There is an urgent need to provide diagnoses for the approximately ~30 million Americans with undiagnosed disease. With the vast majority (85%) of undiagnosed diseases believed to have underlying genetic causes, the utilization of whole exome sequencing (WES), and to a lesser extent whole genome sequencing (WGS), has resulted in diagnosis rates of 25-40%, as reported in the prior literature. In Phase I of the Undiagnosed Diseases Network (UDN), the Duke/Columbia clinical site has capitalized upon both of these technologies, as well as deep phenotyping and innovative bioinformatics, to achieve an overall diagnosis rate of ~50%, and a diagnostic rate of ~40% for the most challenging cases: patients with prior negative WES results. The site's findings from Phase I of the UDN also demonstrated that undiagnosed patients/parents of undiagnosed children experience chaos and parents of children with undiagnosed diseases have high rates of anxiety and depression. This led to the development of a survey to measure patients' and parents' expectations and utilization of genome sequencing results. Beyond this, the team has contributed to UDN policies, established successful collaborations, and been active in key network leadership positions. With an already established infrastructure and successful outcomes, the Duke/Columbia site is well positioned to continue this work for the next four years and to sustain it beyond.
The Specific Aims of this proposal are as follows:
Specific Aim 1 : Comprehensively evaluate 30 patients annually with undiagnosed diseases. We will capitalize on our site's diagnostic specialty strengths, to evaluate patients in any specialty, adult and pediatric, within the one-week timeframe, use phenotypic data to aid genome interpretations, and effectively communicate results to patients and their families with genetic counseling.
Specific Aim 2 : Analyze the WES and WGS of patients to provide diagnoses and use RNA-sequencing as an adjunct when WES/WGS do not provide a diagnosis.
Specific Aim 3 : Prospectively examine psychosocial characteristics associated with being undiagnosed (Aim 3A) and expectations and utilization of genomic sequencing results (Aim 3B).
Specific Aim 4 : Contribute to activities of the UDN to foster a collaborative and sustainable network. The Duke/Columbia clinical site has all the capabilities required to be a successful clinical site in Phase II of the UDN, contributing to achieve the network's goal of evaluating patients with undiagnosed diseases and ultimately improve the health and well- being of these individuals and their families.

Public Health Relevance

Undiagnosed diseases are a public health problem since they cause patients and families medical, psychological and financial distress. In Phase I, we made diagnoses in ~50% of patients at our clinical site. In Phase II, we plan to increase the number of diagnoses, to improve the well-being of the patients and their families and to work towards continuing the UDN beyond 2022.

Agency
National Institute of Health (NIH)
Institute
National Human Genome Research Institute (NHGRI)
Type
Research Project--Cooperative Agreements (U01)
Project #
2U01HG007672-05
Application #
9593036
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Wise, Anastasia Leigh
Project Start
2014-07-01
Project End
2022-06-30
Budget Start
2018-09-19
Budget End
2019-06-30
Support Year
5
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Duke University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
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Raghavan, Neha S; Brickman, Adam M; Andrews, Howard et al. (2018) Whole-exome sequencing in 20,197 persons for rare variants in Alzheimer's disease. Ann Clin Transl Neurol 5:832-842
Walley, Nicole M; Pena, Loren D M; Hooper, Stephen R et al. (2018) Characteristics of undiagnosed diseases network applicants: implications for referring providers. BMC Health Serv Res 18:652
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Shashi, Vandana; Schoch, Kelly; Spillmann, Rebecca et al. (2018) A comprehensive iterative approach is highly effective in diagnosing individuals who are exome negative. Genet Med :
Marcogliese, Paul C; Shashi, Vandana; Spillmann, Rebecca C et al. (2018) IRF2BPL Is Associated with Neurological Phenotypes. Am J Hum Genet 103:456
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Pena, Loren D M; Jiang, Yong-Hui; Schoch, Kelly et al. (2018) Looking beyond the exome: a phenotype-first approach to molecular diagnostic resolution in rare and undiagnosed diseases. Genet Med 20:464-469
Shashi, Vandana; Magiera, Maria M; Klein, Dennis et al. (2018) Loss of tubulin deglutamylase CCP1 causes infantile-onset neurodegeneration. EMBO J 37:

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