Physician-directed genetic screening to evaluate personal risk for medically actionable disorders: a large multi-center cohort study

BACKGROUND

The use of proactive genetic screening for disease prevention and early detection is not yet widespread. Professional practice guidelines from the American College of Medical Genetics and Genomics (ACMG) have encouraged reporting pathogenic variants that confer personal risk for actionable monogenic hereditary disorders, but only as secondary findings from exome or genome sequencing. The Centers for Disease Control and Prevention (CDC) recognizes the potential public health impact of three Tier 1 actionable disorders. Here, we report results of a large multi-center cohort study to determine the yield and potential value of screening healthy individuals for variants associated with a broad range of actionable monogenic disorders, outside the context of secondary findings.

METHODS

Eligible adults were offered a proactive genetic screening test by health care providers in a variety of clinical settings. The screening panel based on next-generation sequencing contained up to 147 genes associated with monogenic disorders within cancer, cardiovascular, and other important clinical areas. Sequence and intragenic copy number variants classified as pathogenic, likely pathogenic, pathogenic (low penetrance), or increased risk allele were considered clinically significant and reported. Results were analyzed by clinical area and severity/burden of disease using chi-square tests without Yates' correction.

RESULTS

Among 10,478 unrelated adults screened, 1619 (15.5%) had results indicating personal risk for an actionable monogenic disorder. In contrast, only 3.1 to 5.2% had clinically reportable variants in genes suggested by the ACMG version 2 secondary findings list to be examined during exome or genome sequencing, and 2% had reportable variants related to CDC Tier 1 conditions. Among patients, 649 (6.2%) were positive for a genotype associated with a disease of high severity/burden, including hereditary cancer syndromes, cardiovascular disorders, or malignant hyperthermia susceptibility.

CONCLUSIONS

This is one of the first real-world examples of specialists and primary care providers using genetic screening with a multi-gene panel to identify health risks in their patients. Nearly one in six individuals screened for variants associated with actionable monogenic disorders had clinically significant results. These findings provide a foundation for further studies to assess the role of genetic screening as part of regular medical care.

An open study of mesoridazine (Serentil) in chronic schizophrenics

Mesoridazine besylate (Serentil) was evaluated in an eight-week open-label trial in 12 male and 41 female patients with chronic schizophrenia who had ceased to progress beyond a certain level of functioning despite continued psychotropic medication not including Serentil. After a ten-day washout period the patients received Serentil in I.M. doses of 25-150 mg daily on the first ten study days, followed by daily tablet doses ranging from 25 to 400 mg until the final day of the study. Observations were made before and after the washout period as well as on days 3, 10, 14, 28 and 56 of the study, and results were expressed in terms of the Nurses' Observation Scale for Inpatient Evaluation (NOSIE) and the Brief Psychiatric Rating Scale (BPRS). The NOSIE ratings showed that the patients were significantly "less mentally ill" at the end of the washout period and underwent a statistically highly significant further improvement in the course of the Serentil treatment. These improvements occurred in irritability, manifest psychosis, retardation, and depressive manifestations, and social competence. Only two BPRS items improved significantly during the washout period. Treatment with Serentil led to improvement in thinking disturbances as well as in psychomotor, paranoid and depressive disturbances. In fact, between baseline and day 56 of the treatment period, all BPRs items except guilt feelings and all BPRS factors were improved to a highly significant (p less than 0.01) degree. Rating for mental illness from study day 10 onward showed that patients in a subgroup of depressive disturbances showed significantly greater improvement than patients in another subgroup, psychomotor disturbances. Adverse reactions were experienced by a total of 13 patients; in 7 of these a dosage adjustment became necessary for this reason. All patients completed the study program.