Clinical OMICS

JAN-FEB 2019

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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www.clinicalomics.com January/February 2019 Clinical OMICs 47 gest racial disparity of any disease, more so than obesity, heart disease, emphysema, and diabetes. When you look at the populations by ethnicity, Puerto Ricans have the highest prevalence of death rates from asthma while Mexicans have the lowest," said Burchard, a professor at the UC San Fran- cisco School of Pharmacy. In November 2018, he and his colleagues at UCSF, along with ones at the National Jewish Health and the Centro de Neumología Pediátrica in Puerto Rico, were awarded a nearly $10 million, five-year grant to study 4,000 children in Puerto Rico, where asthma preva- lence and death are among the highest in the world. The study is funded by the National Heart Lung and Blood Insti- tute, which is part of the NIH, and is called the Puerto Rican Infant Metagenomic and Epidemiologic Study of Respira- tory Outcomes (PRIMERO). The team will follow the chil- dren from birth through early childhood to study how genes and viral infections affect respiratory disease. Burchard said he has been critical in the past of the NIH for not doing more to ensure equity in basic and clinical research. "In recent years, they have really upped their game to address criticisms from myself and others." Diversity is important at all stages of research, he said. "It's important to include all the omics, but it is also important to have diver- sity in clinical trials. In the old days, we tried to general- ize findings in heart disease to women and it didn't work. When we did trials focused on women, we found that there different presentations of the disease and different response to medication." Diversifying basic and clinical studies, as well as including pediatric populations, will be necessary to avoid making the same kind of mistakes, again. Clinical Utility Richard Cooper, M.D., is a trained cardiologist who iden- tifies himself as a skeptic when it comes to genomic inclu- sivity in research and the ultimate clinical utility of omics. Cooper is professor and chair of public health sciences at Stritch School of Medicine at Loyola University Chicago. His skepticism comes from his own experiences. Cooper spent 15 years and $40 million in NIH funds studying the evolution of cardiovascular diseases, especially hyperten- sion, across populations of the African diaspora. Between 1992 and 1995 he analyzed samples from 12,000 individuals living in Nigeria, Cameroon, the Caribbean, the U.S., and the U.K. Ultimately, he found that the high rates of hyper- tension in males of African decent living in the United States are not explained by ancestral genetics. Instead, his work revealed the importance of changing environmental con- ditions on the risk status in these populations. In 2017, he gave a lecture in the Genomics and Health Disparities Lec- ture Series at the National Human Genome Research Institute (NHGRI) in which he discussed "chasing the phantom of race" when it came to studying variation in hypertension across populations. "At a certain point, you have to look at the data and be realistic," Cooper said. While complex disease like hypertension may be the exception, Landry said "the genetics is not there, yet." Still, other diseases areas—especially cancers and rare diseases—would benefit from inclusivity. However, Landry said the call for genomic equity in basic and clinical research is not always received well outside the fields of public health and public health genomics. "We have gotten an incredible amount of pushback from different research communities," including clinical genomics and bioinformatics. Both major academic research centers and pharmaceutical companies draw their study subjects from patient populations that are not diverse. "These systems have been developed and imple- mented." These institutions and companies would have to reinvest in their research infrastructures. "They may not have strategies for recruiting diverse cohorts. These are the argu- ments. People feel it will slow down progress. But, without equity, it's quite clear we are going to create disparities and create a dichotomous health system." A new birth-cohort study of Puerto Ricans—who suffer from the highest mortality rates of asthma—aims to have an impact on the rates of the disease in that population. "In recent years, [NIH has] really upped their game to address criticisms from myself and others." —Esteban Burchard, M.D. UC San Francisco School of Pharmacy ADAM GAULT / Science Photo Library / Getty Images

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