Precision Medicine: A Guide to Genomics in Clinical Practice

Precision Medicine: A Guide to Genomics in Clinical Practice

McCarthy, Jeanette; Mendelsohn, Bryce

McGraw-Hill Education

02/2017

240

Mole

Inglês

9781259644139

15 a 20 dias

404

Descrição não disponível.
Chapters 1-4: Pregnancy and childhood

Chapter 1: Preconception

What are the applications of precision medicine in the preconception period?



Infertility
Carrier screening - traditional and expanded
Genetic counselling, reimbursement, where to get tested
Future prospects: Preimplantation genetic testing

Chapter 2: Pregnancy

What are the applications of precision medicine during pregnancy?



Triple/quad screening
Amniocentesis/CVS
Trisomy testing using non-invasive (cfDNA) methods
Future prospects: expanded uses of cfDNA testing during pregnancy

Chapter 3: The Newborn

What are the applications of precision medicine in the newborn period? What are the situations when a clinician should consider a genetic diagnosis, what tests are commonly used, what evaluation can be performed by the non-specialist versus when to refer to a specialist.



Mandatory newborn screening
Broad classification and evaluation of birth defects
Broad classification and evaluation of metabolic disease
Future prospects: Sequencing from birth

Chapter 4: Childhood and Adolescence

What are the applications of precision medicine during childhood and adolescence?



Autism and Developmental delay
Childhood cancer (hereditary cancer)
Rare diseases and diagnostic sequencing
Support and advocacy for rare diseases

Chapters 5-9: Adulthood

Chapter 5: Pharmacogenetics

What pharmacogenetic tests are available? How valid and useful are they?



Types of pharmacogenetic markers

Efficacy-based, companion diagnostics
Safety-based, avoiding severe adverse events
Dosing-based


Understanding CYP450 alleles
Sources of information about pharmacogenetic tests

Drug labels
Evidence guidelines
PharmGKB, Dutch group



Chapter 6: Heart Disease

How is precision medicine being applied in heart disease?



Predisposition/diagnostic testing for myocardial infarction, thrombosis risk, arrhythmias
The utility of prognostic markers (e.g. CardioDx test)
Managing dose, efficacy and side effects of cardiovascular drugs using pharmacogenomics

Clopidogrel, Warfarin, Simvastatin



Chapter 7: Infectious disease

How is precision medicine being applied in infectious disease?



Managing dose, efficacy and side effects of ID drugs using pharmacogenomics

? Tracking outbreaks, pathogen discovery

? Future prospects: diagnostic sequencing

Chapter 8: Cancer

How is precision medicine being applied in cancer?



Diagnostic/predisposition testing for Hereditary cancers

HBOC, Lynch Syndrome, rare hereditary cancer syndromes


Managing dose, efficacy and side effects of cancer drugs using pharmacogenetics

Irinotecan, Belinostat, Azothioprine, Capecitaban, Tamoxifen, Oliparib


The genetic landscape of tumors
Prognostic markers
Targeted treatment and companion diagnostics
Tumor profiling and expanded treatment options
Future prospects: cfDNA for screening, diagnosing and monitoring cancer

Chapter 9: The Brain - Mental Health and Neurodegeneration

How is precision medicine being applied in mental health and neurodegenerative disease?



Predisposition/diagnostic testing for epilepsies, Alzheimer, Parkinson diseases
Managing dose, efficacy and side effects of antidepressant, antipsychotic, anti-seizure drugs using pharmacogenomics






Appendices. Conceptual framework for understanding genomic and precision medicine

Appendix 1: Genome variation

Describes the structure and organization of the human genome and the different types of variation, their consequences and distribution in different populations



DNA, RNA, Protein variation
Origin and types of genetic (DNA) variation (from big to small)
Consequences of genetic variation
Patterns of genetic variation across populations and ancestry

Appendix 2: Laboratory methods to detect genome variation

A roadmap of different testing methods that a practitioner may come across, what they can measure, and what are their limitations. Includes sample test requisitions and reports with graphical interpretation.



DNA variation (aCGH, karyotyping, FISH,Targeted genotyping, SNP arrays, Sanger and next-gen sequencing -whole genome, whole exome, panel)
The unique mitochondrial genome
RNA variation (QrtPCR, Transcript arrays, next-gen sequencing)
Protein variation (IHC, mass spectrometry)
Epigenome variation (Bisulfite sequencing)
How to find a testing laboratory (general information, specifics discussed within each disease type)

Appendix 3: Genetic variation and disease

How is genetic variation related to disease?



Inheritance patterns
Penetrance, expressivity, environmental influences
Family history: why it still matters

Appendix 4: Evidence base

How do we know if a gene-trait association is valid or clinically useful?

? Evaluating the evidence

o Establishing the role of the gene in disease

? Clinical validity (PPV, NPV)

? Clinical utility (cost effectiveness, comparative effectiveness)

? Where to find evidence, information and practice guidelines

How do we determine pathogenicity of variants in a diagnostic setting?

? Different types of evidence used in variant classification

? ACMG framework for variant classification

? Clinvar and other variant databases

Appendix 5: Regulation and reimbursement

How do regulation and reimbursement play a role in the delivery of precision medicine?



US FDA and genetic testing
Insurance coverage of genomic tests in the US

? Access to genetic testing

Appendix 6: Cross-cutting ethical issues

What key ethical issues to be aware of
with genetic testing?



Secondary/incidental findings
Discrimination and GINA
Privacy and sharing
Testing minors
Population screening
Eugenics and disability rights
How to gather appropriate informed consent
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