Relevance of pharmacogenomics for developing countries in Europe : implementation in the Maltese population

Pharmacogenomics is a promising new discipline that can realize personalized treatment for patients suffering from many common diseases, particularly those with multiple treatment modalities. Recent advances in the deciphering of the human genome sequence and high throughput genotyping technology have led to the reduction of the overall genotyping costs and enabled the inclusion of genotype-related dosing recommendations into drug package inserts, hence allowing the integration of pharmacogenomics into clinical practice. Although, pharmacogenomics gradually assumes an integral part in mainstream medical practice in developed countries, many countries, particularly from the developing world, still do not have access either to the knowledge or the resources to individualize drug treatment. The PharmacoGenetics for Every Nation Initiative (PGENI) aims to fill in this gap, by making pharmacogenomics globally applicable, not only by defining population-specific pharmacogenomic marker frequency profiles and formulating country-specific recommendations for drug efficacy and safety but also by increasing general public and healthcare professionals’ awareness over pharmacogenomics and genomic medicine. This article highlights the PGENI activities in Europe and its implementation in the Maltese population, in an effort to make pharmacogenomics readily applicable in European healthcare systems.peer-reviewe

Impossible protest: noborders in Calais

Since the closure of the Red Cross refugee reception centre in Sangatte, undocumented migrants in Calais hoping to cross the border to Britain have been forced to take refuge in a number of squatted migrant camps, locally known by all as ‘the jungles.’ Unauthorised shanty-like residences built by the migrants themselves, living conditions in the camps are very poor. In June 2009, European ‘noborder’ activists set up a week-long protest camp in the area with the intention of confronting the authorities over their treatment of undocumented migrants. In this article, we analyse the June 2009 noborder camp as an instance of ‘immigrant protest.’ Drawing on ethnographic materials and Jacques Rancière's work on politics and aesthetics, we construct a typology of forms of border control through which to analyse the different ways in which the politics of the noborder camp were staged, performed and policed. Developing a critique of policing practices which threatened to make immigrant protest ‘impossible’, we highlight moments of protest which, through the affirmation of an ‘axiomatic’ equality, disrupted and disarticulated the borders between citizens and non-citizens, the political and non-political

A(1)ATVar: A Relational Database of Human SERPINA1 Gene Variants Leading to alpha(1)-Antitrypsin Deficiency and Application of the VariVis Software

We have developed a relational database of human SERPINA1 gene mutations, leading to a,antitrypsin (AAT) deficiency, called A(1)ATVar, which can be accessed over the World Wide Web at www.goldenhelix.org/A1ATVar. Extensive information has been extracted from the literature and converted into a searchable database, including genotype information, clinical phenotype, allelic frequencies for the commonest AAT variant alleles, methods of detection, and references. Mutation summaries are automatically displayed and user-generated queries can be formulated based on fields in the database. A separate module, linked to the FINDbase database for frequencies of inherited disorders allows the user to access allele frequency information for the three most frequent AAT alleles, namely PiM, PiS, and PiZ. The available experimental protocols to detect AAT variant alleles at the protein and DNA levels have been archived in a searchable format. A visualization tool, called VariVis, has been implemented to combine A(1)ATVar variant information with SERPINA1 sequence and annotation data. A direct data submission tool allows registered users to submit data on novel AAT variant alleles as well as experimental protocols to explore SERPINA1 genetic heterogeneity, via a password-protected interface. Database access is free of charge and there are no registration requirements for querying the data. The A(1)ATVar database is the only integrated database on the Internet offering summarized information on AAT allelic variants and could be useful not only for clinical diagnosis and research on AAT deficiency and the SERPINA1 gene, but could also serve as an example for an all-in-one solution for locus-specific database (LSDB) development and curation. Hum Mutat 30, 308-313, 2009

Учебная история болезни по внутренним болезням и военно-полевой терапии

ВНУТРЕННИЕ БОЛЕЗНИВОЕННО-ПОЛЕВАЯ ТЕРАПИЯИСТОРИЯ БОЛЕЗНИМЕТОДИЧЕСКИЕ УКАЗАНИЯМетодические указания учат студентов правильно оформлять историю болезни пациента

Identification of cancer predisposition variants in apparently healthy individuals using a next-generation sequencing-based family genomics approach

Cancer, like many common disorders, has a complex etiology, often with a strong genetic component and with multiple environmental factors contributing to susceptibility. A considerable number of genomic variants have been previously reported to be causative of, or associated with, an increased risk for various types of cancer. Here, we adopted a next-generation sequencing approach in 11 members of two families of Greek descent to identify all genomic variants with the potential to predispose family members to cancer. Cross-comparison with data from the Human Gene Mutation Database identified a total of 571 variants, from which 47 % were disease-associated polymorphisms, 26 % disease-associated polymorphisms with additional supporting functional evidence, 19 % functional polymorphisms with in vitro/laboratory or in vivo supporting evidence but no known disease association, 4 % putative disease-causing mutations but with some residual doubt as to their pathological significance, and 3 % disease-causing mutations. Subsequent analysis, focused on the latter variant class most likely to be involved in cancer predisposition, revealed two variants of prime interest, namely MSH2 c.2732T>A (p.L911R) and BRCA1 c.2955delC, the first of which is novel. KMT2D c.13895delC and c.1940C>A variants are additionally reported as incidental findings. The next-generation sequencing-based family genomics approach described herein has the potential to be applied to other types of complex genetic disorder in order to identify variants of potential pathological significance

Genomic medicine without borders: which strategies should developing countries employ to invest in precision medicine? A new "fast-second winner" strategy

Genomic medicine has greatly matured in terms of its technical capabilities, but the diffusion of genomic innovations worldwide faces significant barriers beyond mere access to technology. New global development strategies are sorely needed for biotechnologies such as genomics and their applications toward precision medicine without borders. Moreover, diffusion of genomic medicine globally cannot adhere to a “one-size-fits-all-countries” development strategy, in the same way that drug treatments should be customized. This begs a timely, difficult but crucial question: How should developing countries, and the resource-limited regions of developed countries, invest in genomic medicine? Although a full-scale investment in infrastructure from discovery to the translational implementation of genomic science is ideal, this may not always be feasible in all countries at all times. A simple “transplantation of genomics” from developed to developing countries is unlikely to be feasible. Nor should developing countries be seen as simple recipients and beneficiaries of genomic medicine developed elsewhere because important advances in genomic medicine have materialized in developing countries as well. There are several noteworthy examples of genomic medicine success stories involving resource-limited settings that are contextualized and described in this global genomic medicine innovation analysis. In addition, we outline here a new long-term development strategy for global genomic medicine in a way that recognizes the individual country's pressing public health priorities and disease burdens. We term this approach the “Fast-Second Winner” model of innovation that supports innovation commencing not only “upstream” of discovery science but also “mid-stream,” building on emerging highly promising biomarker and diagnostic candidates from the global science discovery pipeline, based on the unique needs of each country. A mid-stream entry into innovation can enhance collective learning from other innovators' mistakes upstream in discovery science and boost the probability of success for translation and implementation when resources are limited. This à la carte model of global innovation and development strategy offers multiple entry points into the global genomics innovation ecosystem for developing countries, whether or not extensive and expensive discovery infrastructures are already in place. Ultimately, broadening our thinking beyond the linear model of innovation will help us to enable the vision and practice of genomics without borders in both developed and resource-limited settings

Success stories in genomic medicine from resource-limited countries

In recent years, the translation of genomic discoveries into mainstream medical practice and public health has gained momentum, facilitated by the advent of new technologies. However, there are often major discrepancies in the pace of implementation of genomic medicine between developed and developing/resource-limited countries. The main reason does not only lie in the limitation of resources but also in the slow pace of adoption of the new findings and the poor understanding of the potential that this new discipline offers to rationalize medical diagnosis and treatment. Here, we present and critically discuss examples from the successful implementation of genomic medicine in resource-limited countries, focusing on pharmacogenomics, genome informatics, and public health genomics, emphasizing in the latter case genomic education, stakeholder analysis, and economics in pharmacogenomics. These examples can be considered as model cases and be readily replicated for the wide implementation of pharmacogenomics and genomic medicine in other resource-limited environments. © 2015 Mitropoulos et al