genomics, medicine, and society american college of radiology may 13, 2003 francis s. collins, m.d.,...
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Genomics, Medicine,and Society
American College of Radiology
May 13, 2003
Francis S. Collins, M.D., Ph.D.
A SMALL SAMPLING OF COOL THINGS ABOUT THE GENOME
• Humans have fewer protein-coding genes than expected – less than 30,000
• Only about 5% of human DNA seems to be under strong selective pressure – but 2/3 of this is of unknown function
• Male mutation rate is twice that of females
All of the original goals of the Human Genome Project have
been accomplished
What’s next?
Genomics to Biology
• Define the structure of human variation: the human haplotype map
• Sequence lots of additional genomes • Develop new technologies for sequencing, genotyping,
expression analysis, proteomics, and molecular imaging• Identify all functional elements of the genome• Identify all the proteins of the cell, and their interactions• Develop a computational model of the cell
Genomics to Biology
• Define the structure of human variation: the human haplotype map
• Sequence lots of additional genomes • Develop new technologies for sequencing, genotyping,
expression analysis, proteomics, and molecular imaging• Identify all functional elements of the genome• Identify all the proteins of the cell, and their interactions• Develop a computational model of the cell
Finding genes for Mendelian phenotypes has made tremendous
progress over the last 10 years
Finding genes for complex (polygenic) disorders and traits has moved much more slowly
Sequence from chromosome 7
GAAATAATTAATGTTTTCCTTCCTTCTCCTATTTTGTCCTTTACTTCAATTTATTTATTTATTATTAATATTATTATTTTTTGAGACGGAGTTTCACTCTTGTTGCCAACCTGGAGTGCAGTGGCGTGATCTCAGCTCACTGCACACTCCGCTTTCC/TGGTTTCAAGCGATTCTCCTGCCTCAGCCTCCTGAGTAGCTGGGACTACAGTCACACACCACCACGCCCGGCTAATTTTTGTATTTTTAGTAGAGTTGGGGTTTCACCATGTTGGCCAGACTGGTCTCGAACTCCTGACCTTGTGATCCGCCAGCCTCTGCCTCCCAAAGAGCTGGGATTACAGGCGTGAGCCACCGCGCTCGGCCCTTTGCATCAATTTCTACAGCTTGTTTTCTTTGCCTGGACTTTACAAGTCTTACCTTGTTCTGCCTTCAGATATTTGTGTGGTCTCATTCTGGTGTGCCAGTAGCTAAAAATCCATGATTTGCTCTCATCCCACTCCTGTTGTTCATCTCCTCTTATCTGGGGTCACA/CTATCTCTTCGTGATTGCATTCTGATCCCCAGTACTTAGCATGTGCGTAACAACTCTGCCTCTGCTTTCCCAGGCTGTTGATGGGGTGCTGTTCATGCCTCAGAAAAATGCATTGTAAGTTAAATTATTAAAGATTTTAAATATAGGAAAAAAGTAAGCAAACATAAGGAACAAAAAGGAAAGAACATGTATTCTAATCCATTATTTATTATACAATTAAGAAATTTGGAAACTTTAGATTACACTGCTTTTAGAGATGGAGATGTAGTAAGTCTTTTACTCTTTACAAAATACATGTGTTAGCAATTTTGGGAAGAATAGTAACTCACCCGAACAGTGTAATGTGAATATGTCACTTACTAGAGGAAAGAAGGCACTTGAAAAACATCTCTAAACCGTATAAAAACAATTACATCATAATGATGAAAACCCAAGGAATTTTTTTAGAAAACATTACCAGGGCTAATAACAAAGTAGAGCCACATGTCATTTATCTTCCCTTTGTGTCTGTGTGAGAATTCTAGAGTTATATTTGTACATAGCATGGAAAAATGAGAGGCTAGTTTATCAACTAGTTCATTTTTAAAAGTCTAACACATCCTAGGTATAGGTGAACTGTCCTCCTGCCAATGTATTGCACATTTGTGCCCAGATCCAGCATAGGGTATGTTTGCCATTTACAAACGTTTATGTCTTAAGAGAGGAAATATGAAGAGCAAAACAGTGCATGCTGGAGAGAGAAAGCTGATACAAATATAAATGAAACAATAATTGGAAAAATTGAGAAACTACTCATTTTCTAAATTACTCATGTATTTTCCTAGAATTTAAGTCTTTTAATTTTTGATAAATCCCAATGTGAGACAAGATAAGTATTAGTGATGGTATGAGTAATTAATATCTGTTATATAATATTCATTTTCATAGTGGAAGAAATAAAATAAAGGTTGTGATGATTGTTGATTATTTTTTCTAGAGGGGTTGTCAGGGAAAGAAATTGCTTTTTTTCATTCTCTCTTTCCACTAAGAAAGTTCAACTATTAATTTAGGCACATACAATAATTACTCCATTCTAAAATGCCAAAAAGGTAATTTAAGAGACTTAAAACTGAAAAGTTTAAGATAGTCACACTGAACTATATTAAAAAATCCACAGGGTGGTTGGAACTAGGCCTTATATTAAAGAGGCTAAAAATTGCAATAAGACCACAGGCTTTAAATATGGCTTTAAACTGTGAAAGGTGAAACTAGAATGAATAAAATCCTATAAATTTAAATCAAAAGAAAGAAACAAACTA/GAAATTAAAGTTAATATACAAGAATATGGTGGCCTGGATCTAGTGAACATATAGTAAAGATAAAACAGAATATTTCTGAAAAATCCTGGAAAATCTTTTGGGCTAACCTGAAAACAGTATATTTGAAACTATTTTTAAA
Three SNPs are present
Whole Genome Association Approach to Common Disease
and Pharmacogenomics
• Identify all 10 million common SNPs
• Collect 1000 cases and 1000 controls
• Genotype all DNAs for all SNPs
2000 DNAs x 10,000,000 SNPs
= 20,000,000,000 genotypes
Sequence from chromosome 7
GAAATAATTAATGTTTTCCTTCCTTCTCCTATTTTGTCCTTTACTTCAATTTATTTATTTATTATTAATATTATTATTTTTTGAGACGGAGTTTCACTCTTGTTGCCAACCTGGAGTGCAGTGGCGTGATCTCAGCTCACTGCACACTCCGCTTTCC/TGGTTTCAAGCGATTCTCCTGCCTCAGCCTCCTGAGTAGCTGGGACTACAGTCACACACCACCACGCCCGGCTAATTTTTGTATTTTTAGTAGAGTTGGGGTTTCACCATGTTGGCCAGACTGGTCTCGAACTCCTGACCTTGTGATCCGCCAGCCTCTGCCTCCCAAAGAGCTGGGATTACAGGCGTGAGCCACCGCGCTCGGCCCTTTGCATCAATTTCTACAGCTTGTTTTCTTTGCCTGGACTTTACAAGTCTTACCTTGTTCTGCCTTCAGATATTTGTGTGGTCTCATTCTGGTGTGCCAGTAGCTAAAAATCCATGATTTGCTCTCATCCCACTCCTGTTGTTCATCTCCTCTTATCTGGGGTCACA/CTATCTCTTCGTGATTGCATTCTGATCCCCAGTACTTAGCATGTGCGTAACAACTCTGCCTCTGCTTTCCCAGGCTGTTGATGGGGTGCTGTTCATGCCTCAGAAAAATGCATTGTAAGTTAAATTATTAAAGATTTTAAATATAGGAAAAAAGTAAGCAAACATAAGGAACAAAAAGGAAAGAACATGTATTCTAATCCATTATTTATTATACAATTAAGAAATTTGGAAACTTTAGATTACACTGCTTTTAGAGATGGAGATGTAGTAAGTCTTTTACTCTTTACAAAATACATGTGTTAGCAATTTTGGGAAGAATAGTAACTCACCCGAACAGTGTAATGTGAATATGTCACTTACTAGAGGAAAGAAGGCACTTGAAAAACATCTCTAAACCGTATAAAAACAATTACATCATAATGATGAAAACCCAAGGAATTTTTTTAGAAAACATTACCAGGGCTAATAACAAAGTAGAGCCACATGTCATTTATCTTCCCTTTGTGTCTGTGTGAGAATTCTAGAGTTATATTTGTACATAGCATGGAAAAATGAGAGGCTAGTTTATCAACTAGTTCATTTTTAAAAGTCTAACACATCCTAGGTATAGGTGAACTGTCCTCCTGCCAATGTATTGCACATTTGTGCCCAGATCCAGCATAGGGTATGTTTGCCATTTACAAACGTTTATGTCTTAAGAGAGGAAATATGAAGAGCAAAACAGTGCATGCTGGAGAGAGAAAGCTGATACAAATATAAATGAAACAATAATTGGAAAAATTGAGAAACTACTCATTTTCTAAATTACTCATGTATTTTCCTAGAATTTAAGTCTTTTAATTTTTGATAAATCCCAATGTGAGACAAGATAAGTATTAGTGATGGTATGAGTAATTAATATCTGTTATATAATATTCATTTTCATAGTGGAAGAAATAAAATAAAGGTTGTGATGATTGTTGATTATTTTTTCTAGAGGGGTTGTCAGGGAAAGAAATTGCTTTTTTTCATTCTCTCTTTCCACTAAGAAAGTTCAACTATTAATTTAGGCACATACAATAATTACTCCATTCTAAAATGCCAAAAAGGTAATTTAAGAGACTTAAAACTGAAAAGTTTAAGATAGTCACACTGAACTATATTAAAAAATCCACAGGGTGGTTGGAACTAGGCCTTATATTAAAGAGGCTAAAAATTGCAATAAGACCACAGGCTTTAAATATGGCTTTAAACTGTGAAAGGTGAAACTAGAATGAATAAAATCCTATAAATTTAAATCAAAAGAAAGAAACAAACTA/GAAATTAAAGTTAATATACAAGAATATGGTGGCCTGGATCTAGTGAACATATAGTAAAGATAAAACAGAATATTTCTGAAAAATCCTGGAAAATCTTTTGGGCTAACCTGAAAACAGTATATTTGAAACTATTTTTAAA
Are the SNPs correlated with their neighbors?
These three SNPs could theoretically occur in 8 different haplotypes
…C…A…A…
…C…A…G…
…C…C…A…
…C…C…G…
…T…A…A…
…T…A…G…
…T…C…A…
…T…C…G…
But in practice, only two are observed
…C…A…A…
…C…A…G…
…C…C…A…
…C…C…G…
…T…A…A…
…T…A…G…
…T…C…A…
…T…C…G…
~ 20,000 bp
A Haplotype Map of Human Variation
• Goal is to define all common haplotypes in the human genome
• Genome-wide association studies can then be done with 30 – 50 times less work
• Project is international (9 labs in 5 countries); was initiated in October 2002, using samples of African, Asian, and European origin
Genomics to Health• Identify the genetic and environmental risk factors for all
common disease• Develop “sentinel systems” for early detection of disease and
molecular taxonomy of illness• Develop and deploy high-throughput robotic screening of
small molecules for academic researchers• Catalyze development of large human cohorts for genotype-
phenotype correlations• Elucidate the role that genomics can play in reducing health
disparities• Utilize genomics to improve health in the developing world
Genomics to Society• Enhance genetic privacy and protection against genetic
discrimination• Encourage appropriate patenting and licensing practices to
benefit the public• Understand the relationship of genomics, race, and
ethnicity, and bring this to bear usefully on the often contentious dialog about race
• Assess the ramifications of advances in understanding genetic factors that influence behavior
• Define boundaries of the appropriate application of genomics in the non-medical arena
What will be the impact of genomics on the
practice of medicine?
I think there is a world market for maybe five computers.
-- Thomas Watson
Chairman of IBM, 1943
The concept is interesting and well-formed, but in order to earn better
than a ‘C’, the idea must be feasible.
-- Yale Professor evaluating Fred Smith’s student paper proposing
the FedEx company
We don’t like their sound, and guitar music is on the way out.
-- Decca Records, rejecting the Beatles, 1962
640K ought to be enough for anybody.
-- Bill Gates, 1981
Most of the major contributing genes for diabetes, heart disease,
cancer, mental illness, Alzheimer’s and Parkinson’s disease, asthma, etc. will be identified within the
next 5 – 10 years.
Pharmacogenomics: Unlocking the Human Genome for Better Drug Therapy
McLeod & Evans, Ann Rev Pharmacol Toxicol 41:101-21, 2001
All patients with same diagnosis
Treat
Remove
No response
Toxic response
Responses without
toxic side effects
Gleevec™ – Specifically TargetsAn Abnormal Protein, Blocking Its Ability To Cause Chronic Myeloid Leukemia
Chromosome 9;22 translocation
CML
Bcr-Abl fusion protein
Gleevec™
Bcr-Abl fusion protein
Normal
2010 -- Predictive genetic tests available for a dozen conditions
-- Interventions to reduce risk available for several of these
-- Will reasonably effective legislative solutions to genetic
discrimination be in place?
BUT….
Mainstreaming of individualized preventive medicine
-- Will access be inequitable? Will health disparities persist?
-- Pharmacogenomics is standard of care for several drugs
2020 -- Gene-based designer drugs available for diabetes, Alzheimer’s…
-- Gene therapy standard of care for several conditions
BUT….
Genomic therapeutic revolution in full swing
-- Intense debate underway on non-medical uses of genetics
To wrest from nature the secrets which have
perplexed philosophers in all ages, to track
to their sources the causes of disease, to
correlate the vast stores of knowledge, that
they may be quickly available for the
prevention and cure of disease -- these are
our ambitions.
Sir William Osler
www.genome.gov
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