Genomic medicine in Africa: a need for molecular genetics and pharmacogenomics experts

Are Hospital Pharmacists Ready for Precision Medicine in Nigerian Healthcare? Insights From a Multi-Center Study

Background

Precision medicine (PM) has taken center stage in healthcare since the completion of the genomic project. Developed countries have gradually integrated PM into mainstream patient management. However, Nigeria still grapples with wide acceptance, key translational research and implementation of PM. This study sought to explore the knowledge and attitude of PM among pharmacists as key stakeholders in the healthcare team.

Methods

A cross-sectional study was conducted in selected tertiary hospitals across the country. A 21-item semi-structured questionnaire was administered by hybrid online and physical methods and the results analyzed with Statistical Package for the Social Sciences Version 25. Descriptive statistics were used to summarize the data. A chi-square test was employed to determine the association of knowledge of PM and the sociodemographic characteristics of the study population.

Results

A total of 167 hospital pharmacists participated in the study. A high proportion of the participants are familiar with artificial intelligence (91.75%), Pharmacogenomics (84.5%), and precision medicine (61%). Overall, 38.9% of the pharmacists had a good knowledge while 13.2% had a poor knowledge of PM and associated terms. The level of knowledge did not correlate significantly with gender (X 2 = 3.21, p = 0.201), age (X 2 = 5, p = 0.27), marital status (X 2 = 3.21, p = 0.201), and professional level (X 2 = 6.85, p = 0.144). The most important value of precision medicine to hospital pharmacists is the ability to minimize the impact of disease through preventive medicine (49%) while a large portion are pursuing and or actively planning to pursue additional education in precision medicine.

Conclusions

There is a highly positive attitude toward the prospect of PM among hospital pharmacists in Nigeria. Education modules in this field are highly recommended as most do not have a holistic knowledge of terms used in PM. Also, more research aimed at translating PM knowledge into clinical practice is recommended.

Pharmacogenomics Tools for Precision Public Health and Lessons for Low- and Middle-Income Countries: A Scoping Review

Pharmacogenomics is the integration of genomics and pharmacology to optimize drug response and reduce side effects. In terms of personalized or individualized medicine, PGx is defined as the identification and analysis of specific genetic variants associated with particular drug treatments for each patient. Under a precision public health (PPH) approach, population-level data are analyzed to generate public health strategies. The objective of this study was to conduct a scoping review of technological tools, examining their evolution, the predominance of high-income countries in their development, and the gaps and needs for genomic data and advances in low- and middle-income countries (LMICs). This review was conducted in accordance with the ScPRISMA guidelines. A search was conducted in PubMed, Web of Science and Embase until January 2024. A total of 40 documents were selected, which revealed the continuous evolution and progressive development of pharmacogenomic tools. The technological tools developed come from high-income countries, particularly the United States, Canada, China, and several European nations, where international collaboration has been essential to maintain and expand these tools, which have evolved to keep pace with the rapid generation of genomic data. This trend shows a scarce development of technological tools for public health precision in LMICs, which evidences the need to increase investment in genomic research infrastructure in this aspect and in the development of capacities to guarantee global accessibility and boost PPH for all populations.

Leveraging human-mouse studies to advance the genetics of hearing impairment in Africa

Mouse models are used extensively to understand human pathobiology and mechanistic functions of disease-associated loci. However, in this review, we investigate the potential of using genetic mouse models to identify genetic markers that can disrupt hearing thresholds in mice and then target the hearing-enriched orthologues and loci in humans. Currently, little is known about the real prevalence of genes that cause hearing impairment (HI) in Africa. Pre-screening mouse cell lines to identify orthologues of interest has the potential to improve the genetic diagnosis for HI in Africa to a significant percentage, for example, 10-20%. Furthermore, the functionality of a candidate gene derived from mouse screening with heterogeneous genetic backgrounds and multi-omic approaches can shed light on the molecular, genetic heterogeneity and plausible mode of inheritance of a gene in hearing-impaired individuals especially in the absence of large families to investigate.

The analyses of human MCPH1 DNA repair machinery and genetic variations

Causal mutations in the MCPH1 gene have been associated with disorders like microcephaly, and recently congenital hearing impairment. This study examined the MCPH1 DNA repair machinery and identified genetic variations of interest in gnomAD database to discuss the biological roles and effects of rare variants in MCPH1-related diseases. Notably, MCPH1 coordinates two of the seven known mechanisms of DNA repair which confirmed its roles in neurogenesis and chromatin condensation. A pathogenic missense variant in MCPH1 p.Gly753Arg, and two pathogenic frameshifts MCPH1 p.Asn189LysfsTer15 and p.Cys624Ter identified in this study, already had entries in ClinVar and were associated with microcephaly. A pathogenic frameshift in MCPH1 p.Val10SerfsTer5 with a loss-of-function flag and a pathogenic stop gained p.Ser571Ter variants with ultra-rare allele frequency (MAF ≤ 0.001) were identified but have not been linked to any phenotype. The predicted pathogenic ultra-rare variants identified in this study, warranty phenotypic discovery, and also positioned these variants or nearby deleterious variants candidate for screening in MCPH1-associated rare diseases.