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Medicine's New Road Map

 

by Barbara Murray

The National Human Genome Center at Howard University is unlocking the secrets of gene mapping to help eliminate disease.

Curiosity about family history has evolved into something of an American hobby over the past three decades. Author Alex Haley piqued the country's interest back in the '70s when he shared his story of tracing his family roots back to Africa.
But knowledge of our past serves more purposes than just satisfying our curiosity-it can save lives. The latest advances in genetic research mean knowing the history of our origins can provide us with answers to why we are prone to certain diseases-and, eventually, how to prevent succumbing to those ailments.

At the center of the recent scientific developments in genetics is the mapping of the human genome, a project that came to fruition just three months ago. Defined as a biological specimen collection of characteristics and corresponding genes, the human genome encodes the approximately 80,000 genes that make a human, human. And it is that in-depth knowledge of our genetic makeup that will eventually change the face of medicine. With that said, if you have yet to hear of the National Human Genome Center at Howard University, you soon will.

Global research under our noses

It would have been nearly impossible to miss the hoopla surrounding the announcement that scientists had mapped the human genome earlier this year. Yet, in spite of the involvement of so many institutions with the global Human Genome Project, the media was unaware of Howard University's role in the genetic project. But at some point during 2001, all eyes could be on the university's National Human Genome Center (NHGC) and its Genomic Research in African Origin Populations (G-RAP) with study sites in Nigeria, Ghana, and the United States. Upon completion, these projects will assist in early diagnosis-and perhaps, prevention-of health issues that have historically plagued African Americans and other peoples of the world. With the help of this project and others, the world of diagnostic medicine is hoping to change the face of health care within the next ten years.
"There's very little published on the Genome Center itself because we're still being formed," says Dr. Georgia Dunston, acting director of the National Genome Center at Howard University.
While offices are still being erected and grants continue to roll in, the Genome Center's research moves forward. The university's involvement in the Human Genome Project dates back to 1985 when Congress appropriated funds for the establishment of research centers in minority institutions. That year, Dunston established Howard's Immunogenetics Laboratory, and in 1990, university investigators proposed the National Institutes of Health establish genomic research in the African American community.

Thus, the G-RAP project was born. "The purpose of the Genome Center is to bring multicultural perspective and resources to the Human Genome Project," Dunston explains. Dr. Francis Collins, director of the National Human Genome Research Institute at the National Institutes of Health, verifies the importance of the center in the Genome Project as a whole. "Advances in understanding the human genome will only happen if there is broad participation in genome research by diverse groups, from many institutions," Collins says. And the role of African Americans in the project is essential. African people in general, and African Americans in particular, represent a degree of genetics that is not captured in populations of primarily European origins. "The African population possesses the broadest range of genetic variations of all humans. Thus, without knowledge of Africans' genetic mapping, scientists cannot have a complete picture of the human genome," says Dunston. In other words, mapping the human genome without full understanding of the African population would be akin to building a house without a foundation.

In mapping the human genome, geneticists utilized genetic information from people of European origins. Since all humans have the same construct or teh same genetic map, the origin the sample group is irrevelent. but Dunston explains that at the sequence level-which is where genetic variations occur-there is a great deal of population differentiation. "The variation in genome changes over time, so in older populations, there's more time for changes to occur," she says. And the oldest populations, the doctor notes, have been traced back to Africa. Indeed, the 3.2 million-year old skeleton called Lucythought to be man's earliest human ancestor or our "missing link"-was discovered in 1974 in Ethiopia. "The human genome was there before homo sapiens-there's more variation in Africa which is consistent with it being the oldest population," adds Dunston.

So when observing the human genome in the United States, the greatest degree of variation is found in the African American population. To understand the genetic makeup of blacks in the U.S., it is essential to look back at Africa. "The period of evolution in Africa was much longer than the period of evolution since we came out of Africa," Dunston says. "We tend to look at African Americans as beginning in the U.S., but the human genome was established before humans migrated from Africa. The group moving out [of Africa] only represents a subset of the entire group."

What good is genetic makeup once discovered?

The greatest benefit to studying the variations in the human genome is to understand the basis of disease. Dunston says that even when you discover variations in the genome, those variations have different causes, which must be investigated and recorded. "There has to be a major appreciation for the difference in variations-natural variations versus changes associated with problems," she explains. "Diseases are multi factorial, involving environmental factors and biological factors-most issues of public health are not due to singlegene defects."

Researchers at Howard's genetic center are currently in the throes of investigating four diseases that appear to be inherently common in the black population: prostate cancer, diabetes, obesity, and hypertension. "Cutting-edge studies on the genetic contributions to diabetes and prostate cancer are already underway, led by a group of superb investigators who have gathered together at Howard to form the National Human Genome Center," says NIH's Dr. Collins.

Statistics show that in the United States, black men have the highest frequency of prostate cancer. This phenomenon makes Howard's genetic research among African American men stricken with prostate cancer an invaluable activity. The ultimate goal of the research is to determine why black men are prone to prostate cancer, and whether the susceptibility is somehow exacerbated by certain environmental conditions. The project requires collaboration and cooperation. Howard has formed a study network with the National Human Genome Research Institute and NIH that covers seven sites, including Washington, D.C., Atlanta. New York, Chicago and Detroit. But which to conduct the research is probably more difficult than the science itself. The criteria for subject qualification are limiting, to say the least, thus making viable test groups difficult to assemble. As she explains, "four men in a family must be diagnosed with prostate cancer and eight other family members must be willing to give blood [for comparative testing]."

Dr. Charles Rotimi heads the genetic epidemiology unit at Howard's Genome Center where scientists are working to unlock the mysteries behind the unusually high incidence of diseases like hypertension, diabetes and obesity among African Americans. Rotimi explains that the primary goal of the genetic epidemiology unit is to design large population-based studies that will interact to increase an individual's or a family's proneness to some diseases. "We know now that some diseases like diabetes and heart disease run in some families," he says.

Rotimi and other scientists at the NHGC at Howard University hope to take advantage of the old and rich evolutionary history of black populations around the world (including the U.S., the Caribbean and sub-Saharan Africa) to identify genes and environmental factors such as diet, stress, and physical activity that may contribute to getting diseases like diabetes, hypertension, obesity, and cancer. Identifying these genes, and the knowledge of how they work, will lead to better understanding of the factors in our environment that may increase our risk of developing these diseases.

As the principal investigator and program director, respectively, Rotimi and Dunston are excited about the diabetes project, Africa America Diabetes Mellitus (AADM, pronounced ADAM-signifying the beginning). Its purpose is to identify genes that are important in the development of adult diabetes in West African ancestral populations of African Americans. The study is an international collaboration between NHGC investigators, the National Human Genome Research Institute of the National Institutes of Health, and West African scientists in Ghana and Nigeria. Despite initial skepticism, the diabetes study has been a gratifying success that is at least six months ahead of schedule. In fact, the first scientific publications from this research effort have been accepted for publication in a peer-reviewed journal.

Later this year, genetic studies of diabetes, obesity, and hypertension involving African American families from the Washington, D.C., and Maryland communities will begin. Volunteers are hard to come by for several reasons, including the not so "pure" history of medical studies in the U.S. and other countries. According to Rotimi, hesiataion expressed by some would-be participants in these genetic studies is not unfounded. He makes specific reference to the Tuskegee experiment, a U.S. Public Health Service's secret and deadly study of syphilis-afflicted black males from 1932 to 1972 in Tuskegee, Alabama. The project officials lied to most of the participants, telling them they were being treated for the disease while, in actuality, they were being monitored for the effects resulting from lack of treatment.

Despite the "not so rosy" history of medical studies, Rotimi says, "African American and other minority communities cannot afford not to participate in the Human Genome Project." Although humans are 99 percent similar, subtle ethnic differences exist at the genetic and environmental levels. If an ethnic group, such as African Americans, is not adequately represented in these genetic studies, scientists may not be able to develop more effective preventive and treatment protocols for that group.

Research institutions, including Howard University and the National Institutes of Health, now have review boards to provide direct supervisory oversight for medical research involving human subjects to prevent human rights abuses similar to those of Tuskegee. These review boards ensure that established federal safeguards are followed and properly implemented by scientific investigators. Participants must be given adequate information, consent must be voluntary, and people must have the freedom to withdraw from the study at anytime. In addition, the risk and benefits must be stated clearly to all potential participants. Rotimi believes minority populations must participate, but must first acquire adequate information about the studies and then, speak up if established procedures are not followed appropriately. 

 
   
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