Doctor of Philosophy

dissertationRapidly evolving technologies such as chip arrays and next-generation sequencing are uncovering human genetic variants at an unprecedented pace. Unfortunately, this ever growing collection of gene sequence variation has limited clinical utility without clear association to disease outcomes. As electronic medical records begin to incorporate genetic information, gene variant classification and accurate interpretation of gene test results plays a critical role in customizing patient therapy. To verify the functional impact of a given gene variant, laboratories rely on confirming evidence such as previous literature reports, patient history and disease segregation in a family. By definition variants of uncertain significance (VUS) lack this supporting evidence and in such cases, computational tools are often used to evaluate the predicted functional impact of a gene mutation. This study evaluates leveraging high quality genotype-phenotype disease variant data from 20 genes and 3986 variants, to develop gene-specific predictors utilizing a combination of changes in primary amino acid sequence, amino acid properties as descriptors of mutation severity and Naïve Bayes classification. A Primary Sequence Amino Acid Properties (PSAAP) prediction algorithm was then combined with well established predictors in a weighted Consensus sum in context of gene-specific reference intervals for known phenotypes. PSAAP and Consensus were also used to evaluate known variants of uncertain significance in the RET proto-oncogene as a model gene. The PSAAP algorithm was successfully extended to many genes and diseases. Gene-specific algorithms typically outperform generalized prediction tools. Characteristic mutation properties of a given gene and disease may be lost when diluted into genomewide data sets. A reliable computational phenotype classification framework with quantitative metrics and disease specific reference ranges allows objective evaluation of novel or uncertain gene variants and augments decision making when confirming clinical information is limited

Recent developments in life sciences research: Role of bioinformatics

Life sciences research and development has opened up new challenges and opportunities for bioinformatics. The contribution of bioinformatics advances made possible the mapping of the entire human genome and genomes of many other organisms in just over a decade. These discoveries, along with current efforts to determine gene and protein functions, have improved our ability to understand the root causes of human, animal and plant diseases and find new cures. Furthermore, many future Bioinformatic innovations will likely be spurred by the data and analysis demands of the life sciences. This review briefly describes the role of bioinformatics in biotechnology, drug discovery, biomarkerdiscovery, biological databases, bioinformatic tools, bioinformatic tasks and its application in life sciences research

Improving identification of familial hypercholesterolaemia in primary care: Derivation and validation of the familial hypercholesterolaemia case ascertainment tool (FAMCAT)

Objective: Heterozygous familial hypercholesterolaemia (FH) is a common autosomal dominant disorder. The vast majority of affected individuals remain undiagnosed, resulting in lost opportunities for preventing premature heart disease. Better use of routine primary care data offers an opportunity to enhance detection. We sought to develop a new predictive algorithm for improving identification of individuals in primary care who could be prioritised for further clinical assessment using established diagnostic criteria. Methods: Data were analysed for 2,975,281 patients with total or LDL-cholesterol measurement from 1 Jan 1999 to 31 August 2013 using the Clinical Practice Research Datalink (CPRD). Included in this cohort study were 5050 documented cases of FH. Stepwise logistic regression was used to derive optimal multivariate prediction models. Model performance was assessed by its discriminatory accuracy (area under receiver operating curve [AUC]). Results: The FH prediction model (FAMCAT), consisting of nine diagnostic variables, showed high discrimination (AUC 0.860, 95% CI 0.848–0.871) for distinguishing cases from non-cases. Sensitivity analysis demonstrated no significant drop in discrimination (AUC 0.858, 95% CI 0.845–0.869) after excluding secondary causes of hypercholesterolaemia. Removing family history variables reduced discrimination (AUC 0.820, 95% CI 0.807–0.834), while incorporating more comprehensive family history recording of myocardial infraction significantly improved discrimination (AUC 0.894, 95% CI 0.884–0.904). Conclusion: This approach offers the opportunity to enhance detection of FH in primary care by identifying individuals with greatest probability of having the condition. Such cases can be prioritised for further clinical assessment, appropriate referral and treatment to prevent premature heart disease

Utility of gene-specific algorithms for predicting pathogenicity of uncertain gene variants

ManuscriptThe rapid advance of gene sequencing technologies has produced an unprecedented rate of discovery for genome variation in humans. A growing numbered of authoritative clinical repositories archive gene variants and disease phenotype, yet there are currently many more gene variants that lack clear annotation or disease association. To date, there has been very limited coverage of gene-specific predictors in the literature. Here we present the evaluation of ?gene-specific? predictor models based on a Na?ve Bayesian classifier for 20 gene-disease data sets, containing 3,986 variants with clinically characterized patient conditions. Utility of gene-specific prediction is then compared ?all-gene? generalized prediction and also to existing popular predictors. Gene-specific computational prediction models derived from clinically curated gene variant disease data sets often outperform established generalized algorithms for novel and uncertain gene variants

Consensus: a framework for evaluation of uncertain gene variants in laboratory test reporting

Accurate interpretation of gene testing is a key component in customizing patient therapy. Where confirming evidence for a gene variant is lacking, computational prediction may be employed. A standardized framework, however, does not yet exist for quantitative evaluation of disease association for uncertain or novel gene variants in an objective manner. Here, complementary predictors for missense gene variants were incorporated into a weighted Consensus framework that includes calculated reference intervals from known disease outcomes. Data visualization for clinical reporting is also discussed

Using Electronic Patient Records to Discover Disease Correlations and Stratify Patient Cohorts

Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracting phenotype information from the free-text in such records we demonstrate that we can extend the information contained in the structured record data, and use it for producing fine-grained patient stratification and disease co-occurrence statistics. The approach uses a dictionary based on the International Classification of Disease ontology and is therefore in principle language independent. As a use case we show how records from a Danish psychiatric hospital lead to the identification of disease correlations, which subsequently can be mapped to systems biology frameworks

Biomedical informatics and translational medicine

Biomedical informatics involves a core set of methodologies that can provide a foundation for crossing the "translational barriers" associated with translational medicine. To this end, the fundamental aspects of biomedical informatics (e.g., bioinformatics, imaging informatics, clinical informatics, and public health informatics) may be essential in helping improve the ability to bring basic research findings to the bedside, evaluate the efficacy of interventions across communities, and enable the assessment of the eventual impact of translational medicine innovations on health policies. Here, a brief description is provided for a selection of key biomedical informatics topics (Decision Support, Natural Language Processing, Standards, Information Retrieval, and Electronic Health Records) and their relevance to translational medicine. Based on contributions and advancements in each of these topic areas, the article proposes that biomedical informatics practitioners ("biomedical informaticians") can be essential members of translational medicine teams

A computable pathology report for precision medicine: extending an observables ontology unifying SNOMED CT and LOINC

Background The College of American Pathologists (CAP) introduced the first cancer synoptic reporting protocols in 1998. However, the objective of a fully computable and machine-readable cancer synoptic report remains elusive due to insufficient definitional content in Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) and Logical Observation Identifiers Names and Codes (LOINC). To address this terminology gap, investigators at the University of Nebraska Medical Center (UNMC) are developing, authoring, and testing a SNOMED CT observable ontology to represent the data elements identified by the synoptic worksheets of CAP. Methods Investigators along with collaborators from the US National Library of Medicine, CAP, the International Health Terminology Standards Development Organization, and the UK Health and Social Care Information Centre analyzed and assessed required data elements for colorectal cancer and invasive breast cancer synoptic reporting. SNOMED CT concept expressions were developed at UNMC in the Nebraska Lexicon© SNOMED CT namespace. LOINC codes for each SNOMED CT expression were issued by the Regenstrief Institute. SNOMED CT concepts represented observation answer value sets. Results UNMC investigators created a total of 194 SNOMED CT observable entity concept definitions to represent required data elements for CAP colorectal and breast cancer synoptic worksheets, including biomarkers. Concepts were bound to colorectal and invasive breast cancer reports in the UNMC pathology system and successfully used to populate a UNMC biobank. Discussion The absence of a robust observables ontology represents a barrier to data capture and reuse in clinical areas founded upon observational information. Terminology developed in this project establishes the model to characterize pathology data for information exchange, public health, and research analytics

A survey of informatics approaches to whole-exome and whole-genome clinical reporting in the electronic health record

Genome-scale clinical sequencing is being adopted more broadly in medical practice. The National Institutes of Health developed the Clinical Sequencing Exploratory Research (CSER) program to guide implementation and dissemination of best practices for the integration of sequencing into clinical care. This study describes and compares the state of the art of incorporating whole-exome and whole-genome sequencing results into the electronic health record, including approaches to decision support across the six current CSER sites