Post by Amy Sturm, Human Genetics, The Ohio State University’s Center for Personalized Health Care
Ohio State Medical Center genetic counselors Amy Sturm and Kevin Sweet and medical geneticist Kandamurugu Manickam, MD, along with Center for Personalized Health Care(CPHC) staff members, are currently working on the development of a new Virtual Genomics Clinic, which will offer genomic counseling through telemedicine vehicles. This genomic counseling service will focus on wellness and keeping healthy individuals from developing disease. The virtual clinic will also provide genetic counseling services for a wide array of single-gene disorders and common, complex diseases. This comprehensive risk assessment will include medical history, family history, behavioral and environmental risk factor analyses, as well as genetic testing services when applicable. Those individuals interested in participating may also pursue different types of genomic testing services.
An especially important area of P4 Medicine is pharmacogenomics, or the study of genetic variants that influence a person’s response to certain drugs. The metabolism of many different drugs is influenced by one’s genetic background. Among the most common are the Cytochrome P450 (CYP) genes, which encode enzymes that control the metabolism of more than 70 percent of prescription drugs. People who carry variations in certain CYP genes often do not metabolize drugs normally, and this can influence response in many ways. Knowing whether a person carries any of these genetic variations can help the healthcare team individualize drug therapy, decrease the number of adverse drug reactions, and increase the effectiveness of drugs.
Members of CPHC are collaborating on a new project with Wolfgang Sadee, PhD, chair of pharmacology at Ohio State, and Peter Embi, MD, MA, associate professor of biomedical informatics at Ohio State, to facilitate the use of genetic variant analysis to determine a patient’s response to certain prescription drugs, and to have this information available in the Ohio State Medical Center electronic medical record (IHIS). The initial focus will target a genetic variant known as CYP2C19 that influences how patients respond to the drug clopidogrel (Plavix). Plavix is a platelet inhibitor used in the treatment and prevention of a number of cardiovascular diseases. Plavix must be metabolized into its active form by the cytochrome P450 enzyme, CYP2C19, and certain genetic variants can alter a patients’ response. Some people are slow metabolizers, leading to an increased risk for heart attack. Having this test available, and the use of advisory flags in IHIS to readily alert the healthcare team for when the drug is prescribed will lead to more effective treatments and safer applications.
Medical geneticist Kandamurugu Manickam, MD and genetic counselors Kevin Sweet and Amy Sturm are leading the clinical implementation of pharmacogenomics at Ohio State.