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Using Genes to Customize Health Care

 

Why do some smokers get cancer and others don’t? Why do some patients respond beautifully to a medication while others see no result, or worse, suffer side-effects?

The answers to those questions lie in a complex tangle of behavioral, environmental and genetic factors that researchers are painstakingly sorting out. The goal: To target medical care and disease prevention efforts more personally and effectively.

Presidents of the Texas Medical Center’s three leading research institutions and select scientists recently explained how the Texas Medical Center Genetics Resource project – TexGen for short – will promote the move to tailored care for cardiovascular disease, cancer and dementia.

We have entered an era of science that is all about teamwork,”
Traber said.

 

“TexGen is an unprecedented genetics research collaboration and in fact an unprecedented research collaboration or collaboration of any kind in TMC,” said TexGen founder James T. Willerson, M.D., president of The University of Texas Health Science Center at Houston.

TexGen capitalizes on a unique strength: 5.5 million patient visits to TMC institutions each year from a richly diverse population. “No other medical center in the world comes close to that,” Willerson told a group of past and potential philanthropic supporters of the program at a luncheon hosted by Peter Coneway, limited partner in the Houston office of the investment banking firm Goldman Sachs. Large sample sizes of patients are crucial to understanding the many factors involved in disease risk. Since TexGen began about two years ago, more than 6,000 patients have voluntarily and confidentially provided blood and tissue samples and their medical histories, and have agreed to provide updated health information annually.

This combination of information provides a resource that scientists at UT Health Science Center, Baylor College of Medicine, and the UT M. D. Anderson Cancer Center have started to use in their research. Present areas of research include stroke, heart attack, heart failure, gastrointestinal cancers and cancer of the prostate, kidney, bladder and testicles.

“We have entered an era of science that is all about teamwork,” said Baylor President Peter Traber, M.D. Baylor’s Human Genome Sequencing center played a crucial role in one such collaboration – the sequencing of the human genome. Clinical science and genomic science are coming together, he said.

“A decade ago, many were skeptical that we could sequence the genome,” Traber said. “Today, we can sequence one entire human genome in six months. I guarantee in five years we will be able to do it in a day.”

“Baylor College of Medicine and the other institutions here should be and will be firmly behind this collaboration,” Traber concluded. “It should yield benefits many hundred-fold above the initial investment.”

TexGen is in line with M. D. Anderson’s expectations for the general direction of medical care and cancer prevention, said John Mendelsohn, M.D., president of the nation’s leading cancer center.

“Patients will come to M. D. Anderson differently 10 years from now than they do today,” Mendelsohn said. Now, people come who have cancer or a suspicious lump or growth – they come as patients or likely cancer patients.

“In 10 years, we would like people to come in for a preview of their cancer risk, for an individual assessment,” Mendelsohn said. The result would be a tailored course of early treatment or a plan for prevention.

TexGen is a bridge to that type of care, Mendelsohn said. “With this magnificent project, we can collect these data, share them and pin down individual risks for diseases.”

Baylor cardiologist and TexGen researcher A. J. Marian, M.D., said genetic research will provide physicians with better answers to their patients’ questions. “When they ask, ‘Doctor, am I among the 30 percent who benefits from this medication? Or am I one of the 20 percent who has side-effects? Or one of the 50 percent with no effect at all?’ The truth is you have to say, ‘We do not know which class you belong to.’… Our ultimate goal is to treat individual patients, not groups,” Marian said.

TexGen will continue to benefit researchers as the database grows, said Margaret Spitz, M.D., professor and chair of epidemiology at M. D. Anderson. “The longer it goes, the greater the value of the database for future health care professionals.”

The National Institutes of Health (NIH) want researchers to have genetic samples on hand and avoids funding projects with no access to samples, said Eric Boerwinkle, Ph.D., director of the Human Genetics Center at the UT School of Public Health at Houston and a similar center at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases.

We are creating a resource that supports applications for research grants to the NIH, Boerwinkle said. “In a nutshell, that’s what TexGen is.” A number of grant proposals related to TexGen are under review.

It’s important to understand the genetics and resultant protein activity tied to disease, Willerson said. As a cardiologist, he has seen the impact of genetic risk.

“You can run all day, keep your weight low as possible, not smoke, and you can’t outrun your genetic risk,” Willerson said. At the other extreme, some people, such as the late British Prime Minister Sir Winston Churchill, do just about everything “wrong,” yet live a long, productive life.

TexGen has been funded by $3 million in philanthropic support. The organization seeks another $3 million to get the program fully launched at TMC institutions.

“After that we should be self-sufficient, with NIH grants, and other sources,” Willerson said, “And we should have some rather extraordinary results to show you.”

— Scott Merville, Development