Ana Rath

The Human Phenotype Ontology in 2017

Deep phenotyping has been defined as the precise and comprehensive analysis of phenotypic abnormalities in which the individual components of the phenotype are observed and described. The three components of the Human Phenotype Ontology (HPO; www.human-phenotype-ontology.org) project are the phenotype vocabulary, disease-phenotype annotations and the algorithms that operate on these. These components are being used for computational deep phenotyping and precision medicine as well as integration of clinical data into translational research. The HPO is being increasingly adopted as a standard for phenotypic abnormalities by diverse groups such as international rare disease organizations, registries, clinical labs, biomedical resources, and clinical software tools and will thereby contribute toward nascent efforts at global data exchange for identifying disease etiologies. This update article reviews the progress of the HPO project since the debut Nucleic Acids Research database article in 2014, including specific areas of expansion such as common (complex) disease, new algorithms for phenotype driven genomic discovery and diagnostics, integration of cross-species mapping efforts with the Mammalian Phenotype Ontology, an improved quality control pipeline, and the addition of patient-friendly terminology.

Representation of rare diseases in health information systems: The orphanet approach to serve a wide range of end users

Rare disorders are scarcely represented in international classifications and therefore invisible in information systems. One of the major needs in health information systems and for research is to share and/or to integrate data coming from heterogeneous sources with diverse reference terminologies. ORPHANET (www.orpha.net) is a multilingual information portal on rare diseases and orphan drugs. Orphanet information system is supported by a relational database built around the concept of rare disorders. Representation of rare diseases in Orphanet encompasses levels of increasing complexity: lexical (multilingual terminology), nosological (multihierarchical classifications), relational (annotations—epidemiological data—and classes of objects—genes, manifestations, and orphan drugs—integrated in a relational database), and interoperational (semantic interoperability). Rare disorders are mapped to International Classification of Diseases (10th version), SNOMED CT, MeSH, MedDRA, and UMLS. Genes are cross‐referenced with HGNC, UniProt, OMIM, and Genatlas. A suite of tools allow for extraction of massive datasets giving different views that can be used in bioinformatics to answer complex questions, intended to serve the needs of researchers and the pharmaceutical industry in developing medicinal products for rare diseases. An ontology is under development. The Orphanet nomenclature is at the crossroads of scientific data repositories and of clinical terminology standards, and is suitable to be used as a standard terminology. Hum Mutat 33:803–808, 2012.

International Cooperation to Enable the Diagnosis of All Rare Genetic Diseases

Provision of a molecularly confirmed diagnosis in a timely manner for children and adults with rare genetic diseases shortens their “diagnostic odyssey,” improves disease management, and fosters genetic counseling with respect to recurrence risks while assuring reproductive choices. In a general clinical genetics setting, the current diagnostic rate is approximately 50%, but for those who do not receive a molecular diagnosis after the initial genetics evaluation, that rate is much lower. Diagnostic success for these more challenging affected individuals depends to a large extent on progress in the discovery of genes associated with, and mechanisms underlying, rare diseases. Thus, continued research is required for moving toward a more complete catalog of disease-related genes and variants. The International Rare Diseases Research Consortium (IRDiRC) was established in 2011 to bring together researchers and organizations invested in rare disease research to develop a means of achieving molecular diagnosis for all rare diseases. Here, we review the current and future bottlenecks to gene discovery and suggest strategies for enabling progress in this regard. Each successful discovery will define potential diagnostic, preventive, and therapeutic opportunities for the corresponding rare disease, enabling precision medicine for this patient population.

Evidence-based clinical practice: Overview of threats to the validity of evidence and how to minimise them

Using the best quality of clinical research evidence is essential for choosing the right treatment for patients. How to identify the best research evidence is, however, difficult. In this narrative review we summarise these threats and describe how to minimise them. Pertinent literature was considered through literature searches combined with personal files. Treatments should generally not be chosen based only on evidence from observational studies or single randomised clinical trials. Systematic reviews with meta-analysis of all identifiable randomised clinical trials with Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment represent the highest level of evidence. Even though systematic reviews are trust worthier than other types of evidence, all levels of the evidence hierarchy are under threats from systematic errors (bias); design errors (abuse of surrogate outcomes, composite outcomes, etc.); and random errors (play of chance). Clinical research infrastructures may help in providing larger and better conducted trials. Trial Sequential Analysis may help in deciding when there is sufficient evidence in meta-analyses. If threats to the validity of clinical research are carefully considered and minimised, research results will be more valid and this will benefit patients and heath care systems.

Rare diseases in ICD11: making rare diseases visible in health information systems through appropriate coding.

BackgroundBecause of their individual rarity, genetic diseases and other types of rare diseases are under-represented in healthcare coding systems; this contributes to a lack of ascertainment and recognition of their importance for healthcare planning and resource allocation, and prevents clinical research from being performed.MethodsOrphanet was given the task to develop an inventory of rare diseases and a classification system which could serve as a template to update International terminologies. When the World Health Organization (WHO) launched the revision process of the International Classification of Diseases (ICD), a Topic Advisory Group for rare diseases was established, managed by Orphanet and funded by the European Commission.ResultsSo far 5,400 rare diseases listed in the Orphanet database have an endorsed representation in the foundation layer of ICD-11, and are thus provided with a unique identifier in the Beta version of ICD-11, which is 10 times more than in ICD10. A rare disease linearization is also planned. The current beta version is open for public consultation and comments, and to be used for field testing. The adoption by the World Health Assembly is planned for 2017.ConclusionsThe overall revision process was carried out with very limited means considering its scope, ambition and strategic significance, and experienced significant hurdles and setbacks. The lack of funding impacted the level of professionalism that could be attained. The contrast between the initially declared goals and the currently foreseen final product is disappointing. In the context of uncertainty around the outcome of the field testing and the potential willingness of countries to adopt this new version, the European Commission Expert Group on Rare Diseases adopted in November 2014 a recommendation for health care coding systems to consider using ORPHA codes in addition to ICD10 codes for rare diseases having no specific ICD10 codes. The Orphanet terminology, classifications and mappings with other terminologies are freely available at www.orphadata.org.

Ontological phenotype standards for neurogenetics

Neurological disorders comprise one of the largest groups of human diseases. Due to the myriad symptoms and the extreme degree of clinical variability characteristic of many neurological diseases, the differential diagnosis process is extremely challenging. Even though most neurogenetic diseases are individually rare, collectively, the subgroup of neurogenetic disorders is large, comprising more than 2,400 different disorders. Recently, increasing efforts have been undertaken to unravel the molecular basis of neurogenetic diseases and to correlate pathogenetic mechanisms with clinical signs and symptoms. In order to enable computer‐based analyses, the systematic representation of the neurological phenotype is of major importance. We demonstrate how the Human Phenotype Ontology (HPO) can be incorporated into these efforts by providing a systematic semantic representation of phenotypic abnormalities encountered in human genetic diseases. The combination of the HPO together with the Orphanet disease classification represents a promising resource for automated disease classification, performing computational clustering and analysis of the neurogenetic phenome. Furthermore, standardized representations of neurologic phenotypic abnormalities employing the HPO link neurological phenotypic abnormalities to anatomical and functional entities represented in other biomedical ontologies through the semantic references provided by the HPO. Hum Mutat 33:1333–1339, 2012.

Orphanet et son réseau : où trouver une information validée sur les maladies rares

Resume On denombre environ 6 000 maladies rares dont 80 % sont d’origine genetique. En Europe, une maladie est dite rare lorsqu’elle touche moins d’1 personne sur 2 000. Chez l’enfant comme chez l’adulte, de nombreuses maladies rares ont une composante neurologique. Orphanet est un portail en libre acces sur internet, sans but lucratif, officiellement soutenu par le Ministere de la Sante Francais et la Commission Europeenne. Il a pour mission d’informer les professionnels de sante et les patients afin de contribuer a ameliorer le diagnostic tout en favorisant une meilleure prise en charge et un meilleur traitement des maladies rares. Le site propose de nombreux services dont un inventaire et une encyclopedie des maladies rares avec les genes associes (parmi ces maladies, plus de 2 000 avec des manifestations neurologiques sont repertoriees) ; une aide au diagnostic ; des recommandations cliniques et d’urgence ; un repertoire de tests diagnostiques ; un inventaire des medicaments orphelins ; les projets de recherche en cours dont les essais cliniques ; les centres de reference et de competences. Le reseau Orphanet, coordonne par l’US14 de l’INSERM, collecte a ce jour les ressources expertes pour les maladies rares dans 37 pays dont les 27 etats membres de la Communaute Europeenne.

Future of Rare Diseases Research 2017–2027: An IRDiRC Perspective

Christopher P. Austin1,∗, Christine M. Cutillo1, Lilian P.L. Lau2, Anneliene H. Jonker2, Ana Rath2,3, Daria Julkowska4, David Thomson5, Sharon F. Terry6, Béatrice de Montleau7, Diego Ardigò8, Virginie Hivert7, Kym M. Boycott9, Gareth Baynam10,11, Petra Kaufmann1, Domenica Taruscio12, Hanns Lochmüller13, Makoto Suematsu14, Carlo Incerti15, Ruxandra Draghia-Akli16,17, Irene Norstedt16, Lu Wang18 and Hugh J.S. Dawkins19 on behalf of the International Rare Diseases Research Consortium (IRDiRC)

The collective impact of rare diseases in Western Australia: an estimate using a population-based cohort

Purpose:It has been argued that rare diseases should be recognized as a public health priority. However, there is a shortage of epidemiological data describing the true burden of rare diseases. This study investigated hospital service use to provide a better understanding of the collective health and economic impacts of rare diseases.Methods:Novel methodology was developed using a carefully constructed set of diagnostic codes, a selection of rare disease cohorts from hospital administrative data, and advanced data-linkage technologies. Outcomes included health-service use and hospital admission costs.Results:In 2010, cohort members who were alive represented approximately 2.0% of the Western Australian population. The cohort accounted for 4.6% of people discharged from hospital and 9.9% of hospital discharges, and it had a greater average length of stay than the general population. The total cost of hospital discharges for the cohort represented 10.5% of 2010 state inpatient hospital costs.Conclusions:This population-based cohort study provides strong new evidence of a marked disparity between the proportion of the population with rare diseases and their combined health-system costs. The methodology will inform future rare-disease studies, and the evidence will guide government strategies for managing the service needs of people living with rare diseases.Genet Med advance online publication 22 September 2016

Mapping orphanet terminology to UMLS

We present a method for creating mappings between the Orphanet terminology of rare diseases and the Unified Medical Language System (UMLS), in particular the SNOMED CT, MeSH, and MedDRA terminologies. Our method is based on: (i) aggressive normalisation of terms specific to the Orphanet terminology on top of standard UMLS normalisation; (ii) semantic ranking of partial candidate mappings in order to group similar mappings and attribute higher ranking to the more informative ones. Our results show that, by using the aggressive normalisation function, we increase the number of exact candidate mappings by 7.1-9.5% compared to a mapping method based on MetaMap. A manual assessment of our results shows a high precision of 94.6%. Our results imply that Orphanet diseases are under-represented in the aforementioned terminologies: SNOMED CT, MeSH, and MedDRA are found to contain only 35%, 42%, and 15% of the Orphanet rare diseases, respectively.