By definition, personalized medicine requires diversity. One-size-fits-all doesn't work for every individual, especially members of groups that are medically underserved.
In collaboration with Arizona State University and Mountain Park Health Center (MPHC) in Phoenix, Mayo Clinic's Center for Individualized Medicine has created a biobank to enhance the diversity of Mayo's medical research. Sangre Por Salud (Spanish for Blood for Health) contains samples and health information from 3,756 people who self-identify as Latino and receive care at Mountain Park. As a Federally Qualified Health Center, MPHC provides comprehensive health services to underserved populations, including Latinos and African-Americans, independent of their immigration status.
"To practice individualized medicine, we need to understand all individuals. We cannot generalize that whatever is discovered in Caucasians is applicable to Latinos or other populations. Our intent is to close these gaps," says Giovanna Moreno Garzon, Mayo Clinic's senior research coordinator for Sangre Por Salud.
Sangre Por Salud is more than a biobank. "With the consent of participants at Mountain Park, we collected blood samples, plasma and DNA, as well as responses to health questionnaires," Moreno Garzon says. "We have access to the participants' electronic medical records at Mountain Park and permission to contact the participants again if needed for research. This is a great resource for investigators to add diversity to their current research activities."
When Mayo Clinic launched its biobank in Rochester, Minnesota, most of the samples were from Caucasians. Only 0.4% came from Latino donors. Mayo Clinic is now at the forefront of efforts to increase research in minority populations, to address health disparities.
"A lot of patients in the population we serve are disease-burdened. Obesity, diabetes, high blood pressure and the risk of heart problems are common," says Valentina Hernandez, director of integrated nutrition services at MPHC. "We started working with Mayo Clinic to create the biobank so that these patients could contribute to the science of genomics. We hope these patients will be better represented in research to help ease the burden of disease in this population."
Data from Sangre Por Salud is available to Mayo Clinic researchers and their collaborators. The Center for Individualized Medicine reviews all requests for data. Among the research projects using Sangre Por Salud data is a study led by Richard Caselli, M.D., involving APOE4, a form of a gene that increases the risk of Alzheimer's disease.
In addition to facilitating diversity in medical research, Sangre Por Salud is directly benefitting Mountain Park patients. Samples from 500 of the donors were genetically sequenced to detect mutations associated with various conditions.
"We were able to identify 10 individuals who have a gene mutation that could be a predictor of a future disease — such as the BRCA gene and breast cancer," Hernandez says. "We could then counsel these individuals on their risks and how they might help prevent the development of disease." Both MPHC and Mayo Clinic are committed to developing further strategies and infrastructure for patients' follow-up care.
Beyond those specific findings, information from the biobank is changing clinical practice at Mountain Park. "We learned a lot about our patients from the lab work that was done to get baseline measures from the donors," Hernandez says. "Although these donors were young and nondiabetic, many of them had high cholesterol or prediabetes. We wouldn't have known that without the lab testing."
Prediabetes means that blood sugar levels are higher than normal but not yet high enough to be type 2 diabetes. With prediabetes, the long-term damage of diabetes to the heart, blood vessels and kidneys might already be starting.
"We had a lot of our patients see a dietitian to talk about diet and lifestyle," Hernandez says. "We're more aware that a seemingly healthy person might have something we can catch early, and prevent bigger problems later. Sangre Por Salud has really changed medical practice in our clinic."
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