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Web-Based Learning Tool DNATwist Shows It's Never Too Early to Start PGx Education

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By Turna Ray

A pilot study that used a tailored web-based tool to teach middle- and high-school kids about the science of genetically tailored therapies has concluded that students are interested in learning about pharmacogenomics topics that speak to their areas of interest.

In the April issue of Clinical Pharmacology & Therapeutics, a team led by Stanford University researchers describes the use of DNATwist — a web-based educational tool that teaches about pharmacogenomics topics — in two groups of advanced placement biology students in California. Researchers concluded after testing students on the material presented through the program that they found the tool and topic "understandable and engaging."

With direct-to-consumer SNP scans available for around $400, the need for genetics education will grow exponentially in the coming years, according to the paper's authors. Furthermore, the current dearth of genetic counselors and physicians' lack of pharmacogenomics expertise has made it ever more critical to introduce the scientific concepts around genetics, as well as the social and ethical questions around genetic testing, to students early in their education.

DNATwist is one of the first attempts to begin to introduce pharmacogenomics to teenagers in a school setting. Due to the positive response from students to the material presented in the pilot study, DNATwist is being adapted for the Understanding Genetics website at the Tech Museum of Innovation, in San Jose, Ca., which receives 60,000 unique visitors per year. As such, the "DNA Twist Tech Museum Adaptation has the potential to reach a very large audience," the researchers noted.

By focusing on gene-drug responses of interest to teenagers, such as alcohol dependence, DNATwist covers several basic "big ideas" in pharmacogneomics through a graphical interface.

First, the program teaches that genetic differences can cause obvious variations, such as eye color, but genes can also interact with environment to impact how people metabolize drugs. Then, the program takes students through "knowledge portals," entitled the "Chromosome Cruiser," "Pathway Portal," and "Gene World," to help them understand concepts such as how genes interact with other molecules and population differences in gene variants.

The pilot study focused on the genetic underpinnings of alcohol dependence, as opposed to prescription drugs, because the decision to drink or not drink is one that kids often face socially in junior and high school.

"High school kids are often dealing with whether they want to experiment with alcohol, so we thought that it would be a good one to help them understand some of the [genetic processes] involved," Russ Altman, director of the biomedical informatics training program at Stanford University and an author of the paper, told Pharmacogenomics Reporter this week.

While the design elements in DNATwist can be reused for other gene-response topics, for the pilot the program explains the role of an aldehyde dehydrogenase 2 variant, or ALDH2*2, in impairing people's ability to tolerate alcohol.

The program then goes through how the variant has a population-specific distribution; discusses how carriers of one or two copies of the loss-of-function ALDH2*2 allele are alcohol intolerant because they cannot convert acetaldehyde into acetate; and shows graphically how the DNA sequences of ALDH2*2 and ALDH2*1 differ at only one nucleotide, "resulting in a single amino acid substitution in the protein."

After learning this material, students were given a test in two groups: one of 19 students and another of 22 students. The evaluation showed that 90 percent of the students found the scientific content "comprehensible." The average score on a test given on the material was 80 percent.

Additionally, all 19 students indicated they wanted to learn about more pharmacogenomics topics. When potential topics were suggested for the future, 48 percent said they had "high interest" in learning about the genetics of nicotine addiction, 54 percent said they want to learn about adverse reactions experienced by HIV patients with a certain gene variant; and 63 percent indicated they wanted to know about gene variants that affect people's response to pain medication.

DNATwist evolved out of the researchers' work on the Pharmacogenomics Knowledge Base. The software used in DNATwist is a simplified version of various online tools and databases used by genomic researchers, such as the University of California Santa Cruz Genome Browser, the National Center for Biotechnology's Information Map Viewer, and the Allele Frequency Database.

Since DNATwist has a basic graphical interface, navigation, and pedagogical structure, it can be populated with other pharmacogenomics instances at low cost, according to the researchers.

"The idea was to use prototypical graphics that you could just swap out for other stories," Altman said. "This would decrease our development cost for adding a new type of drug or medication.

"In addition, it helps students understand that there is a certain template way to think about this," he explained. "So, they know that although the focus may be on alcohol intolerance, the same ideas can be used for depression. And they start to have a model in their head for how you think about genetics."

This pilot study was funded by the Stanford Initiative on Improving K–12 Education and by a Pharmacogenetics Research Network and Database grant from the National Institute for General Medical Sciences. According to Altman, the team would need more funding to expand the tool to cover other topics.

Furthermore, incorporation of DNATwist into formal school curricula would require educators to get on board, as well as approval by state boards of education. "The way to get in there is to win the hearts and minds of the teachers, who really get excited about the material and become convinced that it's important," Altman said.

"Hopefully, teachers can act as internal advocates for putting genetics not all in the science curriculum but also in the curriculum for social studies, even history and geography."

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