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Saturday, July 12, 2025

UWI Sci­en­tists Speak

Harnessing our unique DNA for more effective medical treatment

by

62 days ago
20250509

As a uni­ver­si­ty fo­cused on us­ing re­search for the up­lift­ment of its com­mu­ni­ty, The Uni­ver­si­ty of the West In­dies, St Au­gus­tine (UWI STA), the pre­mier ter­tiary in­sti­tu­tion in the re­gion, pro­duc­ing world-class schol­ars, be­lieves sci­ence should be ac­ces­si­ble to the pub­lic. We are pleased to present our me­dia se­ries, UWI Sci­en­tists Speak. In this se­ries, our sci­en­tists—three of whom re­ceived the na­tion’s high­est ho­n­our, the Or­der of the Re­pub­lic of Trinidad and To­ba­go, in 2023 and one in 2024—will show­case some of their work.

This week, we hear from Dr Ra­ji­ni Haraks­ingh, who dis­cuss­es us­ing our DNA to treat med­ical con­di­tions in the coun­try.

Prin­ci­pal, UWI STA

Lec­tur­er in Biotech­nol­o­gy,

The Uni­ver­si­ty of the West In­dies

Have you ever won­dered why two dif­fer­ent peo­ple could re­act dif­fer­ent­ly to the same med­i­cine?

One ex­pla­na­tion lies in the unique bio­chem­istry of each in­di­vid­ual en­cod­ed by the DNA com­pris­ing our genomes.

The in­for­ma­tion in our genomes can tell us what dis­eases we are prone to from birth, which ac­quired mu­ta­tions may cause dis­ease lat­er on, and how our bod­ies may re­spond to cer­tain treat­ments.

Over the past two decades, re­search on di­verse hu­man genomes world­wide has pro­vid­ed vast in­sights show­ing that dif­fer­ent in­di­vid­u­als and pop­u­la­tions may have vary­ing mol­e­c­u­lar caus­es of com­mon dis­eases. There­fore, dif­fer­ent treat­ments tai­lored to the spe­cif­ic mol­e­c­u­lar cause of the dis­ease in an in­di­vid­ual are re­quired.

Yet, Caribbean genomes are large­ly un­der­ex­plored and un­der­rep­re­sent­ed in the glob­al ge­nomics land­scape. Ad­di­tion­al­ly, most clin­i­cal tri­als are con­duct­ed on a very nar­row rep­re­sen­ta­tion of hu­man­i­ty, which does not nec­es­sar­i­ly in­clude Caribbean genomes. So, med­ical ad­vances from such stud­ies may not nec­es­sar­i­ly ap­ply to Caribbean peo­ple.

My col­leagues and I be­lieve that clos­ing that gap pro­vides op­por­tu­ni­ties to im­prove our health by har­ness­ing the unique in­for­ma­tion in our genomes. As we and oth­ers work to­wards eq­ui­table rep­re­sen­ta­tion in this field, we have made some un­sur­pris­ing but deeply con­cern­ing dis­cov­er­ies about our cur­rent health­care prac­tices.

The Caribbean faces the high­est bur­den from non-com­mu­ni­ca­ble dis­eases (Heart Dis­ease, Di­a­betes, and Can­cer) among de­vel­op­ing coun­tries in the Amer­i­c­as, and Trinidad and To­ba­go has the high­est preva­lence of car­dio­vas­cu­lar dis­ease in the Caribbean.

Clopi­do­grel (Plav­ix) is the most pre­scribed med­ica­tion for car­dio­vas­cu­lar con­di­tions glob­al­ly. How­ev­er, there are known ge­net­ic vari­ants that cause in­di­vid­u­als to ei­ther not metabolise or have re­duced meta­bol­ic ca­pa­bil­i­ty for this med­ica­tion.

The fre­quen­cy of these vari­ants is high­er in some eth­nic­i­ties than oth­ers. This means the med­ica­tion may work less ef­fi­cient­ly in some peo­ple and not in oth­ers due to their unique ge­net­ic make­up.

Fur­ther, the use of this med­ica­tion in pa­tients with these ge­net­ic vari­ants is as­so­ci­at­ed with an in­creased risk of ma­jor ad­verse car­dio­vas­cu­lar events such as stroke and heart at­tack.

No­tably, there are al­ter­na­tive med­ica­tions whose me­tab­o­lism is not af­fect­ed by these ge­net­ic vari­ants, and these are avail­able in T&T.

Re­cent in­ter­na­tion­al guide­lines, in­clud­ing from the Amer­i­can Heart As­so­ci­a­tion (June 2024), sup­port us­ing ge­net­ic da­ta to se­lect med­ica­tion for car­dio­vas­cu­lar dis­ease pa­tients. How­ev­er, this is not cur­rent­ly prac­tised in this re­gion. Un­til now, the preva­lence of these ge­net­ic vari­ants in Caribbean pop­u­la­tions suf­fer­ing from car­dio­vas­cu­lar dis­ease was un­known.

For the first time in a Caribbean co­hort, we re­port­ed a high pro­por­tion of pa­tients with car­dio­vas­cu­lar dis­ease in T&T who are pre­scribed clopi­do­grel and car­ry ge­net­ic vari­ants as­so­ci­at­ed with clopi­do­grel re­sis­tance.

We sam­pled 10 per cent of pa­tients in the ma­jor pub­lic car­dio­vas­cu­lar clin­ic in the coun­try, and found that al­most two-thirds of the pa­tients car­ried ge­net­ic vari­ants that con­fer some re­sis­tance to clopi­do­grel.

This was the most pre­scribed drug in its class in our co­hort, and the ma­jor­i­ty of pa­tients pre­scribed this drug car­ry ge­net­ic vari­ants that con­fer re­sis­tance to it!

In­do-Trinida­di­an pa­tients were 3–4 times more like­ly to car­ry these ge­net­ic vari­ants than Afro-Trinida­di­an pa­tients.

My re­search group in the De­part­ment of Life Sci­ences at The UWI, St Au­gus­tine, re­cent­ly pub­lished these find­ings in Springer Na­ture Car­di­ol­o­gy and Ther­a­py.

The team in­clud­ed Daniele Jones and Shana Per­sad-Ramdeens­ingh (MSc in Biotech­nol­o­gy stu­dents), and She­herazade Abrahim (Re­search As­sis­tant), work­ing in col­lab­o­ra­tion with Dr Naveen Seecher­an (lead car­di­ol­o­gist at the Car­diac Cather­iza­tion Lab at the Er­ic Williams Med­ical Sci­ences Com­plex and Se­nior Lec­tur­er).

Our find­ings re­vealed that us­ing pa­tient-spe­cif­ic ge­net­ic da­ta to help guide treat­ment se­lec­tion may ben­e­fit pa­tients with car­dio­vas­cu­lar dis­ease in T&T. In this ex­am­ple, a straight­for­ward, in­ex­pen­sive PCR-based ge­net­ic test us­ing a sali­va sam­ple can de­ter­mine whether a pa­tient has these prob­lem­at­ic vari­ants to help guide drug se­lec­tion.

While this test is not cur­rent­ly avail­able to the pub­lic, post-pan­dem­ic, all the pub­lic health labs are now well-equipped to im­ple­ment it. This ap­proach rep­re­sents a par­a­digm shift in treat­ing pa­tients, which may re­sult in im­proved health out­comes and sub­stan­tial eco­nom­ic ben­e­fits.

We are just scratch­ing the sur­face of how the mas­sive amount of in­for­ma­tion in our genomes can in­form clin­i­cal prac­tice. We have a re­spon­si­bil­i­ty to in­ves­ti­gate our­selves and our clin­i­cal prac­tices us­ing the most ad­vanced meth­ods avail­able to achieve the best out­comes for our pop­u­la­tion’s health.

How­ev­er, there is need for sig­nif­i­cant in­vest­ments in sci­ence and tech­nol­o­gy for this goal to be­come a re­al­i­ty.


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