Beginning of the end for ethically neutral genetic counseling?

The official position of the National Society of Genetic Counselors (NSGC) is that “reproductive decisions should be made in the context of unbiased and comprehensive information, free from discrimination or coercion.” But lawmakers in a number of US states have begun to chip away at the core principle of ethically neutral genetic counseling, enacting laws that require counselors to impart information mandated by legislative action. Eight states have now passed versions of the Down Syndrome Information Act into law. The legislation requires that specific information provided by the state be given to parents upon a diagnosis of Down syndrome, the most common chromosomal abnormality, affecting about 1 in 800 live births. In at least one state—Pennsylvania—the official state information resource contains information counter to NSGC best practices (http://goo.gl/m8cVVD). In response, the NSGC created its own information sheet (http://nsgc.org/d/do/4640) and has encouraged states to use its resources. But such legislation could be opening the door to attempts to legislate the information patients receive about other genetic conditions. The future autonomy of patients and genetic counselors is discussed in an opinion piece by bioethicist Arthur Caplan of New York University Langone Medical Center in a recent PLOS Biology article. —Karyn Hede, News Editor

Seemingly unrelated autoimmune disorders share genomic pathways

A new genome-wide association study (GWAS) has identified a network of shared regulatory pathways among 10 pediatric-onset autoimmune diseases. The study, published by Nature Medicine on 24 August 2015, pinpoints shared signals among disorders that were not previously understood to have a common origin. The authors state that it is the first systematic examination of shared genetic risk looking simultaneously at the genotype level across multiple autoimmune diseases. The results point to signaling pathways involved in cytokine antigen processing and presentation as well as helper T-cell activation. The study, which looked in detail at 27 genetic loci, showed that more than 70% (19) of the 27 were shared by at least three autoimmune diseases. Some of the associations had been previously reported, but others were newly discovered. The implied genetic sharing of pathways among autoimmune diseases suggests targeted therapeutic interventions that could benefit patients across several of the related disease states, the research team suggests. Many of the shared risk variants affect genes that have multiple biological roles and are already targets for clinical intervention in other diseases. However, because the study included only individuals of self-reported European ancestry, application of the findings could be limited in scope and, of course, must be replicated in future studies, given the history of seemingly promising GWAS failing to hold up to further investigative scrutiny. —Karyn Hede, News Editor