Disclosure: Advisor to Pfizer. No conflicts of interest relevant to - - PowerPoint PPT Presentation

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Yvonne Maldonado, MD Professor of Pediatrics and Health Research and Policy Stanford University School of Medicine

Disclosure: Advisor to Pfizer. No conflicts of interest relevant to this topic.

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Stanford Precision Health for Ethnic and Racial Equity Center (SPHERE) Overview

• SPHERE will focus on identifying genetic and biological markers

that could be used to help reduce disease in minority populations in the United States.

• The center will develop analytical tools for precision health, data

sets and outreach programs that help accelerate the integration

• f treatments and interventions within target communities.
• This model can address populations with other health disparities

as well

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SPHERE Aims

The Center consists of three research projects and five core areas dedicated to the following overarching aims:

• 1. Successfully implement three projects while evolving into an integrated and

sustainable science ”team” able to take on novel projects proposed by our community consortium partners.

• 2. Expand Stanford’s portfolio of precision health work focusing on health

disparities.

• 3. Develop and expand relationships with our project partners to facilitate critical

bidirectional relationships in the community to ensure inclusion of further adversely impacted populations as projects and programs go forward.

• 4. Develop broad experience with “translation” of genetic and biologic information

within different racial and ethnic populations to optimize the application of such precision health approaches to reduce ethnic and racial disparities where such approaches are most relevant.

SPHERE Structure

SPHERE CENTER Steering Committee Administrative Core Laboratory Core Implementation Core Consortium Core Analytics and Modeling Core Stakeholders Community Partners Project 3 Communicating Cancer Genetics Information – Differential Response of Latino and Chinese Families to Information on Cancer Genetics Project 2 iPOP for Obesity and Diabetes Risk in Latino Youth Project 1 BRAICELET Bio-Repository for American Indian Capacity, Education, Law, Economics and Technology

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Project 1: BRAICELET Bio-Repository for American Indian Capacity, Education, Law, Economics and Technology

To help reduce the myriad of health disparities in American Indian populations, this proposal’s primary aim focuses on the establishment of the first tribally-owned biobank as a conduit for education on the benefits of precision medicine and big-data health science.

• 1. Establish American Indian Biobank with BRAICELET- Bio-Repository for American

Indian Capacity, Education, Law, Economics and Technology.

• Create a Lakota Health Community Advisory Group that will optimize

educational methods and promote cultural exchange

• Establish Lakota Biobank infrastructure and engage, educate and train tribal

community members as biobank personnel

• Endorse longterm sustainability through strategic and business management

and early pursuit of diverse funding approaches.

• 2. Establish pilot for first set of biobank material through the collection of 200

additional participants for SAIL (Studies of AutoImmune Illnesses with the Lakota).

• 3. Develop, implement and evaluate Science Health Education and Literacy among

Lakota as part of BRAICELET.

Project 1: BRAICELET Aims

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Project 2: iPOP Integrative Personalized Omics Profiling

To reduce health disparities by developing and applying ‘omics technologies to more effectively prevent and treat excess weight gain and diabetes risk. The first step toward this goal, is to quantify metabolic and bio-molecular differences among children that are associated with and/or predict obesity and diabetes risk, and to characterize the heterogeneous biological responses and moderators and mediators to interventions to reduce weight gain.

• 1. To assess associations of iPOP markers with measures of adiposity and

diabetes risk at baseline.

• 2. To assess the associations of baseline and 3-year longitudinal iPOP markers

with changes in measures of adiposity and diabetes risk.

• 3. To test the additional predictive value of iPOP signatures for changes in

adiposity and diabetes risk over 3-years when combined with cognitive, behavioral, socio-demographic and environmental measures, across all participants and as possible moderators and mediators of intervention effects.

Project 2: iPOP Aims

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Project 3 Communicating Cancer Genetics Information

This project addresses the possible worsening of health disparities associated with not comprehending genetic health risks. It includes a multi-ethnic, multi-lingual, two-site study (Stanford University Health Alliance and University of Southern California Los Angeles County Hospital) of how breast cancer genetic risk information is communicated to Hispanic, Chinese, and Non-Hispanic White women, what they understand, how they respond, and with whom they share this information.

• 1. To assess genomic confidence of clinicians communicating genetic test results and

genetic risk information on breast cancer to diverse patients.

• 2. To audiotape the information that clinicians communicate during the clinical

encounter in delivering genetic test results and to assess whether the information that is provided to patients differs by patient ethnicity, health literacy, and study site.

• 3. To assess the correspondence between the recommendations of doctors and the

subsequent actions of patients over and whether this correspondence differs by ethnicity, health literacy, and study sites.

• 4. To identify if/when patients share their personal genetic risk information with family

member(s) and to what extent this process is influenced by ethnicity, health literacy, and study sites.

Project 3: Communicating Genetics Information Aims

Administration Core Consortium Core Implementation Core Analytics and Modeling Core Laboratory Core

Consortium Core

Members of the Consortium Core will join forces to:

• 1. Create a strategic alliance among diverse partners at the local, regional, and state

levels to address health disparities through innovative precision health projects.

• 2. Build capacity among patients, providers, and communities to incorporate

precision health topics and applications for the promotion of health equity.

• 3. Systematically evaluate the function and progress of SPHERE project partnerships

in promoting health equity through precision health approaches.

• 4. Develop and implement an effective pilot grant program to facilitate assessment
• f emerging needs in precision health related to communities with health

disparities.

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SPHERE Partners

Implementation Core

Members of the Consortium Core will collaborate to accomplish objectives aimed at supporting implementation of results from SPHERE projects:

• 1. Develop and evaluate the SPHERE ethical guidelines for participation in precision

health projects and delivery of precision health approaches among American Indians, Latinos, and Asians.

• 2. Systematically assess the potential for dissemination and implementation of precision

health interventions with mixed methods using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model among American Indians, Latinos, and Asians.

• 3. Establish a “Precision Health Innovation Lab” in Stanford Primary Care where precision

health implementation strategies can be rapidly utilized and refined among racial/ethnic minority and low-income patients in order to improve clinical care.

• 4. Develop, implement, and evaluate a precision health-training curriculum for providers

that serve racial/ethnic minority and low-income patients in community settings.

Analytics and Modeling Core

Members of the Analytics and Modeling Core will:

• 1. Develop generalizable models to understand impact on health disparities of

emerging precision medicine approaches

• 2. Facilitate development of models to study disparities impact of precision

medicine developments › Starting to generate base models for later data input

Laboratory Core

Members of the Laboratory Core will provide services to different projects in the Center as well as any other groups in the consortium

• 1. Perform ancestry estimation and genome-wide association analyses using a

genotyping array and software designed for diverse populations (Projects 1 and 2).

• 2. Perform RNA-SEQ laboratory work including analysis (Projects 1 and 2).
• 3. Perform Metabolomics laboratory work and analyses (Project 2).
• 4. Perform Microbiome laboratory work and analyses (Project 2).
• 5. Assist any other groups in the Center with Omics activities (All Projects).
• 6. Assist in dissemination of results and technologies (All Projects).

3/8/2018 6 Early Successes

• 1. Project 1 team traveled to South Dakota and developed an engagement plan with

community members of the Cheyenne River Reservation.

• 2. Focus groups conducted in January 2017, based on the guide designed by the

Implementation Core. Results will lead to the development of Ethical Guidelines for Precision Health Research.

• 3. Lab Core developed partnership with a lab in Mexico, run by a senior scientist from

Stanford, to expand genotyping/sequencing core lab capabilities for projects 1 and 2.

• 4. Held a successful and well attended Community Consortium meeting to work with our

community partners in understanding the importance and impact of Precision Health in reducing health disparities.

• 5. Analytics and Modeling Core published: “Comparative effectiveness and cost-

effectiveness of treat-to-target versus benefit-based tailored treatment of type 2 diabetes in low-income and middle-income countries: a modelling analysis” in Lancet Diabetes Endocrinol 2016 Oct 4.

Thank you!