Massachusetts Institute of Technology Committee on the Use of Humans as Experimental Subjects Application # (assigned by COUHES) Date APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) Please answer every question Positive answers should be amplified with details You may mark N/A where the question does not pertain to your application Any incomplete application will be rejected and returned for completion A completed CHECKLIST FOR STANDARD APPLICATION FORM must accompany this application I BASIC INFORMATION Title of Study Personal Genome Project Principal Investigator Name: George Church Building and Room #: NE30 #7055 Title: Associate Member, Email: gmc@harvard.edu Department: Broad Institute Phone: Associated Investigator(s) Name: Eric Lander Email: lander@broad.mit.edu Title: Director, Broad Institute Phone: 617-252-1906 Affiliation: Collaborating Institutions If you are collaborating with another institution(s) then you must obtain approval from that institution’s institutional review board, and forward copies of the approval to COUHES) Harvard Medical School – approvals attached Location of Research If at MIT please indicate where on campus If you plan to use the facilities of the Clinical Research Center you will need to obtain the approval of the CRC Advisory Committee You may use this form for simultaneous submission to the CRC Advisory Committee 320 Charles Street and Cambridge Center Broad Institute Funding If the research is funded by an outside sponsor, please enclose one copy of the research proposal with your application A draft of the research proposal is acceptable Source: Broad Gift Funds Contract or Grant Title: N/A Contract or Grant #: N/A OSP #: 2735910 Human Subjects Training All study personnel MUST take and pass a training course on human subjects research MIT has a web-based course that can be accessed from the main menu of the COUHES web site COUHES may accept proof of training from some other institutions List the names of all study personnel and indicate if they have taken a human subjects training course Chad Nusbaum David Jaffe Anticipated Dates of Research Start Date:4/1/2007 Completion Date: 03/31/2010 APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -1- I STUDY INFORMATION Purpose of Study Please provide a concise statement of the background, nature and reasons for the proposed study Use non-technical language that can be understood by non-scientist members of COUHES We will collect DNA & RNA sequence data from ten individuals consented for potential full public disclosure of their genome, RNA, proteome, medical records, imaging data and a broad set of phenotypes The purpose is to employ new methods for selective sequencing of selected regions of the human genome including exons, VDJ-regions, viral and microbial probes, conserved CG dinucleotides, and automate the paired-end library steps into a pipeline which will benefit human and microbial genome resequencing communities We will expand work on software and interpretation pipelines We will make cell lines available for RNA, proteomic, RNAi, chemical biology, and adult-derived (therapeutic) stem cell communities We will develop educational, ELSI, public outreach, IRB, and collaborative programs and documents which would allow us to expand this study to one million participants leveraging existing large cohort biobank and epidemiological studies globally and/or creating new ones Study Protocol For biomedical, engineering and related research, please provide an outline of the actual experiments to be performed Where applicable, provide a detailed description of the experimental devices or procedures to be used, detailed information on the exact dosages of drugs or chemicals to be used, total quantity of blood samples to be used, and descriptions of special diets For applications in the social sciences, management and other non-biomedical disciplines please provide a detailed description of your proposed study Where applicable, include copies of any questionnaires or standardized tests you plan to incorporate into your study If your study involves interviews please submit an outline indicating the types of questions you will include You should provide sufficient information for effective review by non-scientist members of COUHES Define all abbreviations and use simple words Unless justification is provided this part of the application must not exceed pages Attaching sections of a grant application is not an acceptable substitute (A) Collect DNA sequence data from ten individuals consented for ‘potential’ full public disclosure (see section E below) of their genome, RNA, proteome, medical records, imaging data and a broad set of phenotypes The PGP data is being kept initially as secure and private as any other human genomics data, but will not be de-identified in any way (http://arep.med.harvard.edu/PGP/) APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -2- (B) We will employ new methods for selective sequencing of selected regions of the human genome comparing four different methods: (B1) Molecular inversion (padlock) probes – 50 to 200 bp fill-in and ligation (B2) Double-stranded cleavage and ligation-based capture of specific subsets of restriction enzyme fragments (B3) Hybridization capture (B4) Pooled localized priming For each of these four we will automate single-endtag (SET) and paired-endtag (PET) library steps into a pipeline which will benefit human and microbial genome resequencing communities Figure Ways to capture DNA (yellow) subsets for polony sequencing Left: MmeI cleavage of sheared ds-DNA, Middle: fillin-then ligase, Right: ss 5’ end cleaved by Taq Polymerase then ligated to ds-probe(red) All can be highly multiplexed (>20K regions per reaction), and the last two highly targeted (C) We will apply the new methods in aim B for selective sequencing of selected regions of the human genome (C1) Exons (exonome = 1% of the genome), (C2) T or B VDJ-ome (Primary: Jin Billy Li; Collaborators: Christophe Benoist, David Hafler, Diane Mathis) (C3) Viral and microbial probes (Collaborators: Gary Ruvkun) (C4) Conserved CG dinucleotide regions (C5) Megabase-size candidate gene regions (Collaborators: Chris A Walsh & Jim Gusella) (D) Work on software and interpretation pipelines (E) Develop educational, ELSI, PR, IRB, and collaborative programs and documents which would allow us to expand this study to one million participants leveraging existing large cohort studies globally and/or creating a new one (F) Make cell lines available for RNA, proteomic, RNAi, chemical biology, and adultderived (therapeutic) stem cell communities Drugs and Devices If the study involves the administration of an investigational drug that is not approved by the Food and Drug Administration (FDA) for the use outlined in the protocol, then the principal investigator (or sponsor) must obtain an Investigational New Drug (IND) number from the FDA If the study involves the use of an approved drug in an unapproved way the investigator (or sponsor) must submit an application for an IND number Please attach a copy of the IND approval (new drug), or application (new use.) APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -3- If the study involves the use of an investigational medical device and COUHES determines the device poses significant risk to human subjects , the investigator (or sponsor) must obtain an Investigational Device and Equipment (IDE) number from the FDA Will drugs or biological agents requiring an IND be used? YES NO If yes, please provide details: Will an investigational medical device be used? YES NO If yes, please provide details: Radiation If the study uses radiation or radioactive materials it may also have to be approved by the Committee on Radiation Exposure to Human Subjects (COREHS) COUHES will determine if you need COREHS approval Will radiation or radioactive materials be used? YES If yes, please provide details: Diets Will special diets be used? YES NO If yes, please provide details: NO III HUMAN SUBJECTS Subjects A Estimated number: 10 consented B Age(s): adult adults C Inclusion/exclusion criteria i What are the criteria for inclusion or exclusion? Ten consented individuals knowledgeable in genetics and human subjects research who were willing for potential full public disclosure of the entire genome, RNA, proteome, medical records, imaging data and broad set of phenotypes ii Are any inclusion or exclusion criteria based on age, gender, or race/ethnic origin? If so, please explain and justify None D Please explain the inclusion of any vulnerable population (e.g children, cognitively impaired persons, non-English speakers, MIT students), and why that population is being studied None included Subject recruitment Identification and recruitment of subjects must be ethically and legally acceptable and free of coercion Describe below what methods will be used to identify and recruit subjects Volunteers that were knowledgeable in genetics and human subject research were sought out There was a desire to obtain a diverse range of volunteers, male and female, from a varied set of genetic and environmental backgrounds as possible Please attach a copy of any advertisements/ notices and letters to potential subjects Consents are attached No advertising was used because participants required significant knowledge of genetics and human subject research Subject compensation Payment must be reasonable in relation to the time and trouble associated with participating in the study It cannot constitute an undue inducement to participate APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -4- Describe all plans to pay subjects in cash or other form of payment (i.e gift certificate) No payment was provided Will subjects be reimbursed for travel and expenses? no Potential risks A risk is a potential harm that a reasonable person would consider important in deciding whether to participate in research Risks can be categorized as physical, psychological, sociological, economic and legal, and include pain, stress, invasion of privacy, embarrassment or exposure of sensitive or confidential data All potential risks and discomforts must be minimized to the greatest extent possible by using e.g appropriate monitoring, safety devices and withdrawal of a subject if there is evidence of a specific adverse event What are the risks / discomforts associated with each intervention or procedure in the study? none What procedures will be in place to prevent / minimize potential risks or discomfort? none Potential benefits What potential benefits may subjects receive from participating in the study? There are no know benefits from your participation in this study What potential benefits can society expect from the study? Data collection, storage, and confidentiality How will data be collected? Is there audio or videotaping? YES NO Explain the procedures you plan to follow Will data be associated with personal identifiers or will it be coded? Personal identifiers Coded Explain the procedures you plan to follow Where will the data be stored and how will it be secured? This study will collect DNA sequence data from ten individuals consented for potential full public disclosure of their genome, RNA, proteome, medical records, imaging data and a broad set of phenotypes The PGP data is being kept initially as secure and private as any other human genomics data, but will not be de-identified in any way (http://arep.med.harvard.edu/PGP/). What will happen to the data when the study is completed? We anticipate that this data will be studied Can data acquired in the study affect a subject’s relationship with other individuals (e.g employee-supervisor, patient –physician, student-teacher, family relationships)? no Deception Investigators must not exclude information from a subject that a reasonable person would APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -5- want to know in deciding whether to participate in a study Will information about the research purpose and design be withheld from subjects? YES NO If so, explain and justify Adverse effects Serious or unexpected adverse reactions or injuries must be reported to COUHES within 48 hours Other adverse events should be reported within 10 working days What follow-up efforts will be made to detect any harm to subjects and how will COUHES be kept informed? n/a Informed consent Documented informed consent must be obtained from all participants in studies that involve human subjects You must use the templates available on the COUHES web-site to prepare these forms Draft informed consent forms must be returned with this application Under certain circumstances COUHES may waive the requirement for informed consent Attach informed consent forms with this application All informed consents are attached 10 The HIPAA Privacy Rule If your study involves disclosing identifiable health information about a subject outside of M.I.T., then you must conform to the HIPAA Privacy Rule and complete the questions below Please refer to the HIPAA section, and to the definitions of protected health information, de-identified data and limited data set on the COUHES web-site Do you plan to use or disclose identifiable health information outside M.I.T.? YES NO If YES, then the subject must complete an Authorization for Release of Protected Health Information Form Please attach a copy of this draft form You must use the template available on the COUHES web-site Alternatively, COUHES may grant a Waiver of Authorization if the disclosure meets criteria outlined on the COUHES web-site Are you requesting a Waiver of Authorization? YES NO If YES, explain and justify Will the health information you plan to use or disclose be de-identified? YES NO Will you be using or disclosing a limited data set? YES NO If YES, then COUHES will send you a formal data use agreement that you must complete in order for your application to be approved INVESTIGATOR’S ASSURANCE I certify the information provided in this application is complete and correct I understand that I have ultimate responsibility for the conduct of the study, the ethical performance of the project, the protection of the rights and welfare of human subjects, and strict adherence to any stipulations imposed by COUHES APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -6- I agree to comply with all MIT policies, as well all federal, state and local laws on the protection of human subjects in research, including: • ensuring all study personnel satisfactorily complete human subjects training • performing the study according to the approved protocol • implementing no changes in the approved study without COUHES approval • obtaining informed consent from subjects using only the currently approved consent form • protecting identifiable health information in accord with the HIPAA Privacy Rule • promptly reporting significant or untoward adverse effects Signature of Principal Investigator Date _ 23-Mar-2007 Print Full Name and Title _ George Church, Associate Member, Broad Institute Signature of Department Head Date Print Full Name and Title _Diane MacDonald, Chief Financial Officer Please return a signed hard copy of this application to the COUHES office at E25-143b Please also return additional copies, either by email or regular mail, in accord with the instructions on the COUHES web-site APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -7- ... Investigators must not exclude information from a subject that a reasonable person would APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL SUBJECTS (STANDARD FORM) – revised 7/23/2003 -5- want to. .. investigator (or sponsor) must submit an application for an IND number Please attach a copy of the IND approval (new drug), or application (new use. ) APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL. .. reasonable in relation to the time and trouble associated with participating in the study It cannot constitute an undue inducement to participate APPLICATION FOR APPROVAL TO USE HUMANS AS EXPERIMENTAL