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Standardization of Genomic Nomenclature across a Diverse Ecosystem of Stakeholders: Evolution and Challenges. 基因组命名法在不同利益相关者生态系统中的标准化:进化和挑战。
IF 7.1 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2025-01-03 DOI: 10.1093/clinchem/hvae195
Laura K Conlin, Melissa J Landrum, Robert R Freimuth, Birgit Funke

Background: Genetic testing has traditionally been divided into molecular genetics and cytogenetics, originally driven by the use of different assays and their associated limitations. Cytogenetic technologies such as karyotyping, fluorescent in situ hybridization or chromosomal microarrays are used to detect large "megabase level" copy number variants and other structural variants such as inversions or translocations. In contrast, molecular methodologies are heavily biased toward subgenic "small variants" such as single nucleotide variants, insertions/deletions, and targeted detection of intragenic, exon level deletions or duplications. The boundaries between these approaches are now increasingly blurred as next-generation sequencing technologies and their use for genome-wide analysis are used by both disciplines, therefore eliminating the historic and somewhat artificial separation driven by variant type.

Content: This review discusses the history of genomic nomenclature across both fields, summarizes implementation challenges for the clinical genetics community, and identifies key considerations for enabling a seamless connection of the stakeholders that consume variant descriptions.

Summary: Standardization is naturally a lengthy and complex process that requires consensus building between different stakeholders. Developing a standard that not only fits the multitude of needs across the entities that consume genetic variant information but also works equally well for all genetic variant types is an ambitious goal that calls for revisiting this vision.

背景:基因检测传统上分为分子遗传学和细胞遗传学,最初是由于使用不同的测定方法及其相关的局限性。细胞遗传学技术,如核型、荧光原位杂交或染色体微阵列被用于检测大的“兆基水平”拷贝数变异和其他结构变异,如倒置或易位。相比之下,分子方法严重偏向于亚基因“小变异”,如单核苷酸变异、插入/缺失以及基因内、外显子水平缺失或重复的靶向检测。随着下一代测序技术及其用于全基因组分析的应用被两个学科所使用,这些方法之间的界限现在越来越模糊,因此消除了由变异类型驱动的历史性的和有些人为的分离。内容:本综述讨论了基因组命名法在这两个领域的历史,总结了临床遗传学社区的实施挑战,并确定了实现使用变异描述的利益相关者之间无缝连接的关键考虑因素。摘要:标准化自然是一个漫长而复杂的过程,需要在不同的利益相关者之间建立共识。开发一种标准,不仅满足使用遗传变异信息的实体的众多需求,而且同样适用于所有遗传变异类型,这是一个雄心勃勃的目标,需要重新审视这一愿景。
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引用次数: 0
Innovations in Short-Read Sequencing Technologies and Their Applications to Clinical Genomics. 短链测序技术的创新及其在临床基因组学中的应用。
IF 7.1 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2025-01-03 DOI: 10.1093/clinchem/hvae173
Katarzyna Polonis, Joseph H Blommel, Andrew E O Hughes, David Spencer, Joseph A Thompson, Molly C Schroeder

Background: Massively parallel sequencing (MPS) of nucleic acids has been a transformative technology for basic and applied genomic science, increasing efficiencies and decreasing costs to enable studies of unprecedented scope and impact. In clinical settings, these technological and scientific advances have led to the development of tests that are increasingly fast, comprehensive, and more frequently employed. Practitioners of genomic medicine have applied these tools across clinical settings, including diagnosis of inherited disorders and cancers and infectious disease detection and surveillance. In recent years, the commercial marketplace for MPS sequencers and reagents has been dominated by a few companies. The growing demand for sequencing has led to the recent emergence of several new sequencing platforms with techniques that may provide alternatives or improvements to existing workflows or allow the adoption of sequencing workflows in new settings. Clinical genomics laboratories will evaluate these platforms from a unique perspective, focusing on how technological advancements can improve patient care.

Content: This review describes short-read sequencing platforms provided by Illumina, Element Biosciences, MGI, PacBio, Singular Genomics, Thermo Fisher Scientific, and Ultima Genomics. This review discusses their innovative approaches, principles, workflows, and applications.

Summary: This review aims to inform laboratory geneticists, clinicians, and researchers about emerging short-read technologies and their applications in clinical genomics. By highlighting their principles and potential contributions, we aim to assist laboratories in selecting suitable solutions for their sequencing needs considering key factors such as applications, throughput, and integration with existing laboratory workflows.

背景:核酸大规模平行测序(MPS)是基础和应用基因组科学的一项变革性技术,它提高了效率,降低了成本,使研究的范围和影响达到了前所未有的程度。在临床环境中,这些技术和科学进步促使开发出越来越快、越来越全面、越来越频繁使用的检测方法。基因组医学从业人员已将这些工具应用于各种临床环境,包括遗传性疾病和癌症的诊断以及传染病的检测和监控。近年来,MPS 测序仪和试剂的商业市场一直由几家公司主导。随着测序需求的不断增长,最近出现了几种新的测序平台,其技术可替代或改进现有的工作流程,或允许在新的环境中采用测序工作流程。临床基因组学实验室将从独特的角度评估这些平台,重点关注技术进步如何改善患者护理:本综述介绍了由 Illumina、Element Biosciences、MGI、PacBio、Singular Genomics、Thermo Fisher Scientific 和 Ultima Genomics 提供的短读数测序平台。摘要:本综述旨在向实验室遗传学家、临床医生和研究人员介绍新兴的短读技术及其在临床基因组学中的应用。通过强调短读技术的原理和潜在贡献,我们旨在帮助实验室在考虑应用、吞吐量以及与现有实验室工作流程的整合等关键因素的基础上,选择适合其测序需求的解决方案。
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引用次数: 0
Genomic Data and Privacy. 基因组数据和隐私。
IF 7.1 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2025-01-03 DOI: 10.1093/clinchem/hvae184
Candace T Myers, Runjun D Kumar, Lisa Pilgram, Luca Bonomi, Mara Thomas, Obi L Griffith, Stephanie M Fullerton, Richard A Gibbs
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引用次数: 0
Performance of Noninvasive Tests for Metabolic Dysfunction-Associated Steatohepatitis and Liver Fibrosis Resolution after Bariatric Surgery 减肥手术后代谢功能障碍相关脂肪性肝炎和肝纤维化解决的无创测试性能
IF 9.3 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-12-30 DOI: 10.1093/clinchem/hvae208
Giulia Angelini, Simona Panunzi, Maurizio Pompili, Laura Riccardi, Matteo Garcovich, Ornella Verrastro, Sara Russo, Tracey Mare, James Luxton, Carel W le Roux, Marco Raffaelli, Geltrude Mingrone, Royce P Vincent
Background Noninvasive tests (NITs) to monitor metabolic dysfunction-associated steatohepatitis (MASH) progression and response to interventions are needed because of the risks of liver biopsy. A monocytes-based diagnostic test using perilipin-2 (PLIN2) and Ras-related protein-14 (RAB14) predict the severity of MASH and fibrosis. Here we compared the performances of PLIN2 and RAB14 with cytokeratin-18 (CK18) assessed by Ella™ or M65 ELISA in predicting MASH and fibrosis resolution following bariatric surgery in a longitudinal and histologically characterized cohort of individuals with obesity. Methods Participants in the BRAVES randomized controlled trial underwent ultrasound-guided needle liver biopsy at baseline and 1 year after surgery. We evaluated NITs’ performance using area under the receiver operating characteristic and calculated accuracy, sensitivity, and specificity based on the Youden threshold. Univariable and multivariable logistic models were used to assess the role of recorded covariates in predicting MASH and fibrosis severity, as well as resolution or improvement. Results After surgery, patients who experienced MASH improvement or resolution showed a significant decrease in PLIN2 expression as compared to those who did not, while patients with fibrosis improvement displayed an increase in RAB14. No differences were found for CK18. The diagnostic accuracy of PLIN2 and RAB14 for the prediction of MASH resolution or fibrosis improvement was superior to CK18 assessed by either Ella or M65 ELISA. Conclusions PLIN2 and RAB14, but not CK18, are markers for monitoring improvements in MASH and fibrosis after interventions such as bariatric surgery. This may reduce or eliminate the need for frequent liver biopsies. ClinicalTrials.gov Registration Number: NCT03524365
背景:由于肝活检的风险,需要无创检测(nit)来监测代谢功能障碍相关脂肪性肝炎(MASH)的进展和对干预措施的反应。一项基于单核细胞的诊断试验使用perilipin-2 (PLIN2)和ras相关蛋白-14 (RAB14)预测MASH和纤维化的严重程度。在这里,我们比较了PLIN2和RAB14与细胞角蛋白-18 (CK18)的性能,通过Ella™或M65 ELISA评估,在纵向和组织学特征的肥胖个体队列中预测减肥手术后的MASH和纤维化消退。方法:BRAVES随机对照试验的参与者在基线和术后1年接受超声引导下的肝穿刺活检。我们使用接收器工作特征下的面积和基于约登阈值计算的准确性、灵敏度和特异性来评估NITs的性能。使用单变量和多变量逻辑模型来评估记录的协变量在预测MASH和纤维化严重程度以及缓解或改善方面的作用。结果手术后,与未经历MASH改善或缓解的患者相比,经历MASH改善或缓解的患者PLIN2表达显著降低,而纤维化改善的患者RAB14表达增加。在CK18中没有发现差异。PLIN2和RAB14在预测MASH消退或纤维化改善方面的诊断准确性优于Ella或M65 ELISA评估的CK18。结论PLIN2和RAB14,而不是CK18,是监测干预(如减肥手术)后MASH和纤维化改善的标志物。这可能减少或消除频繁肝活检的需要。ClinicalTrials.gov注册号:NCT03524365
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引用次数: 0
The Application of Digital PCR as a Reference Measurement Procedure to Support the Accuracy of Quality Assurance for Infectious Disease Molecular Diagnostic Testing. 应用数字PCR作为参考测量程序支持传染病分子诊断检测质量保证的准确性。
IF 9.3 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-12-26 DOI: 10.1093/clinchem/hvae187
Samreen Falak,Denise M O'Sullivan,Megan H Cleveland,Simon Cowen,Eloise J Busby,Alison S Devonshire,Esmeralda Valiente,Gerwyn M Jones,Martin Kammel,Mojca Milavec,Laura Vierbaum,Ingo Schellenberg,Heinz Zeichhardt,Andreas Kummrow,Peter M Vallone,Rainer Macdonald,Jim F Huggett
BACKGROUNDNucleic acid amplification tests (NAATs) assist in the diagnosis of numerous infectious diseases. They are typically sensitive and specific and can be quickly developed and adapted. Far more challenging is the development of standards to ensure NAATs are performing within specification; reference materials take time to develop and suitable reference measurement procedures (RMPs) have not been available. This study investigated digital PCR (dPCR) RMP delivery of traceability for NAAT external quality assessment (EQA).METHODSThree National Metrology Institutes (NMIs) applied reverse transcription (RT)-dPCR as a candidate RMP to estimate the RNA quantity in 32 independent severe acute respiratory syndrome coronavirus 2 materials. The results were combined to value assign the respective materials: 21 materials were used in 6 rounds of EQA over 17 months for 61 laboratories for COVID-19 testing results compared with reference values.RESULTSThe agreement between the 3 NMIs showed <2-fold difference between laboratories. EQA laboratory reverse transcription quantitative PCR (RT-qPCR) values estimation of viral RNA quantity showed good median agreement with RT-dPCR reference value; however, RT-qPCR differences were generally between 10- and 50-fold between laboratories.CONCLUSIONThis work demonstrates how RT-dPCR can provide reference values for whole virus materials for NAAT quality assurance. RT-dPCR values guided EQA control material selection and provided EQA participants with traceability to RNA copy number delivered through the RMP. This approach can be used to support routine reference material use as well as to standardize quality assurance for NAATs where established reference materials are not available, such as in disease outbreaks.
背景核酸扩增试验(NAATs)有助于许多传染病的诊断。它们通常是敏感和特异性的,可以迅速发展和适应。更具挑战性的是制定标准,以确保naat在规范范围内执行;标准物质的开发需要时间,而且还没有合适的参考测量程序。本研究探讨了数字PCR (dPCR) RMP传递对NAAT外部质量评估(EQA)的可追溯性。方法3个国家计量研究所(NMIs)采用逆转录(RT)-dPCR作为候选RMP方法,对32份独立的sars冠状病毒2型材料的RNA数量进行估计。将结果结合起来对各自的材料进行数值分配:61个实验室在17个月的6轮EQA中使用了21种材料,将COVID-19检测结果与参考值进行比较。结果3种nmi的一致性在实验室间差异<2倍。EQA实验室逆转录定量PCR (RT-qPCR)病毒RNA量估计值与RT-dPCR参考值吻合中值较好;然而,实验室之间的RT-qPCR差异通常在10到50倍之间。结论RT-dPCR可为NAAT全病毒材料的质量保证提供参考价值。RT-dPCR值指导EQA对照材料的选择,并为EQA参与者提供通过RMP传递的RNA拷贝数的可追溯性。这种方法可用于支持常规参考物质的使用,以及在无法获得既定参考物质的情况下(例如在疾病暴发时)标准化NAATs的质量保证。
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引用次数: 0
Transitioning Alzheimer Disease Blood Biomarkers into Primary Care: Are We There Yet? 将阿尔茨海默病血液生物标志物转化为初级保健:我们做到了吗?
IF 9.3 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-12-26 DOI: 10.1093/clinchem/hvae211
Katheryn A Q Cousins,Leslie M Shaw
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引用次数: 0
Evolving Perspectives on Immune Repertoire Profiling: Challenges and Opportunities in the Era of Long-Read Sequencing. 免疫库分析的发展前景:长读测序时代的挑战和机遇。
IF 9.3 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-12-26 DOI: 10.1093/clinchem/hvae219
Martin A Smith
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引用次数: 0
Remnant Cholesterol: Quantification, Concentrations by Sex and Age, and Risk of Ischemic Heart Disease 残余胆固醇:定量,按性别和年龄的浓度,和缺血性心脏病的风险
IF 9.3 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-12-26 DOI: 10.1093/clinchem/hvae217
Mie Balling, Shoaib Afzal, Anette Varbo, Børge G Nordestgaard, Anne Langsted
Background Observational and genetic causal studies have shown an association between high concentrations of remnant cholesterol and increased risk of ischemic heart disease. However, findings from randomized intervention trials that reduced plasma triglycerides, a surrogate marker of remnant cholesterol, have been conflicting. The exact mechanisms by which remnant cholesterol contributes to atherosclerosis and, ultimately, ischemic heart disease remain incompletely understood. Additionally, insight on sex and age differences and the importance of measurement differences of remnant cholesterol in plasma concentrations and risk of ischemic heart disease are sparse. Content This review covers current knowledge regarding remnant cholesterol and its role in ischemic heart disease, with particular attention to measurement and sex- and age-specific differences. Summary Findings from observational, genetic, and mechanistic studies support the notion that higher remnant cholesterol may be an important cause of ischemic heart disease in both women and men. Concentrations of remnant cholesterol vary by age, with a sharp increase at early adulthood for men and around menopause for women. Remnant cholesterol can be calculated from a standard lipid profile and in addition measured directly using manual ultracentrifugation, automated assays, and nuclear magnetic resonance spectroscopy. Irrespective of the method used to assess plasma concentrations, high concentrations of remnant cholesterol are consistently associated with increased risk of myocardial infarction and ischemic heart disease in observational and genetic causal studies; cholesterol rather than triglycerides in remnants drive this risk. Importantly, results from ongoing randomized clinical trials aiming specifically at lowering remnant cholesterol and ischemic heart disease are eagerly awaited.
背景观察性和遗传因果研究表明,高浓度残余胆固醇与缺血性心脏病风险增加之间存在关联。然而,随机干预试验的结果表明,血浆甘油三酯(残余胆固醇的替代标志物)的降低存在矛盾。残留胆固醇导致动脉粥样硬化并最终导致缺血性心脏病的确切机制尚不完全清楚。此外,关于性别和年龄差异的见解以及血浆中残余胆固醇浓度差异和缺血性心脏病风险的测量的重要性尚不多见。本文综述了目前关于残余胆固醇及其在缺血性心脏病中的作用的知识,特别关注测量和性别和年龄特异性差异。来自观察性、遗传学和机制研究的发现支持这样一种观点,即高残留胆固醇可能是女性和男性缺血性心脏病的重要原因。残余胆固醇的浓度因年龄而异,男性在成年早期急剧增加,女性在更年期前后急剧增加。残余胆固醇可以从标准脂质谱计算,另外直接使用人工超离心、自动测定和核磁共振波谱法测量。无论使用何种方法评估血浆浓度,在观察性和遗传因果研究中,高浓度残余胆固醇始终与心肌梗死和缺血性心脏病风险增加相关;导致这种风险的是胆固醇而不是甘油三酸酯。重要的是,正在进行的旨在降低残余胆固醇和缺血性心脏病的随机临床试验的结果正在等待中。
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引用次数: 0
Optimal Cutoff Values and Utility of High-Sensitivity Troponin T and NT-proBNP for the Risk Stratification of Patients with Acute Pulmonary Embolism 高敏感性肌钙蛋白T和NT-proBNP对急性肺栓塞患者风险分层的最佳临界值和效用
IF 9.3 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-12-20 DOI: 10.1093/clinchem/hvae212
Timothy M Matthews, Gregory A Peters, Grace Wang, Nora Horick, Kyle E Chang, Savanah Harshbarger, Christiana Prucnal, Drew A Birrenkott, Karsten Stannek, Eun Sang Lee, Isabel Dhar, Jesse O Wrenn, William B Stubblefield, Christopher Kabrhel
Background Guidelines recommend using high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to risk stratify hemodynamically stable patients with acute pulmonary embolism (PE). However, there are no evidence-based cutoff values defined for this clinical application. Methods We performed a single-center, retrospective cohort study of patients with imaging-confirmed PE and hsTnT and/or NT-proBNP (ElecsysTM, Roche) measured 12 h before or 24 h after PE Response Team (PERT) activation. We excluded hypotensive patients. Our primary outcome was a composite of adverse outcomes or critical interventions within 7 days. We calculated the area under the receiver operating curve (AUC, ROC) for hsTnT and NT-proBNP and determined the optimal cutoffs using the distance from (0,1). We performed a subgroup analysis on patients with PE and right ventricular dysfunction on imaging. Results Two hundred thirty-four patients were included in the hsTnT analysis, and 727 in the NT-proBNP analysis. Mean age was 62 years (SD = 17) and 47% were female. The AUC for hsTnT was 0.64 (95% CI, 0.56–0.71) with an optimal cutoff of 46 ng/L, corresponding to a sensitivity of 59% (95% CI, 49–69) and a specificity of 61% (95% CI, 53–69). The AUC for NT-proBNP was 0.56 (95% CI, 0.51–0.61) with an optimal cutoff of 1092 pg/mL, corresponding to a sensitivity of 53% (95% CI, 45–61) and a specificity of 59% (95% CI, 55–63). Conclusion We identified an optimal cutoff of 46 ng/L for hsTnT and 1092 pg/mL for NT-proBNP, though the AUC for both markers suggests low to moderate performance for the risk stratification of initially hemodynamically stable PERT patients. Use of these biomarkers to risk stratify PE may require reconsideration.
背景:指南推荐使用高敏感性肌钙蛋白T (hsTnT)和n端前b型利钠肽(NT-proBNP)对血流动力学稳定的急性肺栓塞(PE)患者进行风险分层。然而,对于这种临床应用,尚无基于证据的临界值。方法:我们对影像学证实的PE和hsTnT和/或NT-proBNP (ElecsysTM, Roche)患者进行了一项单中心、回顾性队列研究,在PE Response Team (PERT)激活前12小时或激活后24小时测量。我们排除了低血压患者。我们的主要结局是7天内不良结局或关键干预的综合结果。我们计算了hsTnT和NT-proBNP的接收者工作曲线下的面积(AUC, ROC),并使用与(0,1)的距离确定了最佳截止点。我们对PE合并右室功能不全的患者进行了亚组分析。结果hsTnT分析纳入234例患者,NT-proBNP分析纳入727例患者。平均年龄62岁(SD = 17),女性占47%。hsTnT的AUC为0.64 (95% CI, 0.56-0.71),最佳临界值为46 ng/L,相应的灵敏度为59% (95% CI, 49-69),特异性为61% (95% CI, 53-69)。NT-proBNP的AUC为0.56 (95% CI, 0.51-0.61),最佳截止值为1092 pg/mL,相应的敏感性为53% (95% CI, 45-61),特异性为59% (95% CI, 55-63)。我们确定hsTnT的最佳临界值为46 ng/L, NT-proBNP的最佳临界值为1092 pg/mL,尽管这两种标记物的AUC表明,对于初始血流动力学稳定的PERT患者来说,这两种标记物的风险分层表现较低至中等。使用这些生物标志物对PE进行风险分层可能需要重新考虑。
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引用次数: 0
Advances in Cardiac Troponin Composition Assays: A Step Closer to the Clinic? 心肌肌钙蛋白组成测定的进展:离临床又近了一步?
IF 7.1 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-12-19 DOI: 10.1093/clinchem/hvae206
Xander M R van Wijk, Sander A J Damen
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引用次数: 0
期刊
Clinical chemistry
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