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Fields D, Asbury K. Do Children Think it is Important to Predict Learning and Behaviour Problems, and Do They Think Genetic Screening Has a Role to Play in This? J Autism Dev Disord 2024; 54:2368-2385. [PMID: 37022575 PMCID: PMC11143042 DOI: 10.1007/s10803-023-05966-z] [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] [Accepted: 03/12/2023] [Indexed: 04/07/2023]
Abstract
This study explores how capable young children are of thinking about a potential future that uses DNA screening to assess an individual's likelihood of experiencing learning or behaviour difficulties. Puppets and a scenario-based approach were used to ask children aged 4-10 (n = 165) whether they thought DNA screening might be helpful or harmful. A content analysis derived six categories: (1) 'Worried about being - and being seen as - different'; (2) 'Beliefs about the origins of learning and behaviour'; (3) 'Testing is harmful'; (4) 'Testing could help'; (5) 'How soon is too soon for testing?'; and (6) 'What's the point?'. Findings indicate young children, as key stakeholders, can make useful contributions to public debate in this important and controversial area.
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Affiliation(s)
- Diana Fields
- Psychology in Education Research Centre, Department of Education, University of York, Heslington, United Kingdom.
| | - Kathryn Asbury
- Psychology in Education Research Centre, Department of Education, University of York, Heslington, United Kingdom
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2
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Capalbo A, de Wert G, Mertes H, Klausner L, Coonen E, Spinella F, Van de Velde H, Viville S, Sermon K, Vermeulen N, Lencz T, Carmi S. Screening embryos for polygenic disease risk: a review of epidemiological, clinical, and ethical considerations. Hum Reprod Update 2024:dmae012. [PMID: 38805697 DOI: 10.1093/humupd/dmae012] [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: 01/10/2024] [Revised: 03/25/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The genetic composition of embryos generated by in vitro fertilization (IVF) can be examined with preimplantation genetic testing (PGT). Until recently, PGT was limited to detecting single-gene, high-risk pathogenic variants, large structural variants, and aneuploidy. Recent advances have made genome-wide genotyping of IVF embryos feasible and affordable, raising the possibility of screening embryos for their risk of polygenic diseases such as breast cancer, hypertension, diabetes, or schizophrenia. Despite a heated debate around this new technology, called polygenic embryo screening (PES; also PGT-P), it is already available to IVF patients in some countries. Several articles have studied epidemiological, clinical, and ethical perspectives on PES; however, a comprehensive, principled review of this emerging field is missing. OBJECTIVE AND RATIONALE This review has four main goals. First, given the interdisciplinary nature of PES studies, we aim to provide a self-contained educational background about PES to reproductive specialists interested in the subject. Second, we provide a comprehensive and critical review of arguments for and against the introduction of PES, crystallizing and prioritizing the key issues. We also cover the attitudes of IVF patients, clinicians, and the public towards PES. Third, we distinguish between possible future groups of PES patients, highlighting the benefits and harms pertaining to each group. Finally, our review, which is supported by ESHRE, is intended to aid healthcare professionals and policymakers in decision-making regarding whether to introduce PES in the clinic, and if so, how, and to whom. SEARCH METHODS We searched for PubMed-indexed articles published between 1/1/2003 and 1/3/2024 using the terms 'polygenic embryo screening', 'polygenic preimplantation', and 'PGT-P'. We limited the review to primary research papers in English whose main focus was PES for medical conditions. We also included papers that did not appear in the search but were deemed relevant. OUTCOMES The main theoretical benefit of PES is a reduction in lifetime polygenic disease risk for children born after screening. The magnitude of the risk reduction has been predicted based on statistical modelling, simulations, and sibling pair analyses. Results based on all methods suggest that under the best-case scenario, large relative risk reductions are possible for one or more diseases. However, as these models abstract several practical limitations, the realized benefits may be smaller, particularly due to a limited number of embryos and unclear future accuracy of the risk estimates. PES may negatively impact patients and their future children, as well as society. The main personal harms are an unindicated IVF treatment, a possible reduction in IVF success rates, and patient confusion, incomplete counselling, and choice overload. The main possible societal harms include discarded embryos, an increasing demand for 'designer babies', overemphasis of the genetic determinants of disease, unequal access, and lower utility in people of non-European ancestries. Benefits and harms will vary across the main potential patient groups, comprising patients already requiring IVF, fertile people with a history of a severe polygenic disease, and fertile healthy people. In the United States, the attitudes of IVF patients and the public towards PES seem positive, while healthcare professionals are cautious, sceptical about clinical utility, and concerned about patient counselling. WIDER IMPLICATIONS The theoretical potential of PES to reduce risk across multiple polygenic diseases requires further research into its benefits and harms. Given the large number of practical limitations and possible harms, particularly unnecessary IVF treatments and discarded viable embryos, PES should be offered only within a research context before further clarity is achieved regarding its balance of benefits and harms. The gap in attitudes between healthcare professionals and the public needs to be narrowed by expanding public and patient education and providing resources for informative and unbiased genetic counselling.
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Affiliation(s)
- Antonio Capalbo
- Juno Genetics, Department of Reproductive Genetics, Rome, Italy
- Center for Advanced Studies and Technology (CAST), Department of Medical Genetics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Guido de Wert
- Department of Health, Ethics & Society, CAPHRI-School for Public Health and Primary Care and GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Liraz Klausner
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Edith Coonen
- Departments of Clinical Genetics and Reproductive Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - Francesca Spinella
- Eurofins GENOMA Group Srl, Molecular Genetics Laboratories, Department of Scientific Communication, Rome, Italy
| | - Hilde Van de Velde
- Research Group Genetics Reproduction and Development (GRAD), Vrije Universiteit Brussel, Brussel, Belgium
- Brussels IVF, UZ Brussel, Brussel, Belgium
| | - Stephane Viville
- Laboratoire de Génétique Médicale LGM, Institut de Génétique Médicale d'Alsace IGMA, INSERM UMR 1112, Université de Strasbourg, France
- Laboratoire de Diagnostic Génétique, Unité de Génétique de l'infertilité (UF3472), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Karen Sermon
- Research Group Genetics Reproduction and Development (GRAD), Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Todd Lencz
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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3
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Furrer RA, Barlevy D, Pereira S, Carmi S, Lencz T, Lázaro-Muñoz G. Public Attitudes, Interests, and Concerns Regarding Polygenic Embryo Screening. JAMA Netw Open 2024; 7:e2410832. [PMID: 38743425 PMCID: PMC11094562 DOI: 10.1001/jamanetworkopen.2024.10832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
Importance Polygenic embryo screening (PES) is a novel technology that estimates the likelihood of developing future conditions (eg, diabetes or depression) and traits (eg, height or cognitive ability) in human embryos, with the goal of selecting which embryos to use. Given its commercial availability and concerns raised by researchers, clinicians, bioethicists, and professional organizations, it is essential to inform key stakeholders and relevant policymakers about the public's perspectives on this technology. Objective To survey US adults to examine general attitudes, interests, and concerns regarding PES use. Design, Setting, and Participants For this survey study, data were collected from 1 stratified sample and 1 nonprobability sample (samples 1 and 2, respectively) between March and July 2023. The surveys measured approval, interest, and concerns regarding various applications of PES. In the second sample, presentation of a list of potential concerns was randomized (presented at survey onset vs survey end). The survey was designed using Qualtrics and distributed to participants through Prolific, an online sampling firm. Sample 1 was nationally representative with respect to gender, age, and race and ethnicity; sample 2 was recruited without specific demographic criteria. Analyses were conducted between March 2023 and February 2024. Main Outcomes and Measures Participants reported their approval, interest, and concerns regarding various applications of PES and outcomes screened (eg, traits and conditions). Statistical analysis was conducted using independent samples t tests and repeated-measures analyses of variance. Results Of the 1435 respondents in sample 1, demographic data were available for 1427 (mean [SD] age, 45.8 [16.0] years; 724 women [50.7%]). Among these 1427 sample 1 respondents, 1027 (72.0%) expressed approval for PES and 1169 (81.9%) expressed some interest in using PES if already undergoing in vitro fertilization (IVF). Approval among these respondents for using PES for embryo selection was notably high for physical health conditions (1109 [77.7%]) and psychiatric health conditions (1028 [72.0%]). In contrast, there was minority approval for embryo selection based on PES for behavioral traits (514 [36.0%]) and physical traits (432 [30.3%]). Nevertheless, concerns about PES leading to false expectations and promoting eugenic practices were pronounced, with 787 of 1422 (55.3%) and 780 of 1423 (54.8%) respondents finding them very to extremely concerning, respectively. Sample 2 included 192 respondents (mean [SD] age 37.7 [12.2] years; 110 men [57.3%]). These respondents were presented concerns at survey onset (n = 95) vs survey end (n = 97), which was associated with less approval (28-percentage point decrease) and more uncertainty (24 percentage-point increase) but with only slightly higher disapproval (4 percentage-point increase). Conclusions and Relevance These findings suggest that it is critical for health care professionals and medical societies to consider and understand the perspectives of diverse stakeholders (eg, patients undergoing IVF, clinicians, and the general public), given the absence of regulation and the recent commercial availability of PES.
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Affiliation(s)
- Rémy A. Furrer
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts
| | - Dorit Barlevy
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Todd Lencz
- Institute of Behavioral Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Division of Research, Department of Psychiatry, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, New York
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
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Wu X, Pan J, Zhu Y, Huang H. Research progress and challenges of preimplantation genetic testing for polygenic diseases. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023:1-8. [PMID: 37987034 DOI: 10.3724/zdxbyxb-2023-0440] [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: 11/22/2023]
Abstract
Preimplantation genetic testing is an important part in assisted reproductive technology, which can block the intergenerational inheritance of single gene or chromosomal diseases. Preimplantation genetic testing for polygenic disease risk (PGT-P) is the latest development in the field. It is known that polygenic diseases usually have the characteristics of high incidence, late onset, affecting the quality of life and mental health of patients. On the basis of the development of artificial intelligence and genetic detection technology, PGT-P can analyze genetic material, calculate polygenic risk score turning into incidence probability. Embryos with relatively low incidence probability can be screened for transfer, so as to reduce the possibility of offspring suffering from the disease in the future, which has significant clinical and social significance. At present, PGT-P has been applied clinically and made phased progress at home and abroad. At the same time, as a developing technology, PGT-P still has some technical defects, unstable results, environmental influences and racial differences cannot be ruled out. From the perspective of ethics, if the screening indications are not strictly regulated, it is likely to cause new social problems. In this paper, we review the technical composition and recent progress of PGT-P, and put forward the prospect of its future development, especially how to establish a complete and suitable screening model for Chinese population.
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Affiliation(s)
- Xiaojing Wu
- Zhejiang University School of Medicine, Hangzhou 310030, China.
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
| | - Jiexue Pan
- Shanghai Medical College of Fudan University, Shanghai 200032, China
| | - Yimin Zhu
- Zhejiang University School of Medicine, Hangzhou 310030, China.
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
| | - Hefeng Huang
- Zhejiang University School of Medicine, Hangzhou 310030, China.
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
- Shanghai Medical College of Fudan University, Shanghai 200032, China.
- International Peace Maternal and Child Health Hospital of China Welfare Society, Shanghai 200030, China.
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China.
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Siermann M, Valcke O, Vermeesch JR, Raivio T, Tšuiko O, Borry P. Limitations, concerns and potential: attitudes of healthcare professionals toward preimplantation genetic testing using polygenic risk scores. Eur J Hum Genet 2023; 31:1133-1138. [PMID: 36935419 PMCID: PMC10545753 DOI: 10.1038/s41431-023-01333-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/08/2023] [Accepted: 03/07/2023] [Indexed: 03/21/2023] Open
Abstract
Preimplantation genetic testing using polygenic risk scores (PGT-P) has recently been introduced. However, PGT-P has been met with many ethical concerns. It is therefore important to get insights into the perspectives of stakeholders regarding PGT-P. We performed a qualitative interview study on the views of healthcare professionals toward PGT-P. We conducted in-depth semi-structured interviews with 31 healthcare professionals working in the field of preimplantation genetic testing. The interviews explored the attitudes of healthcare professionals toward the technology of PGT-P, e.g., the validity, utility, limitations and potential benefits of PGT-P. We found that most healthcare professionals were concerned about the prematurity of introducing PGT-P into clinical practice. They had various ethical considerations, such as concerns related to validity and utility of PGT-P, limited embryos and options, and difficulties for prospective parents regarding comprehension and informed decision-making. Positive aspects were also identified, e.g., regarding reproductive autonomy and potential health benefits. Overall, most healthcare professionals considered that clinical implementation of PGT-P is premature. More comprehensive, longitudinal and inclusive studies are needed first, though these might not improve PGT-P enough to responsibly implement it. Healthcare professionals were also concerned that PGT-P could cause anxiety and create difficult choices for prospective parents. These perspectives and ethical considerations are crucial to consider for future guidelines and recommendations regarding PGT-P.
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Affiliation(s)
- Maria Siermann
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Ophelia Valcke
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Joris Robert Vermeesch
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Taneli Raivio
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Olga Tšuiko
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
- Reproductive Genetics Unit, Center for Human Genetics, UZ Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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6
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Chapman CR. Ethical, legal, and social implications of genetic risk prediction for multifactorial disease: a narrative review identifying concerns about interpretation and use of polygenic scores. J Community Genet 2023; 14:441-452. [PMID: 36529843 PMCID: PMC10576696 DOI: 10.1007/s12687-022-00625-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
Advances in genomics have enabled the development of polygenic scores (PGS), sometimes called polygenic risk scores, in the context of multifactorial diseases and disorders such as cancer, cardiovascular disease, and schizophrenia. PGS estimate an individual's genetic predisposition, as compared to other members of a population, for conditions which are influenced by both genetic and environmental factors. There is significant interest in using genetic risk prediction afforded through PGS in public health, clinical care, and research settings, yet many acknowledge the need to thoughtfully consider and address ethical, legal, and social implications (ELSI). To contribute to this effort, this paper reports on a narrative review of the literature, with the aim of identifying and categorizing ELSI relating to genetic risk prediction in the context of multifactorial disease, which have been raised by scholars in the field. Ninety-two articles, spanning from 1977 to 2021, met the inclusion criteria for this study. Identified ELSI included potential benefits, challenges and risks that focused on concerns about interpretation and use, and ethical obligations to maximize benefits, minimize risks, promote justice, and support autonomy. This research will support geneticists, clinicians, genetic counselors, patients, patient advocates, and policymakers in recognizing and addressing ethical concerns associated with PGS; it will also guide future empirical and normative research.
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Affiliation(s)
- Carolyn Riley Chapman
- Department of Population Health (Division of Medical Ethics), NYU Grossman School of Medicine, New York, NY, USA.
- Center for Human Genetics and Genomics, NYU Grossman School of Medicine, Science Building, 435 E. 30th St, 8th Floor, New York, NY, 10016, USA.
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7
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Herle M, Pickles A, Pain O, Viner R, Pingault JB, De Stavola BL. Could interventions on physical activity mitigate genomic liability for obesity? Applying the health disparity framework in genetically informed studies. Eur J Epidemiol 2023; 38:403-412. [PMID: 36905531 PMCID: PMC10082115 DOI: 10.1007/s10654-023-00980-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: 07/26/2022] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
Polygenic scores (PGS) are now commonly available in longitudinal cohort studies, leading to their integration into epidemiological research. In this work, our aim is to explore how polygenic scores can be used as exposures in causal inference-based methods, specifically mediation analyses. We propose to estimate the extent to which the association of a polygenic score indexing genetic liability to an outcome could be mitigated by a potential intervention on a mediator. To do this this, we use the interventional disparity measure approach, which allows us to compare the adjusted total effect of an exposure on an outcome, with the association that would remain had we intervened on a potentially modifiable mediator. As an example, we analyse data from two UK cohorts, the Millennium Cohort Study (MCS, N = 2575) and the Avon Longitudinal Study of Parents and Children (ALSPAC, N = 3347). In both, the exposure is genetic liability for obesity (indicated by a PGS for BMI), the outcome is late childhood/early adolescent BMI, and the mediator and potential intervention target is physical activity, measured between exposure and outcome. Our results suggest that a potential intervention on child physical activity can mitigate some of the genetic liability for childhood obesity. We propose that including PGSs in a health disparity measure approach, and causal inference-based methods more broadly, is a valuable addition to the study of gene-environment interplay in complex health outcomes.
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Affiliation(s)
- Moritz Herle
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Oliver Pain
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Russell Viner
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jean-Baptiste Pingault
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Bianca L De Stavola
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Bowman-Smart H, Gyngell C, Mand C, Amor DJ, Delatycki MB, Savulescu J. Non-Invasive Prenatal Testing for "Non-Medical" Traits: Ensuring Consistency in Ethical Decision-Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:3-20. [PMID: 34846986 PMCID: PMC7614328 DOI: 10.1080/15265161.2021.1996659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The scope of noninvasive prenatal testing (NIPT) could expand in the future to include detailed analysis of the fetal genome. This will allow for the testing for virtually any trait with a genetic contribution, including "non-medical" traits. Here we discuss the potential use of NIPT for these traits. We outline a scenario which highlights possible inconsistencies with ethical decision-making. We then discuss the case against permitting these uses. The objections include practical problems; increasing inequities; increasing the burden of choice; negative impacts on the child, family, and society; and issues with implementation. We then outline the case for permitting the use of NIPT for these traits. These include arguments for reproductive liberty and autonomy; questioning the labeling of traits as "non-medical"; and the principle of procreative beneficence. This summary of the case for and against can serve as a basis for the development of a consistent and coherent ethical framework.
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Affiliation(s)
- Hilary Bowman-Smart
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Corresponding author: Hilary Bowman-Smart Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville Victoria Australia 3052, , (03) 8341 6200
| | - Christopher Gyngell
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
| | - Cara Mand
- Murdoch Children’s Research Institute, Parkville, Australia
| | - David J. Amor
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Martin B. Delatycki
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Julian Savulescu
- Murdoch Children’s Research Institute, Parkville, Australia
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
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Pereira S, Carmi S, Altarescu G, Austin J, Barlevy D, Hershlag A, Juengst E, Kostick-Quenet K, Kovanci E, Lathi RB, Mukherjee M, Van den Veyver I, Zuk O, Lázaro-Muñoz G, Lencz T. Polygenic embryo screening: four clinical considerations warrant further attention. Hum Reprod 2022; 37:1375-1378. [PMID: 35604365 PMCID: PMC9247413 DOI: 10.1093/humrep/deac110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/28/2022] [Indexed: 10/25/2023] Open
Abstract
Recent advances in developing polygenic scores have made it possible to screen embryos for common, complex conditions and traits. Polygenic embryo screening (PES) is currently offered commercially, and though there has been much recent media and academic coverage, reproductive specialists' points of view have not yet been prominent in these discussions. We convened a roundtable of multidisciplinary experts, including reproductive specialists to discuss PES and its implications. In this Opinion, we describe four clinically relevant issues associated with the use of PES that have not yet been discussed in the literature and warrant consideration.
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Affiliation(s)
- S Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, MS420, Houston, TX 77030, USA
| | - S Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - G Altarescu
- Preimplantation Genetic Unit and lysosomal Clinic, Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - J Austin
- Departments of Psychiatry and Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - D Barlevy
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, MS420, Houston, TX 77030, USA
| | - A Hershlag
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
- Zucker School of Medicine, Hofstra University, Hempstead, NY, USA
| | - E Juengst
- Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, MS420, Houston, TX 77030, USA
| | - E Kovanci
- Houston Assisted Reproductive Technologies (HART) Fertility Clinic, The Woodlands, TX, USA
| | - R B Lathi
- Stanford University, Stanford, CA, USA
| | - M Mukherjee
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, MS420, Houston, TX 77030, USA
- Department of Sociology, University of Califorinia, Berkeley, Berkeley, CA 94720 USA
| | - I Van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - O Zuk
- Department of Statistics and Data Science, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - G Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - T Lencz
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
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10
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Siermann M, Tšuiko O, Vermeesch JR, Raivio T, Borry P. A review of normative documents on preimplantation genetic testing: Recommendations for PGT-P. Genet Med 2022; 24:1165-1175. [PMID: 35341652 DOI: 10.1016/j.gim.2022.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Recently, preimplantation genetic testing (PGT) for polygenic conditions (PGT-P) has been introduced commercially. In view of the lack of specific guidance on this development, we analyzed normative documents on PGT for monogenic conditions (PGT-M) to understand what we can learn from these documents for recommendations for PGT-P. METHODS We conducted a systematic review of normative guidelines and recommendations on PGT-M. The aim was to understand what the current consensus and disagreements are on ethical acceptability of PGT-M and how this compares with PGT-P. RESULTS We analyzed 38 documents by advisory committees at the national, European, and global level. In total, 2 themes were identified, which included the following: (1) what PGT is considered appropriate for and (2) who can make decisions regarding the use of PGT. Many aspects of PGT-M documents apply to PGT-P as well. Additional factors such as the fact that PGT-P screens for risk indications of multiple polygenic conditions increase ethical difficulties regarding severity, risk, autonomy, and informed decision-making. CONCLUSION On the basis of PGT-M normative documents, we conclude that ethical acceptability for PGT-P is limited. Our findings present various factors that have to be considered for the development of guidelines and the appropriateness of PGT.
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Affiliation(s)
- Maria Siermann
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Olga Tšuiko
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium; Reproductive Genetics Unit, Center of Human Genetics, UZ Leuven, Leuven, Belgium
| | - Joris Robert Vermeesch
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Taneli Raivio
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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11
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Treff NR, Savulescu J, de Melo-Martín I, Shulman LP, Feinberg EC. Should preimplantation genetic testing for polygenic disease be offered to all - or none? Fertil Steril 2022; 117:1162-1167. [PMID: 35513906 DOI: 10.1016/j.fertnstert.2022.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Nathan R Treff
- Genomic Prediction Inc., North Brunswick, New Jersey; Department of Obstetrics Gynecology and Reproductive Sciences, Rutgers University, New Brunswick, New Jersey
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lee P Shulman
- Feinberg School of Medicine-Northwestern University, Chicago, Illinois; Reproductive Genetics Innovations, Chicago, Illinois
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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12
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Responsible use of polygenic risk scores in the clinic: potential benefits, risks and gaps. Nat Med 2021; 27:1876-1884. [PMID: 34782789 DOI: 10.1038/s41591-021-01549-6] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/22/2021] [Indexed: 01/24/2023]
Abstract
Polygenic risk scores (PRSs) aggregate the many small effects of alleles across the human genome to estimate the risk of a disease or disease-related trait for an individual. The potential benefits of PRSs include cost-effective enhancement of primary disease prevention, more refined diagnoses and improved precision when prescribing medicines. However, these must be weighed against the potential risks, such as uncertainties and biases in PRS performance, as well as potential misunderstanding and misuse of these within medical practice and in wider society. By addressing key issues including gaps in best practices, risk communication and regulatory frameworks, PRSs can be used responsibly to improve human health. Here, the International Common Disease Alliance's PRS Task Force, a multidisciplinary group comprising expertise in genetics, law, ethics, behavioral science and more, highlights recent research to provide a comprehensive summary of the state of polygenic score research, as well as the needs and challenges as PRSs move closer to widespread use in the clinic.
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13
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Lencz T, Backenroth D, Granot-Hershkovitz E, Green A, Gettler K, Cho JH, Weissbrod O, Zuk O, Carmi S. Utility of polygenic embryo screening for disease depends on the selection strategy. eLife 2021; 10:e64716. [PMID: 34635206 PMCID: PMC8510582 DOI: 10.7554/elife.64716] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Polygenic risk scores (PRSs) have been offered since 2019 to screen in vitro fertilization embryos for genetic liability to adult diseases, despite a lack of comprehensive modeling of expected outcomes. Here we predict, based on the liability threshold model, the expected reduction in complex disease risk following polygenic embryo screening for a single disease. A strong determinant of the potential utility of such screening is the selection strategy, a factor that has not been previously studied. When only embryos with a very high PRS are excluded, the achieved risk reduction is minimal. In contrast, selecting the embryo with the lowest PRS can lead to substantial relative risk reductions, given a sufficient number of viable embryos. We systematically examine the impact of several factors on the utility of screening, including: variance explained by the PRS, number of embryos, disease prevalence, parental PRSs, and parental disease status. We consider both relative and absolute risk reductions, as well as population-averaged and per-couple risk reductions, and also examine the risk of pleiotropic effects. Finally, we confirm our theoretical predictions by simulating 'virtual' couples and offspring based on real genomes from schizophrenia and Crohn's disease case-control studies. We discuss the assumptions and limitations of our model, as well as the potential emerging ethical concerns.
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Affiliation(s)
- Todd Lencz
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/NorthwellHempsteadUnited States
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell HealthGlen OaksUnited States
- Institute for Behavioral Science, The Feinstein Institutes for Medical ResearchManhassetUnited States
| | - Daniel Backenroth
- Braun School of Public Health and Community Medicine, The Hebrew University of JerusalemJerusalemIsrael
| | - Einat Granot-Hershkovitz
- Braun School of Public Health and Community Medicine, The Hebrew University of JerusalemJerusalemIsrael
| | - Adam Green
- Braun School of Public Health and Community Medicine, The Hebrew University of JerusalemJerusalemIsrael
| | - Kyle Gettler
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Judy H Cho
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount SinaiNew YorkUnited States
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkUnited States
- Department of Medicine, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Omer Weissbrod
- Department of Epidemiology, Harvard T.H. Chan School of Public HealthBostonUnited States
| | - Or Zuk
- Department of Statistics and Data Science, The Hebrew University of JerusalemJerusalemIsrael
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of JerusalemJerusalemIsrael
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14
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Savulescu J, Earp BD, Schuklenk U. Ethics of genetic research on same-sex sexual behaviour. Nat Hum Behav 2021; 5:1123-1124. [PMID: 34426666 DOI: 10.1038/s41562-021-01164-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
| | - Brian D Earp
- Oxford Uehiro Centre for Practical Ethics, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.,Yale-Hastings Program in Ethics & Health Policy, Yale University and The Hastings Center, New Haven, CT, USA
| | - Udo Schuklenk
- Department of Philosophy, Queen's University, Kingston, ON, Canada
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15
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Tellier LCAM, Eccles J, Treff NR, Lello L, Fishel S, Hsu S. Embryo Screening for Polygenic Disease Risk: Recent Advances and Ethical Considerations. Genes (Basel) 2021; 12:1105. [PMID: 34440279 PMCID: PMC8393569 DOI: 10.3390/genes12081105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Machine learning methods applied to large genomic datasets (such as those used in GWAS) have led to the creation of polygenic risk scores (PRSs) that can be used identify individuals who are at highly elevated risk for important disease conditions, such as coronary artery disease (CAD), diabetes, hypertension, breast cancer, and many more. PRSs have been validated in large population groups across multiple continents and are under evaluation for widespread clinical use in adult health. It has been shown that PRSs can be used to identify which of two individuals is at a lower disease risk, even when these two individuals are siblings from a shared family environment. The relative risk reduction (RRR) from choosing an embryo with a lower PRS (with respect to one chosen at random) can be quantified by using these sibling results. New technology for precise embryo genotyping allows more sophisticated preimplantation ranking with better results than the current method of selection that is based on morphology. We review the advances described above and discuss related ethical considerations.
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Affiliation(s)
- Laurent C. A. M. Tellier
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI 48824, USA; (L.C.A.M.T.); (S.H.)
- Genomic Prediction, Inc., North Brunswick, NJ 08902, USA; (J.E.); (N.R.T.)
| | - Jennifer Eccles
- Genomic Prediction, Inc., North Brunswick, NJ 08902, USA; (J.E.); (N.R.T.)
| | - Nathan R. Treff
- Genomic Prediction, Inc., North Brunswick, NJ 08902, USA; (J.E.); (N.R.T.)
| | - Louis Lello
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI 48824, USA; (L.C.A.M.T.); (S.H.)
- Genomic Prediction, Inc., North Brunswick, NJ 08902, USA; (J.E.); (N.R.T.)
| | - Simon Fishel
- CARE Fertility Group, Nottingham NG8 6PZ, UK;
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L2 2QP, UK
| | - Stephen Hsu
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI 48824, USA; (L.C.A.M.T.); (S.H.)
- Genomic Prediction, Inc., North Brunswick, NJ 08902, USA; (J.E.); (N.R.T.)
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