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Updated: Jul 26, 2025

Candidate Gene Testing in Clinical Cohort Studies with Multiplexed Genotyping and Mass Spectrometry
Published on: June 21, 2018
Selection, optimization, and validation of ten chronic disease polygenic risk scores for clinical implementation in
Niall J Lennon1, Leah C Kottyan2, Christopher Kachulis1
1Broad Institute of MIT and Harvard.
Insights
Polygenic risk scores (PRS) show promise for clinical use, but performance varies across diverse populations. The eMERGE Network is implementing PRS for 10 conditions in 25,000 diverse individuals to ensure equitable health.
Area of Science:
- Genomics
- Clinical Medicine
- Health Disparities
Background:
- Polygenic risk scores (PRS) demonstrate increasing predictive power, suggesting clinical utility.
- Disparities in PRS performance across diverse populations risk worsening health inequities.
- The National Human Genome Research Institute (NHGRI)-funded Electronic Medical Records and Genomics (eMERGE) Network is a key initiative.
Conclusions:
- The eMERGE Network's experience provides a foundational framework for implementing PRS in diverse clinical settings.
- Addressing PRS performance disparities is crucial for equitable healthcare.
- The developed infrastructure supports the scalable and compliant clinical integration of PRS.
Abstract:
Polygenic risk scores (PRS) have improved in predictive performance supporting their use in clinical practice. Reduced predictive performance of PRS in diverse populations can exacerbate existing health disparities. The NHGRI-funded eMERGE Network is returning a PRS-based genome-informed risk assessment to 25,000 diverse adults and children. We assessed PRS performance, medical actionability, and potential clinical utility for 23 conditions. Standardized metrics were considered in the selection process with additional consideration given to strength of evidence in African and Hispanic populations. Ten conditions were selected with a range of high-risk thresholds: atrial fibrillation, breast cancer, chronic kidney disease, coronary heart disease, hypercholesterolemia, prostate cancer, asthma, type 1 diabetes, obesity, and type 2 diabetes. We developed a pipeline for clinical PRS implementation, used genetic ancestry to calibrate PRS mean and variance, created a framework for regulatory compliance, and developed a PRS clinical report. eMERGE's experience informs the infrastructure needed to implement PRS-based implementation in diverse clinical settings.
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