EMR Phenotype and Community Engaged Genomic Associations

描述(申请人提供)：电子病历(EMR)可用于大量患者的高通量表型分析，以进行基因组学研究。作为Emerge-L的一部分，我们使用了基于EMR的算法来实现对几个主要的和网络范围的表型的全基因组关联研究(GWAS)。本申请将利用Emerge-L建立的研究基础设施来识别影响医学上重要表型的常见遗传变异。Mayo Emerge-11队列(n=6916)包括3,769名Emerge-L患者和另外3,147名个体，大多数(90%)在同一个llLumina 660W平台上进行基因分型。我们将与其他Emerge-11网站合作，扩展和验证电子表型算法库，以支持感兴趣的多种表型的GWAs。我们应用的一个主要焦点是将最近的GWAS发现转化为临床实践。我们的具体目标是：具体目标1.进行基于EMR的GWAS以确定常见的遗传变异，这些变异影响a)心肺适应性和对他汀类药物的反应的个体间差异，以及b)静脉血栓栓塞症和结肠息肉的易感性。具体目标2.量化一种常见的“复杂”疾病--冠心病(CHD)--和一种药物不良反应--他汀类肌病的遗传风险。我们将开发风险沟通工具，将风险的临床和遗传成分传达给患者和护理提供者。具体目标3.开发信息学方法，将基因组数据纳入EMR，包括与临床决策支持的链接。具体目的4.进行一项随机临床试验，以调查患者对遗传信息的冠心病风险的反应。我们将重新同意150名没有冠心病的Emerge-L患者，通过遗传咨询师传达结果，并详细讨论与疾病风险相关的测试的含义。沟通的有效性和患者对风险的理解、他们的希望和担忧以及计划中的生活方式变化将在患者与辅导员会面后通过调查和采访进行评估。作为我们不断进行的社区咨询工作的一部分，我们将成立一个专门针对这项计划的社区咨询小组。 相关性(参见说明)：拟议的应用程序将利用Emerge-L建立的研究基础设施来识别影响医学上重要表型的常见遗传变异。我们将开发工具，将基因组信息纳入电子病历。此外，我们还将调查复杂疾病基因检测的临床、翻译和伦理方面，并评估患者对基因检测的反应。

DESCRIPTION (provided by applicant): The electronic medical record (EMR) can be leveraged for high throughput phenotyping of large numbers of patients for genomics research. As part of eMERGE-l, we used EMR-based algorithms to enable genome- wide association studies (GWAS) of several primary and network-wide phenotypes. The present application will leverage the research infrastructure established in eMERGE-l to identify common genetic variants that influence medically important phenotypes. The Mayo eMERGE-ll cohort (n=6916) includes the 3769 eMERGE-l patients and an additional 3147 individuals, the majority (90%) genotyped on the same lllumina 660W platform. We will work with other eMERGE-ll sites to expand and validate the library of electronic phenotyping algorithms to enable GWAS of multiple phenotypes of interest. A major focus of our application is to translate recent GWAS findings to clinical practice. Our specific aims are: Specific aim 1. Conduct EMR-based GWAS to identify common genetic variants that influence a) inter-individual variation in cardiorespiratory fitness and response to statin medications and b) susceptibility to venous thromboembolism and colon polyps. Specific aim 2. Quantify genetic risk of a common 'complex' disease - coronary heart disease (CHD) - and an adverse drug response - statin myopathy. We will develop risk communication tools that convey the clinical and genetic components of risk to both patients and care providers. Specific aim 3. Develop informatics approaches to incorporate genomic data into the EMR, including links to clinical decision support. Specific aim 4. Conduct a randomized-clinical trial to investigate how patients respond to genetically informed CHD-risk. We will re-consent 150 eMERGE-l patients without CHD, communicate the results via a genetic counselor, and discuss in detail the implications of the testing relevant to disease risk. The effectiveness of the communication and the patients' comprehension of risk, their hopes and concerns, and planned changes in lifestyle will be assessed by surveys and interviews after the patient-counselor encounter. As part of our ongoing efforts in community consultation, we will establish a community advisory group specific to this project. RELEVANCE (See instructions): The proposed application will leverage the research infrastructure established in eMERGE-l to identify common genetic variants that influence medically important phenotypes. We will develop tools to incorporate genomic information in the EMR. In addition, we will investigate clinical, translational, and ethical aspects of genetic testing for complex diseases and assess the response of patients to genetic testing.