临床评估包括个人基因组
Euan A Ashley1, Atul J Butte, Matthew T Wheeler
1Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA. euan@stanford.edu
Lancet (London, England)
|May 4, 2010
概括
在临床环境中,全基因组测序发现了心肌梗塞,糖尿病和癌症的显著遗传风险. 还发现了与突然心脏死亡和药物反应相关的罕见变异,证明了临床效用.
科学领域:
- 基因组学就是基因组学.
- 临床医学 临床医学
- 个性化医疗是个性化的医疗.
背景情况:
- 全基因组测序的成本已经下降,但其用于遗传风险评估的临床应用尚未完全确定.
- 在临床环境中对完整的人类基因组的综合分析对于理解遗传倾向至关重要.
研究的目的:
- 在临床框架内对患者的整个基因组进行综合分析.
- 评估冠状动脉疾病的遗传风险,查心脏突然死亡的原因,并提供遗传咨询.
- 开发用于整合全基因组数据与临床风险因素的新方法.
主要方法:
- 全基因组测序和单核酸多态和副本数变异的分析.
- 预测冠状动脉疾病的风险,并查与突发心脏死亡相关的基因.
- 将遗传数据与临床信息相结合,包括家族史和药物基因组数据库.
- 测试后疾病概率的估计,考虑到基因与环境的相互作用.
主要成果:
- 鉴定了心肌梗塞,2型糖尿病和某些癌症的遗传风险增加.
- 在TMEM43,DSP和MYBPC3中发现了罕见的变异,与突发心脏病死亡有关.
- 检测到LPA的变体与冠状动脉疾病家族病史一致.
- 确定了影响克洛皮多格雷尔反应,降脂疗法和华法林剂量的药物基因组变异.
结论:
- 全基因组测序为个人患者护理提供了临床相关信息.
- 尽管存在不确定意义的变异挑战,但该方法显示出显著的临床实用性.
- 进一步将基因组数据纳入临床实践是有必要的.
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