Abstract
Conducting genomic research in diverse populations has led to numerous advances in our understanding of human history, biology, and health disparities, in addition to discoveries of vital clinical significance. Conducting genomic research in diverse populations is also important in ensuring that the genomic revolution does not exacerbate health disparities by facilitating discoveries that will disproportionately benefit well-represented populations. Despite the general agreement on the need for genomic research in diverse populations in terms of equity and scientific progress, genomic research remains largely focused on populations of European descent. In this article, we describe the rationale for conducting genomic research in diverse populations by reviewing examples of advances facilitated by their inclusion. We also explore some of the factors that perpetuate the disproportionate attention on well-represented populations. Finally, we discuss ongoing efforts to ameliorate this continuing bias. Collaborative and intensive efforts at all levels of research, from the funding of studies to the publication of their findings, will be necessary to ensure that genomic research does not conserve historical inequalities or curtail the contribution that genomics could make to the health of all humanity.
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References
Adeyemo AA et al (2015) Evaluation of genome wide association study associated type 2 diabetes susceptibility loci in sub Saharan Africans. Front Genet 6:335. doi:10.3389/fgene.2015.00335
Baker JL, Rotimi CN, Shriner D (2017) Human ancestry correlates with language and reveals that race is not an objective genomic classifier. Sci Rep 7:1572. doi:10.1038/s41598-017-01837-7
Band G et al (2013) Imputation-based meta-analysis of severe malaria in three African populations. PLoS Genet 9:e1003509. doi:10.1371/journal.pgen.1003509
Bentley AR, Rotimi CN (2012) Interethnic variation in lipid profiles: implications for underidentification of African-Americans at risk for metabolic disorders. Expert Rev Endocrinol Metab 7:659–667. doi:10.1586/eem.12.55
Bryc K, Durand Eric Y, Macpherson JM, Reich D, Mountain Joanna L (2015) The genetic ancestry of African Americans, Latinos, and European Americans across the United States. Am J Hum Genet 96:37–53. doi:10.1016/j.ajhg.2014.11.010
Burke W, Tarini B, Press NA, Evans JP (2011) Genetic screening. Epidemiol Rev 33:148–164. doi:10.1093/epirev/mxr008
Bustamante CD, De La Vega FM, Burchard EG (2011) Genomics for the world. Nature 475:163–165
Chimusa ER et al (2014) Genome-wide association study of ancestry-specific TB risk in the South African Coloured population. Hum Mol Genet 23:796–809. doi:10.1093/hmg/ddt462
Cohen J, Pertsemlidis A, Kotowski IK, Graham R, Garcia CK, Hobbs HH (2005) Low LDL cholesterol in individuals of African descent resulting from frequent nonsense mutations in PCSK9. Nat Genet 37:161–165
Cohen JC, Boerwinkle E, Mosley TH, Hobbs HH (2006) Sequence variations in PCSK9, low LDL, and protection against coronary heart disease. N Engl J Med 354:1264–1272. doi:10.1056/NEJMoa054013
Cohn DV (2015) Census considers new approach to asking about race—by not using the term at all. http://www.pewresearch.org/fact-tank/2015/06/18/census-considers-new-approach-to-asking-about-race-by-not-using-the-term-at-all/. Accessed 13 Mar 2017
Collins FS, Varmus H (2015) A new initiative on precision medicine. N Engl J Med 372:793–795. doi:10.1056/NEJMp1500523
Cook MB et al (2014) A genome-wide association study of prostate cancer in West African men. Hum Genet 133:509–521. doi:10.1007/s00439-013-1387-z
Cyranoski D (2012) Chinese genomics giant BGI plots commercial path. Nat Biotech 30:1159–1160. doi:10.1038/nbt1212-1159
Cyranoski D (2016) China embraces precision medicine on a massive scale. Nature 529:9–10. doi:10.1038/529009a
de Vries J et al (2015) The H3Africa policy framework: negotiating fairness in genomics. Trends in genetics : TIG 31:117–119. doi:10.1016/j.tig.2014.11.004
Editors PM et al (2016) Towards equity in health: researchers take stock. PLoS Med 13:e1002186. doi:10.1371/journal.pmed.1002186
Fitzgerald K et al (2017) A highly durable RNAi therapeutic inhibitor of PCSK9. N Engl J Med 376:41–51. doi:10.1056/NEJMoa1609243
Freedman BI et al (2014) End-stage renal disease in African Americans with lupus nephritis is associated with APOL1. Arthritis Rheumatol 66:390–396. doi:10.1002/art.38220
Friedman DJ, Pollak MR (2011) Genetics of kidney failure and the evolving story of APOL1. J Clin Invest 121:3367–3374. doi:10.1172/JCI46263
Genomes Project C et al (2015) A global reference for human genetic variation. Nature 526:68–74. doi:10.1038/nature15393
Genovese G et al (2010) Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science:329, 841–845. doi:10.1126/science.1193032
Ginther DK, Schaffer WT, Schnell J, Masimore B, Liu F, Haak LL, Kington R (2011) Race, ethnicity, and NIH research awards. Science 333:1015–1019. doi:10.1126/science.1196783
Gouni-Berthold I, Descamps OS, Fraass U, Hartfield E, Allcott K, Dent R, März W (2016) Systematic review of published Phase 3 data on anti-PCSK9 monoclonal antibodies in patients with hypercholesterolaemia. Br J Clin Pharmacol 82:1412–1443. doi:10.1111/bcp.13066
Gurdasani D et al (2015) The African genome variation project shapes medical genetics in Africa. Nature 517:327–332. doi:10.1038/nature13997
Ha NT, Freytag S, Bickeboeller H (2014) Coverage and efficiency in current SNP chips. Eur J Hum Genet 22:1124–1130. doi:10.1038/ejhg.2013.304
Horton JD, Cohen JC, Hobbs HH (2007) Molecular biology of PCSK9: its role in LDL metabolism. Trends Biochem Sci 32:71–77. doi:10.1016/j.tibs.2006.12.008
Huang Q (2015) Genetic study of complex diseases in the post-GWAS era. J Genet Genomics 42:87–98. doi:10.1016/j.jgg.2015.02.001
Jallow M et al (2009) Genome-wide and fine-resolution association analysis of malaria in West Africa. Nat Genet 41:657–665. doi:10.1038/ng.388
Joubert BR, Lange EM, Franceschini N, Mwapasa V, North KE, Meshnick SR, Immunology NCfHAV (2010) A whole genome association study of mother-to-child transmission of HIV in Malawi. Genome Med 2:17. doi:10.1186/gm138
Julian BA, Gaston RS, Brown WM, Reeves-Daniel AM, Israni AK, Schladt DP, Pastan SO, Mohan S, Freedman BI, Divers J (2016) Effect of replacing race with apolipoprotein L1 genotype in calculation of kidney donor risk index. Am J Trans doi: 10.1111/ajt.14113
Kang SJ et al (2010) Genome-wide association of anthropometric traits in African- and African-derived populations. Hum Mol Genet 19:2725–2738. doi:10.1093/hmg/ddq154
Kasembeli AN et al (2015) APOL1 risk variants are strongly associated with HIV-associated nephropathy in black South Africans. J Am Soc Nephrol 26:2882–2890. doi:10.1681/ASN.2014050469
Kaye J, Heeney C, Hawkins N, de Vries J, Boddington P (2009) Data sharing in genomics—re-shaping scientific practice. Nat Rev Genet 10:331–335. doi:10.1038/nrg2573
Kim S et al (2016) Genetic influences on plasma homocysteine levels in African Americans and Yoruba Nigerians. J Alzheimers Dis 49:991–1003. doi:10.3233/JAD-150651
Knoppers BM (2014) Framework for responsible sharing of genomic and health-related data. HUGO J 8:3. doi:10.1186/s11568-014-0003-1
Kopp JB et al (2011) APOL1 genetic variants in focal segmental glomerulosclerosis and HIV-associated nephropathy. J Am Soc Nephrol 22:2129–2137. doi:10.1681/ASN.2011040388
Ku E et al (2017) Strict blood pressure control associates with decreased mortality risk by APOL1 genotype. Kidney Int 91:443–450. doi:10.1016/j.kint.2016.09.033
Larson C (2013) Inside China’s genome factory. https://www.technologyreview.com/s/511051/inside-chinas-genome-factory/. Accessed 02/23/2017
Li MJ, Sham PC, Wang J (2012) Genetic variant representation, annotation and prioritization in the post-GWAS era. Cell Res 22:1505–1508. doi:10.1038/cr.2012.106
Lingappa JR et al (2011) Genomewide association study for determinants of HIV-1 acquisition and viral set point in HIV-1 serodiscordant couples with quantified virus exposure. PLoS One 6:e28632. doi:10.1371/journal.pone.0028632
Ma L et al (2016) APOL1 renal-risk variants induce mitochondrial dysfunction. J Am Soc Nephrol. doi:10.1681/asn.2016050567
Malaria Genomic Epidemiological N (2017) Ethics of collaboration https://www.malariagen.net/ethics/ethics-collaboration. Accessed March 10 2017
Malaria Genomic Epidemiology N, Band G, Rockett KA, Spencer CC, Kwiatkowski DP (2015) A novel locus of resistance to severe malaria in a region of ancient balancing selection. Nature 526:253–257. doi:10.1038/nature15390
Manrai AK et al (2016) Genetic misdiagnoses and the potential for health disparities. N Engl J Med 375:655–665. doi:10.1056/NEJMsa1507092
Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE (1995) Prevalence of hypertrophic cardiomyopathy in a general population of young adults Echocardiographic Analysis of 4111 Subjects in the CARDIA Study 92:785–789 doi: 10.1161/01.cir.92.4.785
Mathias RA et al (2016) A continuum of admixture in the Western Hemisphere revealed by the African Diaspora genome. Nat Commun 7:12522. doi:10.1038/ncomms12522
McDonald M, Townsend A, Cox SM, Paterson ND, Lafreniere D (2008) Trust in health research relationships: accounts of human subjects. J Empir Res Hum Res Ethics 3:35–47. doi:10.1525/jer.2008.3.4.35
Milet J, Sabbagh A, Migot-Nabias F, Luty AJ, Gaye O, Garcia A, Courtin D (2016) Genome-wide association study of antibody responses to Plasmodium falciparum candidate vaccine antigens. Genes Immun 17:110–117. doi:10.1038/gene.2015.59
Moore JX, Chaudhary N, Akinyemiju T (2017) Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis 14:E24. doi:10.5888/pcd14.160287
Movahed MR, Strootman D, Bates S, Sattur S (2010) Prevalence of suspected hypertrophic cardiomyopathy or left ventricular hypertrophy based on race and gender in teenagers using screening echocardiography. Cardiovasc Ultrasound 8:54. doi:10.1186/1476-7120-8-54
Mtatiro SN et al (2014) Genome wide association study of fetal hemoglobin in sickle cell anemia in Tanzania. PLoS One 9:e111464. doi:10.1371/journal.pone.0111464
Mulder NJ et al (2016) H3ABioNet, a sustainable pan-African bioinformatics network for human heredity and health in Africa. Genome Res 26:271–277. doi:10.1101/gr.196295.115
N’Diaye A et al (2011) Identification, replication, and fine-mapping of Loci associated with adult height in individuals of african ancestry. PLoS Genet 7:e1002298. doi:10.1371/journal.pgen.1002298
Need AC, Goldstein DB (2009) Next generation disparities in human genomics: concerns and remedies. Trends Genet 25:489–494. doi:10.1016/j.tig.2009.09.012
Ng MCY et al (2014) Meta-analysis of genome-wide association studies in African Americans provides insights into the genetic architecture of type 2 diabetes. PLOS Genetics 10:e1004517. doi:10.1371/journal.pgen.1004517
Nielsen R, Akey JM, Jakobsson M, Pritchard JK, Tishkoff S, Willerslev E (2017) Tracing the peopling of the world through genomics. Nature 541:302–310. doi:10.1038/nature21347
Oh SS et al (2015) Diversity in clinical and biomedical research: a promise yet to be fulfilled. PLoS Med 12:e1001918. doi:10.1371/journal.pmed.1001918
Oh SS, White MJ, Gignoux CR, Burchard EG (2016) Making precision medicine socially precise. Take a deep breath. Am J Respir Crit Care Med 193:348–350. doi:10.1164/rccm.201510-2045ED
Panofsky A, Bliss C (2017) Ambiguity and scientific authority: population classification in genomic science. Am Soc Rev 82:59-87. doi:10.1177/0003122416685812
Parsa A et al (2013) APOL1 risk variants, race, and progression of chronic kidney disease. N Engl J Med 369:2183–2196. doi:10.1056/NEJMoa1310345
Peralta CA, Bibbins-Domingo K, Vittinghoff E, Lin F, Fornage M, Kopp JB, Winkler CA (2016) APOL1 genotype and race differences in incident albuminuria and renal function decline. J Am Soc Nephrol 27:887–893. doi:10.1681/asn.2015020124
Petrovski S et al (2011) Common human genetic variants and HIV-1 susceptibility: a genome-wide survey in a homogeneous African population. AIDS 25:513–518. doi:10.1097/QAD.0b013e328343817b
Polychronakos C, Alriyami M (2015) Diabetes in the post-GWAS era. Nat Genet 47:1373–1374. doi:10.1038/ng.3453
Popejoy AB, Fullerton SM (2016) Genomics is failing on diversity. Nature 538:161–164. doi:10.1038/538161a
Price AL, Spencer CCA, Donnelly P (2015) Progress and promise in understanding the genetic basis of common diseases. Proc Royal Soc B Biol Sci 282 doi: 10.1098/rspb.2015.1684
Ramsay M, Sankoh O, study amotA-G, Consortium tHA (2015) African partnerships through the H3Africa Consortium bring a genomic dimension to longitudinal population studies on the continent. Int J Epidemiol. doi:10.1093/ije/dyv187
Ramsuran V et al (2011) Duffy-null-associated low neutrophil counts influence HIV-1 susceptibility in high-risk South African black women. Clin Infect Dis 52:1248–1256. doi:10.1093/cid/cir119
Ray KK et al. (2017) Inclisiran in patients at high cardiovascular risk with elevated LDL cholesterol N Engl J Med 376:1430-1440 doi:10.1056/NEJMoa1615758
Reeves-Daniel AM et al (2011) The APOL1 gene and allograft survival after kidney transplantation. Am J Transplant 11:1025–1030. doi:10.1111/j.1600-6143.2011.03513.x
Roth EM et al (2016) A phase III randomized trial evaluating alirocumab 300 mg every 4 weeks as monotherapy or add-on to statin: ODYSSEY CHOICE I. Atherosclerosis 254:254–262. doi:10.1016/j.atherosclerosis.2016.08.043
Rotimi C et al (2007) Community engagement and informed consent in the International HapMap project Community. Genet 10:186–198. doi:10.1159/000101761
Rotimi C, Mulder N (2014) Data acquisition and data/knowledge sharing in global genomic studies. Appl Transl Genomics 3:109–110. doi:10.1016/j.atg.2014.09.002
Rotimi CN, Jorde LB (2010) Ancestry and disease in the age of genomic medicine. N Engl J Med 363:1551–1558. doi:10.1056/NEJMra0911564
Rotimi CN, Tekola-Ayele F, Baker JL, Shriner D (2016) The African diaspora: history, adaptation and health. Curr Opin Genet Dev 41:77–84. doi:10.1016/j.gde.2016.08.005
Russell GW (2016) China plans leading role in ‘precision medicine’ field. The University of Hong Kong. http://jmsc.hku.hk/reportinghealth2016/2016/04/06/china-plans-leading-role-in-precision-medicine-field/. Accessed 02/23/2017 2017
Sabatine MS et al (2017) Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. doi:10.1056/NEJMoa1615664
Satcher D, Fryer GE Jr, McCann J, Troutman A, Woolf SH, Rust G (2005) What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000. Health Aff (Millwood) 24:459–464. doi:10.1377/hlthaff.24.2.459
Science and inequality (2016) Nature 537:465. doi:10.1038/537465a
Scott LJ et al (2007) A genome-wide association study of type 2 diabetes in Finns detects multiple susceptibility variants. Science 316:1341–1345. doi:10.1126/science.1142382
Sheridan C (2013) Phase 3 data for PCSK9 inhibitor wows. Nat Biotech 31:1057–1058. doi:10.1038/nbt1213-1057
Shriner D, Adeyemo A, Rotimi CN (2011) Joint ancestry and association testing in admixed individuals. PLoS Comput Biol 7:e1002325. doi:10.1371/journal.pcbi.1002325
Shriner D, Tekola-Ayele F, Adeyemo A, Rotimi CN (2014) Genome-wide genotype and sequence-based reconstruction of the 140,000 year history of modern human ancestry. Sci Rep 4:6055. doi:10.1038/srep06055
Skloot R (2011) The immortal life of Henrietta Lacks, 1st edn. Broadway Paperbacks, New York
Sladek R et al (2007) A genome-wide association study identifies novel risk loci for type 2 diabetes. Nature 445:881–885. doi:10.1038/nature05616
Tarver-Carr ME, Powe NR, Eberhardt MS, LaVeist TA, Kington RS, Coresh J, Brancati FL (2002) Excess risk of chronic kidney disease among African-American versus white subjects in the United States: a population-based study of potential explanatory factors. J Am Soc Nephrol 13:2363–2370
Tekola-Ayele F et al (2015a) Novel genomic signals of recent selection in an Ethiopian population. Eur J Hum Genet 23:1085–1092. doi:10.1038/ejhg.2014.233
Tekola-Ayele F et al (2015b) Genome-wide association study identifies African-ancestry specific variants for metabolic syndrome. Mol Gen Metab 116:305–313. doi:10.1016/j.ymgme.2015.10.008
Tekola Ayele F et al (2012) HLA class II locus and susceptibility to podoconiosis. N Engl J Med 366:1200–1208. doi:10.1056/NEJMoa1108448
The H3Africa Consortium (2014) Enabling the genomic revolution in Africa: H3Africa is developing capacity for health-related genomics research in Africa. Science (N Y NY) 344:1346–1348. doi:10.1126/science.1251546
Thomson R et al (2014) Evolution of the primate trypanolytic factor APOL1. Proc Natl Acad Sci U S A 111:E2130–E2139. doi:10.1073/pnas.1400699111
Thye T et al (2012) Common variants at 11p13 are associated with susceptibility to tuberculosis. Nat Genet 44:257–259. doi:10.1038/ng.1080
Thye T et al. (2010) Genome-wide association analyses identifies a susceptibility locus for tuberculosis on chromosome 18q11.2 Nat Genet 42:739-741 doi:10.1038/ng.639
Tindana P et al (2015) Community engagement strategies for genomic studies in Africa: a review of the literature. BMC Med Ethics 16:24. doi:10.1186/s12910-015-0014-z
Trinidad SB, Fullerton SM, Bares JM, Jarvik GP, Larson EB, Burke W (2010) Genomic research and wide data sharing: views of prospective participants. Genet Med 12:486–495. doi:10.1097/GIM.0b013e3181e38f9e
Wells JC (2012) Ethnic variability in adiposity, thrifty phenotypes and cardiometabolic risk: addressing the full range of ethnicity, including those of mixed ethnicity. Obes Rev 13(Suppl 2):14–29. doi:10.1111/j.1467-789X.2012.01034.x
Welter D, MacArthur J, Morales J, Burdett T, Hall P, Junkins H, Klemm A, Flicek P, Manolio T, Hindorff L, Parkinson, H (2013) The NHGRI GWAS Catalog, a curated resource of SNP-trait associations. Nucleic Acids Res 42(D1):D1001–D1006. doi:10.1093/nar/gkt1229
Yarborough M, Fryer-Edwards K, Geller G, Sharp RR (2009) Transforming the culture of biomedical research from compliance to trustworthiness: insights from nonmedical sectors. Acad Med 84:472–477. doi:10.1097/ACM.0b013e31819a8aa6
Zhang Y, Li Q, Wang X, Zhou X (2015) China biobanking. In: Karimi-Busheri F (ed) Biobanking in the 21st century. Springer International Publishing, Cham, pp 125–140. doi:10.1007/978-3-319-20579-3_10
Zhao X, Wang P, Tao X, Zhong N (2013) Genetic services and testing in China. J Commun Genet 4:379–390. doi:10.1007/s12687-013-0144-2
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The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. This research was supported in part by the Intramural Research Program of the National Human Genome Research Institute in the Center for Research in Genomics and Global Health (CRGGH—Z01HG200362). CRGGH is also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Center for Information Technology, and the Office of the Director at the National Institutes of Health.
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This article is part of the Topical Collection on Inclusion of Diverse Populations in Genomics Research and Health Services: A Scientific and Health Equity Imperative.
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Bentley, A.R., Callier, S. & Rotimi, C.N. Diversity and inclusion in genomic research: why the uneven progress?. J Community Genet 8, 255–266 (2017). https://doi.org/10.1007/s12687-017-0316-6
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DOI: https://doi.org/10.1007/s12687-017-0316-6