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Genomic Medicine: Why Do "Similar" Patients Have Different Outcomes?

ABSTRACT: Genomic variation is an important factor in why supposedly "similar" patients react differently to drugs, have different disease course(s), and varying clinical outcomes. This review provides an update on concepts in modern genomic medicine with an emphasis on clinically relevant study approaches, disease/drug pathway analysis, and recent pharmacogenomic findings. The application of genomic medicine and its importance for rapid diagnosis of disease-causing agents, as well as its clinical application in human disease diagnosis/treatment and in cardiovascular disease are discussed. In addition to direct clinical applications, modern genomic approaches also play an important role in elucidating new mechanisms of disease. Finally, the role of the National Institutes of Health national pharmacogenomics research network in codifying "bench to bedside" translation of genetic results that impact drug therapy will also be discussed.

SUBMITTER: Schwinn D

PROVIDER: S-EPMC4699320 | biostudies-other | 2012 May

REPOSITORIES: biostudies-other

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Genomic Medicine: Why Do "Similar" Patients Have Different Outcomes?

Schwinn Debra D Kleine-Brueggeney Maren M Oganesian Anush A

Review course lectures : presented at the ... Clinical and Scientific Congress of the International Anesthesia Research Society 20120501

Genomic variation is an important factor in why supposedly "similar" patients react differently to drugs, have different disease course(s), and varying clinical outcomes. This review provides an update on concepts in modern genomic medicine with an emphasis on clinically relevant study approaches, disease/drug pathway analysis, and recent pharmacogenomic findings. The application of genomic medicine and its importance for rapid diagnosis of disease-causing agents, as well as its clinical applica ...[more]

PMID: 26740973

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Project description:BackgroundCVID patients present an increased risk of prolonged SARS-CoV-2 infection and re-infection and a higher COVID-19-related morbidity and mortality compared to the general population. Since 2021, different therapeutic and prophylactic strategies have been employed in vulnerable groups (vaccination, SARS-CoV-2 monoclonal antibodies and antivirals). The impact of treatments over the last 2 years has not been explored in international studies considering the emergence of viral variants and different management between countries.MethodsA multicenter retrospective/prospective real-life study comparing the prevalence and outcomes of SARS-CoV-2 infection between a CVID cohort from four Italian Centers (IT-C) and one cohort from the Netherlands (NL-C), recruiting 773 patients.Results329 of 773 CVID patients were found positive for SARS-CoV-2 infection between March 1st, 2020 and September 1st 2022. The proportion of CVID patients infected was comparable in both national sub-cohorts. During all waves, chronic lung disease, "complicated" phenotype, chronic immunosuppressive treatment and cardiovascular comorbidities impacted on hospitalization, whereas risk factors for mortality were older age, chronic lung disease, and bacterial superinfections. IT-C patients were significantly more often treated, both with antivirals and mAbs, than NL-C patients. Outpatient treatment, available only in Italy, started from the Delta wave. Despite this, no significant difference was found for COVID-19 severity between the two cohorts. However, pooling together specific SARS-CoV-2 outpatient treatments (mAbs and antivirals), we found a significant effect on the risk of hospitalization starting from Delta wave. Vaccination with ≥ 3 doses shortened RT-PCR positivity, with an additional effect only in patients receiving antivirals.ConclusionsThe two sub-cohorts had similar COVID-19 outcomes despite different treatment approaches. This points out that specific treatment should now be reserved for selected subgroups of CVID patients, based on pre-existing conditions.

Project description:BACKGROUND:Interspecific hybridization occurs in every eukaryotic kingdom. While hybrid progeny are frequently at a selective disadvantage, in some instances their increased genome size and complexity may result in greater stress resistance than their ancestors, which can be adaptively advantageous at the edges of their ancestors' ranges. While this phenomenon has been repeatedly documented in the field, the response of hybrid populations to long-term selection has not often been explored in the lab. To fill this knowledge gap we crossed the two most distantly related members of the Saccharomyces sensu stricto group, S. cerevisiae and S. uvarum, and established a mixed population of homoploid and aneuploid hybrids to study how different types of selection impact hybrid genome structure. RESULTS:As temperature was raised incrementally from 31°C to 46.5°C over 500 generations of continuous culture, selection favored loss of the S. uvarum genome, although the kinetics of genome loss differed among independent replicates. Temperature-selected isolates exhibited greater inherent and induced thermal tolerance than parental species and founding hybrids, and also exhibited ethanol resistance. In contrast, as exogenous ethanol was increased from 0% to 14% over 500 generations of continuous culture, selection favored euploid S. cerevisiae x S. uvarum hybrids. Ethanol-selected isolates were more ethanol tolerant than S. uvarum and one of the founding hybrids, but did not exhibit resistance to temperature stress. Relative to parental and founding hybrids, temperature-selected strains showed heritable differences in cell wall structure in the forms of increased resistance to zymolyase digestion and Micafungin, which targets cell wall biosynthesis. CONCLUSIONS:This is the first study to show experimentally that the genomic fate of newly-formed interspecific hybrids depends on the type of selection they encounter during the course of evolution, underscoring the importance of the ecological theatre in determining the outcome of the evolutionary play.

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Genomic Medicine: Why Do "Similar" Patients Have Different Outcomes?

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Genomic Medicine: Why Do "Similar" Patients Have Different Outcomes?

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