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Bendor-Samuel OM, Wishlade T, Willis L, Aley P, Choi E, Craik R, Mujadidi Y, Mounce G, Roseman F, De La Horra Gozalo A, Bland J, Taj N, Smith I, Ziegler AG, Bonifacio E, Winkler C, Haupt F, Todd JA, Servais L, Snape MD, Vatish M. Successful integration of newborn genetic testing into UK routine screening using prospective consent to determine eligibility for clinical trials. Arch Dis Child 2023; 108:26-30. [PMID: 36171064 PMCID: PMC9763160 DOI: 10.1136/archdischild-2022-324270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/09/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE INGR1D (INvestigating Genetic Risk for type 1 Diabetes) was a type 1 diabetes (T1D) genetic screening study established to identify participants for a primary prevention trial (POInT, Primary Oral Insulin Trial). METHODS The majority of participants were recruited by research midwives in antenatal clinics from 18 weeks' gestation. Using the NHS Newborn Bloodspot Screening Programme (NBSP) infrastructure, participants enrolled in INGR1D had an extra sample taken from their day 5 bloodspot card sent for T1D genetic screening. Those at an increased risk of T1D were informed of the result, given education about T1D and the opportunity to take part in POInT. RESULTS Between April 2018 and November 2020, 66% of women approached about INGR1D chose to participate. 15 660 babies were enrolled into INGR1D and 14 731 blood samples were processed. Of the processed samples, 157 (1%) had confirmed positive results, indicating an increased risk of T1D, of whom a third (n=49) enrolled into POInT (20 families were unable to participate in POInT due to COVID-19 lockdown restrictions). CONCLUSION The use of prospective consent to perform personalised genetic testing on samples obtained through the routine NBSP represents a novel mechanism for clinical genetic research in the UK and provides a model for further population-based genetic studies in the newborn.
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Affiliation(s)
| | - Tabitha Wishlade
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Louise Willis
- Oxford Vaccine Group, University of Oxford, Oxford, Oxfordshire, UK
| | - Parvinder Aley
- Oxford Vaccine Group, University of Oxford, Oxford, Oxfordshire, UK
| | - Edward Choi
- Oxford Vaccine Group, University of Oxford, Oxford, Oxfordshire, UK
| | - Rachel Craik
- Oxford Vaccine Group, University of Oxford, Oxford, Oxfordshire, UK
| | - Yama Mujadidi
- Oxford Vaccine Group, University of Oxford, Oxford, Oxfordshire, UK
| | - Ginny Mounce
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Fenella Roseman
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, Oxfordshire, UK
| | | | - James Bland
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Nazia Taj
- Oxford Screening Laboratory, Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Ian Smith
- Oxford Screening Laboratory, Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany,Technical University Munich, School of Medicine, Forschergruppe Diabetes at Klinikum rechts der Isar, Munich, Germany
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Florian Haupt
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - John A Todd
- Wellcome Centre for Human Genetics, University of Oxford Nuffield Department of Medicine, Oxford, Oxfordshire, UK,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Laurent Servais
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, Université de Liège, Liege, Belgium,MDUK Neuromuscular Centre, University of Oxford Department of Paediatrics, Oxford, Oxfordshire, UK
| | - Matthew D Snape
- Oxford Vaccine Group, University of Oxford, Oxford, Oxfordshire, UK,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, Oxfordshire, UK .,Wellcome Centre for Human Genetics, University of Oxford Nuffield Department of Medicine, Oxford, Oxfordshire, UK
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Winkler C, Haupt F, Heigermoser M, Zapardiel‐Gonzalo J, Ohli J, Faure T, Kalideri E, Hommel A, Delivani P, Berner R, Kordonouri O, Roloff F, von dem Berge T, Lange K, Oltarzewski M, Glab R, Szypowska A, Snape MD, Vatish M, Todd JA, Larsson HE, Ramelius A, Kördel JÅ, Casteels K, Paulus J, Ziegler AG, Bonifacio E. Identification of infants with increased type 1 diabetes genetic risk for enrollment into Primary Prevention Trials-GPPAD-02 study design and first results. Pediatr Diabetes 2019; 20:720-727. [PMID: 31192505 PMCID: PMC6851563 DOI: 10.1111/pedi.12870] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/17/2019] [Accepted: 05/21/2019] [Indexed: 01/15/2023] Open
Abstract
Primary prevention of type 1 diabetes (T1D) requires intervention in genetically at-risk infants. The Global Platform for the Prevention of Autoimmune Diabetes (GPPAD) has established a screening program, GPPAD-02, that identifies infants with a genetic high risk of T1D, enrolls these into primary prevention trials, and follows the children for beta-cell autoantibodies and diabetes. Genetic testing is offered either at delivery, together with the regular newborn testing, or at a newborn health care visits before the age of 5 months in regions of Germany (Bavaria, Saxony, Lower Saxony), UK (Oxford), Poland (Warsaw), Belgium (Leuven), and Sweden (Region Skåne). Seven clinical centers will screen around 330 000 infants. Using a genetic score based on 46 T1D susceptibility single-nucleotide polymorphisms (SNPs) or three SNPS and a first-degree family history for T1D, infants with a high (>10%) genetic risk for developing multiple beta-cell autoantibodies by the age of 6 years are identified. Screening from October 2017 to December 2018 was performed in 50 669 infants. The prevalence of high genetic risk for T1D in these infants was 1.1%. Infants with high genetic risk for T1D are followed up and offered to participate in a randomized controlled trial aiming to prevent beta-cell autoimmunity and T1D by tolerance induction with oral insulin. The GPPAD-02 study provides a unique path to primary prevention of beta-cell autoimmunity in the general population. The eventual benefit to the community, if successful, will be a reduction in the number of children developing beta-cell autoimmunity and T1D.
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Affiliation(s)
- Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany,Forschergruppe Diabetes e.V. at Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany
| | - Florian Haupt
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany,Forschergruppe Diabetes e.V. at Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany
| | - Martin Heigermoser
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany
| | - Jose Zapardiel‐Gonzalo
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany
| | - Jasmin Ohli
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany
| | - Theresa Faure
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany
| | - Evdokia Kalideri
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany
| | - Angela Hommel
- Faculty of Medicine, Center for Regenerative Therapies Dresden (CRTD)Technische Universität DresdenDresdenGermany
| | - Petrina Delivani
- Faculty of Medicine, Center for Regenerative Therapies Dresden (CRTD)Technische Universität DresdenDresdenGermany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Olga Kordonouri
- Hannoversche Kinderheilanstalt, Kinder‐ und Jugendkrankenhaus AUF DER BULTHannoverGermany
| | - Frank Roloff
- Hannoversche Kinderheilanstalt, Kinder‐ und Jugendkrankenhaus AUF DER BULTHannoverGermany
| | - Thekla von dem Berge
- Hannoversche Kinderheilanstalt, Kinder‐ und Jugendkrankenhaus AUF DER BULTHannoverGermany
| | - Karin Lange
- Department of Medical PsychologyHannover Medical SchoolHannoverGermany
| | | | | | | | - Matthew D. Snape
- Department of Paediatrics, NIHR Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
| | - John A. Todd
- Nuffield Department of Medicine, Wellcome Centre for Human GeneticsUniversity of OxfordOxfordUK
| | - Helena E. Larsson
- Unit for Pediatric Endocrinology, Department of Clinical Sciences MalmöLund UniversityLundSweden,Department of PaediatricsSkåne University HospitalMalmöSweden
| | | | | | - Kristina Casteels
- Department of PediatricsUniversity Hospitals LeuvenLeuvenBelgium,Department of Development and RegenerationKU LeuvenLeuvenBelgium
| | - Jasmin Paulus
- Department of PediatricsUniversity Hospitals LeuvenLeuvenBelgium
| | - Anette G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany,Forschergruppe Diabetes e.V. at Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthMunichGermany,Forschergruppe DiabetesKlinikum rechts der Isar, Technical University MunichMunichGermany
| | - Ezio Bonifacio
- Faculty of Medicine, Center for Regenerative Therapies Dresden (CRTD)Technische Universität DresdenDresdenGermany
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