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World of Genomics: Brazil

In this week’s World of Genomics, we travel to the vibrant country of Brazil – home to the majority of the Amazon rainforest and one of the biggest carnivals in the world – Rio de Janeiro Carnival. While the history of genetics in Brazil is only relatively recent, improved infrastructure, funding and experience has enabled Brazil to better develop in the field of genomics compared to other South American regions. With both continued investment from within Brazil, as well as from countries abroad, Brazil is keeping up to date with genomic technology and in turn will hopefully provide novel insights into the great diversity that exists within this unique country.

The population of Brazil

The Federative Republic of Brazil is the largest country in both South America and Latin America. It is the fifth-largest and sixth-most populous country in the world. Brazil is one of the world’s most multicultural and ethnically diverse nations. The first inhabitants of Brazil were native indigenous Indians. The Portuguese arrived in 1500, claiming Brazil for Portugal. During the Atlantic slave trade era, Brazil imported more enslaved Africans than any other country. In September 1822, the country declared its independence from Portugal, and it became the Empire of Brazil. Brazil’s unique environmental heritage makes it one of seventeen megadiverse countries and is the subject of significant global interest. It is also directly impacted by global issues like climate change and biodiversity loss.

Geographic and demographic information

Summary statistics:

  • Land area: 8,515,767 km2
  • Gross domestic product (GDP):
    • Total: $3.328 trillion
    • Per capita: $15,642

Population statistics:

  • Population size: In 2019, the total population size of Brazil was estimated to be 210,147,125.
  • Birth rate: In 2019, the crude birth rate was 13.703 per 1,000 people.
  • Death rate: In 2019, the crude death rate was 6.531 per 1,000 people.
  • Infant mortality rate: The crude infant mortality rate is 18.37 per 1,000 people.
  • Average life expectancy: The average life expectancy in 2018 was 75.67 years. 
  • Ethnicity: The population of Brazil is very diverse. Brazilians generally trace their origins from three sources: Europeans, Amerindians and Africans. White Brazilians (Brancos) are the largest ethnic group forming 47.73% of the country’s population. White Brazilians are the citizens of Brazil with European descent. The second largest ethnic group is Pardo, which combines Brazilian natives, European and African ancestry (43.13%).

Healthcare system

In 1988, the Brazilian Constitution defined health as a universal right. As a result, public healthcare is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System. This is known as the Unified Health System or Sistema Único de Saúde (SUS) in Portuguese. The SUS is universal and free for everyone and was established in 1990. Over the past few decades, the SUS has rapidly expanded to address the changing health needs of the population. Despite its successes, there is still an urgent need to address persistent geographical inequalities, insufficient funding and suboptimal private sector-public sector collaboration. In addition, in 2015, the effect of economic and political crises led to subsequent austerity measures being introduced by the current government. This led to major cuts in public investments, and in the health and education budgets. There are concerns that existing structural problems and disparities will worsen due to these measures, with the risk of reversing the achievements of SUS in improving population health outcomes.

Health priorities

In 2020, the leading causes of death in Brazil were diseases of the circulatory system, mainly ischemic heart disease, followed by infectious and parasitic diseases and malignant neoplasms.

Dengue is found in all states of the country (with four viral serotypes). Despite incidences of malaria reducing, Brazil still has the highest number of cases in the region of the Americas. It is also one of the worst affected countries by COVID-19, just behind the US and India.  

Brazil has prioritised six top areas, including hypertension, physical inactivity, blood pressure screening, hypercholesterolaemia, smoking and binge drinking. They also have one intermediate priority (i.e., overweight-obesity) for noncommunicable disease prevention.

In 2000, mortality rates among indigenous infants were more than triple that of the general population. Since then, Brazil has been among the 25 nations with the best improvement in survival rates for children under the age of five. Despite great improvements, several challenges still must be overcome. These largely include combatting poverty, reducing vulnerability and improving quality of life.

Like many other countries, obesity in Brazil is a growing health concern. In 2018, 35% of Brazilians were obese.

Genomic medicine capabilities

A lot of the early genetic research in Brazil was focussed on the study of Drosophila. The importance of genetics within the medical community was only recognised from around the 1960s onwards. The real turning point for Brazilian genomics occurred with the complete sequencing of Xylella fastidiosa, a citrus pathogen, in 2000.

Genetic services began within research settings and universities. Most clinical services are now located in State capitals, usually integrated within public universities and teaching hospitals. In the private setting, genetic tests are more readily available.

The use of molecular techniques has grown, with some groups implementing next-generation sequencing technologies. Nonetheless, their use for diagnosis has been challenged in many institutions due to the lack of funding.

Newborn screening became mandatory for some diseases in the 1990s, with SUS funding the tests needed for such procedures. It became formally established in 2001 by the Ministry of Health and became known as the National Newborn Screening Program (Programa Nacional de Triagem Neonatal – PNTN). The following diseases are included: phenylketonuria (PKU), congenital hypothyroidism (CH), SCD and other hemoglobinopathies, cystic fibrosis (CF), biotinidase deficiency (BD) and congenital adrenal hyperplasia (CAH).

Reproductive health is one of the areas strongly affected by structural inequalities. Abortion is illegal in Brazil, meaning only affluent Brazilian women have access to safe termination of pregnancy, while poor women’s fertility is often compromised by unsafe abortions. In a 2008 case, the Supreme Federal Court ruled that the right to life only applies to intrauterine embryos, and that frozen embryos, that are not eligible for a uterine transfer, do not hold fundamental rights and may be manipulated for research purposes. In 2012, the Supreme Court also authorised the practice of abortion on foetuses with anencephaly.

Notable projects

  • The Brazilian Initiative on Precision Medicine (BIPMed): In 2015, the São Paulo Research Foundation created the BIPMed, with the aim of facilitating the implementation of precision medicine in Brazil. It is based on a software platform that will offer public access to genomic and phenotypic data.
  • DNA do Brasil (DNABr): Initiated in 2018, the DNABr project aims to explore the genetic admixture of the Brazilian population to address key questions about health and population history. This will be achieved by generating reference genomes of the Brazilian population according to different allele frequencies.
  • The ZiBRA project: The ZiBRA project (real-time sequencing of Zika virus in Brazil) aims to sequence a thousand genomes from Brazil to provide important epidemiological information about the spread of the Zika virus in Brazil.

Notable organisations and companies

Notable individuals

  • Crodowaldo Pavan (1919-2009): Pavan was a Brazilian biologist and geneticist, who was involved in pioneering research on the genetics, taxonomy and ecology of Drosophila. He also was among one of the first to prove that the structure of genes and chromosomes could be changed by infections. Pavan was very influential and became involved in the main development of science and technology in Brazil.
  • Warwick Estevam Kerr (1922-2018): Kerr was an agricultural engineer, geneticist and entomologist, most known for his discoveries in the genetics and sex determination of bees.
  • Mayana Zatz (1947-): Born in France, Zatz moved to Brazil with her family in 1955. She was interested in the study of muscular dystrophies and worked in genetic counselling with families who were affected by neuromuscular diseases.
  • Oswaldo Frota-Pessoa (1947-2010): Frota-Pessoa was a physician, biologist and geneticist born in Rio de Janeiro. His main interests included the genetics of human populations, cytogenetics, medical genetics and genetic counselling, and genetics in psychiatry. He was also active in promoting public understanding of science.
  • Newton Freire-Maia (1918-2003): Freire-Maia was a teacher, researcher and geneticist. He conducted in-depth studies on consanguineous marriages and was a pioneer in providing genetic counselling.
  • Chana Malogolowkin-Cohen (1924-): Malogolowkin-Cohen is a pioneering Brazilian naturalist and geneticist. She was the first woman to have a PhD in Natural History in Brazil, the founder of the Brazilian Society of Genetics in 1955 and the first Brazilian woman to publish in the journal Science.

Going forward

Looking ahead, a future challenge for the implementation of genomic medicine in Brazil will be striking the right balance between strengthening genetic services already available and creating new ones. Furthermore, as NGS becomes more integrated into the clinic, ethical issues will arise that will need to be taken into consideration. However, it is hoped that the integration of these advanced genomics technologies will reduce costs for establishing a diagnosis and have a significant impact on improving healthcare for the Brazilian population.

The scientific community within Brazil, particularly in São Paulo, has shown that it is able to achieve ambitious goals, including the launch of the precision medicine initiative which will play an important role in sharing knowledge and putting Brazil on the genomics map. Nonetheless, achieving these goals requires clear limits and proper funding, the latter being a major barrier to the success of genomics within Brazil.

The Brazilian population is highly heterogeneous and admixed, making it an extremely fascinating and important population to study. Despite political and economic crises, the field of genetics/ genomics has developed reasonably well in Brazil. With continued efforts and international support and collaboration, the future of genetics and genomics in Brazil looks promising!

References

  • Massuda A, Hone T, Leles FA, de Castro MC, Atun R. The Brazilian health system at crossroads: progress, crisis and resilience. BMJ global health. 2018 Jul 1;3(4):e000829.
  • Castro MC, Massuda A, Almeida G, Menezes-Filho NA, Andrade MV, de Souza Noronha KV, Rocha R, Macinko J, Hone T, Tasca R, Giovanella L. Brazil’s unified health system: the first 30 years and prospects for the future. The Lancet. 2019 Jul 27;394(10195):345-56.
  • Correa M, Löwy I. Reproductive technology and social justice: a view from Brazil. Reproductive BioMedicine Online. 2020 Dec 1;41(6):1151-3.
  • Passos‐Bueno MR, Bertola D, Horovitz DD, de Faria Ferraz VE, Brito LA. Genetics and genomics in Brazil: a promising future. Molecular genetics & genomic medicine. 2014 Jul;2(4):280-91.
  • Salzano FM. The evolution of science in a Latin-American country: genetics and genomics in Brazil. Genetics. 2018 Mar 1;208(3):823-32.
  • Patrinos GP, Pasparakis E, Koiliari E, Pereira AC, Hünemeier T, Pereira LV, Mitropoulou C. Roadmap for Establishing Large-Scale Genomic Medicine Initiatives in Low-and Middle-Income Countries. The American Journal of Human Genetics. 2020 Oct 1;107(4):589-95.

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