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Science, Policy, and Ethics in Personalized Medicine

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What are "Omics" Technologies?

I want to get back to considering some ideas to build infrastructure, but I need to take one other detour first. I've used the terms "high-thoughput" and "omics" quite a bit, but what, exactly do they mean? Simply, high-throughput refers to just that, a technology in which a large (or even exhaustive) number of measurements that can be taken in a fairly short time period. "Ome" and "omics" are suffixes that are derived from genome (the whole collection of a person's DNA, as coined by Hans Winkler, as a combinaion of "gene" and "chromosome"1) and genomics (the study of the genome). Scientists like to append to these to any large-scale system (or really, just about anything complex), such as the collection of proteins in a cell or tissue (the proteome), the collection of metabolites (the metabolome), and the collection of RNA that's been transcribed from genes (the transcriptome). High-throughput analysis is essential considering data at the "omic" level, that is to say considering all DNA sequences, gene expression levels, or proteins at once (or, to be slightly more precise, a significant subset of them). Without the ability to rapidly and accurately measure tens and hundreds of thousands of data points in a short period of time, there is no way to perform analyses at this level.

There are four major types of high-throughput measurements that are commonly performed: genomic SNP analysis (i.e., the large-scale genotyping of single nucleotide polymorphisms), transcriptomic measurements (i.e., the measurement of all gene expression values in a cell or tissue type simultaneously), proteomic measurements (i.e., the identification of all proteins present in a cell or tissue type), and metabolomic measurements (i.e., the identification and quantification of all metabolites present in a cell or tissue type). Each of these four is distinct and offers a different perspective on the processes underlying disease initiation and progression as well as on ways of predicting, preventing, or treating disease.

Genomic SNP genotyping measures a person's genotypes for several hundred thousand single nucleotide polymorphisms spread throughout the genome. Other assays exists to genotype ten thousand or so polymorphic sites that are near known genes (under the assumption that these are more likely to have some effect on these genes). The genotyping technology is quite accurate, but the SNPs themselves offer only limited information. These SNPs tend to be quite common (with typically at least 5% of the population having at least one copy of the less frequent allele), and not strictly causal of the disease. Rather, SNPs can act in unison with other SNPs and with environmental variables to increase or decrease a person's risk of a disease. This makes identifying important SNPs difficult; the variation in a trait that can be accounted for by a single SNP is fairly small relative to the total variation in the trait. Even so, because genotypes remain constant (barring mutations to individual cells) throughout life, SNPs are potentially among the most useful measurements for predicting risk.

Transcriptomic measurements (often referred to as gene expression microarrays or "gene chips" are the oldest and most established of the high-throughput methodologies. The most common are commercially produced "oligonucleotide arrays", which have hundreds of thousands of small (25 bases) probes, between 11 and 20 per gene. RNA that has been extracted from cells is then hybridized to the chip, and the expression level of ~30,000 different mRNAs can be assessed simultaneously. More so than SNP genotypes, there is the potential for a significant amount of noise in transcriptomic measurements. The source of the RNA, the preparation and purification methods, and variations in the hybridization and scanning process can lead to differences in expression levels; statistical methods to normalize, quantify, and analyze these measures has been one of the hottest areas of research in the last five years. Gene expression levels influence traits more directly than than SNPs, and so significant associations are easier to detect. While transcriptomic measures are not as useful for pre-disease prediction (because a person's gene expression levels very far in advance of disease initiation are not likely to be informative because they have the potential to change so significantly), they are very well-suited for either early identification of a disease (i.e., finding people who have gene expression levels characteristic of a disease but who have not yet manifested other symptoms) or classifying patients with a disease into subgroups (by identifying gene expression levels that are associated with either better or worse outcomes or with higher or lower values of some disease phenotype).

Proteomics is similar in character to transcriptomics. The most significant difference is in regards to the measurements. Unlike transcriptomics, where the gene expression levels are assessed simultaneously, protein identification is done in a rapid serial fashion. After a sample has been prepared, the proteins are separated using chromatography, 2 dimensional protein gels (which separate proteins based on charge and then size) or 1 dimensional protein gels (which separate based on size alone), and digested, typically with trypsin (which cuts proteins after each arginine and lysine), and then run through mass spectroscopy. The mass spec identifies the size of each of the peptides, and the proteins can be identified by comparing the size of the peptides created with the theoretical digests of all know proteins in a database. This searching is the key to the technology, and a number of algorithms both commercial and open-source have been created for this. Unlike transcriptomic measures, the overall quantity of a protein cannot be assessed, just its presence or absence. Like transcriptomic measures, though, proteomic measures are excellent for early identification of disease or classifying people into subgroups.

Last up is metabolomics, the high-throughput measure of the metabolites present in a cell or tissue. As with proteomics, the metabolites are measured in a very fast serial process. NMR is typically used to both identify and quantify metabolites. This technology is newer and less frequently used than the other technologies, but similar caveats apply. Measurements of metabolites are dynamic as are gene expression levels and proteins, and so are best suited for either early disease detection or disease subclass identification.

These are obviously fore-shortened descriptions of each of these technologies, but a passing familiarity with the state of technology is really important to understanding what personalized medicine can and can't accomplish and what the best strategies are. By understanding what current technologies can accurately measure and what that in turn can tell us, we can make informed choices about where to focus time, money, and effort developing tools and encouraging infrastructure growth.

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Reagan Kelly is a PhD student at University of Michigan studying bioinformatics. His thesis is focused on risk prediction algorithms for personalized medicine systems, and he is also interested in the policy and societal implications of individualized healthcare.You can read his CV for more information about him. If you would like to contact him, please send an email to reagank -at- reagank.com

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