Technological developments in the field of genomics now afford the opportunity to define the complete sequence of an individual's genome in a rapid and affordable manner. Such "whole genome sequencing" and its simpler corollary, "whole exome sequencing" (WES), have already established themselves as powerful research tools. The natural next step in the evolution of this technology is its direct application in the clinical arena. However, while such technology holds considerable clinical promise, tremendous challenges exist in applying it and deriving practical benefit to patients. In this proposal we outline a highly interdisciplinary approach to identifying, confronting and overcoming the major challenges which must be met in order to implement deep sequencing technology in clinical medicine.
Aim 1 will explore the use of WES as a diagnostic tool in the care of a broad array of patients, evaluate its performance, identify critical clinical characteristics which can guide its application and measure the impact of such information on patients and providers.
Aim 2 will tackle one of the most pressing challenges in the clinical application of WES: the inevitable generation of "collateral" or "bystander" information. Educational materials will be developed to enable patients to make decisions about appropriate return of results and the impact of collateral information will be assessed at the level of the provider, laboratory and patient. The third major challenge in clinical implementation of genomic medicine, how do deal with vast amounts of information, will be addressed by Aim 3. A clinically oriented "binning" structure will be created and refined for classifying, storing and transmitting data within practical categories so as to make sense of the large amounts of data generated. Finally, as we stand on the cusp of genomic medicine, we must ensure that all have access to its benefits. Thus, Aim 4 will pursue clinical WES in traditionally underrepresented populations to identify special opportunities and challenges in the clinical translation of this new tool to the broadest possible population. Our ultimate aim is to establish a set of best practices to guide future implementation of robust genomic technologies for the real and practical betterment of human health.

Public Health Relevance

Genomic medicine has tremendous potential to improve human health by facilitating improved diagnosis, offering deep insight into mechanisms of disease and by enabling individually targeted prevention and treatment. In this proposal we will confront the major challenges which stand between genomic medicine and its broad implementation to a diverse population.

Agency
National Institute of Health (NIH)
Institute
National Human Genome Research Institute (NHGRI)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01HG006487-01
Application #
8236285
Study Section
Special Emphasis Panel (ZHG1-HGR-N (O1))
Program Officer
Hindorff, Lucia
Project Start
2011-12-05
Project End
2015-11-30
Budget Start
2011-12-05
Budget End
2012-11-30
Support Year
1
Fiscal Year
2012
Total Cost
$1,630,816
Indirect Cost
$522,968
Name
University of North Carolina Chapel Hill
Department
Genetics
Type
Schools of Medicine
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Amendola, Laura M; Jarvik, Gail P; Leo, Michael C et al. (2016) Performance of ACMG-AMP Variant-Interpretation Guidelines among Nine Laboratories in the Clinical Sequencing Exploratory Research Consortium. Am J Hum Genet 98:1067-76
Adams, Michael C; Evans, James P; Henderson, Gail E et al. (2016) The promise and peril of genomic screening in the general population. Genet Med 18:593-9
Berg, Jonathan S; Foreman, Ann Katherine M; O'Daniel, Julianne M et al. (2016) A semiquantitative metric for evaluating clinical actionability of incidental or secondary findings from genome-scale sequencing. Genet Med 18:467-75
Tan, Nina; Amendola, Laura M; O'Daniel, Julianne M et al. (2016) Is "incidental finding" the best term?: a study of patients' preferences. Genet Med :
Skinner, Debra; Raspberry, Kelly A; King, Martha (2016) The nuanced negative: Meanings of a negative diagnostic result in clinical exome sequencing. Sociol Health Illn 38:1303-1317
Rasmussen, Luke V; Overby, Casey L; Connolly, John et al. (2016) Practical considerations for implementing genomic information resources. Experiences from eMERGE and CSER. Appl Clin Inform 7:870-82
O'Daniel, Julianne M; McLaughlin, Heather M; Amendola, Laura M et al. (2016) A survey of current practices for genomic sequencing test interpretation and reporting processes in US laboratories. Genet Med :
Berg, Jonathan S (2016) Exploring the importance of case-level clinical information for variant interpretation. Genet Med :
Tomlinson, Ashley N; Skinner, Debra; Perry, Denise L et al. (2016) "Not Tied Up Neatly with a Bow": Professionals' Challenging Cases in Informed Consent for Genomic Sequencing. J Genet Couns 25:62-72
Green, Robert C; Goddard, Katrina A B; Jarvik, Gail P et al. (2016) Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine. Am J Hum Genet 98:1051-66

Showing the most recent 10 out of 50 publications