Clinical OMICS

NOV-DEC 2018

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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Page 46 of 51 November/December 2018 Clinical OMICs 45 cision medicine. For example, precision psychiatry, exome sequencing to evaluate fetal anomalies and the clinical applications of population genetics. These topics are the offshoots of the pioneering work that has been done in the field, expanding the role of genomics in medicine. Is There a Future for Precision Psychiatry? Jordan Smoller, M.D., a professor of psychiatry at Harvard Medical School, started his talk by detail- ing how common psychiat- ric disorders are, affecting more than a quarter of the population in any given year and more than half of all people over the course of a lifetime. For that rea- son, Smoller said that there is an important future for precision psychi- atry, despite being in its infancy and that, similar to the pioneering work that has been done in precision approaches to cardiology, progress is being made. He hopes that the tremendous resources like the Electronic Medical Records and Genomics (eMERGE) Net- work, a national consortium organized by the National Human Genome Research Insti- tute (NHGRI) and UK Biobank will incorporate mental health data as they grow, to enable more research. Smoller touched on several different areas were the integration of precision medicine could benefit psychiatry including pharmacogenetics, risk stratification, prevention of intervention, and genome guided therapies. He noted that drugs for mental health are limited—avail- able FDA approved therapeutics are based on mechanisms identified in the 1950s or 60s and too often fall short or have intolerable side effects. And yet, 1 in 5 Americans are on psy- chotropic drugs. The result is that when they are prescribed, "we really don't know who is going to respond to what" and that genomic information could be used to inform that process, Smoller noted. One goal of precision psychiatry is to combine EHR data with clinical genomics to predict risk. Using bipolar disor- der as a model, researchers created an algorithm that could evaluate risk of having bipolar disorder and tested it, head to head, with psychiatrists' diagnoses. To rigoruously test the method, they used a group of people with depression and schizophrenia, two disorders that are often conflated with bipolar disorder. The algorithm performed almost the same as an expert clinician. Smoller added that "predicting risk early for something like schizophrenia is compelling." There are 100,000 people who have a first episode of psychotic illness each year in the U.S. Many of these people go undiagnosed and the longer someone goes without a diagnosis or treatment, the worse the outcomes are. So, the goal is to flag people earlier who are affected but undiagnosed. Because the only ways to decrease the chances of hav- ing mental illness are not necessarily actionable—i.e., not having an affected first degree relative and avoiding signif- icant childhood adversity—people are looking to genomics to uncover other preventative strategies. Two that have garnered atten- tion are physical activity and social support. Using GWAS data from the UK Biobank combined with data on people's level of activity, Smoller 's team found a causal protec- tive effect of physical activity on depression. Similarly, analyzing a vari- able called "unit cohesion" in soldiers that were pre- and post-deployment in Afghanistan, they found that it has a protective effect, work that could lead to genome guided thera- peutic development. While the field of precision psychiatry is just beginning,. Smoller says, "The need is tremendous, the future is long and no family goes untouched." Exome Sequencing in the Evaluation of Fetal Anomalies Programming a talk on psychiatry followed by one on fetal anomalies, AGBT Precision Health illustrated just how diverse the field of precision medicine has become. (continued on next page) VICTOR DE SCHWANBERG/SCIENCE PHOTO LIBRARY / Getty Images Jordan Smoller, M.D., Harvard Medical School

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