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By Dennis Thompson’s HealthDay correspondent

(Health Day)

Thursday, July 1, 2021 (HealthDay News) – The idea of ​​parents choosing genetically perfect newborns may seem like science fiction. But in a new report, a multidisciplinary team of researchers warns that some companies have already started offering couples undergoing in vitro fertilization ways to select better embryos through polygenic evaluation.

“Polygenic units are the weighted average of all the gene insertions we have information about in the genome to try to predict whether a person has a higher or lower incidence of a disease or a trait,” explained Patrick Turley. Professor of Research at the Center for Economic and Social Research, University of Southern California, Los Angeles.

Cou women may be tempted to use polygenic assessment to select embryos with predictable specific properties in the hope that their offspring will be taller, smarter, or less likely to develop cancer or heart disease. However, polygenic assessments are not as predictive as genetic companies can claim, and experts say there are many possible pitfalls to selecting an embryo.

“It simply came to our notice then. “We just don’t know it very well, that’s what polygenic units are all about,” said Michelle Mayer, assistant director of research at the Geisinger Health System Research Center for Translation Biology and Health Policy at the Geisinger Health System Center in Denville, Pennsylvania. “These are not guarantees at all. “They are a lot of forecasts; they are infinitely worse than the weather forecasts, which we all know are imperfect.”

But while the technology is currently flawed, it is expected to improve as scientists expand their understanding of genetic risk.

As it does, this service will open up the possibility of a future where there will be no genetic assets, Meyer added.

“Given the inconsistencies that already exist in medicine, this is not too far-fetched,” said Meyer, who co-authored a trend report published in the July 1 issue. New England Journal of Medicine:,

“You will have a narrow segment of society that is likely to benefit [polygenic scoring] “than others, so there is a certain risk of creating certain asymmetries,” Meyer said.

At the moment, experts are mainly concerned about the fact that false promises are made to future parents regarding the polygenic evaluation of embryos.

Still uncertain science

Genetics firms have promised polygenic embryo assessments that will weigh the risks of cancer, heart disease, high blood pressure, high cholesterol, inflammatory bowel disease, Alzheimer’s disease, mental retardation, dwarfism and a number of other common medical conditions. their report.

Scientists simply do not know about human genetics in order to promise for sure that these units will have a significant impact on the individual characteristics of such “chosen” children.

“There is a lot of risk, uncertainty, we are worried about whether people really know about it,” Meyer said. “Companies have no incentive to help consumers understand the limitations of the service they offer. Their built-in incentive is to emphasize և perhaps overestimate the benefits և underestimate the limitations. ”

For example, parents may want to use polygenic units to reduce the risk of having a short child.

But one can expect a child chosen this way to be only 1 inch taller than average, “a result that is unlikely to make sense in practice, which in any case may surprise parents who believe they have successfully opted for short stature.” stated.

“There is a serious risk of the expected consequences, given that individual genes often play a large role in humans,” said Turley.

“Genes usually do not do only one thing. When choosing an embryo based on a reduced risk of one disease, such as cancer or diabetes, you may be choosing an embryo that grows for another disease that we simply do not have. “Find out about it,” he said.

“If you choose an embryo that is predicted to have the highest level of education, it will also theoretically increase your child’s risk of eventually having a bipolar disorder,” Turlin said. “It’s about the relationship we know about.”

In the field of education, in the case of an embryo selected on the basis of a polygenic assessment, the risk of bipolar disorder increases by 16%, for example, the absolute genetic risk of bipolar disorder in a child increases from 1% to 1.16%.

The wider repercussions of society play out when you consider who can first allow in vitro fertilization, which groups now have the most knowledge of human genetics.

IVF costs tens of thousands of dollars per cycle և is not covered by most policies, says Meyer, making it a procedure that only insured couples can afford.

Mediators are also likely to be on the winning side of existing health inconsistencies in the United States.

“There is a particular risk that over time, in general, it may widen or exacerbate health inconsistencies; other types of inconsistencies already exist,” Meyer said. “It’s because not everyone will have equal access to this technology.”

And even today, if an Asian or Hispanic couple can afford in vitro fertilization, they are unlikely to benefit as much from the polygenic evaluation of their embryos.

This is because most of the genetic information collected so far is focused on people of European descent, making the assessment more accurate for those people, the authors say.

“At the moment, polygenic units will be more predictable for people of European descent than for people of other origins. “It’s only because the research underlying polygenic assessments comes from people of European genetic descent,” Meyer said.

Meyer would like the Federal Trade Commission (FTC) to intervene and protect couples from the false promises of genetic analysis companies.

“The Federal Trade Commission just has to apply its truth to advertising laws,” Meyer said. “The agency should be informed about those companies that there are many companies that were born in a very short period of time. They must monitor their marketing materials and campaigns to ensure that the materials are true under FTC law. – misleading

“They used to do this through in vitro fertilization clinics when they advertised certain pregnancy rates, so there is a precedent for that,” Meyer said.

Beyond that, the field of polygenic assessment needs more research to find out how best to communicate the risks and promises of this technology to the average person, Meyer added.

Grab some properties

“We are on the outskirts,” Meyer said. “People who study things like risk communication are just starting to do empirical research to find out how people understand or do not understand polygenic units, how we can communicate them in ways that mitigate those communication risks.”

“Based on that research, medical professional societies need to develop policies, guidelines for the use of polygenic units, and how this is explained to couples,” Meyer said.

It is also necessary that there is talk in the public about whether polygenic assessment is something that should be done.

“Do we want to choose the types of children we have?” We need to look more at the gift of parenthood, և should we try not to choose so much for it? Meyer said.

Meyer noted that the door is already open for this type of fertilization experiment.

Pre-implantation genetic diagnosis is a common procedure used during IVF for couples who have a high risk of transmitting a known genetic condition to their offspring.

“Bioethicists have been working on these kinds of issues for decades, so I think a lot of people will say we’re pretty good off the slope right now,” Meyer said. “That Rubicon has already been cut, there are people who use it to choose for or against contradictory traits,” such as deafness, dwarfism, Down Syndrome.

“The number of people born with Down syndrome has decreased over time, in part because of reproductive technologies. It is not free from controversy. What does it mean for people with Down Syndrome to know that other people choose not to have children with Down Syndrome? How does it affect them in life? ” Meyer said.

“Here we extend that problem to many other lines,” Meyer said of polygenic units. “Theoretically, if you start making a choice against embryos with different properties, you are wondering about people whose parents did not use the technology or they used it, but because it is not a perfect predictor that their child will still have that feature. Do their parents view them, how does society treat them when there is a signal that that quality or result is not appreciated? ”

A SO BYURS. Los Angeles, University of Southern California Center for Economic and Social Research PhD, PhD Patrick Thurley, Michel Meyer, PhD, JD, Assistant Director, Research Ethics, Geisinger Health System Translation Bioethics and Health Policy Center, Danville, Penn .; New England Journal of Medicine:, July 1, 2021

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