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临床中多基因风险评分的合理使用:潜在的获益、风险和差距。

Responsible use of polygenic risk scores in the clinic: potential benefits, risks and gaps.

出版信息

Nat Med. 2021 Nov;27(11):1876-1884. doi: 10.1038/s41591-021-01549-6. Epub 2021 Nov 15.

Abstract

Polygenic risk scores (PRSs) aggregate the many small effects of alleles across the human genome to estimate the risk of a disease or disease-related trait for an individual. The potential benefits of PRSs include cost-effective enhancement of primary disease prevention, more refined diagnoses and improved precision when prescribing medicines. However, these must be weighed against the potential risks, such as uncertainties and biases in PRS performance, as well as potential misunderstanding and misuse of these within medical practice and in wider society. By addressing key issues including gaps in best practices, risk communication and regulatory frameworks, PRSs can be used responsibly to improve human health. Here, the International Common Disease Alliance's PRS Task Force, a multidisciplinary group comprising expertise in genetics, law, ethics, behavioral science and more, highlights recent research to provide a comprehensive summary of the state of polygenic score research, as well as the needs and challenges as PRSs move closer to widespread use in the clinic.

摘要

多基因风险评分(PRSs)聚合了人类基因组中许多等位基因的微小效应,以估计个体患某种疾病或与疾病相关特征的风险。PRSs 的潜在好处包括成本效益高的主要疾病预防增强、更精细的诊断以及在开具药物时提高精准度。然而,这些必须与潜在风险相权衡,例如 PRS 性能中的不确定性和偏差,以及在医疗实践和更广泛的社会中对这些评分的潜在误解和滥用。通过解决包括最佳实践、风险沟通和监管框架方面的差距在内的关键问题,PRSs 可以负责任地用于改善人类健康。在这里,由遗传学、法律、伦理、行为科学等多学科专业知识组成的国际常见疾病联盟 PRS 工作组强调了最近的研究,提供了对多基因评分研究现状的全面总结,以及随着 PRSs 更广泛地应用于临床,所面临的需求和挑战。

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