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Research will support personalized medicine for African Americans

Research will support personalized medicine for African Americans
Children at Little Flowers Child Development Center play during one morning on the playground. Some of the children at the school are exposed to violence in the neighborhood - an exposure scientists increasingly realize can cause health impacts. (Lloyd Fox / Baltimore Sun)

We live in one of the most violent cities in America, where for several of the past years over 300 citizens have died by gunfire — the vast majority African American. These killings reflect a number of urban pathologies that disproportionately affect African Americans. In neighborhoods like Upton and Druid Heights where income falls below the poverty line, life expectancy is only 63 years. Less than five miles away in Roland Park, life expectancy is 83 years.

Violence and poverty are psychological nightmares, but they also are biological toxins that affect how the brain works. Scientists have shown that extreme stress, especially during childhood, biologically changes how cells in the brain function by modifying how genes are turned on and turned off, and these changes can last for years, altering how we think and interact with others. Toxic stress in childhood also increases risk for many medical disorders later in life, including heart disease, diabetes, cancer, depression, drug abuse and suicide. Inner city violence and poverty is not just a threat to life and state of mind, it is a biological time bomb.

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Numerous studies support the tragic realities of health care disparities among ethnic minority groups. More recently, researchers reported that African-American youth have higher suicide rates than whites. This finding turned long held assumptions about racial imbalances in mental illness on its head; this high suicide in African Americans could not be explained by economic circumstances.

In responding to this new data about suicide in African Americans, few experts have discussed the possible genetic causes for the uptick in frequency. Instead, the discussion tends to remain focused on environmental and social factors. But we know that many mental illnesses, such as suicide and depression, manifest through an interplay of genetics and environment early in life, even as early as prenatal development. For example, emerging research from the Lieber Institute for Brain Development, located on the medical campus of Johns Hopkins, finds that genes expressed in the placenta and pregnancy complications combine to increase the likelihood of the baby developing schizophrenia later in life.

Learning that pregnancy complications might cause a newborn to develop mental illness later in life should cause some alarm. African-American women have much higher rates of pregnancy complications. The most notable statistic is mortality, as black babies die at twice the rate of white babies. Again this is not explained solely by socioeconomic factors. In short, a higher rate of pregnancy complications likely puts newborn African Americans at increased risk of later mental illnesses, and this could explain the noticeable rise in suicides. But we need cutting edge research devoted to finding possible genetic factors in African Americans to figure this out.

Together with our clergy colleagues, we believe that we must fight back against these health disparities. Fighting back means that we must activate leaders across society to ensure greater representation of African Americans in genomic research that will lead to personalized treatments and cures that disproportionately impact this community.

Working together, we must shift the paradigm to ensure that research directly addresses the medical needs of African Americans, particularly related to brain disorders. At present, few African Americans are represented in genetic studies that form the foundation of personalized medicine. As well, African Americans are underrepresented in clinical trials that test new drugs, even in cases where the disease being studied disproportionately affects African Americans. In brain research, studies are conspicuously lacking in African American participants.

That’s why we have launched the African American Neuroscience Research Initiative within the Lieber Institute as a much needed effort to understand how genomic risk for brain disorders influences the development and function of the brain and to ensure personalized medicine serves the needs of all persons.

Earlier this year, a group of Baltimore ministers established the African American Clergy Research Initiative to support the effort, knowing that the need for such research has never been more clear, and Baltimore is the perfect location for it.

Dr. Daniel R. Weinberger (drweinberger@libd.org) is director of the Lieber Institute for Brain Development and a Johns Hopkins University professor in the departments of psychiatry, neurology, neuroscience and in The Institute of Genetic Medicine. Alvin C. Hathaway Sr. (alhathaway@gmail.com) is senior pastor at Union Baptist Church in Baltimore.

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