NIMHD 2018 Annual Grantees Meeting: Transdisciplinary Collaborative Centers for Health Disparities Research Focused on Precision Medicine (TCC-PM)
As medicine continues to advance, the benefits are marginal to underrepresented populations in clinical research. Studies designed around the concept of one-size-fits-all lead to therapies that may work for certain patients but not for others.
Precision medicine is an innovative approach to disease prevention, early detection, and treatment by taking into account individual differences in people’s genes, environments, and lifestyles. Understanding the biological and environmental mechanisms underlying a patient’s health or condition allows clinicians to better predict which treatments will be most effective. This approach is especially valuable to health disparity populations, who may not respond to standard diagnostic or treatment strategies developed from clinical trials lacking representative study participants.
The NIMHD Transdisciplinary Collaborative Centers for Health Disparities Research Focused on Precision Medicine (TCC-PM) held the third annual grantees meeting in December 2018. NIMHD staff and grantees gathered on the NIH Main Campus in Bethesda, Maryland, to discuss their work at 5 current NIMHD-funded centers across the country. Panelists from the National Institute of Nursing Research (NINR), National Library of Medicine (NLM), the National Heart, Lung, and Blood Institute (NHLBI), National Human Genome Research Institute (NHGRI), National Cancer Institute (NCI), and National Institute on Aging (NIA) provided recommendations for future research directions and collaborations.
The TCC-PM explore the potential for precision medicine to promote health equity and reduce health disparities. By collaborating with community organizations, service providers and systems, government agencies, and other stakeholders, the centers can conduct meaningful research to help propel sustainable individual-, community-, and systems-level changes that improve population health. In the keynote address by Eric Dishman, the director of the All of Us project reminded TCC-PM grantees to (1) consider the need to care for the whole person, not just their particular condition; (2) develop best practices for sustained engagement with research participants; and (3) identify and develop proposals to maximize the use of the data collected for All of Us.
The grantees presented posters on several TCC-PM research priority areas: understanding how genes affect a person’s response to drugs (“pharmacogenomics”), applying research findings, and integrating data on health disparities. NIMHD-supported grantees from the Transdisciplinary Collaborative Center (TCC) at Northwestern University, IL, presented an overview of their project, African American Cardiovascular Pharmacogenomics Consortium (ACCOuNT), which focuses on African American populations in Washington, D.C., and Chicago. The project—led by Drs. Minoli Perera and David Meltzer—aims to establish a research network and ways to support the use of precision medicine in African Americans. Among various recommendations, panelists encouraged collaboration with the Jackson Heart Study, addressing the lack of pharmacogenomics in many medical school curriculums, and integrating the Genomic Prescribing System with electronic health records (EHR) and the model of care.
Vanderbilt-Meharry-Miami TCC grantees discussed their work, which focuses on African American and Latino health in 3 projects. Dr. Consuelo Wilkins provided an overview of the center and related projects including, one project that involves predictive modeling of cancer survival, using gene-related and social factors. The second project encompasses data from a biobank and EHR to characterize genome variation affecting health disparities, such as increased risks for diabetes, high blood pressure, and asthma in individuals of African ancestry. The third endeavor is tailoring a behavioral intervention for overweight African American and Latino men. An important recommendation was to consider how to integrate social factors affecting health into the EHR.
The Medical University of South Carolina TCC, led by Dr. Chanita Hughes-Halbert, presented an overview of the center’s work focusing on minority men's health. This center’s research has focused on prostate cancer, which African American men are more likely to develop and die of, compared with White men. Together, the researchers hope to define a tool to measure the wear and tear of the body caused by chronic stress with immune and tumor microenvironment factors. Their goal is to ultimately help health care providers give proper care in the right dose to the right patient at the right time. The team also presented a pilot research project evaluating the feasibility of a procedure to understand biological, behavioral, and environmental factors associated with cardiovascular disease risk among Black emerging adult men. Panelists called for consideration of how to communicate risk back to patients.
The Stanford Precision Health for Ethnic and Racial Equity (SPHERE) initiative was introduced with 3 ongoing projects led by Stanford University researchers Drs. Mark Cullen and Bonnie Maldonado. The first project, Communicating Cancer and Genetic Information (CCGI), focuses on how to deliver information in the proper cultural context so that patients understand this information, remember it, and act upon it. The second project, Precision Aging and Dementia for all Races and Ethnicities (PADRE) builds on Stanford’s Alzheimer’s Disease Research Center (ADRC) to examine metabolic and biomolecular differences among Latino and White participants in a 1-year study. Lastly, the third project, Integrated Personalized Omics Profiling (iPOP), seeks to identify biomarkers in Latino youth that can predict the development of obesity and diabetes later in life. The goal is to develop behavioral interventions to reduce these chronic disease risks. Panelists offered a few recommendations, such as ensuring representation of multiple disciplines within the research teams and developing best practices for community engagement and methods to impute missing data.
Finally, the last group of grantees from the Yale TCC at Yale University, CT, presented on their work, which focuses on populations of Caribbean descent. The Yale TCC builds on the partnerships, infrastructure, and knowledge created by the Eastern Caribbean Health Outcomes Research Network (ECHORN) study. ECHORN currently has two active projects led by Drs. Marcella Nunez-Smith. One project is dedicated to diabetes risk prediction via early biomarkers. The second project aims to prevent and stratify risk of high blood pressure in Eastern Caribbean populations by measuring blood pressure while patients are outside of the clinic. Through cross-island collaboration and in partnership with the Health Caribbean Coalition, the TCC-PM seeks to help empower people of the Caribbean in chronic disease prevention and control. Besides examining ethnic differences in genes that may increase one’s risk of developing chronic diseases, like high blood pressure and diabetes, the team is studying a way to detect whether patients are not taking or not responding to their medication. Meanwhile, the implementation core is working on translating evidence into practice and policy, such as lifestyle workshops and healthy school environments to address the obesity and diabetes epidemic, particularly in this minority population. Two key considerations included addressing the impact of climate change on health disparities and formalizing training opportunities for the next generation.
Common recommendations were shared across the TCC-PM. For example, panelists suggested that future studies compare self-identified race and genetic ancestry. They also advised collecting evidence for the cost-effectiveness of precision medicine approaches and ensuring sustainability. NIMHD Director Eliseo J. Pérez-Stable, M.D., shared his remarks on the TCC program with enthusiasm about the growth of the research field, while reminding participants of the importance of demonstrating efficacy of precision medicine approaches. He also recommended using multilevel methods to address complex problems and remaining patient-centered.
Pioneering spirit was evident throughout the 2018 annual meeting exploring the intersection between precision medicine and health disparities. The 2019 meeting will include further updates on the implementation of pharmacogenomics, disease prevention, and precision medicine applications in diverse populations, as the field continues to evolve in complex ways incorporating genetics, lifestyle, and social determinants of health.
Posted November 15, 2018