Focus: Bioethics: Targeting Representation: Interpreting Calls for Diversity in Precision Medicine Research

Scientists have identified a “diversity gap” in genetic samples and health data, which have been drawn predominantly from individuals of European ancestry, as posing an existential threat to the promise of precision medicine. Inadequate inclusion as articulated by scientists, policymakers, and ethicists has prompted large-scale initiatives aimed at recruiting populations historically underrepresented in biomedical research. Despite explicit calls to increase diversity, the meaning of diversity – which dimensions matter for what outcomes and why – remain strikingly imprecise. Drawing on our document review and qualitative data from observations and interviews of funders and research teams involved in five precision medicine research (PMR) projects, we note that calls for increasing diversity often focus on “representation” as the goal of recruitment. The language of representation is used flexibly to refer to two objectives: achieving sufficient genetic variation across populations and including historically disenfranchised groups in research. We argue that these dual understandings of representation are more than rhetorical slippage, but rather allow for the contemporary collection of samples and data from marginalized populations to stand in as correcting historical exclusion of social groups towards addressing health inequity. We trace the unresolved historical debates over how and to what extent researchers should procure diversity in PMR and how they contributed to ongoing uncertainty about what axes of diversity matter and why. We argue that ambiguity in the meaning of representation at the outset of a study contributes to a lack of clear conceptualization of diversity downstream throughout subsequent phases of the study.     

A study of human myocardial tissue in Chagas' disease: distribution and frequency of inflammatory cell types

Although many reports have described the presence of inflammatory cells in chagasic lesions, the precise role(s) of these cells and whether their numbers in the lesions correlate with lesion severity are not known. In this work, we determined the numbers of mononuclear cells, neutrophils and eosinophils present in lesion sites of heart tissue sections from one acute and nine chronic chagasic patients. These numbers were independently recorded for five types of histologic patterns (HP) defined by the following characteristics: interstitial myocarditis with degeneration and necrosis of muscle fibers (HP I), interstitial myocarditis with preservation of muscle fibers (HP II), minimal or absent myocarditis with essentially preserved myocardium (HP III), interstitial fibrosis (HP IV), and myocytolysis (HP V). The largest numbers of inflammatory cells were found in HP I where substantial numbers of eosinophils were found. Eosinophils were frequently seen in areas showing HP I in the tissue sections from the patients with the most severe myocarditis (in terms of the high frequency of necrotic areas in HP I). Eosinophils were also seen in areas of HP III, i.e. in relatively preserved areas of tissue sections from patients displaying the most severe myocarditis, although in lesser numbers than found in HP I. The smallest numbers of inflammatory cells were seen in HP III, where the myocardium was essentially intact. Although significant numbers of inflammatory cells were seen in HP II and IV, eosinophils were either present in small numbers or absent, and there was no obvious correlation between the content of any of the monitored cell types and the overall intensity of myocarditis. The presence of relatively large proportions of eosinophils in tissue areas with HP I type of lesions would appear to implicate these cells in the production of chagasic heart lesions.     

Nuclear localization of TRK-A in liver cells

The liver represents a site of expression of neurotrophins and their receptors. We have characterized the expression and intracellular localization of the nerve growth factor (NGF) receptor, Trk-A, in liver cells in vivo and in vitro. In both normal and fibrotic liver tissue, Trk-A immunostaining was present in different cell types, including parenchymal cells and cells of the inflammatory infiltrate. In hepatocytes and activated stellate cells (HSC), Trk-A showed a predominant nuclear localization, both in the presence and absence of injury. In cultured HSC, Trk-A was found to be functional, because exposure of the cells to recombinant NGF resulted in stimulation of cell migration and activation of intracellular signaling pathways, including Ras-ERK and PI3K/Akt. Remarkably, in cultured HSC, Trk-A staining was found constitutively in the nucleus. In these cells, Trk-A could be stained only by antibodies directed against the intracellular domain but not by those recognizing the extracellular portion of Trk-A suggesting that the intracellular portion of the receptor is the major determinant of nuclear Trk-A staining. In contrast to HSC, freshly isolated hepatocytes did not show any nuclear localization of the intracellular portion of Trk-A. In pheocromocytoma cells, nuclear staining for Trk-A was not present in conditions of serum deprivation, but could be induced by exposure to NGF or to a mixture of soluble mediators. We conclude that nuclear localization of the intracellular domain of Trk-A is observed constitutively in liver cells such as HSC, while in other cell types it could be induced in response to soluble factors.     

Analysis of ribosomal DNA restriction patterns in the genusKluyveromyces

Riboprinting was used to determine the relationships among strains belonging to 15 species of the genusKluyveromyces. The small subunit ribosomal RNA gene (SSU rDNA) was amplified using the Polymerase Chain Reaction (PCR) and subjected to a battery of nine restriction enzymes. Similarity coefficients between strains were calculated based on shared and unique restriction fragments. Cluster analysis revealed three major groups that generally correlated with previously reported relationships based on other molecular data. Variations in SSU rDNA restriction fragments may be used for differentiation of theKluyveromyces strains included in this study.The U.S. Government right to retain a non-exclusive, royalty free licence in and to any copyright is acknowledged.     

Mitomycin C effect on Robertsonian translocations

Centromeric breaks and dissociation of Robertsonian translocations have been suggested to be the cause of a few cases of mosaicism. One possible explanation for dissociation could be that the point of reunion of the two acrocentrics would be a structurally fragile site. Mitomycin C (MMC) treatment of lymphocyte cultures from 6 patients having a Robertsonian translocation showed that in cases 1 and 2, who were already mosaics, MMC induced a statistically significant increase of the number of cells with the dissociated translocation. In the remaining cases a preferential centromeric break on the translocation was observed, indicating instability of the region. The relationship of monocentric and dicentric translocations, the viability of the cells resulting from the dissociation, and the clinical implications are discussed.     

Mitochondrial oxidative phosphorylation compensation may preserve vision in patients with OPA1-linked autosomal dominant optic atrophy

Autosomal Dominant Optic Atrophy (ADOA) is the most common inherited optic atrophy where vision impairment results from specific loss of retinal ganglion cells of the optic nerve. Around 60% of ADOA cases are linked to mutations in the OPA1 gene. OPA1 is a fission-fusion protein involved in mitochondrial inner membrane remodelling. ADOA presents with marked variation in clinical phenotype and varying degrees of vision loss, even among siblings carrying identical mutations in OPA1. To determine whether the degree of vision loss is associated with the level of mitochondrial impairment, we examined mitochondrial function in lymphoblast cell lines obtained from six large Australian OPA1-linked ADOA pedigrees. Comparing patients with severe vision loss (visual acuity [VA]<6/36) and patients with relatively preserved vision (VA>6/9) a clear defect in mitochondrial ATP synthesis and reduced respiration rates were observed in patients with poor vision. In addition, oxidative phosphorylation (OXPHOS) enzymology in ADOA patients with normal vision revealed increased complex II+III activity and levels of complex IV protein. These data suggest that OPA1 deficiency impairs OXPHOS efficiency, but compensation through increases in the distal complexes of the respiratory chain may preserve mitochondrial ATP production in patients who maintain normal vision. Identification of genetic variants that enable this response may provide novel therapeutic insights into OXPHOS compensation for preventing vision loss in optic neuropathies.     

Introduction to the Themed Issue on Human–Animal Interaction and Healthy Human Aging

ABSTRACT

In 2016, the Gerontological Society of America (GSA) developed a research focus on the benefits and potential risks associated with pets among older adults. With the goal of developing a roadmap for human–animal interaction (HAI) research in older people residing in both the community and institutions, GSA convened a workshop of international experts and policy-makers in the fields of aging and HAI. The status of current knowledge was shared on the success factors for healthy aging and the potential challenges (GSA, 2016). Participants considered what roles pets might play in the lives of older adults and their potential to mitigate loneliness, social isolation, and depression, and to enhance mobility and cognitive function. Existing research was shared to provide insights into the ways in which pets can impact older adults and their caregivers and to identify where further research is needed. This paper introduces a series of papers from that meeting, with some additional papers from meeting attendees to expand on the topics covered and provide key perspectives and gaps in information needed, as a foundation for those considering research into this topic. Although HAI/Animal-Assistant Intervention (AAI) research is in its infancy, there is some evidence that pet ownership or animal interaction can have major benefits for many older adults. At the same time, there are some risks to both the pet and the older adult that need to be addressed. Innovative approaches to both AAIs and the ways to overcome challenges are presented in this themed issue of Anthrozoös. Our hope is that the findings from these reviews and reports will stimulate additional work in this area.