Clinical OMICS

JUL-AUG 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 July/August 2019 Clin ical OMICs 5 NIH to Evaluate Use of Genomics to Inform Chronic Disease Treatment The NIH plans to spend $42 million over five years to fund clinical trials designed to eval- uate whether and how the management of diseases such as high blood pressure, depres- sion, and chronic pain can be improved through genomic medicine. The two trials to be funded constitute the second phase of the Implementing Genomics in Practice (IGNITE) Network, launched in 2013, and will be called IGNITE II. The first trial will be designed to examine whether early access to patients' genomic data can help with treatment of high blood pressure, hy- pertension, and chronic kidney disease, more common among people of African ancestry than European and Asian descent. The second trial will focus on pain and depression. According to NIH, the study will seek to test wheth- er patients with acute post-surgical pain, chronic pain, and depression have better clinical out- comes if pharmacogenomics guide opioid and antidepressant prescriptions. Research teams at the University of Florida, the University of Indiana, Duke University, Vanderbilt University, and the Icahn School of Medicine at Mount Sinai, New York will carry out the clinical trials. n Genetic Variation Influences Effectiveness of Vaccines A genome-wide association study (GWAS) involving thousands of children in the U.K. and The Netherlands, has linked a num- ber of genetic variations with the level of protective antibodies generated following routine childhood immunizations. The sci- entists say that with further research it may be feasible to incorporate genetic tests into neonatal screening programs that can pre- dict immunity to vaccines, and so guide per- sonalized vaccination regimens. "This study is the first to use a ge- nome-wide genotyping approach, as- sessing several million genetic variants, to investigate the genetic determinants of immune responses to three routine childhood vaccines," said Daniel O'Con- nor, Ph.D., a postdoctoral researcher at University of Oxford and first author of the published paper in Cell Reports. Vaccines prevent millions of deaths every year, but continued protection against the pathogen after vaccination depends on the body's ability to maintain antibody levels. For some vaccines, antibody levels decline quick- ly after immunization during infancy, and so boosters are required during childhood. "Evoking robust and sustained vac- cine-induced immunity from early life is a crucial component of global health initia- tives to combat the burden of infectious dis- ease," O'Connor noted. "The mechanisms underlying the persistence of antibody is of major interest, since effectiveness and acceptability of vaccines would be im- proved if protection were sustained after infant immunization without the need for repeated boosting through childhood." n taa22 / iStock / Getty Images Clinical NGS IDs Pathogens in Brain and Spinal Fluid Missed by Other Tests In a study published in the New England Journal of Medicine, researchers reported the use of metagenomic next-generation sequencing (NGS) to successfully identify potentially lethal pathogens in the brain and spinal fluid of 22% of patients that con- ventional testing missed, allowing them to administer life-saving treatment. "The infectious cause of half the cases of meningitis and encephalitis go undi- agnosed in hospitals around the country," said the study's senior author, Charles Chiu, M.D., Ph.D., professor of laboratory med- icine at the University of California, San Francisco, in a press release. "This study was designed to evaluate the real-life clinical performance and effect of the metagenomic NGS assay in comparison with conventional microbiologic testing in patient-care scenarios in which the test is likely to be used," Chiu and his colleagues wrote in the publication. The challenge for front-line physicians is that fewer than half of encephalitis and meningitis cases are caused by pathogens (viruses, bacteria, fungi, and parasites) and yet are clinically indistinguishable from cases caused by autoimmune disorders. Metagenomic testing, the authors point out, offers an unbiased way of testing for the presence of pathogens in patients' spinal fluid, allowing quick and decisive action if a pathogen is detected. n KATERYNA KON / SCIENCE PHOTO LIBRARY / Getty Images

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