Krzysztof Kiryluk, MD, MS; David B. Goldstein, PhD; John W. Rowe, MD; Ali G. Gharavi, MD; Ronald Wapner, MD; Wendy K. Chung, MD, PhD
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Grant Support: The authors were supported by the Columbia Precision Medicine Initiative, Columbia University, New York, New York, as well as the following grants from the National Institutes of Health: Columbia Clinical and Translational Science Award UL1TR001873 from the National Center for Advancing Translational Sciences; the Electronic Medical Records and Genomics Network grant U01HG8680 from the National Human Genome Research; the Columbia Kidney Precision Medicine Project grant UG3DK114926 from the National Institute of Diabetes and Digestive and Kidney Diseases; and the All of Us Network grant UG3OD023183 from the Office of the Director, National Institutes of Health.
Disclosures: Dr. Gharavi reports grants from the Renal Research Institute and other support from AstraZeneca during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0425.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Krzysztof Kiryluk, MD, MS, Department of Medicine, Division of Nephrology, College of Physicians and Surgeons, Columbia University, 1150 St. Nicholas Avenue, Russ Berrie Pavilion #412E, New York, NY 10032; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Kiryluk: Department of Medicine, Division of Nephrology, College of Physicians and Surgeons, Columbia University, 1150 St. Nicholas Avenue, Russ Berrie Pavilion #412E, New York, NY 10032.
Dr. Goldstein: Institute for Genomic Medicine, Columbia University, P & S, 630 West 168th Street, Suite 11-101, New York, NY 10032.
Dr. Rowe: Robert N. Butler Columbia Aging Center, Mailman School of Public Health of Columbia University, 722 West 168th Street, New York, NY 10032.
Dr. Gharavi: Department of Medicine, Division of Nephrology, College of Physicians and Surgeons, Columbia University, 1150 St. Nicholas Avenue, Russ Berrie Pavilion #413, New York, NY 10032.
Dr. Wapner: Department of Obstetrics and Gynecology, Presbyterian Hospital, 16th Floor, Room 1666, New York, NY 10032.
Dr. Chung: Departments of Pediatrics and Medicine, College of Physicians and Surgeons, Columbia University, 1150 St. Nicholas Avenue, 620, New York, NY 10032.
Author Contributions: Conception and design: K. Kiryluk, D.B. Goldstein, J.W. Rowe, R. Wapner, A.G. Gharavi, W.K. Chung.
Drafting of the article: K. Kiryluk, A.G. Gharavi, R. Wapner, W.K. Chung.
Critical revision of the article for important intellectual content: K. Kiryluk, D.B. Goldstein, J.W. Rowe, A.G. Gharavi, R. Wapner, W.K. Chung.
Final approval of the article: K. Kiryluk, D.B. Goldstein, J.W. Rowe, A.G. Gharavi, R. Wapner, W.K. Chung.
Obtaining of funding: K. Kiryluk, D.B. Goldstein, A.G. Gharavi, W.K. Chung.
Medicine has long sought to match diagnostic and treatment approaches to the particular needs and risks of individual patients. The decreasing cost and increasing ease of genetic sequencing have propelled the rise of precision medicine. Precision medicine aims to use genetic and other information to provide care tailored to the individual patient, with the goal of improving clinical outcomes and minimizing unnecessary diagnostic and therapeutic interventions. Although developments in genetic sequencing have the potential to transform clinical care, there are important limitations, including uncertainty in the clinical interpretation of many genetic variants and concerns about privacy, discrimination, and cost.
To help clinicians understand the basics of genetic sequencing and how to apply it in clinical practice, Annals of Internal Medicine is launching a new “Precision Medicine” series. This introduction provides a general overview of clinical sequencing, with a focus on germline variation. Subsequent articles will use a case-based format to provide concise summaries of specific clinical precision medicine scenarios that are relevant to the practice of internal medicine. These cases will highlight specific clinical indications; interpretation of genetic test results; and ethical, legal, cost, and privacy issues related to genetic testing. The goal is to provide practical information on the appropriate application and interpretation of genomics in routine clinical practice.
Kiryluk K, Goldstein DB, Rowe JW, Gharavi AG, Wapner R, Chung WK. Precision Medicine in Internal Medicine. Ann Intern Med. [Epub ahead of print 30 April 2019]170:635–642. doi: 10.7326/M18-0425
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Published: Ann Intern Med. 2019;170(9):635-642.
Published at www.annals.org on 30 April 2019
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