Aspectos éticos y recomendaciones para investigación en seres humanos en la era genómica / Ethical aspects and recommendations for human research in the genomic age

Este artículo revisa los principales desafíos éticos que plantea la investigación vinculada al genoma humano a la luz de la bibliografía internacional y entrega recomendaciones sobre su abordaje basada en nuestra experiencia en el Comité de Ética para la Investigación en Seres Humanos de la Facultad de Medicina, Universidad de Chile, incluyendo las regulaciones legales nacionales. Los estándares éticos de la investigación en seres humanos deben extremarse para proteger adecuadamente a los participantes en estudios involucrados con la genómica. Especialmente relevantes en este contexto son: la protección de la confidencialidad y anonimato; la política de entrega de resultados y la posibilidad de retirarse del estudio. Compartir datos resultantes de investigaciones genéticas permite optimizar recursos, otorga mayor transparencia y replicabilidad de los análisis y permite descubrir alteraciones genéticas responsables de enfermedades raras y genes involucrados en enfermedades hereditarias multifactoriales, además de contribuir al diseño de medicina de precisión y de nuevas estrategias terapéuticas. Sin embargo, plantea grandes desafíos: proteger la privacidad y evitar la re-identificación de los voluntarios, la entrega de resultados con asesoría pre y post estudio. Estos aspectos requieren la elaboración de un cuidadoso proceso de consentimiento informado para investigaciones genómicas cuyos componentes principales se analizan en este artículo.

This article reviews the main ethical challenges posed by human genome research in the light of the international literature and provides recommendations on how to approach them based on our experience in the Ethics Committee for Research on Human Subjects of the Faculty of Medicine, University of Chile, including national legal regulations. Ethical standards in human research must be extreme, in order to adequately protect participants in studies involving genomics. Particularly relevant in this context are the protection of confidentiality and anonymity; the policy of delivery of results and the possibility of withdrawing from the study. Sharing data resulting from genetic research optimizes resources, provides greater transparency, and replicability of the analyses and makes it possible to discover genetic alterations responsible for rare diseases and genes involved in multi-factorial hereditary diseases, as well as contributing to the design of precision medicine and new therapeutic strategies. However, it poses great challenges: protecting privacy and avoiding re-identification of volunteers, delivery of results with pre- and post-study counseling. These aspects require the elaboration of a careful informed consent process for genomic research, the main components of which are discussed in this article.

Genetic research progress in branchio-oto syndrome/ branchio-oto-renal syndrome / 中南大学学报(医学版)

Branchio-oto syndrome (BOS)/branchio-oto-renal syndrome (BORS) is a kind of autosomal dominant heterogeneous disorder. These diseases are mainly characterized by hearing impairment and abnormal phenotype of ears, accompanied by renal malformation and branchial cleft anomalies including cyst or fistula, with an incidence of 1/40 000 in human population. Otic anormalies are one of the most obvious clinical manifestations of BOS/BORS, including deformities of external, middle, inner ears and hearing loss with conductive, sensorineural or mix, ranging from mild to profound loss. Temporal bone imaging could assist in the diagnosis of middle ear and inner ear malformations for clinicians. Multiple methods including direct sequencing combined with next generation sequencing (NGS), multiplex ligation-dependent probe amplification (MLPA), or array-based comparative genomic hybridization (aCGH) can effectively screen and identify pathogenic genes and/or variation types of BOS/BORS. About 40% of patients with BOS/BORS carry aberrations of EYA1 gene which is the most important cause of BOS/BORS. A total of 240 kinds of pathogenic variations of EYA1 have been reported in different populations so far, including frameshift, nonsense, missense, aberrant splicing, deletion and complex rearrangements. Human Endogenous Retroviral sequences (HERVs) may play an important role in mediating EYA1 chromosomal fragment deletion mutations caused by non-allelic homologous recombination. EYA1 encodes a phosphatase-transactivator cooperated with transcription factors of SIX1, participates in cranial sensory neurogenesis and development of branchial arch-derived organs, then regulates the morphological and functional differentiation of the outer ear, middle ear and inner ear toward normal tissues. In addition, pathogenic mutations of SIX1 and SIX5 genes can also cause BOS/BORS. Variations of these genes mentioned above may cause disease by destroying the bindings between SIX1-EYA1, SIX5-EYA1 or SIX1-DNA. However, the role of SIX5 gene in the pathogenesis of BORS needs further verification.

Advances in genetic research on autism spectrum disorders / 中华医学遗传学杂志

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders. Patients usually exhibit certain degree of social interaction impairment in accompany with impairment in language development as well as repetitive behaviors or interests. In recent years, ASD-related variants, genes, functional pathways, and expression patterns in the brain have been discovered, along with advance in sequencing techniques. This article reviews various aspects of genetic research in association with ASD.

Global publication trends in ophthalmic genetics and gene therapy research: A Scientometric analysis / Tendências globais de publicação de pesquisas sobre genética oftálmica e terapia genética: uma análise cientométrica

ABSTRACT Objective: A scientometric analysis produced in ophthalmic genetics and gene therapy research is lacking. The purpose of this study is to present a holistic analysis of ophthalmic genetics literature. Methods: The data used in this study were obtained from the Web of Science (WoS) Core Collection. All published documents between 1975-2019 were included. The data exported from WoS enabled the extensive details of ophthalmic genetics related literature including countries, institutions, authors, citations and keywords. Scientometric network maps of keywords and also country and institution co-authorships were created with free software. Global contributions of the countries to the ophthalmic genetics literature were shown by a graphic. Results: The search query revealed a total of 2322 documents. Most of the documents were original articles (75.75%). USA was the leading country by producing 45.39% of all documents in ophthalmic genetics research followed by UK, Germany, China and France. Pennsylvania University was the most contributing institution in the literature (5.25%) followed by University College London and Moorfields Eye Hospital. The average citations per item was 29.4. The most used keywords over a 40-year period were 'family', 'cell', 'photoreceptor' and 'expression'. Conclusions: USA and UK dominated the ophthalmic genetics research. A substantial increase in the number of published documents in this field were observed after 2010.

RESUMO Objetivo: A literatura carece de análise cienciométrica produzida em genética oftálmica e de pesquisa em terapia genética. O objetivo deste estudo é apresentar uma análise holística da literatura genética oftálmica. Métodos: Os dados utilizados neste estudo foram obtidos na base de dados Web of Science (WoS) Core Collection. Todos os documentos publicados entre 1975 e 2019 foram incluídos na análise. Os dados exportados da WoS viabilizaram acesso a amplos detalhes da literatura relacionada à genética oftálmica, incluindo países, instituições, autores, citações e palavras-chave. Mapas de rede cienciométrica foram criados por meio de software gratuito, com base em palavras-chave e em coautorias de países e instituições. As contribuições globais dos países para a literatura sobre genética oftálmica foram apresentadas em gráfico. Resultados: a busca por pesquisas revelou um total de 2.322 documentos cuja maioria eram artigos originais (75,75%). Os EUA foram o país que mais produziu artigos sobre o tema, com 45,39% de todos os documentos em pesquisa genética oftálmica; ele foi seguido pelo Reino Unido, Alemanha, China e França. A Universidade da Pensilvânia foi a instituição que mais contribuiu para a literatura (5,25%), e foi seguida pela University College London e pelo Moorfields Eye Hospital. A média de citações por item foi de 29,4. As palavras-chave mais usadas em um período de 40 anos foram 'família', 'célula', 'fotorreceptor' e 'expressão'. Conclusões: Os EUA e o Reino Unido dominaram a pesquisa em genética oftálmica. Após 2010, observou-se um aumento substancial no número de documentos publicados nessa área.

Progress in genetic research on tooth agenesis associated with Wnt/beta-catenin signaling pathway / 中华医学遗传学杂志

Tooth agenesis is the most common form of congenital craniofacial dysplasia seen in stomatology clinics, which may be caused by genetic and/or environmental factors. Tooth development is regulated by a series of signaling pathways, and variants in any of these strictly balanced signaling cascades can result in tooth agenesis and/or other oral defects. Notably, variants of genes of the Wnt/beta-catenin signaling pathway are important cause for both non-syndromic and syndromic tooth agenesis. This article has provided a review for the molecular genetics of tooth agenesis associated with Wnt/beta-catenin signaling pathway, which may shed lights on the etiology and molecular mechanism of this disease.

Desafíos éticos en investigación genómica y biotecnología. Veinte años de Acta Bioethica / Ethical challenges present in genomic research and biotechnology. Twenty years of Acta Bioethica / Desafios éticos na pesquisa genômica e biotecnológica. Vinte anos de Acta Bioethica

Resumen El presente artículo es una revisión de las reflexiones éticas sobre temas de genética y manipulación genética que se han publicado en 20 años de Acta Bioethica. Se identifican los siguientes temas relevantes en el diálogo bioético: evaluación de riesgos, inequidad, pérdida de la biodiversidad, eugenesia, definir los límites entre natural y artificial, diálogo entre detractores y promotores de la biotecnología, desafíos en el cuidado de la salud, manejo de la información y confidencialidad. Se concluye que la bioética puede actuar como intermediaria entre los diversos interlocutores ante los problemas que se suscitan al aplicar la tecnología a la vida, permitiendo reconocer y llegar a consensos para enfrentar con responsabilidad las diferencias en temas de equidad, autonomía y el balance entre riesgos y beneficios. Las reflexiones en Acta Bioethica sobre genómica son similares a las de otras revistas, solo que el énfasis es en la región latinoamericana. En veinte años de reflexión, los desafíos siguen siendo los mismos, aunque el énfasis está cambiando de la prevención y rechazo en cuanto a los riesgos de la modificación genética, a la regulación de la tecnología de ingeniería genética, que va perfeccionándose cada vez más. En cuanto a los beneficios, la medicina genómica siempre ha generado más expectativas que realidades, sin lograr demostrar eficacia en ensayos clínicos. Con las nuevas técnicas de edición genómica, se amplían aún más las expectativas de mejores intervenciones, pero aumenta la preocupación de que se realicen modificaciones genéticas sin finalidad terapéutica, afectando al equilibrio social y ecológico.

Abstract This article reviews ethical reflections about genetic research and genetic manipulation published in 20 years of Acta Bioethica. The following relevant topics are identified in bioethics dialogue: risks evaluation, inequity, loss of biodiversity, eugenics, definition of limits between artificial and natural, dialogue between detractors and promoters of biotechnology, challenges in health care, information and confidentiality management. Reflections consider that bioethics can act as mediator among diverse stakeholders affronting the problems that arise when applying technology to life, allowing to recognize and to reach consensus for solving differences in equity, autonomy and the balance of risks and benefices. The reflections in Acta Bioethica are similar to those of other journals, but with emphasis in the Latin American region. In twenty years of reflection, the challenges are similar, but the emphasis is changing from preventing to the avoidance of actual risks of genetic modifications, which demands regulation of genetic engineering, taking into account that it is more effective than before. Among the benefits, genomic medicine has always generated more expectations than actual therapy with problems in demonstrating efficacy in clinical trials. With the new technique of genomic edition, there are even more expectations for enhancing therapeutic approaches, but worries increase about using genetic modifications without therapeutic aim and interventions that affect the social and ecological equilibrium.

Resumo O presente artigo é uma revisão das reflexões éticas sobre temas de genética e manipulação genética que foram publicadas em 20 anos de Acta Bioethica. Os seguintes temas de importância para o diálogo bioético foram identificados: avaliação de riscos, inequidade, perda da biodiversidade, eugenia, definir os limites entre natural e artificial, diálogo entre opositores e defensores da biotecnologia, desafios em cuidados à saúde, manejo da informação e confidencialidade. Concluiu-se que a bioética pode atuar como intermediaria entre os diversos interlocutores ante os problemas que aparecem ao aplicar a tecnologia à vida, permitindo reconhecer e alcançar consensos para enfrentar com responsabilidade as diferenças em temas de equidade e autonomia, e o equilíbrio entre riscos e benefícios. As reflexões na Acta Bioethica sobre genômica são similares às de outras revistas, mas com ênfase na região latino-americana. Em vinte anos de reflexão, os desafios seguem sendo os mesmos, ainda que a ênfase esteja mudando da prevenção e repúdio quanto aos riscos da modificação genética, à regulação da tecnologia de engenharia genética, que se aperfeiçoa cada vez mais. Quanto aos benefícios, a medicina genômica sempre gerou mais expectativas que realidades, sem conseguir demonstrar eficácia em ensaios clínicos. Com as novas técnicas de edição genômica, ampliam-se ainda mais as expectativas de melhores intervenções, mas aumenta a preocupação de que se realizem modificações genéticas sem finalidade terapêutica, afetando o equilíbrio social e ecológico.

Modelo médico hegemónico: tendencias posibles y tendencias más o menos imaginarias / Hegemonic medical model: Possible trends, and more or less imaginary trends

RESUMEN El objetivo de este texto es analizar la posibilidad futura de que el modelo médico hegemónico siga perpetuándose o se generen cambios significativos. Para ello, se parte de las características y funciones actuales del modelo médico hegemónico y se las observa a través de algunos de los aportes de la inteligencia artificial, de las investigaciones genéticas y de la robótica, referidas a procesos de salud-enfermedad-atención-prevención, entre los que se analizan las posibilidades de fuertes incrementos en la esperanza de vida, las necesidades de "curar la senectud", así como los procesos que están modificando la relación médico-paciente, llegando a la conclusión de que si bien se observan algunas modificaciones sustantivas, las características y funciones del modelo médico hegemónico siguen siendo las mismas.

ABSTRACT The purpose of this article is to analyze the possibilities that the hegemonic medical model will continue to prevail in the future or if significant changes will take place. The discussion will take as a starting point the characteristics and current functions of the hegemonic medical model, and reexamine them through a look at advancements in artificial intelligence, genetic research, and robotics in health-illness-care-prevention processes. The analysis takes on issues such as possible increases in life expectancy, what is needed to "cure old age," as well as processes that are modifying the doctor-patient relationship. It is concluded that although significant changes are taking place, the characteristics and functions of the hegemonic medical model remain unmoved.

Implicaciones éticas de la identificación del potencial atlético infantil mediante pruebas genéticas / Ethical implications of the identification of children´s athletic potential through genetic testing

Introducción: La irrupción de la investigación genética en la esfera del deporte ha permitido la localización en el genoma de un considerable número de genes implicados en el rendimiento deportivo y, con ello, el desarrollo de tecnologías genéticas orientadas a la identificación del potencial atlético en niños, cuya aplicación, dada su relativa juventud, debe ser sometida al escrutinio de la comunidad científica desde el prisma de la ética. Objetivo: Evaluar, desde una perspectiva ética, el uso de tecnologías genéticas en la identificación del potencial atlético en niños. Material y métodos: Para la elaboración de la presente revisión, además de la consulta de publicaciones no seriadas, se efectuó una pesquisa en la base de datos Scopus. Resultados: En la actualidad se conocen más de 200 marcadores genéticos relacionados con la predisposición para la aptitud física y al menos 120 vinculados directamente con el rendimiento atlético de élite, información que ha sido utilizada por numerosas compañías para desarrollar los llamados Tests Directos al Consumidor, que pretenden identificar el potencial atlético en niños a partir de su genotipo, sin necesidad de consultar a un especialista. Conclusiones: El uso de tecnologías genéticas en la determinación del potencial atlético en niños no solo viola el espíritu del deporte, sino que también tiene el potencial de causar efectos nocivos en el individuo a nivel psicológico y social; razones por las que es éticamente inadmisible su uso en futuros atletas(AU)

Introduction: The emergence of genetic research in the field of sports has allowed the location of the genome of a considerable number of genes involved in sports performance and thus, the development of genetic technologies aimed at the identification of the athletic potential in children whose application, given its relative youth, should be subject to the review of the scientific community through the prism of ethics. Objective: To evaluate, from an ethical perspective, the use of genetic technologies in the identification of the athletic potential in children. Materials and methods: A search in Scopus database and the consultation of non-serial publications were carried out for the development of this review. Results: Currently, there are more than 200 genetic markers related to the predisposition for physical fitness and, at least, 120 of them are directly linked to elite athletic performance. This information has been used by many companies to develop the so-called Direct-to-Consumer Tests, which aim to identify the athletic potential in children from their genotype, without any need to consult a specialist. Conclusions: The use of genetic technologies in the determination of athletic potential in children not only violates the spirit of sport, but also has the potential to cause harmful effects on the individual at psychological and social levels, reasons why their use is ethically inadmissible in future athletes(AU)

Progress of clinical and genetic research on distal hereditary motor neuropathy / 中华医学遗传学杂志

Distal hereditary motor neuropathy (dHMN) is a group of clinically and genetically heterogeneous disorders characterized by progressive distal weakness and atrophy. The onset of dHMN is at mid-adulthood or early childhood, and the symptoms are mainly present in the lower limbs. Besides weakness and atrophy of distal limb muscles, some patients may develop bulbar paralysis, and some may also present with mild sensory disturbance. Decreased or absent tendon reflexes may be discovered. Electromyography may show neurogenic damages. Muscular biopsy may reveal neurogenic amyotrophy. An increasing number of genes have been associated with dHMN. Pathogenesis of dHMN may include formation of protein aggregates, impairment of autophagy pathway, RNA processing, translation synthesis, axonal transport, endoplasmic reticulum stress, calcium channel and neuroprotection. A review for recent progress made on clinical characterization and molecular genetics of dHMN is provided.

Progress in genetic research on familiar aneurysms / 中南大学学报(医学版)

The subarachnoid hemorrhage (SAH) caused by ruptured intracranial aneurysms (IAs) is always a lethality. Increasing evidence suggests a familiar aggregation of IA occurrence, which may relate to genetics and there might be an increasing number of IAs in IA families when mutation of disease genes is aggregating. With the progress in the study of familiar intracranial aneurysms (FIAs), a large number of chromosome fragments are found to be related with IAs, such as 1p36, 5q31, 7q11, 14q22, 17cen, 19q13, Xp22. Further studies indicated that mutation of several genes could be the cause of FIAs, including TNFRSF13B, ANRIL, SOX17, ADAMTS15, RNF213 and LOXL2. The independent genetic epidemiologic study on aneurysm families can be used to discover the related genes more effectively, and to explore the mechanism of occurrence of IAs. It's also the precondition for the prevention of disease.