Genomic approach for drug target discovery and validation
|
|
- Deborah O’Neal’
- 5 years ago
- Views:
Transcription
1 Genomic approach for drug target discovery and validation Hong-Hee Won, Ph.D. SAIHST, SKKU
2 Well-known example of genetic findings triggering drug development Genetics Mendelian randomisation Drug interventions Randomized Clinical Trials Humans with Normal PCSK9 Humans with Mutant PCSK9 Control Alirocumab LDL 140 mg/dl 28% LDL 100 mg/dl LDL 140 mg/dl 57% LDL 60 mg/dl ~40% Heart Attack TBD Odyssey Outcomes Cohen et al., NEJM 2006 Stein et al, NEJM 2012 Robinson et al, NEJM 2015 Ref: Andy Plump, Sanofi
3 From Bedside to Bench to Bedside in a decade Only ~10 years from genetic evidence in humans to FDA approaval of PCSK9 inhibitors Natarajan and Kathiresan, Cell, 165, 2016
4 PCSK9 inhibitors are expected to achieve annual sales of $11.5 billion by 2021
5 Questions to be addressed LDL cholestrol 을낮추는것이심혈관질환의예방에도움을준다? HDL cholesterol 을높이는것이심혈관질환의예방에도움을준다? LDL cholesterol 을낮추는약물의부작용이있을까? 심혈관질환위험을낮추는약물의효과를예측할수있을까? 지질농도와심혈관질환위험을낮추는새로운약물타겟을찾을수있을까? Do we have genetic evidence?
6 By frequency and effect size / Common complex / Common complex / Common complex
7 Increase in # of GWAS loci as a function of sample size
8 Large-scale meta-analysis consortia Nature Reviews Genetics 14, (2013)
9 GLGC cohort 188,577 individuals 157 genetic loci 10-15% of lipid
10 CARDIoGRAMplusC4D 200,000 CAD cases and controls from 46 genetic loci 10.6% of CAD heritability
11 GWA loci by 2015 Sept at p<5e- 8
12 Challenges in GWAS GWAS is a popular and successful approach, but Common SNPs (MAF>5%) >500 independent strong SNP associations (p<10-8 ) Very small effect sizes (increase in risk by a given causal variant) Less than modest heritability Only few associated with gene expression 90% lie in intergenic or intronic regions Causal gene? Nearest gene? Biological
13 Possible hypotheses for missing heritability Genetic interactions Genes work together Polygenic effects Many (common) variants with small effects Low-frequency and rare variants Large effects Zuk et al, PNAS Zuk et al, PNAS 2014.
14 Heritability of GWAS hits and all GWAS Height 100% SNPs 80% 45% Nat Genet 2010 GCTA 27% Nature 2017 Missing heritability 10% Nature 2010 Total variance Heritability (based on twin or family study) All SNP-heritability (variance explained by all SNPs) Variance explained by GW significant SNPs
15 Common polygenic variation contributes to the risk of SCZ, BD and MI/CAD Int. Schizophrenia Consortium data MIGen WTCCC CAD ISC, Nature 2009 Won et al, PLoS Genetics 2015
16 Vincent van Gogh Starry Night Over the Rhone, Musée d'orsay, Paris
17 Genetic risk and a healthy lifestyle (NEJM ) NYT Reuters ABC news CNS news
18 Study methods (NEJM ) Four cohorts (N=55,685 participants) Three prospective cohorts (N=7814, 21222, 22389) One cross-sectional study (N=4260) Genetic risk score 50 GWAS SNPs from CARDIoGRAM, CARDIoGRAMplusC4D studies Healthy lifestyle (4 factors) No current smoking, no obesity, regular physical activity, and a healthy diet End points Coronary artery events in prospective cohorts Coronary artery calcification in cross-sectional study
19
20 Across four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease.
21 Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50% lower relative risk of coronary artery disease than was an unfavorable lifestyle.
22 Mendealian randomization approach Tada et al, J Hum Genet 2017
23 Mendelian randomization: HDL, LDL and MI risk Lancet 2012 HDL : 14 common variants LDL : 13 common variants myocardial infarction cases, controls
24 RCTs of CETP inhibitors (HDL increasing drugs) Torcetrapib Darcetrapib Evacetrapib Anacetrapib HDL-C LDL-C TG CHD +72% -25% -9% Fail +35% 0-7% Fail +130% -37% N/A Fail +139% -36% -5% Ongoing Schaefer EJ. Curr Op Lipidol Yamashita S, et al. Curr Op Lipidol 2016.
25 Mendelian randomization: low LDL and high T2D JAMA NEJM Lancet
26 PCSK9 variants
27 LDL-lowering drugs (genetic target) PCSK9 inhibitor (PCSK9) Statins (HMGCR) Ezetimibe (NPC1L1) Variants Lowering LDL-C 10mg/dL Reduced Risk of MI/CHD 19 percent Increased Risk of T2D 12 percent
28
29
30 Possible hypotheses for missing heritability Genetic interactions Genes work together Polygenic effects Many (common) variants with small effects Low-frequency and rare variants Large effects Zuk et al, PNAS Zuk et al, PNAS 2014.
31 Statistical imputation : more variants
32 1000 Genomes based imputation 1000 Genomes HapMap MAF<0.05 MAF> Number of variants (million) 1000 Genomes Reference HapMap Project Reference
33
34 Imputation reference
35 Exome chip Designed to include low-freq. coding variants Based on existing genomes and exomes sequenced (N=12,000) Nonsynonymous seen 3+ times across 2+ datasets Splice variants seen 1+ Stop gain or loss seen 1+ GWAS Common variants, etc.
36
37
38 Effects of rare and low-frequency variants on height 458,927 individuals 697 known loci explained 23.3% of height heritability New loci explained additional 4.1% Rare variants give an increase of 1-2 cm per allele Nature 2017 Feb
39 Illumina NovaSeq
40 Precision Medicine Initiative (1M genomes) 2015
41 100K Genomes Projects Announced in 2012 (started in 2015) Whole genome sequencing of 100K by ,540 genomes sequenced (Nov 6, 2017) 100+ rare disease and 7 common cancers When the project ends Genomics as part of routine care
42
43 32 projects Nearly 98,000 genomes have been sequenced Mean depth = 38x (Last modified on )
44 1000 Genomes results: Lots of rare variants that are private to a population Variants found to be rare (<0.5%) within the global sample but common within a population F ST -based population branch statistic (PBS) Common variants Skin pigmentation Rare variants Lactose tolerance Eye color A Auton et al. Nature 526, (2015) doi: /nature15393
45 Population specific rare mutations associated with disease TBC1D4 Arg684Ter 17% allele frequency in Inuit ~0% in other populations Homozygous carriers at OR=10.3 HNF1A E508K 2.1% in Latino cases ~0% in other populations Heterozygous carriers at OR=5.5
46 Estimated progress for research in PMI
47 Human gene knockouts
48 Human gene knockouts Variant in Exon ATGCTTCATGGTT ATGCTTTATGGTT Synonymous Missense Nonsense Splice site Indel frameshift Loss-of-function Protein-disruptive Protein-inactivatin Null Genetic variations predicted to completely disrupt the function of protein-coding genes
49 Normal: 2 working copies of a gene
50 With null mutations: one or two copies of a gene broken Gene Protein Gene Heterozygous null Homozygous null
51 Homozygotes of LoF variants are too rare to be seen
52
53 Predicted efficacy of Lp-PLA2 inhibitor (GSK) Lack of human genetic evidence (Nature 2017) - Previous meta-analysis : high expression of Lp-PLA2 and risk of CAD (Lancet 2010) Failure of Darapladib (GSK) (NEJM 2014)
54 Large family with APOC3 knockouts
55 Crosby et al. NEJM, 201 Rare mutations in APOC3 and TG and CHD
56 CHD Hypothesis Genetics LDL Are there other genes than PCSK9 whose mutations lower LDL and protect against CHD?
57 Pharmacological treatments to reduce LDL-C Statins are most commonly prescribed treatment to reduce LDL-C Ezetimibe is a non-statin LDL-C lowering agent
58 NPC1L1 is the protein target of ezetimibe Ezetimibe inhibits the protein product of the Niemann-Pick C1-Like 1 (NPC1L1) gene NPC1L1 is expressed in the liver and small intestine NPC1L1 mediates intestinal cholesterol absorption Jia et al. Annu. Rev. Physio
59 ENHANCE randomized controlled trial Designed to test whether ezetimibe plus simvastatin (compared with simvastatin alone) will have beneficial effects on LDL-C and carotid intima-media thickness (CIMT), a surrogate measure of atherosclerosis Kastelein et al. NEJM, 20
60 Ezetimibe treatment lowers LDL-C by 17% 720 patients with familial hypercholesterolemia Treatment with simvastatin plus ezetimibe lowers LDL-C more than simvastatin alone ENHANCE trial 17% decrease Kastelein et al. NEJM, 20
61 Ezetimibe treatment did not alter a surrogate measure of atherosclerosis thickness of carotid artery Measured carotid intima-media thickness (CIMT), surrogate marker for atherosclerosis ENHANCE trial Combined therapy of ezetimibe and simvastatin did not result in change in CIMT, despite decrease in LDL-C Kastelein et al. NEJM, 20
62 It is uncertain if inhibiting NPC1L1 reduces risk for CHD Can human genetics yield insight into potential effects of NPC1L1 inhibition on CHD risk?
63 Rare variant association with CHD Focus on LoF (protein-inactivating) mutations Nonsense / Splice-site / Indel frameshift Sequencing of protein-coding region of NPC1L1 in seven case-control studies 7,364 individuals with CHD 14,728 individuals without CHD Genotyping of NPC1L1 p.arg406x in nine sample sets 22,590 individuals with CHD 68,412 individuals without CHD
64 Rare variant association study Three different scenarios Common variants 1. Collective frequency 2. Synergistic fashion 3. Specific regions
65 Rare inactivating mutations in NPC1L1 Discovered 15 protein-inactivating mutations from sequencing 10 nonsense 3 splice-site 2 frameshifts Among controls, 1 in 500 carried an inactivating mutation
66 Association of NPC1L1 inactivating mutations with LDL-C Cohort CHD free controls Total N (N carriers) 4586 (11) Difference [95% CI] [-49.51, 2.4 ARIC EA WGHS European subgroup (10) (11) [-29.58, [-32.97, [-26.50, 0.6 CHD free controls/jhs2287 (7) [-52.64, 9.5 ARIC AA AA subgroup 2671 (8) [-28.60, [-30.52, 10.0 All [-23.38, Mean difference in carriers (mg/dl)
67 Association of NPC1L1 inactivating mutations with LDL-C Cohort CHD free controls Total N (N carriers) 4586 (11) Difference [95% CI] [-49.51, 2.4 ARIC EA WGHS European subgroup (10) (11) [-29.58, [-32.97, [-26.50, 0.6 CHD free controls/jhs2287 (7) [-52.64, 9.5 ARIC AA African subgroup 2671 (8) [-28.60, [-30.52, 10.0 All [-23.38, Mean difference in carriers (mg/dl)
68 Association of NPC1L1 inactivating mutations with LDL-C Cohort Total N (N carriers) P value Difference [95% CI] CHD free controls 4586 (11) [-49.51, 2.4 ARIC EA WGHS European subgroup (10) (11) [-29.58, [-32.97, [-26.50, 0.6 CHD free controls/jhs2287 (7) [-52.64, 9.5 ARIC AA African subgroup 2671 (8) [-28.60, [-30.52, 10.0 All [-23.38, Mean difference in carriers (mg/dl)
69 Carrier frequency Rare alleles at NPC1L1 are enriched in controls free of CHD 0.09% 0.08% 0.07% 0.06% 0.05% 0.04% 0.03% 0.02% 0.01% 0.00% 0.09% 0.04% Controls 71/83, % CHD cases 11/29,954
70 Carrier frequency Rare alleles at NPC1L1 are enriched in controls free of CHD 0.09% 0.08% 0.07% 0.06% 0.05% 0.04% 0.03% 0.02% 0.01% 0.00% 0.09% 0.04% Controls 71/83, % CHD cases 11/29,954
71 Carrier frequency Rare alleles at NPC1L1 are enriched in controls free of CHD 0.09% 0.08% 0.07% 0.06% 0.05% 0.04% 0.03% 0.02% 0.01% 0.00% 0.09% 0.04% Controls 71/83,140 Odds ratio=0.47 (P=0.003) 0.04% CHD cases 11/29,954
72 Carrier frequency 0.09% 0.08% Individuals 0.07% with an inactivating 0.06% mutation 0.05% in NPC1L1 have 53% 0.04% 0.03% 0.02% 0.01% 0.00% 0.09% reduced 0.04% Controls 71/83,140 Odds ratio=0.47 (P=0.003) risk for CHD 0.04% CHD cases 11/29,954
73
74
75 LDL reduction and vascular disease Pharmacological reduction Genetically mediated reducti Khera et al. EJPC, 2015.
76 Rare mutations in LPL and TG and CHD Khera*, Won*, et al. JAMA, 2017.
77 Khera and Kathiresan, Nat Rev Genet, 2017
78 CHD Risk Nature 2015 Carriers of LoF mutations at LDLR Had LDL-C of 279 mg/dl on aver Were at 13-fold increased risk fo LDLR PCSK9, NPC1L1 Plasma LDL Level
79 emerge (Electronic Medical Records and Genomics)
80 One Million Genomes by M genomes
81 MyCode Partnership with Regeneron (PCSK9 inhibitor) PCSK9 market could be worth $12 billion a year 5-10 year genome (WES) sequencing study 250,000 participants + EMR Health System 250 K genomes Covers 2.6 million people in 36 county 49.5% GHS patients for 20+ years 85% receive majority of care at GHS
82
83
84 Health System 250 K genomes 2 M genomes 20,000 genes Combinations 100-1,000s human phenotypes
85 Summary Common variants GWAS successful and missing heritability Polygenic risk score and Mendelian randomization Cohorts (UK Biobank) and PheWAS Low-frequency / rare variants Statistical imputation (HRC) Exome chip, Korean chip Sequencing (human gene knockout and LoF) Drug target / efficacy / side effect Rare variants with large effects 5-20 odds ratio (compared to ORs of common variants)
86 Questions addressed LDL cholestrol 을낮추는것이심혈관질환의예방에도움을준다? Multiple lines of genetic evidence HDL cholesterol 을높이는것이심혈관질환의예방에도움을준다? Lack of genetic evidence, and failure of RCTs LDL cholesterol 을낮추는약물의부작용이있을까? T2D risk 심혈관질환위험을낮추는약물의효과를예측할수있을까? NPC1L1 (ezetimibe), Lp-PLA2 (darapladib) 지질농도와심혈관질환위험을낮추는새로운약물타겟을찾을수있을까? ANGPTL4, APOC3, LPL, etc. > Triglycerides & CAD
87 Thank you Hong-Hee Won, Ph.D. SAIHST, SKKU
ESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future
ESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future Rory Collins BHF Professor of Medicine & Epidemiology Clinical Trial Service Unit & Epidemiological Studies
More informationSupplementary Online Content
Supplementary Online Content Lotta LA, Stewart ID, Sharp SJ, et al. Association of genetically enhanced lipoprotein lipase mediated lipolysis and low-density lipoprotein cholesterol lowering alleles with
More informationRare Variant Burden Tests. Biostatistics 666
Rare Variant Burden Tests Biostatistics 666 Last Lecture Analysis of Short Read Sequence Data Low pass sequencing approaches Modeling haplotype sharing between individuals allows accurate variant calls
More informationInhibition of PCSK9: The Birth of a New Therapy
Inhibition of PCSK9: The Birth of a New Therapy Prof. John J.P. Kastelein, MD PhD FESC Dept. of Vascular Medicine Academic Medical Center / University of Amsterdam The Netherlands Disclosures Dr. Kastelein
More informationGenetic and biochemical characteristics of patients with hyperlipidemia who require LDL apheresis
Genetic and biochemical characteristics of patients with hyperlipidemia who require LDL apheresis Mato Nagel, Ioan Duma, Constantina Vlad, Mandy Benke, Sylvia Nagorka Zentrum für Nephrologie & Stoffwechsel,
More informationAccumulating Clinical data on PCSK9 Inhibition: Key Lessons and Challenges
ESC 2015 London Accumulating Clinical data on PCSK9 Inhibition: Key Lessons and Challenges Paul M Ridker, MD, MPH Eugene Braunwald Professor of Medicine Harvard Medical School Director, Center for Cardiovascular
More informationA loss-of-function variant in CETP and risk of CVD in Chinese adults
A loss-of-function variant in CETP and risk of CVD in Chinese adults Professor Zhengming CHEN Nuffield Dept. of Population Health University of Oxford, UK On behalf of the CKB collaborative group (www.ckbiobank.org)
More informationGenetics of Arterial and Venous Thrombosis: Clinical Aspects and a Look to the Future
Genetics of Arterial and Venous Thrombosis: Clinical Aspects and a Look to the Future Paul M Ridker, MD Eugene Braunwald Professor of Medicine Harvard Medical School Director, Center for Cardiovascular
More informationCentral role of apociii
University of Copenhagen & Copenhagen University Hospital Central role of apociii Anne Tybjærg-Hansen MD DMSc Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen,
More informationEvolving Concepts on Lipid Management from Ezetimibe (IMPROVE IT) to PCSK9 Inhibitors
Evolving Concepts on Lipid Management from Ezetimibe (IMPROVE IT) to PCSK9 Inhibitors Sidney C. Smith, Jr. MD, FACC, FAHA, FESC Professor of Medicine/Cardiology University of North Carolina at Chapel Hill
More informationGenomic and Genetic Medicine in the Clinical Setting
Genomic and Genetic Medicine in the Clinical Setting Objectives Define genomic and genetic medicine Introduce molecular genetic testing Outline clinical applications including those for: Mendelian disease
More informationCurrent Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD
Current Cholesterol Guidelines and Treatment of Residual Risk J. Peter Oettgen, MD Associate Professor of Medicine Harvard Medical School Director, Preventive Cardiology Beth Israel Deaconess Medical Center
More informationContemporary management of Dyslipidemia
Contemporary management of Dyslipidemia Todd Anderson Feb 2018 Disclosure Statement Within the past two years: I have not had an affiliation (financial or otherwise) with a commercial organization that
More informationNature Genetics: doi: /ng Supplementary Figure 1
Supplementary Figure 1 Illustrative example of ptdt using height The expected value of a child s polygenic risk score (PRS) for a trait is the average of maternal and paternal PRS values. For example,
More informationModern Lipid Management:
Modern Lipid Management: New Drugs, New Targets, New Hope Kirk U. Knowlton, M.D Director of Cardiovascular Research Co Chief of Cardiology Why lower LDL C in those without evidence of CAD (primary prevention)
More informationThe Cardiovascular Institute Mount Sinai School of Medicine, New York
The Cardiovascular Institute Mount Sinai School of Medicine, New York HDL YES HDL NO Juan Jose Badimon, Ph.D Professor of Medicine Director, Atherothrombosis Research Unit The Mount Sinai School of Medicine
More informationPlasma lipids and lipoproteins are heritable risk factors for
Original Article Multiple Associated Variants Increase the Heritability Explained for Plasma Lipids and Coronary Artery Disease Hayato Tada, MD*; Hong-Hee Won, PhD*; Olle Melander, MD, PhD; Jian Yang,
More informationB. Patient has not reached the percentage reduction goal with statin therapy
Managing Cardiovascular Risk: The Importance of Lowering LDL Cholesterol and Reaching Treatment Goals for LDL Cholesterol The Role of the Pharmacist Learning Objectives 1. Review the role of lipid levels
More informationLow-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies
Low-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies A Consensus Statement from the European Atherosclerosis Society
More informationAn update on lipidology and cardiovascular risk management. Lipids, Metabolism & Vascular Risk Section - Royal Society of Medicine
An update on lipidology and cardiovascular risk management Lipids, Metabolism & Vascular Risk Section - Royal Society of Medicine National and international lipid modification guidelines: A critical appraisal
More informationA Naturally Randomized Trial Comparing the Effect of Genetic Variants that Mimic CETP Inhibitors and Statins on the Risk of Cardiovascular Disease.
A Naturally Randomized Trial Comparing the Effect of Genetic Variants that Mimic CETP Inhibitors and Statins on the Risk of Cardiovascular Disease. Brian A. Ference MD, MPhil, MSc, John J. P. Kastelein
More informationCholesterol Reduction Therapy in 2018 A Perspective Role Of Statins, Ezetimibe and PCSK9-Inhibitors
USC-April 21, 2018, Los Angeles Cholesterol Reduction Therapy in 2018 A Perspective Role Of Statins, Ezetimibe and PCSK9-Inhibitors P.K.Shah, MD, MACC Shapell and Webb Chair in Clinical Cardiology, Director,
More informationMarshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona,
Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Jamaica At the end of this presentation the participant
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Ference BA, Robinson JG, Brook RD, et al. Variation in PCSK9
More informationNovel HDL Targeted Therapies: The Search Continues Assoc. Prof. K.Kostner,, Univ. of Qld, Brisbane
Novel HDL Targeted Therapies: The Search Continues Assoc. Prof. K.Kostner,, Univ. of Qld, Brisbane Kostner, 2007 2008 LDL Target depends on your level of Risk Acute Plaque Rupture ACS (UA/NSTEMI/STEMI)
More informationGenetic testing in cardiovascular disease Atul K. Sachdev, MD
Genetic testing in cardiovascular disease Atul K. Sachdev, MD New Horizon Healthcare 1 Disclosures Speaker Quest/Cleveland HeartLab 9p21 The heart attack gene 9p21 is a region of the genome on the short
More informationFarmaci innovativi in ambito cardiovascolare: considerazioni di Farmacologia. Prof. Alberto Corsini University of Milan, Italy
Farmaci innovativi in ambito cardiovascolare: considerazioni di Farmacologia Prof. Alberto Corsini University of Milan, Italy Outline of the presentation State of the art on statin therapy Explore unmet
More informationJoslin Diabetes Center Advances in Diabetes and Thyroid Disease 2013 Consensus and Controversy in Diabetic Dyslipidemia
Consensus and Controversy in Diabetes and Dyslipidemia Om P. Ganda MD Director, Lipid Clinic Joslin diabetes Center Boston, MA, USA CVD Outcomes in DM vs non- DM 102 Prospective studies; 698, 782 people,
More informationApproach to Dyslipidemia among diabetic patients
Approach to Dyslipidemia among diabetic patients Farzad Hadaegh, MD, Professor of Internal Medicine & Endocrinology Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences
More informationMaking War on Cholesterol with New Weapons: How Low Can We/Should We Go? Shaun Goodman
Making War on Cholesterol with New Weapons: How Low Can We/Should We Go? Shaun Goodman Disclosures Research grant support, speaker/consulting honoraria: Sanofi and Regeneron Including ODYSSEY Outcomes
More informationLipid Lowering in Patients at High Risk for Cardiovascular Disease
Lipid Lowering in Patients at High Risk for Cardiovascular Disease Prof. John J.P. Kastelein, MD PhD FESC Dept. of Vascular Medicine Academic Medical Center / University of Amsterdam The Netherlands Novel
More informationDyslipidemia in the light of Current Guidelines - Do we change our Practice?
Dyslipidemia in the light of Current Guidelines - Do we change our Practice? Dato Dr. David Chew Soon Ping Senior Consultant Cardiologist Institut Jantung Negara Atherosclerotic Cardiovascular Disease
More informationCholesteryl ester transfer protein inhibitors - what have we learnt? Philip Barter The Heart Research Institute Sydney, Australia
Cholesteryl ester transfer protein inhibitors - what have we learnt? Philip Barter The Heart Research Institute Sydney, Australia Philip Barter Disclosures Received honorariums for lectures, consultancies
More informationCardiovascular Disease Prevention: Current Knowledge, Future Directions
Cardiovascular Disease Prevention: Current Knowledge, Future Directions Daniel Levy, MD Director, Framingham Heart Study Professor of Medicine, Boston University School of Medicine Editor-in-Chief, Journal
More informationTHE ESC/EAS LIPID GUIDELINES IN THE ELDERLY
THE ESC/EAS LIPID GUIDELINES IN THE ELDERLY Alberico L. Catapano alberico.catapano@unimi.it Alberico L. Catapano Potential Conflict Of Interest Prof. Catapano has received honoraria, lecture fees, or research
More informationExplore a Trait Assignment Heart Disease Scenario
Explore a Trait Assignment Heart Disease Scenario 1. After reading the 23AndMe Facts on Heart Disease provided below, write a one-paragraph summary in your own words of the information provided. Include
More informationEarly Clinical Development #1 REGN727: anti-pcsk9
Early Clinical Development #1 REGN727: anti-pcsk9 July 15, 2010 Neil Stahl, Ph.D. Senior Vice President Research and Development Sciences 1 Safe Harbor Statement Except for historical information, the
More informationSupplementary Online Content
Supplementary Online Content Lotta LA, Sharp SJ, Burgess S, et al. Association between low-density lipoprotein cholesterol lowering genetic variants and risk of type 2 diabetes: a meta-analysis. JAMA.
More informationPCSK9 Inhibition: From Genetics to Patients
PCSK9 Inhibition: From Genetics to Patients John Chapman BSc, Ph.D., D.Sc., FESC Research Professor, University of Pierre and Marie Curie Director Emeritus, INSERM Dyslipidemia and Atherosclerosis Research
More informationFocus on FH (Familial Hypercholesterolemia) Joshua W. Knowles, MD PhD for PCNA May, 2013
Focus on FH (Familial Hypercholesterolemia) Joshua W. Knowles, MD PhD for PCNA May, 2013 Conflicts CMO for The FH Foundation Pre-talk quiz What is cascade screening? 1. screening all family members 2.
More information2) Cases and controls were genotyped on different platforms. The comparability of the platforms should be discussed.
Reviewers' Comments: Reviewer #1 (Remarks to the Author) The manuscript titled 'Association of variations in HLA-class II and other loci with susceptibility to lung adenocarcinoma with EGFR mutation' evaluated
More informationCholesterol; what are the future lipid targets?
Cholesterol; what are the future lipid targets? lipidologist out-of-business in 5-10 years? G.Kees Hovingh dept of vascular medicine, Academic Medical Center g.k.hovingh@amc.uva.nl Disclosure - Consultant
More informationCompound heterozygosity Yurii S. Aulchenko yurii [dot] aulchenko [at] gmail [dot] com. Thursday, April 11, 13
Compound heterozygosity Yurii S. Aulchenko yurii [dot] aulchenko [at] gmail [dot] com 1 Outline Recessive model Examples of Compound Heterozygosity Compound Double Heterozygosity (CDH) test 2 Recessive
More informationThere are many ways to lower triglycerides in humans: Which are the most relevant for pancreatitis and for CV risk?
There are many ways to lower triglycerides in humans: Which are the most relevant for pancreatitis and for CV risk? Michael Davidson M.D. FACC, Diplomate of the American Board of Lipidology Professor,
More informationILLUMINATE. Effects of torcetrapib in patients at high risk for coronary events NEJM. 2007; 357:
ILLUMINATE. Effects of torcetrapib in patients at high risk for coronary events NEJM. 2007; 357: 2109-2122. ILLUMINATE The most important trial since 2000? Background Inhibition of cholesteryl ester transfer
More informationThe Addition of Ezetimibe to Statin therapy in. Patients with Homozygous Familial. Hypercholesterolaemia
The Addition of Ezetimibe to Statin therapy in Patients with Homozygous Familial Hypercholesterolaemia Submitted in fulfilment with the requirements for the degree Master in Medicine (MMed) Dr Adriano
More informationLipid Therapy: Statins and Beyond. Ivan Anderson, MD RIHVH Cardiology
Lipid Therapy: Statins and Beyond Ivan Anderson, MD RIHVH Cardiology Outline The cholesterol hypothesis and lipid metabolism The Guidelines 4 Groups that Benefit from Lipid therapy Initiation and monitoring
More informationLecture 20. Disease Genetics
Lecture 20. Disease Genetics Michael Schatz April 12 2018 JHU 600.749: Applied Comparative Genomics Part 1: Pre-genome Era Sickle Cell Anaemia Sickle-cell anaemia (SCA) is an abnormality in the oxygen-carrying
More informationPCSK9 inhibition across a wide spectrum of patients: One size fits all?
PCSK9 inhibition across a wide spectrum of patients: One size fits all? PACE ESC Barcelona 2017 G.K. Hovingh MD PhD MBA dept of vascular medicine Academic Medical Center the Netherlands g.k.hovingh@amc.uva.nl
More informationDyslipidemia: Lots of Good Evidence, Less Good Interpretation.
Dyslipidemia: Lots of Good Evidence, Less Good Interpretation. G Michael Allan Evidence & CPD Program, ACFP Associate Professor, Dept of Family, U of A. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure
More informationHow would you manage Ms. Gold
How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56
More informationLearning Objectives. Predicting and Preventing Cardiovascular Disease. ACC/AHA Cholesterol Guidelines Key differences vs ATP III
Presenter Disclosure Information 10:30 11:15am Predicting and Preventing Cardiovascular Disease: Can we put the Cardiologist out of business? The following relationships exist related to this presentation:
More informationGenetics and the prevention of CAD
Genetics and the prevention of CAD Presented by: Robert Roberts, MD, FRCPC, MACC, FAHA, FRSC Professor and Departmental Chair ISCTR University of Arizona College of Medicine Phoenix Past President and
More informationDIAGNOSIS AND TREATMENT OF FH CHILDREN. O. GUARDAMAGNA Dipartimento di Scienze della Sanità Pubblica e Pediatriche UNIVERSITA DI TORINO
DIAGNOSIS AND TREATMENT OF FH CHILDREN O. GUARDAMAGNA Dipartimento di Scienze della Sanità Pubblica e Pediatriche UNIVERSITA DI TORINO DISCLOSURES Kowa MSD Pfizer Astrazeneca Synageva/Alexion OUTLINE Background
More informationCardiovascular Controversies: Emerging Therapies for Lowering Cardiovascular Risk
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationEzetimibe and SimvastatiN in Hypercholesterolemia EnhANces AtherosClerosis REgression (ENHANCE)
Ezetimibe and SimvastatiN in Hypercholesterolemia EnhANces AtherosClerosis REgression (ENHANCE) Thomas Dayspring, MD, FACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry
More informationDuring the hyperinsulinemic-euglycemic clamp [1], a priming dose of human insulin (Novolin,
ESM Methods Hyperinsulinemic-euglycemic clamp procedure During the hyperinsulinemic-euglycemic clamp [1], a priming dose of human insulin (Novolin, Clayton, NC) was followed by a constant rate (60 mu m
More informationFrom Population Studies to Clinical Trials
From Population Studies to Clinical Trials Prof Kausik Ray MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed), FESC, FACC, FAHA Department of Primary Care and Public Health School of Public Health, Imperial
More informationPharmacy Policy Bulletin
Pharmacy Policy Bulletin Title: Policy #: PCSK9 inhibitors Rx.01.170 Application of pharmacy policy is determined by benefits and contracts. Benefits may vary based on product line, group, or contract.
More informationDrug Class Monograph
Drug Class Monograph Class: Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitor Drugs: Praluent (alirocumab), Repatha (evolocumab) Line of Business: Medi-Cal Effective Date: February 17, 2016
More informationThe Target is LDL, HDL not so much
The Target is LDL, HDL not so much HDL: A riddle wrapped in a mystery inside an enigma Jacques Genest MD Cardiovascular Research Laboratories McGill University Health Center Disclosure J. Genest MD 2013
More informationNature Genetics: doi: /ng.3561
Supplementary Figure 1 Pedigrees of families with APOB p.gln725* mutation and APOB p.gly1829glufs8 mutation (a,b) Pedigrees of families with APOB p.gln725* mutation. (c) Pedigree of family with APOB p.gly1829glufs8
More informationREPATHA (PCSK9 INHIBITORS)
REPATHA (PCSK9 INHIBITS) Indications: PCSK9 Inhibitors are indicated for treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease as
More informationSTABILITY Stabilization of Atherosclerotic plaque By Initiation of darapladib TherapY. Harvey D White on behalf of The STABILITY Investigators
STABILITY Stabilization of Atherosclerotic plaque By Initiation of darapladib TherapY Harvey D White on behalf of The STABILITY Investigators Lipoprotein- associated Phospholipase A 2 (Lp-PLA 2 ) activity:
More informationIs Lower Better for LDL or is there a Sweet Spot
Is Lower Better for LDL or is there a Sweet Spot ALAN S BROWN MD, FACC FNLA FAHA FASPC DIRECTOR, DIVISION OF CARDIOLOGY ADVOCATE LUTHERAN GENERAL HOSPITAL, PARK RIDGE, ILLINOIS DIRECTOR OF CARDIOLOGY,
More informationCirculation Topic Review
Circulation Topic Review Genetic Epidemiology in Circulation and the Circulation Subspecialty Journals The Editors The following articles are being highlighted as part of Circulation s Topic Review series.
More informationLIPOPROTEINE ATEROGENE E ANTI-ATEROGENE ATEROGENE
LIPOPROTEINE ATEROGENE E ANTI-ATEROGENE ATEROGENE Sebastiano Calandra Dipartimento di Scienze Biomediche Università di Modena e Reggio Emilia Incidence Rate/1000 200-150 - 100-50 - Women 0 Men
More informationMonogenic causes of elevated HDL cholesterol and implications for development of new therapeutics
Clinical Lipidology ISSN: 1758-4299 (Print) 1758-4302 (Online) Journal homepage: http://www.tandfonline.com/loi/tlip20 Monogenic causes of elevated HDL cholesterol and implications for development of new
More informationA Rare View Of Coding Mutations And Plasma Lipid Levels
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine January 2014 A Rare View Of Coding Mutations And Plasma Lipid Levels
More informationPCSK9 Inhibitors and Modulators
PCSK9 Inhibitors and Modulators Pam R. Taub MD, FACC Director of Step Family Cardiac Rehabilitation and Wellness Center Associate Professor of Medicine UC San Diego Health System Disclosures Speaker s
More informationDrug Prior Authorization Guideline PCSK9 Inhibitors -
Drug Prior Authorization Guideline PCSK9 Inhibitors - REPATHA (evolocumab) PRALUENT (alirocumab) PA9911 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes-as shown below Additional
More informationDrug Class Prior Authorization Criteria PCSK9 Inhibitors
Drug Class Prior Authorization Criteria PCSK9 Inhibitors Line of Business: Medicaid P & T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review of
More informationRegence. Medical Policy Manual. Date of Origin: May Topic: Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
Regence Medical Policy Manual Topic: Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment Date of Origin: May 2013 Section: Genetic Testing Last Reviewed Date: June 2013
More informationHeritability and genetic correlations explained by common SNPs for MetS traits. Shashaank Vattikuti, Juen Guo and Carson Chow LBM/NIDDK
Heritability and genetic correlations explained by common SNPs for MetS traits Shashaank Vattikuti, Juen Guo and Carson Chow LBM/NIDDK The Genomewide Association Study. Manolio TA. N Engl J Med 2010;363:166-176.
More informationCardiometabolics in Children or Lipidology for Kids. Stanley J Goldberg MD Diplomate: American Board of Clinical Lipidology Tucson, Az
Cardiometabolics in Children or Lipidology for Kids Stanley J Goldberg MD Diplomate: American Board of Clinical Lipidology Tucson, Az No disclosures for this Presentation Death Risk Approximately 40% of
More informationDo we all have an actionable genome?
Do we all have an actionable genome? Evidence from, and implications for, registries and electronic health records Professor Harry Hemingway, MD, FFPH, FRCP Director Farr Institute of Health Informatics
More informationLipid Panel Management Refresher Course for the Family Physician
Lipid Panel Management Refresher Course for the Family Physician Objectives Understand the evidence that was evaluated to develop the 2013 ACC/AHA guidelines Discuss the utility and accuracy of the new
More informationUpdate on Dyslipidemia and Recent Data on Treating the Statin Intolerant Patient
Update on Dyslipidemia and Recent Data on Treating the Statin Intolerant Patient Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical
More informationControversies in Lipid Therapy: Is there any value in adjusting HDL levels?
Controversies in Lipid Therapy: Is there any value in adjusting HDL levels? Sergio Fazio, MD, PhD Cornelius Vanderbilt Chair of Cardiovascular Medicine and Professor of Medicine, Pathology, Immunology,
More informationDoes IMPROVE-IT & FOURIER Confirm or Refute the LDL Hypothesis?
Does IMPROVE-IT & FOURIER Confirm or Refute the LDL Hypothesis? Controversies and Advances in the Treatment of Cardiovascular Disease The Seventeenth in the Series Beverly Hills, November 16, 2017 Sanjay
More informationAtherosclerosis Regression An Overview of Recent Findings & Issues
Atherosclerosis Regression An Overview of Recent Findings & Issues 13th Angioplasty Summit 2008 Cheol Whan Lee, MD University of Ulsan, Asan Medical Center, Seoul, Korea CardioVascular Research Foundation
More informationPlacebo-Controlled Statin Trials
PREVENTION OF CHD WITH LIPID MANAGEMENT AND ASPIRIN: MATCHING TREATMENT TO RISK Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of
More informationImaging Biomarkers: utilisation for the purposes of registration. EMEA-EFPIA Workshop on Biomarkers 15 December 2006
Imaging Biomarkers: utilisation for the purposes of registration EMEA-EFPIA Workshop on Biomarkers 15 December 2006 Vascular Imaging Technologies Carotid Ultrasound-IMT IVUS-PAV QCA-% stenosis 2 ICH E
More informationJanet B. Long, MSN, ACNP, CLS, FAHA, FNLA Rhode Island Cardiology Center
Primary and Secondary Prevention of Coronary Artery Disease: What is the role of non statin drugs (fenofibrates, fish oil, niacin, folate and vitamins)? Janet B. Long, MSN, ACNP, CLS, FAHA, FNLA Rhode
More informationDisclosures No relationships (not even to an employer) No off-label uses. Cholesterol Lowering Guidelines: What now?
Disclosures No relationships (not even to an employer) No off-label uses Cholesterol Lowering Guidelines: What now?, FACP 1 2 65-year-old white woman Total cholesterol 175mg/dL HDL 54 mg/dl LDL 96 mg/dl
More informationNew ACC/AHA Guidelines on Lipids: Are PCSK9 Inhibitors Poised for a Breakthrough?
New ACC/AHA Guidelines on Lipids: Are PCSK9 Inhibitors Poised for a Breakthrough? Sidney C. Smith, Jr. MD, FACC, FAHA Professor of Medicine/Cardiology University of North Carolina at Chapel Hill Immediate
More informationA total of 2,822 Mexican dyslipidemic cases and controls were recruited at INCMNSZ in
Supplemental Material The N342S MYLIP polymorphism is associated with high total cholesterol and increased LDL-receptor degradation in humans by Daphna Weissglas-Volkov et al. Supplementary Methods Mexican
More informationCHOLESTEROL-LOWERING THERAPHY
CHOLESTEROL-LOWERING THERAPHY TRIALS NUMBER OF PARTICIPANTS NUMBER OF WOMEN PERCENTAGE OF WOMEN MEAN AGE MEAN - (YEARS) TRIALS WITH ANALYSIS BY GENDER N, (%) 50,194 15,036 30.0% 60.8 3.2 1/ 6 (16.7%) HR
More informationThe Role of Apolipoprotein CIII in Coronary Artery Disease. Disclosures
Miami Cardiac & Vascular Institute Cardiovascular Disease Prevention 15th Annual Symposium February 16, 2017 Nobu Eden Roc Hotel, Miami Beach, Florida. The Role of Apolipoprotein CIII in Coronary Artery
More informationRequest for Prior Authorization for PCSK9 inhibitor therapy Website Form Submit request via: Fax
Request for Prior Authorization for PCSK9 inhibitor therapy Website Form www.highmarkhealthoptions.com Submit request via: Fax - 1-855-476-4158 PCSK9 is a protein that reduces the hepatic removal of low-density
More informationWhat Role do the New PCSK9 Inhibitors Have in Lipid Lowering Treatment?
What Role do the New PCSK9 Inhibitors Have in Lipid Lowering Treatment? Jennifer G. Robinson, MD, MPH Professor, Departments of Epidemiology & Medicine Director, Prevention Intervention Center University
More informationCETP inhibition: pros and cons. Philip Barter The Heart Research Institute Sydney, Australia
CETP inhibition: pros and cons Philip Barter The Heart Research Institute Sydney, Australia Philip Barter Disclosures Received honorariums for lectures, consultancies or membership of advisory boards from:
More informationGenome Summary. Sequencing Coverage: Variation Counts: Known Phenotype Summary: 131 disease or trait variations are found in this genome
Report Date: August 2, 215 Software Annotation Version: 8 Genome Summary Name: Greg Mendel Genome ID: genome_greg_mendel_dad Sequencing Provider: 23andMe Sequencing Type: Genotyping SNP Array Sequencing
More informationEpigenetics. Jenny van Dongen Vrije Universiteit (VU) Amsterdam Boulder, Friday march 10, 2017
Epigenetics Jenny van Dongen Vrije Universiteit (VU) Amsterdam j.van.dongen@vu.nl Boulder, Friday march 10, 2017 Epigenetics Epigenetics= The study of molecular mechanisms that influence the activity of
More informationAdvances in Lipid Management
Advances in Lipid Management Kavita Sharma, MD Assistant Professor of Medicine, Division of Cardiology Clinical Director of the Lipid Management Clinics, The Ohio State University Wexner Medical Center
More informationBest Lipid Treatments
Best Lipid Treatments Pam R. Taub MD, FACC Director of Step Family Cardiac Rehabilitation and Wellness Center Associate Professor of Medicine UC San Diego Health System Overview of Talk Review of pathogenesis
More informationDisclosures. Objectives 2/11/2017
Role of Non-Statin Therapy in CV Risk Reduction James A. Underberg, MD, MS, FACPM, FACP, FASH, FNLA,FASPC Clinical Assistant Professor of Medicine NYU School of Medicine NYU Langone Center for Cardiovascular
More informationReview of guidelines for management of dyslipidemia in diabetic patients
2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University
More informationQuantitative genetics: traits controlled by alleles at many loci
Quantitative genetics: traits controlled by alleles at many loci Human phenotypic adaptations and diseases commonly involve the effects of many genes, each will small effect Quantitative genetics allows
More informationClinical Trials and Clinical Practice: Surrogates at the Clinician/Patient Interface
Clinical Trials and Clinical Practice: Surrogates at the Clinician/Patient Interface Linda Lévesque, BScPhm, MSc, PhD Associate Professor, Department of Community Health and Epidemiology Queen s University
More information