Genes and other biological markers are rapidly being identified that can provide presymptomatic estimates of risk to individuals for the eventual development of complex late-onset diseases. There is widespread public interest in obtaining risk information, particularly as treatments are developed to slow or prevent the onset of degenerative diseases. Many of the recently discovered gene markers are not deterministic genes, but rather susceptibility genes that interact with other, yet unidentified genes, and with factors such as age, gender, race, family history and environmental exposures. Therefore, genotyping individuals for susceptibility genes will require different protocols for providing risk assessment and counseling than those that have been used with deterministic genes. With few restrictions on the marketing and utilization of such tests, their usage may soon increase. Yet, there are almost no data available to understand who (e.g., age, sex, race) would seek susceptibility risk information once it is available; and why they would do so (e.g., to alleviate anxiety, to prepare financially). Nor is there information on the benefits or negative consequences of providing susceptibility risk information that could guide rational clinical decisions or public policy. This research project proposes to determine who actually chooses to obtain susceptibility genotyping for Alzheimer's disease (AD) and what the consequences of that information will be. Subjects will be randomized to one of two arms of the study. In the Control arm, risk will be estimated based upon family history. In the Intervention arm, risk will be estimated by family history and by genotyping ApoE - a common susceptibility polymorphism. Three clinical centers of care (Atlanta, New York City, and Cleveland) will enroll adult offspring of persons with AD; and using a carefully monitored protocol of counseling, assess the benefits and risks of providing this information. Determination of ApoE status will be used in a format that parallels likely clinical usage and will permit the development of guidelines for clinicians for genetic testing, risk assessment and appropriate counseling scenarios. ApoE determination and counseling, because of its inherent uncertainties, is an ideal model to develop new guidelines for whether and how best to use susceptibility gene markers in this and other diseases where such markers are or will be available in the near future.

Agency
National Institute of Health (NIH)
Institute
National Human Genome Research Institute (NHGRI)
Type
Research Project (R01)
Project #
3R01HG002213-03S1
Application #
6683023
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Mcewen, Jean
Project Start
1999-09-30
Project End
2003-05-08
Budget Start
2001-11-26
Budget End
2003-05-08
Support Year
3
Fiscal Year
2003
Total Cost
$97,008
Indirect Cost
Name
Boston University
Department
Neurology
Type
Schools of Medicine
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Christensen, Kurt D; Uhlmann, Wendy R; Roberts, J Scott et al. (2018) A randomized controlled trial of disclosing genetic risk information for Alzheimer disease via telephone. Genet Med 20:132-141
Uhlmann, Wendy R; Roberts, J Scott (2018) Ethical issues in neurogenetics. Handb Clin Neurol 147:23-36
Ridge, Perry G; Wadsworth, Mark E; Miller, Justin B et al. (2018) Assembly of 809 whole mitochondrial genomes with clinical, imaging, and fluid biomarker phenotyping. Alzheimers Dement 14:514-519
Guan, Yue; Roter, Debra L; Wolff, Jennifer L et al. (2018) The impact of genetic counselors' use of facilitative strategies on cognitive and emotional processing of genetic risk disclosure for Alzheimer's disease. Patient Educ Couns 101:817-823
Han, Paul K J; Umstead, Kendall L; Bernhardt, Barbara A et al. (2017) A taxonomy of medical uncertainties in clinical genome sequencing. Genet Med 19:918-925
Guan, Yue; Roter, Debra L; Erby, Lori H et al. (2017) Disclosing genetic risk of Alzheimer's disease to cognitively impaired patients and visit companions: Findings from the REVEAL Study. Patient Educ Couns 100:927-935
Christensen, Kurt D; Roberts, J Scott; Whitehouse, Peter J et al. (2016) Disclosing Pleiotropic Effects During Genetic Risk Assessment for Alzheimer Disease: A Randomized Trial. Ann Intern Med 164:155-63
Baptista, Natalie M; Christensen, Kurt D; Carere, Deanna Alexis et al. (2016) Adopting genetics: motivations and outcomes of personal genomic testing in adult adoptees. Genet Med 18:924-32
Olfson, Emily; Hartz, Sarah; Carere, Deanna Alexis et al. (2016) Implications of Personal Genomic Testing for Health Behaviors: The Case of Smoking. Nicotine Tob Res 18:2273-2277
Lebo, Matthew S; Sutti, Sheila; Green, Robert C (2016) ""Big Data"" Gets Personal. Sci Transl Med 8:322fs3-3fs3

Showing the most recent 10 out of 107 publications