This may take years, but there are several steps that can be taken now to make better use of what we already know and to position the field to capitalize quickly

on new biologic insights, whenever they arise. We have find more already explained why genetic discoveries require large samples, but these can be slow and expensive to collect. Volunteers in ongoing clinical trials offer an attractive alternative. Although they represent a heterogeneous group in terms of ascertainment, diagnosis, and treatments employed, the many ongoing clinical trials may collectively constitute a reasonably representative sample of the population, well-suited to large-scale genetic studies. We need a coordinated effort by academia, industry, and government to begin collecting DNA in clinical trials and to send the samples and associated data—in anonymous form—to a central repository, where they can be used to fuel future large-scale studies. The pharmacopeia is full of drugs that MK-2206 ic50 seem to have outlived their usefulness or never found wide application: long-used medications known to be safe that have been superseded by drugs that are considered more efficacious; newer drugs that, while highly effective, were found to cause severe

adverse events in some people. By use of genetic methods, it may be possible to “repurpose” some of these medications for other indications. If good genetic markers of safety and efficacy can be established, such repurposed drugs could be helpful for targeted populations, in which acceptable risk:benefit ratios can be more easily achieved. Systematic efforts along these lines are now being initiated in the National Center for Advancing Translational the Sciences (NCATS). NCATS is a new component of the NIH that aims to catalyze the generation of innovative methods and technologies to enhance the development, testing, and implementation of diagnostic tests and therapeutic agents across a wide range of human ills (http://www.ncats.nih.gov). Traditional drug development pipelines are inefficient

and expensive. Innovative strategies are needed, but innovation requires new perspectives. Genetics is providing some of these new perspectives. Genome-wide association studies have revealed a spectrum of common genetic markers for a number of traits, diseases, and treatment outcomes. At about the same time, a whole new class of genetic variation was discovered, known as copy number variants (CNVs): deletions and insertions of small chromosomal segments, containing from one to dozens of genes. CNVs have been shown to play a major role in autism, schizophrenia, and developmental disorders and may also contribute to treatment outcomes (for review, see Malhotra and Sebat, 2012). CNVs often arise de novo as chromosomes are passed from parent to offspring, providing a dynamic source of genetic differences within every generation. Large-scale sequencing of the genome is providing another new perspective.