November 28, 2011
APL Leads Team to Leverage Advances in Genomics
Fans of "Star Trek: The Next Generation" may recall an episode where Dr. Crusher—having found a genetic abnormality in Capt. Picard—traveled back in time to change his DNA and return him to optimal health. That was 1990s science fiction. Physicians today might not have time-traveling machines, but they do have the ability to personalize a patient's health care based on the pattern of their genes, and APL is helping to expand the use of this practice.
The Air Force Surgeon General's office has asked the Laboratory to lead development of Patient Centered Precision Care, or PC2, an innovative program that will build on science and technological advances in genomics to ultimately deliver targeted preventive health care to Air Force personnel and their beneficiaries.
"We plan to implement advanced clinical decision support that will compile, interpret, and present actionable information from a myriad of patient data," said Lt. Gen. Charles Green, the surgeon general of the Air Force, in a congressional appropriations hearing last spring. The information will include data on family history and environment, as well as genomic, proteins, and an individual's metabolism.
"Personalized medicine puts the health care community in a better position to provide preventive care," says Ruth Vogel, of APL's Research and Exploratory Development Department, who will lead an interdisciplinary team of government agencies, universities, and private firms for PC2.
"We are really beginning to see the promise of genetics and medicine. Over the last 10 years—while mapping the human genome—scientists have worked to better understand the genome, and associate gene mutations with disease."
"The cost of genome sequencing has fallen rapidly and the technical capability to manage health information is also in place," she adds.
Scientists have developed DNA microarrays (also known as gene chips, DNA chips, or biochips) and supporting informatics that can screen patients and determine the relative risk that someone with a specific genetic variant will develop a disease such as age-related macular degeneration, Crohn's disease, myocardial infarction, inflammatory bowel disease, diabetes, bipolar disorder, coronary artery disease, hypertension, or rheumatoid arthritis.
The overall goal of the program is to integrate this into routine health care, Vogel says. "It seemed like a straightforward task, but we soon realized that there were very important challenges that had to be addressed before moving forward," she says. "How will the genetic information be used and where will it be stored? What are the patient's rights? Do employers have a right to know if a patient is predisposed for a certain disease? How well are health care providers trained?"
This is not just a technical project, Vogel says. "It has all the dynamics of a health care issue."
APL has assembled a team of researchers in genetics and personalized medicine, including investigators from Air Force Medical Command, the Coreill Institute for Medical Research, Duke Institute for Genome Sciences and Policy, the National Institutes of Health (including its National Cancer Institute and the National Human Genome Research Institute), and Johns Hopkins Medical Institutes.
The team will initially focus on five areas: research (to continue to increase what is known about the application of genetic information to health care); informatics (looking for ways to incorporate genomic data into Department of Defense health information technology); policy (exploring the ethical, legal, and social issues arising from genomic information gathering, storage, and use, as well as the associated policy implications); education (examining ways to expand graduate education in the field and ensure that patients and physicians understand genomic medicine); and systems engineering (bringing it all together).
"There are fears about the proliferation of genetic medicine and what that means for our society," says Vogel. "But it is clear that the benefits of sequencing and applying that information to improve health care are going to be immeasurable, and worth it."