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Description of an Innovative Pediatric Individualized Therapeutics Clinic: Working toward Precision Drug Therapy. CHILDREN-BASEL 2019; 6:children6020035. [PMID: 30823616 PMCID: PMC6406944 DOI: 10.3390/children6020035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/01/2022]
Abstract
The GOLDILOKs® (Genomic and Ontogeny-Linked Dose Individualization and cLinical Optimization for KidS) Clinic aims to provide families and physicians with data to make more informed decisions with regard to pharmacological therapy by using innovative therapy and genomic technologies. The objectives are two-fold: (1) To describe the utility of the GOLDILOKs® Clinic to referring prescribers by evaluating the type of referrals made to the GOLDILOKs® Clinic and (2) to assess the most often utilized technologies (e.g., genotyping) completed to formulate therapy recommendations. Patient data from July 2010 to June 2016 was retrospectively reviewed following Institutional Review Board (IRB) approval. The GOLDILOKs® Clinic evaluated 306 patients and had increases in annual referrals from 14 in 2010–2011 to 84 in 2016–2017. The children that were referred were predominately Caucasian (82%) and male (59%) with an average age of 12.4 ± 5.9 years. Subspecialty versus primary care referrals accounted for 82% and 18% of referrals, respectively. Adverse drug reactions (n = 166) and poor medication response (n = 179) were the major reasons for referral. However, it must be noted that patients could have multiple reasons for referral. Pharmacogenetic results were extensively used to provide guidance for future therapy in patients with medication-related problems. Genotyping of drug metabolizing enzymes and drug target receptors was performed in 221 patients (72.2%). Recommendations were fully accepted by 63% and partially accepted by 22% of internal provider referrals.
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Botkin JR, Belmont JW, Berg JS, Berkman BE, Bombard Y, Holm IA, Levy HP, Ormond KE, Saal HM, Spinner NB, Wilfond BS, McInerney JD. Points to Consider: Ethical, Legal, and Psychosocial Implications of Genetic Testing in Children and Adolescents. Am J Hum Genet 2015; 97:6-21. [PMID: 26140447 PMCID: PMC4570999 DOI: 10.1016/j.ajhg.2015.05.022] [Citation(s) in RCA: 299] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/29/2015] [Indexed: 12/12/2022] Open
Abstract
In 1995, the American Society of Human Genetics (ASHG) and American College of Medical Genetics and Genomics (ACMG) jointly published a statement on genetic testing in children and adolescents. In the past 20 years, much has changed in the field of genetics, including the development of powerful new technologies, new data from genetic research on children and adolescents, and substantial clinical experience. This statement represents current opinion by the ASHG on the ethical, legal, and social issues concerning genetic testing in children. These recommendations are relevant to families, clinicians, and investigators. After a brief review of the 1995 statement and major changes in genetic technologies in recent years, this statement offers points to consider on a broad range of test technologies and their applications in clinical medicine and research. Recommendations are also made for record and communication issues in this domain and for professional education.
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Affiliation(s)
| | | | - Jonathan S Berg
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Yvonne Bombard
- University of Toronto, Toronto, ON M5B 1T8, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | | | | | | | - Howard M Saal
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nancy B Spinner
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Affiliation(s)
- Sara L Van Driest
- From Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Steven A Webber
- From Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
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Abstract
Clinicians and patients continue to convey interest in personalized medicine. The objective of personalized medicine is to improve healthcare by tailoring disease prevention, diagnosis, and treatment strategies for individuals based on their unique clinical history and genetic composition. This article offers an overview of pharmacogenomics, discusses caveats specific to pharmacogenomics in pediatric populations, provides evidence-based recommendations for pediatric clinicians, and offers insight regarding the future role of pharmacogenomics testing in pediatric medicine. Reviews of the current literature and thoughtful discussions are presented regarding the pharmacogenomics of antidepressants, codeine and oncologic, asthma, and immunomodulatory pharmacotherapies.
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Affiliation(s)
- Lindsey Korbel
- The Ohio State University College of Medicine, Columbus, OH, USA
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de Denus S, Andelfinger G, Khairy P. Personalizing the management of heart failure in congenital heart disease: challenges and opportunities. Pharmacogenomics 2014; 15:123-7. [DOI: 10.2217/pgs.13.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada and Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada
| | - Gregor Andelfinger
- Faculty of Medicine, Université de Montréal, Montreal, Canada and Sainte-Justine Hospital, Montreal, QC, Canada
| | - Paul Khairy
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Faculty of Medicine, Université de Montréal, Montreal, Canada
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D'Alessandro LC, Mital S. Pediatric transplantation: opportunities for pharmacogenomics and genomics. Per Med 2013; 10:397-404. [PMID: 29783417 DOI: 10.2217/pme.13.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Heterogeneity is the rule among pediatric heart transplant recipients. Patients vary in age, size, organ maturity, immune system maturity and underlying disease etiology, which can all influence post-transplant outcomes. Overall, the survival of pediatric transplant recipients continues to improve and the goal remains long-term survival of the primary graft and mitigation of long-term complications and adverse events. The evolving fields of pharmacogenomics and genomics have the potential to revolutionize and personalize the care of pediatric transplant recipients, and although clinical validation in a pediatric cohort is lacking, many of these technologies are becoming more readily available. We discuss genotype-guided dosing of immunosuppressant medications and other commonly used medications after transplantation, the influence of donor and recipient genotype on risk of post-transplant complications, genotype-guided selection of therapies to treat complications, and the use of next-generation sequencing for noninvasive detection of graft rejection.
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Affiliation(s)
- Lisa Ca D'Alessandro
- Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Binesh Marvasti T, D'Alessandro LCA, Manase D, Papaz T, Mital S. Personalized medicine in the care of the child with congenital heart disease: discovery to application. CONGENIT HEART DIS 2013; 8:266-9. [PMID: 23601919 DOI: 10.1111/chd.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
On October 27-28, 2012, the SickKids Labatt Family Heart Centre and the Heart Centre Biobank Registry hosted the second international GenomeHeart symposium in Toronto, Ontario. The symposium featured experts in cardiology, developmental biology, pharmacology, genomics, bioinformatics, stem cell biology, biobanking, and ethics. The theme of this year's symposium was the application of emerging technologies in genomics, proteomics, transcriptomics, and bioinformatics to diagnostics and therapeutics of the child with heart disease. Social, ethical, and economic issues were also discussed in the context of clinical translation. We highlight some of the themes that emerged from this exciting 2-day event.
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Affiliation(s)
- Tina Binesh Marvasti
- Division of Pediatric Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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