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Angelim CC, Martins LD, Andrade ÁAF, Moreira FC, Guerreiro JF, de Assumpção PP, dos Santos SEB, Costa GDLC. Variants of IFNL4 Gene in Amazonian and Northern Brazilian Populations. Genes (Basel) 2023; 14:2075. [PMID: 38003018 PMCID: PMC10671175 DOI: 10.3390/genes14112075] [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: 09/15/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Since the discovery of the polymorphic nature of the IFNL4 gene, its variants have been investigated and associated with several viral diseases, with an emphasis on hepatitis C. However, the impacts of these variants on mixed-race and native populations in the northern region of Brazil are scarce. We investigated three variants of the IFNL4 gene in populations from this location, which were among the 14 most frequent variants in worldwide populations, and compared the frequencies obtained to populational data from the 1000 Genomes Project, gnomAD and ABraOM databases. Our results demonstrate that mixed-race and native populations from the northern region of Brazil present frequencies like those of European and Asian groups for the rs74597329 and rs11322783 variants, and like all populations presented for the rs4803221 variant. These data reinforce the role of world populations in shaping the genetic profile of Brazilian populations, indicate patterns of illness according to the expressed genotype, and infer an individual predisposition to certain diseases.
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Affiliation(s)
- Carolina Cabral Angelim
- Programa de Pós-Graduação em Agentes Infecciosos e Parasitários, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (C.C.A.); (L.D.M.); (Á.A.F.A.); (S.E.B.d.S.)
| | - Letícia Dias Martins
- Programa de Pós-Graduação em Agentes Infecciosos e Parasitários, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (C.C.A.); (L.D.M.); (Á.A.F.A.); (S.E.B.d.S.)
- Programa de Pós-Graduação em Virologia, Instituto Evandro Chagas, Ananindeua 67030-000, PA, Brazil
| | - Álesson Adam Fonseca Andrade
- Programa de Pós-Graduação em Agentes Infecciosos e Parasitários, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (C.C.A.); (L.D.M.); (Á.A.F.A.); (S.E.B.d.S.)
| | - Fabiano Cordeiro Moreira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (F.C.M.); (J.F.G.)
- Núcleo de Pesquisa em Oncologia, Federal University of Pará, Belém 66073-000, PA, Brazil;
| | - João Farias Guerreiro
- Programa de Pós-Graduação em Genética e Biologia Molecular, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (F.C.M.); (J.F.G.)
| | | | - Sidney Emanuel Batista dos Santos
- Programa de Pós-Graduação em Agentes Infecciosos e Parasitários, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (C.C.A.); (L.D.M.); (Á.A.F.A.); (S.E.B.d.S.)
- Programa de Pós-Graduação em Genética e Biologia Molecular, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (F.C.M.); (J.F.G.)
| | - Greice de Lemos Cardoso Costa
- Programa de Pós-Graduação em Agentes Infecciosos e Parasitários, Laboratório de Genética Humana e Médica, Federal University of Pará, Belém 66073-000, PA, Brazil; (C.C.A.); (L.D.M.); (Á.A.F.A.); (S.E.B.d.S.)
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Vergara C, Duggal P, Thio CL, Valencia A, O'Brien TR, Latanich R, Timp W, Johnson EO, Kral AH, Mangia A, Goedert JJ, Piazzola V, Mehta SH, Kirk GD, Peters MG, Donfield SM, Edlin BR, Busch MP, Alexander G, Murphy EL, Kim AY, Lauer GM, Chung RT, Cramp ME, Cox AL, Khakoo SI, Rosen HR, Alric L, Wheelan SJ, Wojcik GL, Thomas DL, Taub MA. Multi-ancestry fine mapping of interferon lambda and the outcome of acute hepatitis C virus infection. Genes Immun 2020; 21:348-359. [PMID: 33116245 PMCID: PMC7657970 DOI: 10.1038/s41435-020-00115-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
Clearance of acute infection with hepatitis C virus (HCV) is associated with the chr19q13.13 region containing the rs368234815 (TT/ΔG) polymorphism. We fine-mapped this region to detect possible causal variants that may contribute to HCV clearance. First, we performed sequencing of IFNL1-IFNL4 region in 64 individuals sampled according to rs368234815 genotype: TT/clearance (N = 16) and ΔG/persistent (N = 15) (genotype-outcome concordant) or TT/persistent (N = 19) and ΔG/clearance (N = 14) (discordant). 25 SNPs had a difference in counts of alternative allele >5 between clearance and persistence individuals. Then, we evaluated those markers in an association analysis of HCV clearance conditioning on rs368234815 in two groups of European (692 clearance/1 025 persistence) and African ancestry (320 clearance/1 515 persistence) individuals. 10/25 variants were associated (P < 0.05) in the conditioned analysis leaded by rs4803221 (P value = 4.9 × 10-04) and rs8099917 (P value = 5.5 × 10-04). In the European ancestry group, individuals with the haplotype rs368234815ΔG/rs4803221C were 1.7× more likely to clear than those with the rs368234815ΔG/rs4803221G haplotype (P value = 3.6 × 10-05). For another nearby SNP, the haplotype of rs368234815ΔG/rs8099917T was associated with HCV clearance compared to rs368234815ΔG/rs8099917G (OR: 1.6, P value = 1.8 × 10-04). We identified four possible causal variants: rs368234815, rs12982533, rs10612351 and rs4803221. Our results suggest a main signal of association represented by rs368234815, with contributions from rs4803221, and/or nearby SNPs including rs8099917.
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Affiliation(s)
- Candelaria Vergara
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Priya Duggal
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chloe L Thio
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Ana Valencia
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Thomas R O'Brien
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rachel Latanich
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Winston Timp
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - Alex H Kral
- RTI International, Research Triangle Park, NC, USA
| | - Alessandra Mangia
- Liver Unit IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valeria Piazzola
- Liver Unit IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Shruti H Mehta
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory D Kirk
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marion G Peters
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | | | - Brian R Edlin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael P Busch
- University of California San Francisco and Vitalant Research Institute, San Francisco, CA, USA
| | - Graeme Alexander
- University College London Institute for Liver and Digestive Health, The Royal Free Hospital, London, UK
| | - Edward L Murphy
- University of California San Francisco and Vitalant Research Institute, San Francisco, CA, USA
| | - Arthur Y Kim
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Georg M Lauer
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Raymond T Chung
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Andrea L Cox
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Salim I Khakoo
- University of Southampton, Southampton General Hospital, Southampton, UK
| | | | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, Centre Hospitalier Universitaire Rangueil, UMR 152, Institut de Recherche pour le Développement Toulouse 3 University, Toulouse, France
| | - Sarah J Wheelan
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Genevieve L Wojcik
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L Thomas
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Margaret A Taub
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Lindgren M, Samuelsson J, Nilsson L, Knutsen H, Ghanima W, Westin J, Johansson PL, Andréasson B. Genetic variation in IL28B (IFNL3) and response to interferon-alpha treatment in myeloproliferative neoplasms. Eur J Haematol 2018; 100:419-425. [PMID: 29369421 DOI: 10.1111/ejh.13034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In myeloproliferative neoplasms (MPN), interferon-alpha (IFN-α) is an effective treatment with disease-modifying properties but currently with no clear predictors of treatment outcome. Recent genomewide association studies in chronic hepatitis C have found a strong influence of genetic polymorphism near the IL28B (IFNL3) gene in response to IFN-α treatment. In this study, we sought to evaluate the prognostic impact of IL28B rs12979860, rs8099917, and rs12980275 on IFN-α treatment response in myeloproliferative neoplasms. METHOD We retrospectively evaluated 100 patients with MPN treated with IFN-α. The hematologic treatment response on IFN-α was compared between patients and correlated with host genetic variations in IL28B. The genotypes of IL28B were determined by allelic discrimination assays. RESULTS The CC genotype of rs12979860 was found significantly associated with hematologic response in polycythemia vera (PV) with a complete response (CR) in 79% (CC) compared to 48% (non-CC), (P = .036). No association between the genotypes and treatment response on hydroxyurea was found. CONCLUSION These results imply an effect of IL28B genotype on the outcome of IFN-α treatment in MPN.
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Affiliation(s)
- Marie Lindgren
- Department of Medicine, Kalmar County Hospital, Kalmar, Sweden
| | - Jan Samuelsson
- Department of Medicine, Stockholm South Hospital, Stockholm, Sweden
| | - Lars Nilsson
- Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Håvar Knutsen
- Department of Hematology, Ullevål University Hospital, Oslo, Norway
| | - Waleed Ghanima
- Department of Medicine, Östfold Hospital, Fredrikstad, Norway
| | - Johan Westin
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter L Johansson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medicine, Section of Hematology, NU Hospital, Uddevalla, Sweden
| | - Björn Andréasson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medicine, Section of Hematology, NU Hospital, Uddevalla, Sweden
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Mozzi A, Pontremoli C, Sironi M. Genetic susceptibility to infectious diseases: Current status and future perspectives from genome-wide approaches. INFECTION GENETICS AND EVOLUTION 2017; 66:286-307. [PMID: 28951201 PMCID: PMC7106304 DOI: 10.1016/j.meegid.2017.09.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 02/06/2023]
Abstract
Genome-wide association studies (GWASs) have been widely applied to identify genetic factors that affect complex diseases or traits. Presently, the GWAS Catalog includes > 2800 human studies. Of these, only a minority have investigated the susceptibility to infectious diseases or the response to therapies for the treatment or prevention of infections. Despite their limited application in the field, GWASs have provided valuable insights by pinpointing associations to both innate and adaptive immune response loci, as well as novel unexpected risk factors for infection susceptibility. Herein, we discuss some issues and caveats of GWASs for infectious diseases, we review the most recent findings ensuing from these studies, and we provide a brief summary of selected GWASs for infections in non-human mammals. We conclude that, although the general trend in the field of complex traits is to shift from GWAS to next-generation sequencing, important knowledge on infectious disease-related traits can be still gained by GWASs, especially for those conditions that have never been investigated using this approach. We suggest that future studies will benefit from the leveraging of information from the host's and pathogen's genomes, as well as from the exploration of models that incorporate heterogeneity across populations and phenotypes. Interactions within HLA genes or among HLA variants and polymorphisms located outside the major histocompatibility complex may also play an important role in shaping the susceptibility and response to invading pathogens. Relatively few GWASs for infectious diseases were performed. Phenotype heterogeneity and case/control misclassification can affect GWAS power. Adaptive and innate immunity loci were identified in several infectious disease GWASs. Unexpected loci (e.g., lncRNAs) were also associated with infection susceptibility. GWASs should integrate host and pathogen diversity and use complex association models.
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Affiliation(s)
- Alessandra Mozzi
- Bioinformatics, Scientific Institute IRCCS E.MEDEA, 23842 Bosisio Parini, Italy
| | - Chiara Pontremoli
- Bioinformatics, Scientific Institute IRCCS E.MEDEA, 23842 Bosisio Parini, Italy
| | - Manuela Sironi
- Bioinformatics, Scientific Institute IRCCS E.MEDEA, 23842 Bosisio Parini, Italy.
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Dzekova-Vidimliski P, Nikolov IG, Matevska-Geshkovska N, Boyanova Y, Nikolova N, Romanciuc G, Dumitrascu D, Caloska-Ivanova V, Joksimovic N, Antonov K, Mateva L, Rostaing L, Dimovski A, Sikole A. Genetic predictors of the response to the treatment of hepatitis C virus infection. Bosn J Basic Med Sci 2015; 15:55-9. [PMID: 26614853 PMCID: PMC4690443 DOI: 10.17305/bjbms.2015.632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023] Open
Abstract
The genome-wide association studies have identified a strong association between interleukin 28B (IL28B) gene polymorphisms and the response to treatment in patients with hepatitis C virus (HCV) infection. The aim of the study was to evaluate the association between three most widely studied IL28B gene polymorphisms and the response to antiviral treatment of chronic hepatitis C. We performed the genotyping of the three IL28B gene polymorphisms: rs12979860, rs8099917, and rs12980275 in 72 Caucasian patients with chronic hepatitis C, previously treated with the combination therapy of pegylated interferon alpha (PEGIFN α) and ribavirin (RBV). The patients included in the study had finished the treatment regimen at least 6 months before enrolling in the study. We used the sustained viral response (SVR) for the evaluation of the effectiveness of the antiviral treatment, and it was tested with an assay with a sensitivity of 20 IU/mL. An SVR was achieved in 59.7% (43/72) of the treated patients. The three IL28B gene polymorphisms (CC genotype of rs12979860, TT genotype of rs8099917, and AA genotype of rs12980275) were associated with the SVR (p=0.029, p=0.016, and p=0.028, respectively) in the study patients with chronic hepatitis C treated with the combination therapy of PEGIFN α and RBV. The association of IL28B gene polymorphisms with the treatment response points to the possibility of personalized medicine for the treatment of HCV infection.
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Chandra PK, Gunduz F, Hazari S, Kurt R, Panigrahi R, Poat B, Bruce D, Cohen AJ, Behorquez HE, Carmody I, Loss G, Balart LA, Wu T, Dash S. Impaired expression of type I and type II interferon receptors in HCV-associated chronic liver disease and liver cirrhosis. PLoS One 2014; 9:e108616. [PMID: 25265476 PMCID: PMC4180933 DOI: 10.1371/journal.pone.0108616] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/22/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Chronic Hepatitis C Virus (HCV)-infected patients with liver cirrhosis (LC) respond poorly to interferon-alpha (IFN-α) and ribavirin (RBV) combination therapy, but the reason for this is unclear. We previously reported that HCV-infection induces endoplasmic reticulum (ER) stress and autophagy response that selectively down regulates the type I IFN-α receptor-1 (IFNAR1) and RBV transporters (CNT1 and ENT1), leading to IFN-α/RBV resistance. The goal of this study is to verify whether an increase in ER stress and autophagy response is also associated with the reduced expression of IFNAR1 and RBV transporters in chronic HCV-infected patients. METHODS Primary human hepatocytes (PHH) were infected with cell culture grown HCV particles (JFH-ΔV3-Rluc). HCV replication was confirmed by the detection of viral RNA by RT-qPCR and HCV-core protein by Western blotting. The ER stress and autophagy response and expression of IFN receptors and RBV transporters in HCV infected PHH and liver tissues derived from patients were measured by Western blotting. RESULT HCV infection of PHH showed impaired expression of IFNAR1, IFNγR1 (Type II IFN receptor) and RBV transporters but not IL10Rβ (Type III IFN-λ receptor). ER stress markers (BiP, IRE1α and peIF2α) and autophagy response (LC3II, Beclin 1 and ATG5) were induced in HCV infected chronic liver disease (CLD) and LC patients. Liver biopsies (CLD) show a 50% reduced expression of IFNAR1 and RBV transporters. Furthermore, the expression of IFNAR1 and RBV transporters was impaired in almost all LC patients. CONCLUSION HCV infection induces ER stress and autophagy response in infected PHH and chronically infected liver tissues. The expression of IFNAR1, IFNγR1 and RBV transporters were significantly impaired in CLD and cirrhotic livers. Our study provides a potential explanation for the reduced response rate of IFN-α and RBV combination therapy in HCV infected patients with liver cirrhosis.
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Affiliation(s)
- Partha K. Chandra
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Feyza Gunduz
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Sidhartha Hazari
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ramazan Kurt
- Department of Medicine, Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Rajesh Panigrahi
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Bret Poat
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - David Bruce
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Ari J. Cohen
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Humberto E. Behorquez
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Ian Carmody
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - George Loss
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Luis A. Balart
- Department of Medicine, Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Tong Wu
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Srikanta Dash
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Medicine, Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- * E-mail:
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Brazas MD, Lewitter F, Schneider MV, van Gelder CWG, Palagi PM. A quick guide to genomics and bioinformatics training for clinical and public audiences. PLoS Comput Biol 2014; 10:e1003510. [PMID: 24722068 PMCID: PMC3983038 DOI: 10.1371/journal.pcbi.1003510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Fran Lewitter
- Whitehead Institute for Biomedical Research, Massachusetts Institute of Technology, Cambridge, United States of America
| | | | - Celia W. G. van Gelder
- Netherlands Bioinformatics Centre and Department of Bioinformatics, Radboud Medical Center, Nijmegen, The Netherlands
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McCarthy JJ, McLeod HL, Ginsburg GS. Genomic medicine: a decade of successes, challenges, and opportunities. Sci Transl Med 2014; 5:189sr4. [PMID: 23761042 DOI: 10.1126/scitranslmed.3005785] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Genomic medicine--an aspirational term 10 years ago--is gaining momentum across the entire clinical continuum from risk assessment in healthy individuals to genome-guided treatment in patients with complex diseases. We review the latest achievements in genome research and their impact on medicine, primarily in the past decade. In most cases, genomic medicine tools remain in the realm of research, but some tools are crossing over into clinical application, where they have the potential to markedly alter the clinical care of patients. In this State of the Art Review, we highlight notable examples including the use of next-generation sequencing in cancer pharmacogenomics, in the diagnosis of rare disorders, and in the tracking of infectious disease outbreaks. We also discuss progress in dissecting the molecular basis of common diseases, the role of the host microbiome, the identification of drug response biomarkers, and the repurposing of drugs. The significant challenges of implementing genomic medicine are examined, along with the innovative solutions being sought. These challenges include the difficulty in establishing clinical validity and utility of tests, how to increase awareness and promote their uptake by clinicians, a changing regulatory and coverage landscape, the need for education, and addressing the ethical aspects of genomics for patients and society. Finally, we consider the future of genomics in medicine and offer a glimpse of the forces shaping genomic medicine, such as fundamental shifts in how we define disease, how medicine is delivered to patients, and how consumers are managing their own health and affecting change.
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Affiliation(s)
- Jeanette J McCarthy
- Institute for Genome Sciences & Policy, Duke University, Durham, NC 27708, USA
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