Translational genomics for human diseases: toward a new era of precision medicine

The ethics of resource allocation in translational genomic medicine

Two basic models of the rationale of translational genomic medicine (TGM)-the "Lab Assisting Clinic" (LAC) and the "Clinic Assisting Lab" (CAL) models-are distinguished, in order to address the ethics of allocating resources for TGM. The basic challenge of justifying such allocation is for TGM to demonstrate sufficient benefits to justify the opportunity cost of lost benefits in other areas of medicine or research. While suggested ethics frameworks for translational medicine build on clearly distinguishing these models, actual TGM typically blurs them. Due to lack of and difficulty in collecting evidence, prospects for justifying the LAC model currently seem poor, but this difficulty might be overcome by more research that tests the very concept of TGM. The CAL model aims to thus advance science, but is ridden by ethical hazard, undermining attempts at justification. This leaves the notion of running bona fide controlled trials of entire TGM concepts that have been justified from the perspective of clinical and research ethics (and approved by IRBs). It remains, however, an open question if the outcomes of such trials will demonstrate benefits that can justify the investment in TGM. To advance the prospect of such justification further, charting of the cost-benefit profile of TGM compared to alternative health investments would be helpful.

Advances of single-cell genomics and epigenomics in human disease: where are we now?

Cellular heterogeneity is revolutionizing the way to study, monitor and dissect complex diseases. This has been possible with the technological and computational advances associated to single-cell genomics and epigenomics. Deeper understanding of cell-to-cell variation and its impact on tissue function will open new avenues for early disease detection, accurate diagnosis and personalized treatments, all together leading to the next generation of health care. This review focuses on the recent discoveries that single-cell genomics and epigenomics have facilitated in the context of human health. It highlights the potential of single-cell omics to further advance the development of personalized treatments and precision medicine in cancer, diabetes and chronic age-related diseases. The promise of single-cell technologies to generate new insights about the differences in function between individual cells is just emerging, and it is paving the way for identifying biomarkers and novel therapeutic targets to tackle age, complex diseases and understand the effect of life style interventions and environmental factors.