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Posts Tagged ‘NGS’


Genomics in Medicine – Establishing a Patient-Centric View of Genomic Data

Reporter: Aviva Lev-Ari, PhD, RN

UPDATED on 12/13, 2013

Second  Annual
Genomics in Medicine
Establishing a Patient-Centric View of  Genomic Data
February 13-14, 2014 | San Francisco,  CA

Dr. Michael Christman, President and CEO of the  Coriell Institute for Medical Research, to Present “Using a  Patient’s Genetic Information in the Real World” at the Second  Annual Genomics in Medicine  Symposium

When  a patient needs a new prescription, it will be necessary for the  physician to quickly and securely access his/her genetic data to  understand drug efficacy prior to dosing. Who will patients and  doctors trust to store and interpret the data? Coriell and the CPMC  research study have defined several of the key barriers to  accelerate the adoption and routine use of genomics in medicine and  have proposed solutions that are generally  applicable.

Dr.  Christman is an expert in genetics and genomics, with a focus on the  integration of genome information into the delivery of clinical  care. In 2007, he joined Coriell and initiated the Coriell  Personalized Medicine Collaborative® (CPMC®), a research study  evaluating the utility of using the knowledge of genetics in  medicine. Prior to joining Coriell, he served as professor and  founding chair of the Department of Genetics and Genomics for Boston  University School of Medicine. There he led an international team of  scientists in one of the first genome-wide association studies using  the Framingham Heart Study cohort, published in Science magazine.  Dr. Christman received his bachelor’s degree in chemistry with  honors from the University of North Carolina, Chapel Hill, his  doctorate in biochemistry from the University of California,  Berkeley, and was a Jane Coffin Childs postdoctoral fellow at the  Massachusetts Institute of Technology.

FINAL AGENDA

RETURNING GENOMIC INFORMATION TO THE  PATIENT

KEYNOTE  PRESENTATION
Incidental Findings in Genomic  Medicine: The Debate and the Data
Robert C.  Green, M.D., MPH, Director, G2P Research Program; Associate  Director, Research, Partners Center for Personalized Genetic  Medicine, Division of Genetics, Department of Medicine, Brigham and  Women’s Hospital and Harvard Medical  School

Genomic Medicine Implementations for  Primary Care
Erwin Bottinger, M.D., The Irene and  Dr. Arthur Fishberg Professor of Medicine; Director, The Charles  Bronfman Institute for Personalized Medicine, Icahn School of  Medicine, Mount Sinai

Ethical Issues Related to the  Return of Incidental Findings in  Children/Families
Ingrid A. Holm, M.D., MPH,  Director, Phenotyping Core, Program in Genomics, Divisions of  Genetics and Endocrinology, Boston Children’s  Hospital

EMERGING TOOLS TO ENABLE  PHYSICIAN USE

Reducing the Complexity of  Clinical Omics Reporting for Clinicians and  Laboratories   [Listen  to Podcast <http://www.chicorporate.com/click-thru/131500/?email=avivalev-ari@alum.berkeley.edu> ]
Jonathan Hirsch, Founder &  President, Syapse

Beyond Sequence: Integration of Full-Genome  Technologies for Personalized Medicine in the  Clinic
Raphael Lehrer, Founder and Chief Scientist,  GeneKey

Targeted NGS of Clinical Samples:  Overcoming the Challenges of Obtaining High Quality Data from Low  Quality DNA
Diane Ilsley, Ph.D., Marketing Manager,  Genomic Services, Asuragen
Sponsored  by:
<http://www.asuragen.com/>

BRIDGING THE  GAP BETWEEN RESEARCH AND  TREATMENT

Genome Sequencing in the Clinic:  Found the Variants – Now What?
Jennifer Friedman,  M.D., Associate Clinical Professor, Neurosciences and Pediatrics,  UCSD/Rady Children’s Hospital San Diego

The  Answer is There, but I Don’t Understand It: Solutions from the Front  Line
Vanya Gant, Ph.D., FRCP, FRCPath, Divisional  Clinical Director for Infection, The Department of Microbiology,  UCLH NHS Foundation Trust

Using a Patient’s  Genetic Information in the Real World
Michael F.  Christman, Ph.D., President and CEO, Coriell Institute for Medical  Research

Developing Clinical Sequencing Assays  at Einstein-Montefiore
Cristina Montagna, Ph.D.,  Associate Professor, Genetics, Albert Einstein College of  Medicine

THE IMPACT OF DTC  TESTING

Direct-to-Consumer Genetic  Testing: Balancing the Good and the Bad
Nazneen  Aziz, Ph.D., Director, Molecular Medicine, Transformation Program  Office, College of American  Pathologists

Crowdsourcing Genetic  Discovery
Nicholas Eriksson, Ph.D., Principal  Scientist, Statistical Genetics,  23andMe

Personal Genomics through Smart Digital  Media
Patrick Merel, Ph.D., Founder & CEO,  Portable Genomics

> Sponsored Presentation  (Opportunities  Available
<http://www.triconference.com/click-thru/127354/?email=avivalev-ari@alum.berkeley.edu> )

The Ethical and Social  Implications of Direct-to-Consumer Genetic  Testing
Sandra Soo-Jin Lee, Ph.D., Senior Research  Fellow, Center for Biomedical Ethics, Stanford University Medical  School

THE IMPACT AND EVOLVING ROLE OF  GENETIC COUNSELING

Next-Generation Genetic  Counseling
Ramji Srinivasan, CEO & Co-Founder,  Counsyl

TDTC(CC) – Consumers, Clinicians and  Counseling
Erica Ramos, MS, CGC, Clinical Genomics  Specialist, Certified Genetic Counselor, Translational and Consumer  Genomics, Illumina, Inc.

For  exhibit and sponsorship information, including sponsored  podium presentations <http://www.triconference.com/click-thru/127354/?email=avivalev-ari@alum.berkeley.edu> , please  contact:

Jon Stroup  (Companies A-K)
Manager, Business  Development
Cambridge Healthtech Institute
T: (+1)  781-972-5483
E: jstroup@healthtech.com

Joseph Vacca (Companies  L-Z)
Manager, Business Development
Cambridge Healthtech  Institute
T: (+1) 781-972-5431
E: jvacca@healthtech.com 

Cambridge Healthtech Institute’s Second Annual

Part of the 21st Annual Molecular Medicine Tri-Conference
February 13-14, 2014 | Westin St. Francis | San Francisco, CA

Cambridge Healthtech Institute’s Second Annual Genomics in Medicine symposium will provide insight into common implementation issues as they relate to practicing clinicians, as well as address the evolving role of genomics in guiding diagnoses and treatments. Special focus will be given to processing and delivering complex data to the practicing physician. Integration of decision-making tools with existing patient records will also be discussed. This symposium will provide a forum for those hoping to learn more about genomic medicine as well as those currently practicing and looking for an update on the field’s latest advances.

Thursday, February 13

7:30 am Registration and Morning Coffee

RETURNING GENOMIC INFORMATION TO THE PATIENT

9:00 Chairperson’s Opening Remarks

9:05 KEYNOTE PRESENTATION:

Incidental Findings in Genomic Medicine: The Debate and the Data

Robert C. Green, M.D., MPH, Director, G2P Research Program; Associate Director, Research, Partners Center for Personalized Genetic Medicine, Division of Genetics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School

Genomics is being rapidly integrated into medicine with many unanswered questions about how and how much risk information should be communicated, and how such information will influence physician and patient behaviors, health outcomes and health care costs. This presentation will summarize data from over 10 years of experimental work in translational genomics and health outcomes, discuss recent ACMG recommendations for incidental findings and preview results from our newest NIH-funded studies, the ongoing MedSeq Project and the recently funded BabySeq Project.

9:35 Genomic Medicine Implementations for Primary Care

Erwin Bottinger, M.D., The Irene and Dr. Arthur Fishberg Professor of Medicine; Director, The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine, Mount Sinai

Increasingly, genomic discoveries provide opportunities to personalize medication use and prediction and prevention of common chronic diseases. However, effective integration of genomic medicine in busy primary care practices is hampered by multiple barriers, including provider education gaps and negative impact on clinical workflow. Innovative programs for real-time, point-of-care integration of genomic medicine for primary care providers through genome-informed clinical decision support enabled in electronic health records will be presented.

10:05 Ethical Issues Related to the Return of Incidental Findings in Children/Families

Ingrid A. Holm, M.D., MPH, Director, Phenotyping Core, Program in Genomics, Divisions of Genetics and Endocrinology, Boston Children’s Hospital

10:35 Coffee Break with Exhibit and Poster Viewing

EMERGING TOOLS TO ENABLE PHYSICIAN USE

11:05 Reducing the Complexity of Clinical Omics Reporting for Clinicians and Laboratories

Jonathan Hirsch, Founder & President, Syapse

Syapse has built a cloud-based software platform that enables the use of omics at the point of care through an interactive web portal. We will describe how clinical omics labs use the Syapse platform to maintain an evolving omics knowledgebase which drives updated clinical reporting through interactive, intuitive interfaces designed for ease of use and comprehension. We will describe how hospitals use the Syapse platform to place omics results in the context of clinical guidelines, enabling physicians to easily adopt and integrate omics into their clinical workflow.

11:35 Beyond Sequence: Integration of Full-Genome Technologies for Personalized Medicine in the Clinic

Raphael Lehrer, Founder and Chief Scientist, GeneKey

Here we describe how we have used a combination of multiple full genome technologies to triangulate on key dysregulated mechanisms in a patient’s sample. By using a combination of systems biology and statistical analysis, we are able to draw conclusions far more precise than one could from sequence alone. We describe how we have applied in the clinic with patients and their oncologists and what we have seen/learned to date, including cases where the dysfunction is not mutation-based.

Sponsored by

Asuragen

12:05 pm Targeted NGS of Clinical Samples: Overcoming the Challenges of Obtaining High Quality Data from Low Quality DNA

Diane Ilsley, Ph.D., Marketing Manager, Genomic Services, Asuragen

12:35 Luncheon Presentation (Sponsorship Opportunity Available) or Lunch on Your Own

1:05 Session Break

BRIDGING THE GAP BETWEEN RESEARCH AND TREATMENT

1:50 Chairperson’s Remarks

1:55 Genome Sequencing in the Clinic: Found the Variants – Now What?

Jennifer Friedman, M.D., Associate Clinical Professor, Neurosciences and Pediatrics, UCSD/Rady Children’s Hospital San Diego

Advances in genome sequencing hold tremendous promise for providing answers and tailored therapies for undiagnosed patients. How to interpret, transmit and act upon volumes of complex data remains a challenge for sequencing providers, physicians and their patients. This presentation will use case-based examples to demonstrate promises and pitfalls encounter along the way.

2:25 The Answer is There but I Don’t Understand It: Solutions from the Front Line

Vanya Gant, Ph.D., FRCP, FRCPath, Divisional Clinical Director for Infection, The Department of Microbiology, UCLH NHS Foundation Trust

This talk will introduce the concept and fundamental problem of how to present complex NGS datasets to clinicians – and how this will be critical for rapid uptake. A case study outlining the principles behind a very new and innovative pathology project and way of delivering healthcare diagnostics will also be presented.

2:55 Refreshment Break with Exhibit and Poster Viewing

3:25 Using a Patient’s Genetic Information in the Real World

Michael F. Christman, Ph.D., President and CEO, Coriell Institute for Medical Research

When a patient needs a new prescription, it will be necessary for the physician to quickly and securely access his/her genetic data to understand drug efficacy prior to dosing. Who will patients and doctors trust to store and interpret the data? Coriell and the CPMC research study have defined several of the key barriers to accelerate the adoption and routine use of genomics in medicine and have proposed solutions that are generally applicable.

3:55 Developing Clinical Sequencing Assays at Einstein-Montefiore

Cristina Montagna, Ph.D., Associate Professor, Genetics, Albert Einstein College of Medicine

We developed a program to introduce Next-Generation Sequencing (NGS) to address the needs of individuals receiving clinical care at Montefiore Medical Center. After extensive dialogue with clinicians, we designed a custom gene panel, spanning 5Mb and consisting of 650 genes targeting known Mendelian loci, some pediatric diseases and several hotspot genes in various cancer types. By building a basic infrastructure for transitioning NSG in the clinic we have encountered roadblocks and established protocols to overcome these.

4:25 Breakout Discussions (see website for details)

5:25 Close of Day

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Reporter: Aviva Lev-Ari, PhD, RN

J Cardiovasc Transl Res. 2012 Sep 7. [Epub ahead of print]

Next Generation Diagnostics in Inherited Arrhythmia Syndromes : A Comparison of Two Approaches.

Ware JSJohn SRoberts AMBuchan RGong SPeters NSRobinson DOLucassen ABehr ERCook SA.

Source

MRC Clinical Sciences Centre, Imperial College London, London, UK, j.ware@imperial.ac.uk.

Abstract

Next-generation sequencing (NGS) provides an unprecedented opportunity to assess genetic variation underlying human disease. Here, we compared two NGS approaches for diagnostic sequencing in inherited arrhythmia syndromes. We compared PCR-based target enrichment and long-read sequencing (PCR-LR) with in-solution hybridization-based enrichment and short-read sequencing (Hyb-SR). The PCR-LR assay comprehensively assessed five long-QT genes routinely sequenced in diagnostic laboratories and “hot spots” in RYR2. The Hyb-SR assay targeted 49 genes, including those in the PCR-LR assay. The sensitivity for detection of control variants did not differ between approaches. In both assays, the major limitation was upstream target capture, particular in regions of extreme GC content. These initial experiences with NGS cardiovascular diagnostics achieved up to 89 % sensitivity at a fraction of current costs. In the next iteration of these assays we anticipate sensitivity above 97 % for all LQT genes. NGS assays will soon replace conventional sequencing for LQT diagnostics and molecular pathology.

PMID: 22956155 [PubMed]
Source: 
http://www.ncbi.nlm.nih.gov/pubmed/22956155

Researchers in the UK have compared a PCR-based and a capture hybridization-based assay for sequencing panels of inherited cardiovascular disease genes and have found both to be suitable for diagnostics in principle, though their sensitivity needs to be optimized.

According to James Ware, a clinical lecturer at Imperial College London, the purpose of the study, published online this month in the Journal of Cardiovascular Translational Research, was to evaluate different approaches for sequencing cardiovascular disease genes, both for molecular diagnosis and for large-scale resequencing research studies.

His group, in the National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit, is interested in a range of inherited heart disease types, including cardiomyopathies and inherited arrhythmia syndromes such as long QT syndrome.

For their study, they compared two next-gen sequencing assays: a PCR-based approach that uses Fluidigm’s Access Array to amplify 96 amplicons in five LQT genes and one other gene, followed by sequencing on the 454 GS Junior; and an in-solution hybridization approach that uses Agilent’s SureSelect to target 49 inherited arrhythmia genes and sequences them on Life Technologies’ SOLiD 4.

The study focused on the sensitivity of the assays, or how well they were able to capture their intended targets, rather than their specificity, or their ability to avoid false positives.

Ware said that at the time of the study, PCR and in-solution capture were the two main target selection methods available. The researchers are still using both approaches but are now employing “a wide range of sequencers” from various providers for both types of assays, including Illumina instruments and Life Tech’s Ion Torrent.

For their comparison, they analyzed 48 samples, of which they sequenced 33 with both approaches and 15 using either one or the other.

The samples included 19 known variants in three disease genes, of which the hybridization-SOLiD method detected 17 and the PCR-454 method 14. Undetected variants were generally in areas that were not well covered, either due to a failure in enrichment, sequencing, or because the alignment was not unique. One variant that was missed by both approaches fell in a very GC-rich region.

Consumables costs for both assays were considerably lower than with Sanger sequencing: While sequencing five genes by Sanger costs more than $700 in consumables, the five-gene PCR/454 assay cost about $55 and the 49-gene hybridization/SOLiD assay cost about $200, according to the study.

Turnaround time is the shortest for Sanger sequencing, which, according to the study, can be done in one day for five genes and 17 samples, not including sample prep. The PCR/454 assay takes about two days for target enrichment and sequencing 48 samples, and the hybridization/SOLiD assay takes about two weeks for sequencing alone, they wrote.

Overall, Ware said, both sequencing approaches performed “reasonably well” and are significantly cheaper than Sanger sequencing. He said that in the UK, molecular diagnosis for inherited cardiovascular disease has traditionally been performed by Sanger, at a cost of approximately £500 to £1,000 ($800 to $1,600) for several genes involved in a clinical condition. However, for cost reasons, not all relevant genes are usually sequenced.

Target selection was the performance-limiting step for both approaches, a result the researchers expected. “It sounds obvious, but not all genes are equally easy to target,” Ware said. For example, in the hybridization assay, the overall target coverage was about 98 percent, but for some genes, it was only 80 percent or 90 percent. The two most important genes in long QT syndrome, KCNQ1 and KCNH2, “proved to be the hardest to sequence.”

Thus, for diagnostic use of NGS gene panels, “it’s important to know not just how the system performs overall but really how it’s performing for the specific genes you’re interested in,” he said.

To use either approach in diagnostics, the target selection step would need to be optimized. Ware’s team has already improved both assays and is now trying them in a number of fully Sanger-sequenced samples to study both sensitivity and specificity.

Longer term, the sensitivity of next-gen sequencing could approach that of Sanger sequencing, he said. And even if it does not reach 100 percent, because NGS approaches can target so many more genes, “maybe you can afford a very slight tradeoff in the per-gene sensitivity if the overall diagnostic sensitivity of the panel goes up,” he said. “At the moment, because we don’t have that much experience in sequencing the less-common genes, we don’t exactly know where that tradeoff lies.” In addition, any gaps could be filled by Sanger sequencing, while the test would probably still be cost effective.

Each approach also has some features that make it more suitable for certain applications. The PCR-based method has a fast turnaround and an “extremely user-friendly workflow,” Ware said, but it can only accommodate a small number of genes at the moment. His team also found it to be easier to optimize and improve. Thus, in the short term, PCR and sequencing “is probably closer to providing a diagnostic solution,” he said, especially for conditions where only a few genes are causative.

The hybridization-based approach, on the other hand, has much greater capacity, and there are advantages in “having a single assay that covers everything,” he said. It might also be possible to detect copy number variants using this approach, but not the more limited PCR method, he added.

Ware and his colleagues are currently using the hybridization approach to study a large panel of genes in 2,000 well-phenotyped volunteers, both healthy individuals and heart disease patients.

They have also started to use the hybridization method to sequence the TTN gene, truncating mutations in which were recently found to be a common cause of dilated cardiomyopathy. They are running the TTN test routinely for patients consented for research diagnostic testing that is not available anywhere else. Because this gene is so large, it is “completely impractical to be sequenced by conventional Sanger,” Ware said.

Julia Karow tracks trends in next-generation sequencing for research and clinical applications for GenomeWeb’s In Sequenceand Clinical Sequencing News. E-mail her here or follow her GenomeWeb Twitter accounts at @InSequence and@ClinSeqNews.

 

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Reporter: Larry Bernstein, MD

Bioinformatics  refers to the creation and maintenance of a database to store biological information such as nucleotide sequences and amino acid sequences. Development of this type of database involved not only design issues but the development of complex interfaces whereby researchers could access existing data as well as submit new or revised data.

In order to study how normal cellular activities are altered in different disease states, the biological data must be combined to form a comprehensive picture of these activities. Therefore, the field of bioinformatics This includes nucleotide and amino acid sequences, protein domains, and protein structures. The actual process of analyzing and interpreting data is referred to as computational biology.

The primary goal of bioinformatics is to increase the understanding of biological processes. What sets it apart from other approaches, however, is its focus on developing and applying computationally intensive techniques to achieve this goal.

Bioinformatics elements for NGS data analysis

4 – 5 – 6 – 7 Dicembre 2012
c/o Polo Scientifico e Tecnologico di Careggi
Viale Morgagni 40, Firenze
Inscription Deadline: 3 November 2012

The high level training in “Bioinformatics for NGS data analysis” is oriented for students and PhD students in mathematics, physics, natural science, medicine, biotechnology, pharmacy and ingenering as well as employees of public institutions, industry and university researchers interested in problems of NGS bioinformatics.

The primary object of the course is to introduce the participants to the basic theory and the technical knowledge of NGS data analysis for the identification of single nucleotide polymorphism, insertion/deletion, genomic variants and for the study of gene expression.

The course will span four days structured in seminars and hands-on sessions at the computer given by docents and professionals.

Contacts
For more information visit: http://sites.google.com/site/corsobioinformatica/
e-mai: corsobioinformatica@gmail.com
telephone: (+39) 055 7949036

 

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