Veterans enlist in droves for gene study

SERVING AGAIN: Veterans John Camp, of East Providence, and Michelle Jackson, of Johnston, are participating in the Million Veteran Project. / PBN PHOTO/ MICHAEL SALERNO
SERVING AGAIN: Veterans John Camp, of East Providence, and Michelle Jackson, of Johnston, are participating in the Million Veteran Project. / PBN PHOTO/ MICHAEL SALERNO

The Veterans Administration is creating the world’s largest genomic database, having already enrolled some 500,000 veterans in its Million Veteran Project to study the effects genes have on health

Dr. Satish Sharma, Providence VA Medical Center’s lead researcher on the project, says there’s more and more data researchers can learn from about pharmacogenetics – the study of genes to understand how different patients respond to the same medication.

Conceived in 2011 by VA researchers in Boston and Connecticut, the multiyear veterans project is a voluntary initiative. Sharma, the Providence VAMC’s chief of staff and a professor of medicine at Brown University’s Warren Alpert Medical School, noted that the Providence VAMC is one of 52 sites now participating in the project, which has a rolling admission for new sites.

“This is at the forefront of personalized medicine, [which] will be the wave of the future,” he said. “It will go a long way toward expanding personalized medicines and therapies for diseases we don’t yet understand.”

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Even before project researchers dig into the data, some pharmacogenetics information already exists. For example, two types of genes result in slow/reduced metabolism or normal/increased metabolism of warfarin, a common anticoagulant. A patient’s genetic makeup, said Sharma, will impact whether he or she will require higher or lower doses of warfarin.

“With pharmacogenetics, we can identify these patient types before beginning [warfarin] therapy; without … patients are treated by empirically adjusting the doses,” he said. Although this genome-based, personalized medicine is widely available, he added, its use is not ubiquitous, as many physicians still rely on empirical dosing.

The Providence VAMC, which became a study site in March 2016, has enrolled more than 150 veterans.

“We have 36,000 [veterans] that we treat here [in Providence and at our outpatient clinics in Middletown, New Bedford and Hyannis, Mass.], so I’m hoping to enroll as many as we can,” said Sharma. “After we reach a saturation point, another VA research site [will open].”

An annual $150,000 grant from the VA to the Providence VAMC is used to support the salaries of the research assistants and nurse, highly trained staff who interact with enrolling veterans. After a veteran agrees to participate in the program and completes a brief medical questionnaire, a nurse draws a single tube of blood, labeled only with a bar code, said Sharma. That’s the full extent of the enrolled veteran’s involvement with the project; veterans’ names are never connected to the study, medical questionnaire or blood samples, which are used exclusively for the project and not for diagnoses. Blood draws are stored in large freezers in the VAMC in Boston. Word-of-mouth, flyers, posters and social media help promote the project.

“I get my medical here at the VA; I love it,” said John Camp, a recent project enrollee. The retired maintenance worker and security guard from East Providence credited the VA with saving his life by diagnosing and treating a ruptured ulcer in 2004. A SeaBee serving stateside during the Vietnam War, Camp said, “I figured I’d still be doing something for the country by [enrolling in the project]. I think everybody – whether they’ve been in the military or not – should do their share.”

Others share Camp’s view, said Sharma.

“It’s mostly altruism; they don’t benefit particularly from this but [it’s for the] greater good for society and will help veterans and fellow citizens,” he said.

Michele Jackson, of Johnston, is a business-office manager at the Providence VAMC. Before being medically discharged, she had served in the Army, stateside and in Germany, from 1980 to 1989.

“I know I won’t benefit from [the project], but I hope that [others] will,” said Jackson, who also recruited a fellow employee for the project.

While some veterans treated at the Providence VAMC have Medicare, Medicaid or private insurance through their employer or that of their spouse, the vast majority have no insurance, said Sharma.

A cardiologist, Sharma hopes to study cardiac conditions that have some bearing on genes, while genetically oriented Alzheimer’s disease and some mental health issues, such as post-traumatic stress disorder and depression, are other promising research topics.

“With so much data at hand, I think it will be a gold mine to do research,” said Sharma.

Research likely will begin in the next few years; in the meantime, VA researchers – many affiliated with medical schools – are contemplating ideas. Brown’s Warren Alpert Medical School and its School of Public Health are eager to access the database, which will be shared widely among researchers internationally, he said. •

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