The promise of personalized medicine is not for everyone

Les Afro-Américains sont sous-représentés dans les études génétiques et neuroscientifiques à grande échelle.  <a href="https://unsplash.com/photos/4U1x6459Q-s" rel="nofollow noopener" cible="_Vide" data-ylk="slk :Wadi Lissa/Unsplash" classe="lien ">Oued Lissa/Unsplash</a>” src=”https://s.yimg.com/ny/api/res/1.2/fwMw1HgpDvcMUJ_tocaOgg–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTc2NA–/https://s.yimg.com/uu/api/res/1.2/XDs3I0LoKw2XQU_jN. ZLAg–~B/aD0xNTYwO3c9MTQ0MDthcHBpZD15dGFjaHlvbg–/https://media.zenfs.com/en/the_conversation_us_articles_815/d8cb7f11c317e98726d11abb71cf2989″ data-src=”https://s.yimg.com/ny/apiDcaJgfwMvgfwMvw –/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTc2NA–/https://s.yimg.com/uu/api/res/1.2/XDs3I0LoKw2XQU_jN.ZLAg–~B/aD0xNTYwO3c9MTQ0MDthcHBpZD15dGFjaHlvbg–/https://media.zenfs_the_articles8_convers1us_convers1555 /d8cb7f11c317e98726d11abb71cf2989″/></div>
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African Americans are underrepresented in large-scale genetic and neuroscientific studies. Oued Lissa/Unsplash

Could your medical treatment one day be adapted to your DNA? This is the promise of “personalized medicine”, an individualized approach that has captured the imagination of physicians and researchers in recent years. This concept is based on the idea that small genetic differences between one person and another can be used to design tailor-made treatments for conditions as diverse as cancer and schizophrenia.

In principle, “personalized” does not mean one person but not another, although this may not be the case. Existing genetic and medical research data clearly under-represent certain populations.

Case in point: In 2018, researchers published a startling study on youth suicide rates. Scientists have long believed that young white people have the highest suicide rates. But, looking at data from the Centers for Disease Control and Prevention, they found that suicide rates among African American children under 13 were twice as high as among whites.

This finding overturned long-held assumptions about racial imbalances in mental illness. This cannot be explained by economic circumstances, which suggests that there are other factors at play, possibly even genetic factors. Suicide is a complicated personal act, but science has shown that genes play an important role.

This unexpected result may have implications for gene-based prevention and treatment – ​​in other words, personalized medicine. But the state of current genetic research suggests that African Americans are likely to miss out on many potential future benefits of personalized medicine.

As lead author Jeffrey Bridge of Nationwide Children’s Hospital in Ohio noted in The Washington Post, “Most previous research has largely focused on white suicide. So we don’t even know if the same risk and protective factors apply to black youth.

Few experts have studied the possible genetic causes of African American suicide, focusing instead on environmental and social reasons.

While most mental illnesses such as depression are first diagnosed in adulthood, they actually have their origins in early development, as genes and environment interact to shape the brain of a fetus. growing. For example, my colleagues and I published a study in May showing that genes and pregnancy issues combine to increase the likelihood of schizophrenia.

This should be concerning, as African American women have much higher rates of pregnancy complications. Black infants die twice as fast as white infants. Again, this cannot be explained by socio-economic reasons.

In short, a higher rate of pregnancy problems likely puts African Americans at an increased risk of developing mental illnesses, perhaps explaining the notable increase in suicide rates. Additional genetic data on this population could potentially shed light on the matter.

To better understand the genes that increase the risk of mental illness, researchers are studying the brains of deceased people. They examine how genetic differences could have caused changes in the brains of people who developed these conditions. This is one of the best ways to understand any brain disorder at a biological level.

But African Americans are underrepresented in large-scale genetic and neuroscientific studies. A 2009 analysis found that 96% of participants in large genetic studies were of European descent. When researchers looked into this a few years ago, they found that the proportion of people of African descent in these studies had only increased by 2.5%. Likewise, studies of African-American brains are almost non-existent.

Why the low turnout? One reason is that researchers favor populations that are genetically more homogeneous to ensure the accuracy of a study. People of European descent genetically resemble each other more than African Americans.

Some experts have postulated that African Americans are less likely to participate in genetic studies due to a lack of trust with the medical community.

At the Lieber Institute for Brain Development, where I work, people can donate the brains of family members who want to contribute to scientific research. We have the largest collection of African American brains donated to study mental illness, although it is relatively small compared to the availability of Caucasian brains. In our experience, the donation rate of African American families is comparable to that of white families, suggesting that mistrust may not be as prevalent as believed.

Without studies focused on the African American brain, scientists will struggle to fully understand how any possible unique genetic risk in the African American population translates to the prevention and treatment of virtually any disorder that involves the brain, including suicide.

Researchers must invest to correct this shortcoming before the personalized medicine train is so far from the station that the African-American community can board it.

This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts.

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Daniel R. Weinberger receives funding from the NIH and the Lieber Institute. The work of the Lieber Institute is partially funded by grants from the NIH and donations from the Lieber and Maltz family foundations.

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