One of the boldest undertakings that NIH has ever attempted, the All of Us Research Program has been hard at work in a “beta” testing phase, and is now busy gearing up for full recruitment in the spring. This historic effort will enroll 1 million or more people in the United States to share information about their health, habits, and what it’s like where they live. This information will be part of a resource that scientists can use to accelerate research and improve health. How? By taking into account individual differences in lifestyle, environment, and biology, researchers will uncover paths toward realizing the full potential of precision medicine.
Before embarking on this adventure, All of Us is reaching out to prospective researchers, community organizations, and citizen scientists—including people just like you—to get their input. Imagine that the project has already enrolled 1 million participants from all over the country and from diverse backgrounds. Imagine that they have all agreed to make available their electronic health records, to put on wearable sensors that can track body physiology and environmental exposures, and to provide blood samples for lab testing, including DNA analysis. Is there a particular research question that you think All of Us could help answer? Possible topics include risks of disease, factors that promote wellness, and research on human behavior, prevention, exercise, genetics, environmental health effects, health disparities, and more. To submit an idea, just go to this special All of Us web page.
It might have been 25 years ago, but Karina Davidson remembers that day like yesterday. She was an intern in clinical psychology, and two concerned parents walked into the hospital with their troubled, seven-year-old son. The boy was severely underweight at just 37 pounds and had been acting out violently toward himself and others. It seemed as though Ritalin, a drug commonly prescribed for Attention Deficit Disorder, might help. But would it?
To find out, the clinical team did something unconventional: they designed for the boy a clinical trial to test the benefit of Ritalin versus a placebo. The boy was randomly assigned to take either the drug or placebo each day for four weeks. As a controlled study, neither clinical staff nor the family knew whether he was taking the drug or placebo at any given time. The result: Ritalin wasn’t the answer. The boy was spared any side effects from long term administration of a medication that wouldn’t help him, and his doctors could turn to other potentially more beneficial approaches to his treatment.
Davidson, now an established clinical psychologist at the Columbia University Irving Medical Center, New York, wants to take the unconventional approach that helped this boy and make it more of the norm in medicine. With support from a 2017 NIH Director’s Transformative Research Award, she and her colleagues will develop three pilot computer applications—or digital platforms—to help doctors conduct one-person studies in their offices.
Caption: Stanford University’s Michael Snyder displays some of his wearable devices. Credit: Steve Fisch/Stanford School of Medicine
Millions of Americans now head out the door each day wearing devices that count their steps, check their heart rates, and help them stay fit in general. But with further research, these “wearables” could also play an important role in the early detection of serious medical conditions. In partnership with health-care professionals, people may well use the next generation of wearables to monitor vital signs, blood oxygen levels, and a wide variety of other measures of personal health, allowing them to see in real time when something isn’t normal and, if unusual enough, to have it checked out right away.
In the latest issue of the journal PLoS Biology , an NIH-supported study offers an exciting glimpse of this future. Wearing a commercially available smartwatch over many months, more than 40 adults produced a continuous daily stream of accurate personal health data that researchers could access and monitor. When combined with standard laboratory blood tests, these data—totaling more than 250,000 bodily measurements a day per person—can detect early infections through changes in heart rate.
Caption: A mix of cells collected from an abdominal cancer. The cancer cells (green) are positive for a cell surface cancer marker called EpCAM. The red cell is a normal mesothelial cell. The nuclei of all the cells are stained blue. Each of the five rows in the red, orange, and yellow “heat map” in the corner represents one cell, and the intensity of the color in each of the ~30 narrow columns reflects the abundance of a particular protein. It is apparent that there is a lot of heterogeneity in this collection of cancer cells. Credit: Ralph Weissleder, Center for Systems Biology, Massachusetts General Hospital, Boston
The proteins speckling the surface of a cancer cell reveal critical clues—the type of cancer cell and a menu of possible mutations that may have triggered the malignancy. Since these proteins are exposed on the outside of the cell, they are also ideal targets for so-called precision cancer therapies (especially monoclonal antibodies), optimized for the particular individual. But in the past, to analyze and identify these different proteins, large samples of tissue have been needed. Typically, these are derived from surgical biopsies. But biopsies are expensive and invasive. Furthermore, they aren’t a practical option if you want to monitor the effects of a drug in a patient closely over time.
Using a minimally invasive method of cell sampling called fine needle aspiration, physicians can collect miniscule cell samples frequently, cheaply, and safely. But, until now, these tiny samples only provided enough material to analyze a handful of cell surface proteins. So, it comes as particularly good news that NIH-funded researchers at Massachusetts General Hospital in Boston have developed a new technology that quickly identifies hundreds of these proteins simultaneously, using just a few of the patient’s cells . The key to this new method is a clever adaptation of the familiar barcode.
NIH-funded researchers analyzed the DNA of these cancers.
Cancer is a disease of the genome. It arises when genes involved in promoting or suppressing cell growth sustain mutations that disturb the normal stop and go signals. There are more than 100 different types of cancer, most of which derive their names and current treatment based on their tissue of origin—breast, colon, or brain, for example. But because of advances in DNA sequencing and analysis, that soon may be about to change.
Using data generated through The Cancer Genome Atlas, NIH-funded researchers recently compared the genomic fingerprints of tumor samples from nearly 3,300 patients with 12 types of cancer: acute myeloid leukemia, bladder, brain (glioblastoma multiforme), breast, colon, endometrial, head and neck, kidney, lung (adenocarcinoma and squamous cell carcinoma), ovarian, and rectal. Confirming but greatly extending what smaller studies have shown, the researchers discovered that even when cancers originate from vastly different tissues, they can show similar features at the DNA level