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Mayo Clinic Medical Science Blog

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Thu, Jul 20 9:30am · Obesity: an individualized approach doubles the success rate of weight loss therapy

Article by Sharon Rosen

Many people think if they just stick to a diet and exercise, they’ll lose weight; unfortunately, many are not successful. They wonder why they can’t lose weight even after trying many different diets, work out programs and medications. According to Andres Acosta, M.D., Ph.D., the answers, at least partially, may be in your genes. His research in obesity shows that there is not just one type of obesity, and there are many different genetic and biological factors that play a role in losing or gaining weight. That’s why Dr. Acosta and his team have developed an individualized approach to tackle obesity – one patient at a time.

In the new Obesity Clinic within Mayo Clinic Center for Individualized Medicine, a multidisciplinary team selects therapy for each patient based on his or her genetic and biological characteristics, environment and behavior. The new approach is already dramatically increasing treatment success and pioneering the application of precision medicine to treat chronic diseases.

Dr. Andres Acosta

“Prior to using an individualized approach, only 30 percent of obese patients had successful weight loss after treatment. We studied 500 patients to identify the factors leading to their obesity and then selected the best therapy for each patient based on their unique characteristics. With this new approach, patients with obesity will lose two times more weight than with standard therapy. This is critical because obesity is one of the leading causes of death and increases the risk for developing diabetes, heart disease and many types of cancer. Our goal is to help people get control of their weight and live a healthier lifestyle,” says Dr. Acosta.

“We often think of individualized medicine being used to treat cancer or rare genetic disorders. Now we are pioneering a new treatment for obesity, a chronic disease. This is where the future of precision medicine is headed – developing individualized treatments for many common, chronic conditions.”

So how does the individualized approach work for patients with obesity?

Here is an example: some obese patients do not experience a normal sensation of fullness after eating and it takes them longer to feel full. Dr. Acosta and his team were able to identify genetic characteristics linked to this condition and then prescribe a currently available medication to help these patients feel full sooner, stop overeating and lose weight.

“This individualized approach to treating obesity allows physicians to maximize the effectiveness and safety of currently available, FDA-approved medications and endoscopic and surgical procedures. It may also lead to the development of new treatments to meet the unique needs of patients.” – Dr. Andres Acosta

“This individualized approach to treating obesity allows physicians to maximize the effectiveness and safety of currently available, FDA-approved medications and endoscopic and surgical procedures. It may also lead to the development of new treatments to meet the unique needs of patients,” says Dr. Acosta.

The Obesity Clinic is open to anyone who is overweight or obese and wants to lose weight. Patients visiting the clinic will see a multidisciplinary health care team, which includes gastroenterologists, dietitians, surgeons, endocrinologists and psychologists, all specializing in the treatment of obesity. As part of their evaluation, patients will have:

  • Genetic testing to identify unique characteristics that may impact weight gain or make weight loss more difficult
  • Pharmacogenomics testing to identify any genetic factors that impact how a person processes medications
  • Evaluation of eating habits, including appetite and diet
  • Assessment of lifestyle and behavioral factors that may play a role in weight gain

Patients also meet one on one with staff in Mayo Clinic Healthy Living Program to develop a personalized plan for nutrition, fitness and wellness. With follow up support from wellness coaches, the program helps patients successfully maintain control over their weight and live a healthier lifestyle.

This article originally appeared on the Center for Individualized Medicine blog on July 13, 2017.

Tue, Jun 27 8:00am · Personalized care for aggressive breast cancers: 4 steps forward from the BEAUTY study

Article by Sharon Rosen

Chemotherapy substantially reduces the chance that certain types of breast cancer will return or spread to other parts of the body and improves survival. Chemotherapy before surgery is a standard approach to treat women with aggressive breast cancer. However, chemotherapy does not shrink tumors in all women.

Mayo Clinic researchers are turning to genomic sequencing to learn which patients are most likely to be helped by chemotherapy. And, they hope to develop alternative therapies for those who don’t, using genomic data and by growing tumors in mice that mimic the patient’s response to treatment.

They recently reported findings from the Breast Cancer Genome-Guided Therapy (BEAUTY) study in the Journal of the National Cancer Institute.

Below are four key findings from the study that may have an impact on clinical practice and bring more personalized therapies to patients with aggressive breast cancer.

#1: A unique approach to identifying individualized therapies

Dr. Judy Boughey

The BEAUTY trial combined multiple scientific approaches to evaluate treatment for aggressive breast cancer. Tumor biopsies from 140 patients with aggressive breast cancer were collected before patients were treated with chemotherapy. These tumor samples were analyzed using:

  • DNA and RNA sequencing to find unique genetic mutations or characteristics of patients’ tumors
  • Analysis to identify possible links between a patients’ response to chemotherapy and their individual genetic characteristics
  • Creation of patient derived xenografts (PDX), in which a sample of a patient’s tumor is injected into a mouse, resulting in a biological model  duplicating the patient’s tumor

“By combining these approaches, we gained insights that will help us develop individualized therapies based on the genetic characteristics of a patient’s tumor. Our goal is to use this information to develop alternative therapies for those patients who do not respond to chemotherapy,” says Judy Boughey, M.D., breast surgeon and co-chair of the BEAUTY study.

This study also helped researchers learn more about aggressive breast cancer.

As Matthew Goetz, M.D., medical oncologist and co-chair of the BEAUTY Study explains, “For patients with cancer remaining at the time of surgery, there is a great need to bring forward additional treatments that address chemotherapy resistance. The BEAUTY study was designed to develop tools and provide insight into the molecular underpinnings of chemotherapy resistance.”

#2: Searching for new drug targets

Dr. Matthew Goetz

Prior research has demonstrated that genetic alterations in some cancers can be targeted with drugs that cause tumor shrinkage and prolong life. A major focus of the BEAUTY study was to determine if patients with resistance to chemotherapy had evidence for genetic alterations that could be targeted.

While common genetic changes that could be targeted were not “enriched” in chemotherapy resistant tumors, BEAUTY investigators identified rare alterations including genes involved in DNA repair. BEAUTY investigators tested a cancer drug (olaparib) currently only approved for patients with inherited mutations in the DNA repair genes BRCA1 and BRCA2. Importantly, the presence of genetic changes that did not involve BRCA1 and BRCA2 in the chemotherapy resistant tumor predicted for response to olaparib,when this drug was tested in the PDX.

“The  BEAUTY study has created a new paradigm in research wherein in one study, we identify genetic changes associated with chemotherapy resistance, identify a drug or drug combination designed to address that resistance mechanism, followed by use of that same tumor (PDX) from which the genetic changes were identified to study new drug or drug combinations to reverse resistance,” explains Dr. Goetz.

“Our preliminary findings tell us that we may need to treat each patient individually based on their unique genetic makeup,” says Dr. Boughey.

#3: Key genetic discoveries may impact patients with triple negative breast cancer

Fifteen to twenty percent of women diagnosed with breast cancer have triple negative breast cancer, an aggressive breast cancer defined by the absence of key proteins and biomarkers that are currently targeted in breast cancer. Using genomic analysis, investigators identified key findings that could improve care for patients with triple negative breast cancer:

  • Patients with a rare type of triple negative breast cancer that expresses the androgen receptor are more likely to have tumors that resist chemotherapy.
  • Based on this finding, an important next step is to develop new targeted therapy combinations for the androgen receptor expressing triple negative breast cancer.

#4: Tumor models offer a promising tool to develop new therapies

The BEAUTY study investigators were able to successfully grow patients’ tumors in mice – PDX – for 27 percent of all patients enrolled in the trial and for more than half of those patients with triple negative breast cancer. This model provides a better replica of a patient’s tumor than a petri dish.

As Dr. Goetz explains, “These PDX have already proved to be a powerful tool for us to test new drug therapies, especially those  PDX that were generated from women whose tumor was resistant to standard therapy.”

Investigators will continue their quest for new alternative, individualized treatments for patients with aggressive breast cancer with the launch of the BEAUTY2 study that will get underway later this year and evaluate novel drug therapies in patients with chemotherapy resistant disease prior to surgery.

 

This article was originally published on the Center for Individualized Medicine blog on May 19, 2017

 

Thu, Jun 15 8:00am · A personalized approach to brain tumor surgery

By Susan Buckles

New technology invented and used only at Mayo Clinic lets physicians plan an individualized approach to brain surgery. Brain magnetic resonance elastography (MRE) allows surgeons to see inside a patient’s skull and determine the firmness of a brain tumor before surgery. Slip interface imaging is another new invention that shows level of adhesion of the tumor to normal brain tissue. When used together, physicians can plan the precise amount of time and the safest method for removing a patient’s tumor, reducing the risk of complications.

Mayo Clinic’s Center for Individualized Medicine provided funding to accelerate the research and development in order to make slip interface imaging available to patients. May is Brain Tumor Awareness Month, a perfect time to reflect on how the discovery, translation and application of this new technology are improving options for brain surgery.

Mayo Clinic-invented technologies show brain tumor firmness, adhesion before surgery

Helen Powell holds a water bottle adorned with her beaded jewelry.

It’s not often that a fall saves someone’s life. Helen Powell, 74, says that was the case for her. A computerized tomography scan that followed her fall revealed a cancerous brain tumor that led her to Mayo Clinic and surgery using first-in-the-world technology. Brain magnetic resonance elastography (MRE) imaging, showed the precise firmness of her tumor. New slip interface imaging further revealed how attached the tumor was to normal brain tissue — even before starting surgery. The imaging techniques, invented and available only at Mayo Clinic, show whether the tumor is soft and can be removed easily, or if it is firm, making surgery more challenging and time consuming.

“Brain magnetic resonance elastography and slip interface imaging help avoid surprises in surgery that could lead to complications for the patient,” says Jamie Van Gompel, M.D., a neurosurgeon at Mayo Clinic. “Once in surgery, we may find a tumor is stiffer than expected and will take more time to remove than we had planned, or alternatively, we may find the tumor to be more adherent to brain than anticipated, raising the risk of a complication from that surgery.”

Dr. Jamie Van Gompel

Slip interface imaging provides information on the interface between the tumor boundary and surrounding tissue. This interface can be capsule-like in which the tumor slides or slips within the surrounding normal tissue, or it can form a rigid connection in which the tumor is fixed to the surrounding tissue. Surgeons use the images to plan the proper time and the safest method for extraction.

“This technology allows us to get a feel for the tumor without opening someone’s head and this will really impact patient safety,” says Dr. Van Gompel.

New Mayo Clinic research, published in the Journal of Magnetic Resonance Imaging, confirms the effectiveness of slip interface imaging. The study looked at the level of tumor adhesion in 25 patients. The brain magnetic resonance elastography and slip interface imaging showed 16 patients had tumors that could be easily removed; nine patients had tumors with adhesion to the brain; and six were mixed. Physicians found all the pre-surgical images to be an accurate assessment  of the tumors and therefore an invaluable surgical planning tool.

Dr. John Huston III

“Slip interface imaging gives Mayo Clinic physicians new information that allows an individualized approach to tumor surgery for both cancerous and noncancerous lesions. If a tumor is soft, it can sometimes be sucked out. If it is firm, it may need ultrasonic extraction. Before we had this imaging capability, it was not uncommon to find unexpected risks that required follow up surgery,” says John Huston III, M.D., a radiologist who helped develop the imaging technology.

In Helen Powell’s case, slip interface imaging helped her surgeon determine that despite having a challenging, firm tumor, he could remove most of it in one surgery and attack the rest with radiation. And, he could extract it through her nose rather than performing a craniotomy.  That cut risk of rare but also significant potential complications like stroke or blindness.

For Powell, it was an answer to her prayers. For 3½ years before her diagnosis at Mayo Clinic, no doctor or medical center could figure out what was wrong. She suffered constant shoulder and joint pain, was nauseated most of the time and was slowly losing her eyesight. She was so uncomfortable that she slept in a recliner most nights. She thought she might die. After surgery, she noticed a dramatic change.

“When I woke up, I could see again. My shoulders didn’t hurt anymore and I didn’t have any more joint pain. I could walk and think again. It was a miracle,” she says.

Powell has recovered enough to return to her hobby of making beaded jewelry. And, she says she feels well enough to travel across the country to visit her adult children.

Dr. Keith Stewart

The Center for Individualized Medicine Imaging Biomarker Discovery Program at Mayo Clinic provided the funding and support to bring the MRE and slip interface to patients at Mayo Clinic. The Center for Individualized Medicine collaborates closely in research and practice across many disciplines at Mayo Clinic to apply a comprehensive team science approach to patient care. According to Keith Stewart, M.B., Ch.B., Carlson and Nelson Endowed Director, Mayo Clinic Center for Individualized Medicine, this new imaging technology advances an individualized approach to surgery that patients can’t get anywhere else.

“The Center for Individualized Medicine supports Mayo Clinic’s efforts to seamlessly move breakthrough therapies and critical advances in patient care from the research lab to the doctor’s practice so more patients can benefit from the promise of individualized medicine,” says Dr. Stewart, who is also the Anna Maria and Vasek Polak Professor of Cancer Research, Division of Hematology-Oncology at Mayo Clinic.

The research paper was funded partly through a grant from the National Institutes of Health.

Authors on the study from Mayo Clinic are:

Additional collaborator:

  • Anthony Romano, Ph.D., U.S. Naval Research Laboratory

*Dr. Ehman is the Blanche R. and Richard J. Erlanger Professorship in Medical Research

###

 

This article originally ran on the Center for Individualized Medicine blog on May 3, 2017.

 

Thu, May 4 8:00am · Precision care for heart disease - a practical approach

Article by Sharon Rosen

Heart disease can sometimes be a silent killer. Many of us know seemingly healthy people who’ve suddenly or unexpectedly had a heart attack. It can be shocking when people who are at a a healthy weight and exercise regularly die from heart disease that they never knew they had. Many forms of heart disease can be prevented or treated with healthy lifestyle changes. Physicians are turning to genetic testing to help identify whether a patient is at risk for developing the disease or to detect and treat it early.

Mayo Clinic researchers have developed practical approaches that physicians can use to bring precision medicine care to their patients with heart disease, a leading killer in America. John Giudicessi, M.D., Ph.D., Iftikhar Kullo, M.D., and Michael Ackerman, M.D., Ph.D. outline these clinical guidelines in their paper Precision Cardiovascular Medicine: State of Genetic Testing in the April 2017 issue of Mayo Clinic Proceedings.

Dr. John Giudicessi

The authors highlight the importance of creating the guidelines to help guide patient care.

“As genomic testing has become more affordable, faster and more accessible, both physicians and patients have many questions. Which genetic tests should be used? What do the genetic test results mean for patients and their family members? The clinical guidelines we have assembled will help physicians understand how to use current genomic knowledge to provide the best care for their patients. This can help physicians diagnose heart disease earlier, before the patient, and in some cases other family members, experience a life threatening event like a heart attack, ” explain the researchers.

Genomics – improving care for cardiovascular disease

Genomics has already played a key role in providing individualized care for many patients with cardiovascular diseases.

The Mayo researchers highlight these areas where precision medicine has led to improved prevention, screening, earlier diagnosis and treatment for patients, and in many cases, their family members:

  • Familial cardiovascular disease: Genetic testing has helped identify familial cardiovascular diseases that result in heart rhythm disturbances, thickening/dilation of the heart’s lower chambers, and high cholesterol. These tests help physicians diagnose and treat inherited heart diseases in patients and also screen family members as young as eight years old for the condition.
  • Increased risk for common heart diseases: Researchers have discovered many genetic variants that lead to increased risk for developing common cardiovascular diseases such as coronary heart disease and atrial fibrillation. By identifying whether a patient has these genetic variants, physicians can then recommend additional screening and lifestyle changes to prevent the need for heart surgery down the road or to diagnosis and treat the condition sooner.
  • Drug-gene interactions: Pharmacogenomics tests have been developed to identify genetic variants that can impact how patients process medications to treat cardiovascular diseases. These tests help physicians select the right drug and dosage of medications to maximize the benefit and reduce the chance for harmful, sometimes life threatening side effects.

Team approach – ensures the maximum benefit

Dr. Iftikhar Kullo

The Mayo researchers emphasize the importance of using a multidisciplinary team to select the appropriate genetic tests and interpret test results for each patient. The team should include coordinated care from cardiologists, genetic counselors and medical geneticists.

Why is this team approach so important? Because as the authors explain, when it comes to genetic testing, one size does not fit all.

“A ‘one size fits all’ mentality to genetic testing is not advised. Genetic testing should be used only if the medical team suspects that a patient has an underlying genetic cardiovascular disease after performing a thorough clinical evaluation, which should include a detailed family history and comprehensive cardiovascular testing,” explain the authors.

Dr. Michael Ackerman

Once testing is complete, the team plays a critical role in interpreting test results for each patient. Many genetic tests generate large amounts of data that often contain ambiguous or uncertain findings. Medical geneticists and genetic counselors can help identify which test results can be used to guide patient care and when a patient’s family members need screening for heart disease. Team members work with the patients and their families through every step of the genetic testing process.

Mayo Clinic Proceedings Symposium on Precision Medicine 

This paper is the third in Mayo Clinic Proceedings Symposium on Precision Medicine, a series of articles that cover a wide range of topics in personalized medicine. Watch for upcoming articles in the symposium, which will focus on how personalized medicine and genomics are impacting patient care. Learn more about the series.

John Giudicessi, M.D., Ph.D, is a resident in the Department of General Internal Medicine at Mayo Clinic’s campus in Rochester, Minnesota.

Iftikhar Kullo, M.D, . professor of Medicine and consultant in the Department of Cardiovascular Diseases at Mayo Clinic’s campus in Rochester, Minnesota.

Michael Ackerman, M.D., Ph.D. professor of Pharmacology, Medicine and Pediatrics and consultant in the Department of Cardiovascular Diseases and Department of Pediatrics and Adolescent Medicine at Mayo Clinic’s campus in Rochester, Minnesota.

 

This post originally appeared on the Center for Individualized Medicine blog on April 14, 2017.

 

Thu, Apr 27 8:00am · Developing new tests to find and defeat cancer at its earliest stages

Mammography and other screening tools have made great strides in finding cancer early, when it is most likely to be successfully treated. However, some early-stage cancers are missed by conventional screening and are only detected when symptoms occur. Mayo Clinic and other research institutions are wondering: could a blood test complement current practice to improve rates of early detection and cure?

 

Research suggests that novel blood tests may be able to find cancer early, by identifying small pieces of genetic material shed by tumors.  Mayo Clinic is collaborating with GRAIL, a life science company, and Sutter Health of California, on the STRIVE clinical research study to facilitate the development of GRAIL’s blood tests for early-stage cancer detection.

 

Dr. Minetta Liu

Minetta Liu, M.D.,  Fergus Couch, Ph.D. and Celine Vachon, Ph.D. are leading the STRIVE study at Mayo Clinic. The study will enroll 40,000 women at the time of screening mammography over the next 15 months at Mayo Clinic’s campuses in Rochester, Minnesota; Jacksonville, Florida; and Phoenix, Arizona; as well as at the Mayo Clinic Health System Franciscan Healthcare locations in La Crosse and Onalaska, Wisconsin.

 

Sutter Health will enroll another 80,000 women at locations in California during that same time frame. Participants will provide blood samples, complete an electronic questionnaire and allow for follow-up regarding their clinical outcomes. Learn more about this study in GRAIL’s news release.

Dr. Fergus Couch

 

Mayo Clinic Center for Individualized Medicine (CIM) has been an early supporter of the STRIVE study. Mayo Clinic has placed a high priority on being a leader in the development of blood tests for the most effective detection and treatment of breast and other cancers. Use of such tests should improve the sensitivity of early cancer detection and will allow monitoring of existing cancers for remission, recurrence and therapeutic choice without the need for an invasive biopsy.

Dr. Celine Vachon

 

With these goals in mind, Mayo Clinic Cancer Center investigators have collaborated with the biotechnology company GRAIL to develop and initiate this study. CIM facilitated the rapid launch of this study within the Mayo Clinic by providing early funding and internal project management support.

 

 

 

 

This post originally appeared on the Center for Individualized Medicine blog on April 20, 2017

Tue, Apr 4 8:00am · Exploring the link between the gut and multiple sclerosis

Article by Sharon Rosen

Could the bacteria in a person’s digestive system provide a clue about whether he or she may develop multiple sclerosis? This is a question that Mayo Clinic researchers asked when trying to unravel the causes of multiple sclerosis, a potentially debilitating condition that impacts a person’s nervous system. A Mayo Clinic study published in Scientific Reports demonstrates that patients with multiple sclerosis have a unique gut microbiome – the community of bacteria in the digestive system – when compared to that of healthy patients.

Dr. Nicholas Chia

“Patients with multiple sclerosis have more gastrointestinal problems such as constipation and irritable bowel disease. Studies have shown that a lack of certain bacteria within the gut can impair the immune system and may predispose a patient to develop inflammatory diseases like multiple sclerosis. Therefore, we wanted to compare the gut bacteria from patients with multiple sclerosis to the gut bacteria of healthy individuals. Our findings show that there is a connection that needs to be explored further,” says Nicholas Chia, Ph.D. , one of the study investigators and associate director of the Mayo Clinic Center for Individualized Medicine Microbiome Program.

Impact on patient care

Approximately 85 percent of patients who experience symptoms from multiple sclerosis have recurring episodes. While there is currently no cure for multiple sclerosis, there are treatments to manage symptoms.

While multiple sclerosis is thought to be caused by both genetic and environmental factors, the exact environmental factors that lead to the disease are unknown.

By identifying the role that gut bacteria plays in causing multiple sclerosis, researchers hope to develop new ways to detect the disease, treat symptoms and even prevent the disease from developing.

“Gut bacteria could be a key environmental factor, along with genetic factors, in causing a person to develop multiple sclerosis. Our study lays the groundwork for future research. Large scale research studies are needed to examine gut bacteria of multiple sclerosis patients at multiple time points and different stages of the disease, says Ashutosh Mangalam, Ph.D., assistant professor, Department of Pathology, University of Iowa and co-author of the study.

According to Dr. Mangalam, future studies will address questions such as:

  • Do multiple sclerosis patients with disease relapses have a distinct gut microbiome compared to patients in remission?
  • Are there certain types of gut bacteria which are present in either a lower or higher proportion in multiple sclerosis patients compared to healthy patients?
  • Can gut microbiota profiling be used to identify bacterial markers that predict whether multiple sclerosis patients will relapse?
  • Do changes in the gut microbiota in multiple sclerosis patients impact the effect of commonly used multiple sclerosis drugs, such as Copaxone, and beta-Interferons?
  • Can multiple sclerosis patients be treated with the use of medications and/or changes in diet (prebiotics) to alter their gut microbiota in order to stop the progression or prevent the disease?

 

Tue, Mar 28 8:00am · Next generation sequencing – a game changer

Article by Sharon Rosen

Imagine scanning a page for errors manually one letter at a time, versus using a faster tool like spell check. That’s the difference between the first DNA sequencing methods and the new computerized machines known as next generation sequencing. It’s revolutionizing health care.

Next generation sequencing technology enables geneticists to examine all of your 22,000 genes at once. So finding a change in a gene, called a genetic variation, which causes a patient’s disease, can be done much faster and cheaper. In contrast, older sequencing methods only focus on one or a few genes at a time.

Dr. Matthew Ferber

“This new technology is constantly evolving. It’s becoming faster and cheaper so more patients can benefit from individualized care. It used to take us months or even years to identify genetic causes of disease, Now we can get results back in a matter of weeks,” says Matthew Ferber, Ph.D., director, Clinical Genome Sequencing Laboratory in the Department of Laboratory Medicine and Pathology  and  one of the founding members of the Rare and Undiagnosed Disease Service for the Mayo Clinic Center for Individualized Medicine.

This new technology has transformed care for patients with many conditions.

Dr. Pavel Pichurin

“There are many genetic conditions where the diagnosis can be suspected based on clinical grounds and confirmed by a single gene analysis or other conventional tests. But when it comes to complicated cases with multiple issues, it becomes tedious, labor intensive and prohibitively expensive to establish a correct diagnosis by conventional testing. In these cases, next generation sequencing technology has become a game changer. In addition to significantly decreasing cost and time of testing, it also empowers clinicians with different diagnostic choices, from a specific group of disorders and custom panels to whole exome sequencing, that ultimately improves patient care,” says Pavel Pichurin, M.D., assistant professor of Medical Genetics at Mayo Clinic.

Finding answers for patients with undiagnosed genetic diseases

One of the areas where next generation sequencing has made the biggest impact is in the diagnosis of rare genetic diseases.

“Many patients, who are often children with very complex symptoms, and their families, will spend years searching for a diagnosis. These families spend tens of thousands of dollars on traditional tests that do not provide answers. Using whole exome sequencing, a form of next generation sequencing that enables us to look at all 22,000 genes in the human genome, we can make a diagnosis for 30 percent of these patients,” says Dr. Ferber. “While we cannot cure most rare genetic diseases, we can provide patients with information for future family planning and advice on how to better manage and monitor their symptoms.”

Providing a focused tool to identify disease

Next generation sequencing also offers the opportunity to examine a select group of genes, called targeted panel testing. This type of testing is used to diagnose and develop individualized treatments for many conditions, including:

  • Neurological diseases
  • Heart disease
  • Many types of cancer

Dr. Ferber highlights the impact of targeted panel genetic testing by explaining how it is used to diagnose hereditary colorectal cancer.

“In 2012, we developed a targeted panel to examine 17 genes associated with hereditary colorectal cancer. Next generation sequencing technology enabled us to look at all 17 genes at the same time and find the genetic variant causing the disease faster. This is important for cancer families whose survival may depend upon prophylactic surgery, or heightened surveillance,” says Dr. Ferber.

Results from targeted panel testing can guide care not only for the patient but their family members as well:

  • Physicians may be able to identify a genetic variant for which there is a targeted therapy.
  • Family members of patients with inherited cancers can be tested to identify others at risk for developing the disease.
  • Family members, who discover they have the same gene mutation but have not developed the disease, may choose pre-emptive screening, treatment or surgery.

Dr. Ferber explains that there are still cases where the older DNA sequencing methods, which look at one gene at a time, can be useful. In cases where physicians are fairly certain that a specific gene may be causing a disorder, single gene testing is still the best tool. At a cost of approximately $1,500, single gene test results are provided to patients within a week.

Choosing the right test for each patient

According to Dr. Ferber, the key to the successful use of genetic testing is to pick the right test for each patient.

“If you are a patient who may need genetic testing to diagnose your condition, talk with your physician and a genetics team that includes a genetic counselor or medical geneticist. At Mayo, we have a multidisciplinary clinical genomics team that ensures that the right genetic test method is selected for each patient and the test results are interpreted accurately,” says Dr. Ferber.

Thu, Mar 23 8:00am · This diet’s for you: personalized nutrition to improve your health

Article by Sharon Rosen

Dr. Heidi Nelson

Dr. Heidi Nelson

You may use the phrase “gut reaction” to describe what your instincts tell you about a particular situation. But it turns out that your gut offers much more than an emotional reaction – it processes food you eat in a way that is unique to you. For example, some people may feel energized and lose weight from eating a high protein and low carbohydrate diet, while others might not get the same benefit from eating the same foods. This occurs because each of us has a unique community of bacteria inside our digestive system, known as the gut microbiome. As a result, we each process the foods we eat differently.

Researchers at Mayo Clinic Center for Individualized Medicine are exploring ways to analyze a person’s gut microbiome and then design a diet to maintain a person’s health and avoid the development of disease.

“We have long wondered why one diet works for one person, but not another. Now, we are beginning to understand that how a person processes food depends upon that individual’s gut microbiome, immune system and the community of bacteria in the gut. This is where the concept of designing individualized diets was developed. Given these multiple factors, we are exploring ways to develop customized diets that will maintain wellness and prevent the development of disease,” explains Heidi Nelson, M.D., director of the Mayo Clinic Center for Individualized Medicine Microbiome Program.

As part of the effort to explore ways individualized diets can be used to improve health, Mayo Clinic is working with DayTwo Inc. to explore the use of microbiome data to advance individualized diet and wellness for patients.

Researchers at DayTwo Inc. completed a study examining the impact of changes in diet on blood glucose levels, which show the level of sugar in the blood. Investigators developed a mathematical model to predict how people’s glucose level would change after eating a variety of foods. Based on that model, they were able to create customized diets appropriate for each person and control glucose levels. Researchers also provided participants with suggested meals, including their top five breakfasts, lunches and dinners, as well as appropriate snacks to maintain their health.

“Glucose levels are abnormally high in patients with diabetes. If we can understand what causes high glucose levels, we may be able to prevent patients from developing prediabetes and type II diabetes. Often traditional interventions to control glucose levels have limited benefit for patients. These study results highlight the important role that personalized diets can play in maintaining better control over blood glucose levels and overall health,” says Dr. Nelson.

Mayo Clinic researchers are working to validate DayTwo’s study at the Weizmann Institute of Science by examining the impact of diet on controlling blood glucose levels. Mayo investigators are also studying the microbiome and different responses to diets in the treatment of obesity, with the plan to develop customized diets for people to someday prevent and/or treat obesity and reduce obesity-related health issues.

Mayo Clinic has a financial interest in DayTwo and will participate in DayTwo’s Series A funding round. Any revenue received will be reinvested in patient care research at Mayo Clinic.

Learn more about the microbiome

 

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