protein-altering alleles that overlap with "pathogenic" ClinVar alleles (table available at https://github.com/macarthur-lab/clinvar/blob/master/output/clinvar.tsv), including those that account for 10-100 fold differences in prevalence between AJ and non-AJ populations of some rare diseases, especially recessive conditions, including Gaucher disease (GBA, p.Asn409Ser, 8-fold enrichment); Canavan disease (ASPA, p.Glu285Ala, 12-fold enrichment); and Tay-Sachs disease (HEXA, c.1421+1G>C, 27-fold enrichment; p.Tyr427IlefsTer5, 12-fold enrichment). We next sought to use this catalog, of well-established relevance to Mendelian disease, to explore Crohn's disease, a common disease with an estimated two to four-fold excess prevalence in AJ. We specifically attempt to evaluate whether strong acting rare alleles, particularly protein-truncating or otherwise large effect-size alleles, enriched by the same founder-effect, contribute excess genetic risk to Crohn's disease in AJ, and find that ten rare genetic risk factors in NOD2 and LRRK2 are enriched in AJ (p < 0.005), including several novel contributing alleles, show evidence of association to CD. Independently, we find that genomewide common variant risk defined by GWAS shows a strong difference between AJ and non-AJ European control population samples (0.97 s.d. higher, p<10-16). Taken together, the results suggest coordinated selection in AJ population for higher CD risk alleles in general. The results and approach illustrate the value of exome sequencing data in case-control studies along with reference data sets like ExAC (sites VCF available via FTP at ftp.broadinstitute.org/pub/ExAC_release/release0.3/) to pinpoint genetic variation that contributes to variable disease predisposition across populations.
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Affiliation(s)
- Manuel A. Rivas
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States of America
| | - Brandon E. Avila
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jukka Koskela
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Hailiang Huang
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Christine Stevens
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Talin Haritunians
- Translational Genomics Unit, F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Benjamin M. Neale
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Mitja Kurki
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Andrea Ganna
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Daniel Graham
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Benjamin Glaser
- Hadassah-Hebrew University Medical Center, Endocrinology and Metabolism Service Department of Internal Medicine, Jerusalem, Israel
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Gil Atzmon
- Department of Genetics and Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
- Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - Nir Barzilai
- Department of Genetics and Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Adam P. Levine
- Division of Medicine, University College London, London, United Kingdom
| | - Elena Schiff
- Division of Medicine, University College London, London, United Kingdom
| | - Nikolas Pontikos
- Division of Medicine, University College London, London, United Kingdom
- UCL Genetics Institute, University College London, London, United Kingdom
| | - Ben Weisburd
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Monkol Lek
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Konrad J. Karczewski
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jonathan Bloom
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Eric V. Minikel
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Britt-Sabina Petersen
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Laurent Beaugerie
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Philippe Seksik
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Jacques Cosnes
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Stefan Schreiber
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Johannes Bethge
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | | | - Graham Heap
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter, United Kingdom
| | - Tariq Ahmad
- Peninsula College of Medicine and Dentistry, Exeter, United Kingdom
| | - Vincent Plagnol
- UCL Genetics Institute, University College London, London, United Kingdom
| | - Anthony W. Segal
- Division of Medicine, University College London, London, United Kingdom
| | - Stephan Targan
- Translational Genomics Unit, F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Paivi Saavalainen
- Research Programs Unit, Immunobiology, and Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Martti Farkkila
- Department of Medicine, Division of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Aarno Palotie
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Steven R. Brant
- Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Richard H. Duerr
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America
| | - Mark S. Silverberg
- Inflammatory Bowel Disease Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John D. Rioux
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Luke Jostins
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, United Kingdom
| | - Carl A. Anderson
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Jeffrey C. Barrett
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Daniel G. MacArthur
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Chaim Jalas
- Bonei Olam, Center for Rare Jewish Genetic Disorders, Brooklyn, NY, United States of America
| | - Harry Sokol
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Ramnik J. Xavier
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease and Center for Computational and Integrative Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ann Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Judy H. Cho
- Icahn School of Medicine at Mount Sinai, Dr Henry D. Janowitz Division of Gastroenterology, New York, NY, United States of America
| | - Dermot P. B. McGovern
- Translational Genomics Unit, F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Mark J. Daly
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
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Abstract
Screening for genetic disorders began in 1963 with the initiation of newborn screening for phenylketonuria. Advances in molecular technology have made both newborn screening for newborns affected with serious disorders, and carrier screening of individuals at risk for offspring with genetic disorders, more complex and more widely available. Carrier screening today can be performed secondary to family history-based screening, ethnic-based screening, and expanded carrier screening (ECS). ECS is panel-based screening, which analyzes carrier status for hundreds of genetic disorders irrespective of patient race or ethnicity. In this article, we review the historical and current aspects of carrier screening for single gene disorders, including future research directions.
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Affiliation(s)
- Nancy C Rose
- Intermountain Healthcare, University of Utah Health Sciences, Intermountain Medical Center, Maternal Fetal Medicine, Salt Lake City, UT, USA.
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50
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Spencer S, Ewing S, Calcagno K, O'Neill S. Adopted Individuals' Views on the Utility and Value of Expanded Carrier Screening. J Genet Couns 2018; 27:1341-1348. [PMID: 29603037 DOI: 10.1007/s10897-018-0256-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
Adoptees may not have family medical history and ethnicity information. Carrier screening assesses reproductive risk. Expanded carrier screening (ECS) screens for many genetic conditions regardless of a patient's knowledge of family history and ethnicity. This study aimed to better understand the opinions and attitudes of adopted individuals on the use of ECS in determining a patient's reproductive genetic risks. Specifically, the study assessed how adopted individuals feel that results of ECS may be useful to them and whether adoptees feel that meeting with a genetics professional in the process of undergoing ECS would be useful. Adult adoptees (N = 124) were recruited online. Their opinions on ECS were explored. The majority reported they had never been offered carrier screening (92%). The majority of adoptees wanted ECS (76%). Neither the amount of contact with biological relatives nor having medical knowledge about biological relatives was significantly associated with adoptees' desire to pursue ECS. There was a significant positive correlation between adoptees of higher education levels and the amount they would pay for ECS (p = 0.004). The majority of participants (95%) indicated a genetics professional would be helpful when undergoing ECS. The findings suggest this population may want ECS and support from genetics healthcare professionals. Advocacy for genetic counseling and testing for adoptees appears justifiable.
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Affiliation(s)
- Sara Spencer
- Obstetrics and Gynecology, Northwestern Medicine, 675 N. St. Clair Ste. 14-200, Chicago, IL, 60611, USA.
| | - Sarah Ewing
- Department of Clinical Genomics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Suzanne O'Neill
- Center for Genetic Medicine, Northwestern University, 645 North Michigan Ave, Suite 630, Chicago, IL, 60611, USA
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