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Mount Sinai Lands $3.7M for Genomic Medicine Project in Kidney Disease

NEW YORK (GenomeWeb News) – Researchers at the Icahn School of Medicine at Mount Sinai will use a $3.7 million grant from the National Human Genome Research Institute to try to find out if the use of genomic information and electronic medical records can improve treatment of kidney disease patients who are of African ancestry.

Specifically, they aim to find out if incorporating knowledge about APOL1 status — which according to research has a strong impact on risk for kidney disease if a patient has high blood pressure — into treatment at the point-of-care can improve patient outcomes, Mount Sinai said today.

The investigators will partner with the Institute for Family Health, which runs a network of community health centers in New York City, to conduct a cluster-randomized controlled clinical trial across 12 primary care centers.

Healthcare providers at these centers will use a Mount Sinai program called Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomic Program, or CLIPMERGE, to support decisions they make about testing, and to monitor their patients based on APOL1 status.

The partners hope to find out if patients at primary care facilities participating in this initiative where the genomic information is used have different outcomes than in facilities where it is not.

"We hope to screen patients, identify those with increased genetic risk and work with them to prevent kidney disease," Neil Calman, president and CEO of the Institute for Family Health and Chair of Family Medicine and Community Health at Mount Sinai, said in a statement. "We will also train community-based primary care providers in how to discuss genetic risk with patients and their families and how to use genetic-based information in the electronic health record."

"We believe that with genomic information made available to doctors through a patient's electronic health record, we will be able to achieve better and stricter control of blood pressure and targeted use of medications that inhibit the renin angiotensin system, which are recommended in hypertensive patients at risk for kidney disease. More comprehensive tracking will also help ensure that optimal tests will be performed to stop progression of kidney disease," added Erwin Bottinger, director of Mount Sinai's Charles Bronfman Institute for Personalized Medicine and a principal investigator on the grant.

The investigators said that hypertension-associated chronic kidney disease (CKD) in African ancestry groups would make a strong model for this exercise in clinical genomics because people in those populations with hypertension have a two to three times higher risk of developing CKD, and a five-fold risk of progressing to end-stage renal disease. Nearly all of that excess risk may be linked to the APOL1 locus on chromosome 22, they speculated.

The investigators also aim to learn about attitudes on testing for APOL1 status and the return of test results and related clinical care, and to develop evidence-based advice for primary care providers using renal care practice guidelines with or without genomic risk information.

In the long-term, this project may result in new ways to disseminate genomic medicine in diverse clinical settings and for an underserved population that suffers from an excessive burden of chronic kidney diseases, the researchers said.