Genomics in the Kidney Clinic

Transcription

1 Genomics in the Kidney Clinic Translation, Implementation and Challenges Dr Andrew Mallett Nephrologist, RBWH & MNHHS National Director, KidGen AGHA Renal Genetics Flagship

2 Why Kidneys? Frequency, Outcomes and the Nephron 1 in 8 Australian Adults have a marker of Kidney Disease Genetic or Inheritable Kidney Disease 1 in 10 Adults with renal disease >250 Implicated genes, multiple disease spectra 1 in 2 Children with renal disease Understanding remains significantly incomplete

3 Mission Statement The KidGen Collaborative is an Australian-based consortium of clinicians, genetic counsellors and researchers focused on providing a definitive diagnosis to patients with inherited forms of kidney disease within a multidisciplinary clinic. Goal Within a three year period standard care for patients with inherited kidney disease will include access to a multi-disciplinary clinic, with genomic testing and genetic counselling for the family where appropriate Aims 1. Provide equitable access to genomic technology within clinical care for Australian families with kidney disease. 2. Evaluate whether multidisciplinary clinics which include a nephrologist, clinical geneticist and genetic counsellor improve the outcome, patient experience and standard of care for patients with inherited kidney disease and their families 3. Expand knowledge of the causes of inherited kidney disease through gene validation and disease modelling. 4. Improve understanding of inherited kidney disease in the hope of developing new treatments.

4 Where are we? Nationwide clinical, diagnostic, translational, research

5 What do we do? Bed to Bench and back again

6 What do we do? Bed to Bench and back again Family Research Genomics Gene Negative GBM Disorders Clinic & Diagnostic Genomic Evaluation Functional Genomics Nephrotic Syndrome Diagnostic Genomics Services Education & Outreach Initiatives HiDDEn C3GN

7 Clinic & Diagnostic Genomic Evaluation AGHA Flagship - Evaluating Renal Genetics MDT Clinics

8 Clinic & Diagnostic Genomic Evaluation AGHA Flagship - Evaluating Renal Genetics MDT Clinics

9 LOST LOST - Language and Other Socio-economic barriers to Translation of genomic medicine to the clinic

10 FOUND FOUND - FOllowing Up New renal genetic Diagnoses

11 Diagnostic Genomics Services Reporting Genetic Diagnostic Outcomes Mallett et al (2017), In Press N = 135 families 10 panels, 207 genes 43% Secured Genetic Dx (Pathogenic Variant/s)

12 Family Research Genomics Identifying Rare & Novel Genetic Causes 49 Families Proposed and Accepted for Recruitment o 4 Gene Negative Alport Syndrome/TBMN Sub Study 32 Families Sequenced & Analyzed o 13 via WES o 28 via WGS o 1 via WES & WGS 12 have a candidate variant/s in a known gene o 6 genes are very rare (<10 reported families) 3 genes were reported <24months prior 1 genes was reported within 6months Reanalysis ongoing o New analysis elements being incorporated o 6 th monthly re-review Mutations in mitochondrial DNA causing TIKD Connor et al (2017)

13 Functional Genomics Modelling Disease & Validating Variants disease modelling

14 HIDDEN Flagship HIDDEN Flagship - whole genome Investigation to identify undetected Nephropathies

15 HIDDEN Flagship HIDDEN Flagship - whole genome Investigation to identify undetected Nephropathies

16 HIDDEN Flagship HIDDEN Flagship - whole genome Investigation to identify undetected Nephropathies New Patients and Change Australia Change from previous year New patients Change from previous year 2016 ANZDATA Annual Report, Figure 1.2

17 Education & Outreach Initiatives An Annual National Event

18 Intersections Collaborating with others Patient & Consumer Groups Program 1 Program 2 External Partners Program 4 Program 3

19 Where to from here? through collaboration, evidence and understanding.. and realism K I D N E Y S

20 Where to from here? through collaboration, evidence and understanding.. Goal and realism Within a three year period standard care for patients with inherited kidney disease will include access to a multi-disciplinary clinic, with genomic testing and genetic counselling for the family where appropriate

21 Genomics in the Kidney Clinic Translation, Implementation and Challenges Dr Andrew Mallett Nephrologist, RBWH & MNHHS National Director, KidGen AGHA Renal Genetics Flagship