Proceedings of a Workshop—in Brief

Convened February 2–3, 2025

Promoting Knowledge Exchange and Collaboration Between Kuwait and the United States: Precision Medicine
Proceedings of a Workshop—in Brief

Advancing precision medicine—sometimes referred to as personalized medicine—relies on active collaboration among domestic and international scientific organizations to accelerate the translation of research into clinical practice by bringing together complementary expertise, resources, and perspectives. To further knowledge exchange between Kuwait and the United States in this field, the U.S. National Academies of Sciences, Engineering, and Medicine (the National Academies) and the Kuwait Foundation for the Advancement of Sciences (KFAS) launched a collaborative series of workshops designed to investigate interdisciplinary approaches between biological and material sciences, engineering disciplines, and data science to achieve meaningful solutions in precision medicine.

The first workshop in the series was held between February 2 and 3, 2025, in Kuwait.¹ The sessions explored advancements in point-of-care technologies and the unprecedented impact of artificial intelligence (AI) on the evolving landscape of precision medicine in the United States and Kuwait. Workshop discussions also highlighted how precision health research is revolutionizing the understanding and treatment of chronic diseases, such as type 2 diabetes, which is prevalent in both countries. This Proceedings of a Workshop—in Brief provides a high-level summary of key discussions held during the February 2025 workshop.

Dr. Salman Al-Sabah, Kuwait Authority for Medical Responsibility, and Dr. Fawaz Haj, University of California, Davis, introduced the workshop topic, thanking participants for attending the event.

Dr. Ibrahim Rashid Al Rashdan, KFAS, provided context for the workshop discussions, noting the importance of the collaboration between KFAS and the National Academies in furthering a shared mission to advance excellence in medical care through precision medicine. “Today, we stand at the threshold of a new era driven by groundbreaking innovations in genomics and artificial intelligence. This is a fundamental shift in how we understand and deliver personalized healthcare,” Al Rashdan said. By integrating genomics, AI, and point-of-care genetic testing, there are opportunities to refine treatment, ensuring maximum efficacy with minimal side effects. He added that the synergy between genomics and AI has translated into opportunities to redefine patient care and advance medical innovations.

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Dr. Dalal Najib, the National Academies, discussed the work of the Science and Engineering Capacity Development unit within Policy and Global Affairs of the National Academies. The unit’s portfolio is dedicated to fostering partnerships among institutions and individuals both domestically and globally. This occurs through fellowships and training programs as well as capitalizing on opportunities for interdisciplinary collaboration and network building. This workshop was a result of a long-standing collaboration between the National Academies and KFAS which dates back to 2011, she said.

PRECISION MEDICINE LANDSCAPE IN KUWAIT

Dr. Fahd Al-Mulla, Dasman Diabetes Institute, discussed current research to advance precision medicine in Kuwait. He began by providing a brief overview of genomics, including the Human Genome Project and its contribution to the field. The sequencing of the entire human genome through the Human Genome Project enabled researchers to understand how genetics affect disease. He provided several examples of how genomics has transformed medicine. In one example, researchers studying HIV (human immunodeficiency virus) in Africa found that some individuals who were exposed to the virus did not acquire HIV. This was due to a deletion in the CCR5 gene—the co-receptor for HIV. Those with this deletion, or roughly 10 percent of the population, have an innate, genetic resistance to HIV.

He also discussed a particular form of rectal cancer found in patients with mismatch repair deficient cells. With this information, scientists were able to design a medication that effectively treated cancer in these patients without the need for chemotherapy or radiation. In fact, in a study of 12 patients with rectal cancer who received this medication, none required chemotherapy, underwent surgery, or had a progression or recurrence of cancer after 2 years.

Kuwait has contributed significantly to the global understanding of genomics as well. For example, Kuwaiti scientists were among the first in the region to sequence SARS-CoV-2 and identify those who would be genetically susceptible to experiencing a more severe form of COVID-19.

Genomics has also informed the development of precision medicine. Al-Mulla said that through precision medicine, clinicians can target treatments and interventions which are most effective for particular groups of people that share genetic or other factors. Precision medicine can help tailor a medical diagnosis and treatment for an individual by considering their genetics, lifestyle, environment, and personal preferences.

Al-Mulla described several examples of personalized therapy, where patients can make informed decisions about their own health based on knowledge about their genetics, including preemptively reducing their risk of breast and colon cancer. Finally, he discussed the importance of research collaboration in advancing genomics and precision medicine. For example, there is a global genomic medicine consortium that is furthering work in these fields. However, there is a need for additional investment in research collaborations to advance genomics in the region, such as the Kuwait Genome Project.

DISCUSSION

During the discussion, Dr. Hutan Ashrafian, Imperial College London and Flagship Pioneering, thanked Al-Mulla for his presentation, offering that it sounded as though Kuwait had an opportunity to develop the infrastructure and the capacity to examine deeper mutations (ex., somatic vs. germline). He asked Al-Mulla to comment on what he thought Kuwait should focus on in its efforts to develop an infrastructure to support this type of sequencing.

Al-Mulla described the difference between germline and somatic mutations, noting that exposures in the environment can cause somatic mutations that can lead to cancer. In Kuwait, his work has included an examination of both germline and somatic mutations in the same patient, stating that it is important to capture both mutations as well as methylation data.

Also, he said that by utilizing this infrastructure to focus on predictive testing, there is the potential to significantly reduce healthcare costs. For example, 40 percent of people in Kuwait are pre-diabetic, and it is estimated that 15 percent of these will go on to develop diabetes. There are opportunities to develop cost-effective preventive programs to reduce the impact of prediabetes as well as diabetes in the country. Al-Mulla added that it would be helpful to conduct economic analyses to assess the impact of predictive medicine in Kuwait.

SESSION I: PRECISION MEDICINE FOR CHRONIC METABOLIC DISEASES

The first session addressed opportunities for furthering precision medicine to address chronic metabolic diseases. Dr. Ahmad Al-Serri, Kuwait University, began the session by discussing personalized medicine for obesity from a genomics perspective. As the Human Genome Project fundamentally changed scientists’ understanding of the mechanism underlying diseases, Al-Serri gave an overview of other research that has informed work on obesity. In 2007, the first Genome-Wide Association Study (GWAS) identified the FTO (fat mass and obesity-associated) gene along with variants that increase the risk of obesity and type 2 diabetes. Additional research in the 2010s identified numerous genetic variants associated with body mass index (BMI) and obesity, such as melanocortin 4 receptor, or MC4R, gene variants. During this time, the American Medical Association also recognized obesity as a disease, which helped advance the understanding that obesity is a complex disease affected by genes, biology, environment, and behavior.

Other studies have examined the effect of genes on weight loss and related interventions for obesity. For example, studies indicated that a person with MC4R mutation is more likely to have a better outcome with gastric bypass surgery than with other interventions. Studies using polygenic/genetic risk scores to estimate weight loss outcomes have been useful in predicting surgical outcomes and helping clinicians develop a personalized management plan for patients. While these and other tools and research have advanced our understanding of the genomics of obesity, we continue to lack the ability to conduct long-term monitoring of patients, which is crucial to this work, Al-Serri noted. He emphasized that the rise of AI and the establishment of “bio-banks” (repositories that store biological samples for use in research) will ultimately allow for data analysis from a multi-omics perspective. Finally, he highlighted the importance of researching the effects of providing such detailed information to the public and the role of behavioral science in facilitating its delivery.

Dr. Mohammad Jamal, Kuwait University, discussed precision medicine for fatty liver disease. Metabolic dysfunction-associated fatty liver disease, or MAFLD, is the most common liver disease worldwide; it is particularly high in Kuwait. The global prevalence of MAFLD is currently 40 percent, and it is increasing along with the prevalence of obesity. About 85 percent of those with a BMI above 35 will have a simple presence of fat in the liver. Those with diabetes are also more likely to develop an inflammation of the liver due to the presence of fat. Highlighting findings from the Global Burden of Disease (GBD) study on mortality related to chronic liver disease,² Jamal emphasized that, “men in Kuwait and Qatar had the highest prevalence of cirrhosis in the world due to fatty liver disease, more than twice the global estimates.”³ The prevalence of fatty liver disease is also climbing in children and teenagers. This is likely due to changes in diet, particularly an increase in consumption of processed foods with little fiber, which can affect appetite and the microbiome. Other environmental factors are also of interest, for example, exposure to air toxins that could contribute to epigenetic or genetic changes in the population. Metabolic dysfunction-associated steatohepatitis (MASH), a more aggressive form of MALFD, is also becoming more common globally.

Jamal added that Qatar also has higher rates of obesity-related diabetes, particularly among younger populations. There are significant opportunities to further the study of genetics related to liver disease, particularly given the high incidence of the disease. The focus of precision medicine in this area is to identify which medical approaches will be effective based on a patient’s genetic, environmental, and lifestyle factors.

Dr. Jason Kim, University of Massachusetts Chan Medical School, also discussed fatty liver disease and opportunities for advancing precision medicine. Global figures indicate that there are one billion people with obesity. Obesity is a multifactorial condition that can result in fatty liver disease, type 2 diabetes, heart disease, dementia, and some forms of cancer. It also disproportionately impacts minorities and individuals living in low-income neighborhoods. Additionally, Kim noted that type 2

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diabetes is widely understood to be a chronic inflammatory and progressive metabolic disease led by obesity and insulin resistance. While there are drugs on the market that can effectively manage type 2 diabetes, there is no effective treatment to address some of these comorbidi-ties, including MASH.

A recently published study⁴ from Kim lab that examined the livers of high fat-fed obese animals and lean control animals indicated that many of the metabolic and inflammatory genes are differentially expressed in response to a high fat intake. Macrophages are activated to pro-inflammatory state in obesity, releasing cytokines (e.g., IL-6, TNFα, IL-12); interferon gamma (IFNγ) is well known to regulate this process. These inflammatory cytokines are elevated in both obese humans and animals. Animal studies from Kim lab have found that inflammation—not the fattiness of the liver—affects insulin sensitivity, and mice lacking IFNγ signaling in macrophages were shown to be protected from obesity-mediated insulin resistance in the liver. Their novel findings further indicate that IL-12, an inflammatory cytokine primarily secreted by macrophages and stimulates the proliferation of Th1 cells, modulates insulin resistance in the liver. This is consistent with elevated serum IL-12 levels in obese children and adults. Their analysis of RNA-seq data from human MASH liver has found that liver expression of IFNγ receptor and IL-12 is strongly associated with severe fatty liver disease, supporting the translational significance of the findings from the Kim lab.

Dr. Rohit Kulkarni, Harvard Medical School, discussed studies of RNA modifications to examine metabolic disorders, including type 2 diabetes. He stated that diabetes affects 38.4 million people in the U.S., or 11.6 percent of the U.S. population; the number of undiagnosed people in the United States with diabetes is 8.7 million, or 22.8 percent of the adult population. Diabetes cases continue to climb worldwide, with an estimated 783.2 million people projected to develop the disease by 2045.

The pancreatic β cell is a critical component in both type 1 and type 2 diabetes. As such, precision medicine to address diabetes must consider the type of diabetes as well as the role of the β cell. Kulkarni noted that studies of the ambient stress pathway locally in the β cell leads to an alteration in the M6A regulation pattern, which is followed by alterations in the hydrate synthase genes, which are important for maintaining β cell viability.

He added that there is a need for basic biological research to advance personalized medicine related to diabetes. This could include research on mRNA modifications, such as how mRNA methylation regulates human β cell biology in type 2 diabetes. Additionally, research targeting the β cell, examining important nucleotides and proteins, and addressing transcriptome turnover is critical.

DISCUSSION

Haj and Al-Sabah moderated a panel discussion following the presentations. Donna Ryan, Pennington Biomedical Research Center, noted that researchers are currently using out of date tools to assess obesity, such as BMI and body circumference. She asked panelists about the potential to utilize genetic markers as an improved way to assess obesity. Al-Serri responded that this may be an option along with other markers, but developing these tools has been a challenge to the field. This is in part due to a lack of a universal definition for obesity. Efforts are underway to redefine the disease, for example, classifying it in terms of pre-obesity and post-obesity, which may inform disease markers.

Another panelist noted that once diagnosed with obesity, the main concern is not a person’s total body fat; instead, it is where fat is located, for example, in the regional adipose tissue. Research shows that a person whose weight and BMI are within the normal range can have fat distributed in organs that would classify them as metabolically obese; this is another factor that makes it challenging to develop clear markers for obesity. A participant also asked panelists to discuss potential triggers before a patient develops MASH and how those might inform interventions. Jamal said that a patient will often have elevated liver enzymes and an ultrasound that shows a fatty liver. If the patient accepts a liver biopsy, there is an ability to quantify fibrosis. Elastography tests can also be used to assess subtypes that can help differentiate or distinguish the stages of MASH. MASH is a metabolic syndrome, so there is a need to examine mus-

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cle mass, fat mass, waist circumference, BMI, and organ damage. The participant suggested, based on observational information, that newly approved FDA medications to treat diabetes are not likely to be effective in treating MASH, however, more research is needed. The participant added that they are currently assessing the impact of these drugs on their patients with MASH.

When asked why MASH is so prevalent in Kuwait and neighboring countries, a panelist responded that while diet, exercise, and genetics were previously thought to be the sole contributing factors, more research is needed to understand other factors related to the high prevalence. Jamal reiterated the need for precision and personalized approach for treating obesity, diabetes, and MASH, including developing tools for providers that can more precisely diagnose individuals. AI models may someday be able to identify markers of disease at the individual level.

SESSION II: AI AND THE FUTURE OF PRECISION MEDICINE

Dr. Amina Qutub, The University of Texas at San Antonio, discussed how AI is shaping biomedical sciences across different applications. Qutub discussed a project bridging clinical research and AI to address problems related to trauma care—the leading cause of death worldwide. The project includes a “Tiger Team” of trauma experts, AI researchers, biomedical engineers, psychologists, and data analysts who launched a coordinated trauma dataset across Texas. Data were shared across seven leading hospitals and informed an analysis of trauma outcomes. This supported the development of an AI-augmented tool designed to inform real-time clinical decisions related to trauma care.

Another project (iRemedy ACT), Qutub said, is using AI to create a Google Map where a user can zoom in on any given location and learn more about where trauma events are occurring and what would happen if a new trauma unit were added to that location. AI is also being used to support researchers and decision makers on trauma care decisions through training.

Qutub also discussed the use of AI and brain models for biomedicine to address neurological conditions, such as dementia. Researchers are developing patient-specific cellular models to understand how the brain responds to environmental stress and are using that information to identify therapies to address neurodegeneration. The models mimic brain regions regulating sensory response and circadian cycles. A key aspect of this research is examining the role of sleep in dementia symptoms. The project is collecting sleep, biological, genetic, and epigenetic data to examine how sleep relates to cognitive changes.

Dr. Sarah Al Youha, Kuwait University, discussed the evolving role of AI in informed consent. Currently, most patients discuss informed consent with a surgeon or other health professional. During this discussion, a patient may face language barriers, feel rushed, or be overwhelmed by complex, lengthy forms. In fact, studies indicate that 70 percent of patients feel the time spent on informed consent is inadequate, and over 50 percent find consent forms to be too lengthy and complex. Additionally, informed consent has historically focused on legal protection, rather than patient education, understanding, and satisfaction with the process.

Al Youha noted that AI-delegated informed consent includes AI-generated consent forms, AI chatbots that can guide users through consent dialogue, AI generated videos or images that explain key concepts to patients, AI-powered translation, and AI-powered interactive consent systems with in-built quizzes. These types of AI delegated consent can immediately develop translated versions of documents and can be customized to address the needs of the patient. The benefits of AI-generated consent forms include standardization to reduce the risk of omitting crucial information. It also offers customization, which can tailor to a patient’s literacy and preferences and can support patient education and recordkeeping.

In a systematic review of AI-driven consent in healthcare, many of the studies found that AI-assisted consent is superior for patient recall, understanding, and satisfaction compared to traditional consent, Al Youha noted. However, there are challenges in implementing AI-driven consent, including ethical issues, legal uncertainty, data privacy, and lack of human interaction. Technical issues such as AI hallucinations and language and cultural nuances are also of concern as well as cost and infrastructure, physician and patient acceptance, and digital literacy requirements. Solutions to some of these

challenges include developing AI-specific regulations and ethics standards with clear legal frameworks and defining AI standards of care for medical consent, such as risk disclosure.

Dr. Mehrtash Babadi, Broad Institute, discussed opportunities to accelerate biomedicine through genomics and AI. He began by describing work at the Broad Center for Human Brain Variation, which is studying 200 human brains and 50 brain regions to understand the nature of human brain cell variation across individuals. This research will capture variation at the resolution of individual cells and molecular processes, including how genetics influences variability. It will also examine the molecular mechanisms underlying psychiatric, neurodegenerative, and aging-related diseases.

Babadi also discussed research on genomics related to rare diseases, noting that 1 in 10 individuals has a rare disease. There are 8,000 to 10,000 different rare diseases, each of which affects a small fraction of the population. Given the sizes of the populations affected, there has been little attention to research on these diseases. To help address this gap, Project RADICAL (RAre DIsease Cures AcceLerator) is examining every genomic mutation that is linked to any rare disease using CRISPR genetic technology. The hope is that this research will inform scientists about rare diseases that affect the same function in the cell, allowing them to categorize tens or hundreds of rare genetic diseases into the same group to identify effective therapeutic targets.

He also discussed research to develop an AI platform for cell biology research, called the “Cellarium AI Platform.” This platform is a native data and machine learning operations infrastructure for single cell biology data built upon modern AI practices. The platform can store and query billion-scale, single-cell omics data, and reveal cell-type specific gene functions. It provides an example of how AI models of the intrinsic language of cells and tissues will allow researchers to expand their ability to perform more experiments and evaluate more hypotheses in silico.

Genomics and AI are supporting the precise identification of therapeutic targets and agents to inform precision medicine. These fields are also adding comprehensive in silico evaluations of therapeutic agents and supporting significant improvements in the design of clinical trials.

DISCUSSION

Dr. Ahmad Nabeel, Imperial College London, and Dr. Stacey Gabriel, Broad Institute, co-moderated the discussion following the presentations. One participant asked how panelists are considering users as they develop AI models. A panelist responded that they are developing profiles for various users to assess their experience with a model as well as profiling individual researchers to gain their feedback. Real-time integration of user feedback that can offer updates is also important. Humans should help optimize the development of AI as well as inform computational approaches, one panelist said.

Another participant asked if panelists have a sense for when frameworks and infrastructure may be available to begin uploading data to support the engineering of AI systems. A panelist responded that companies are beginning to offer these frameworks and infrastructure. It may also be possible to test a model using Google or Open AI to see how it compares when completing the same task. The development of AI tools should be regulated, one participant added, particularly by verifying the source of the data and how the data are processed and validated.

KEYNOTE REMARKS: ADVANCING PRECISION MEDICINE THROUGH DOMESTIC AND GLOBAL COLLABORATION AND PARTNERSHIPS

Dr. Hilal Lashuel, Qatar Foundation, addressed the importance of partnerships in advancing precision medicine, particularly through the lens of his foundation’s work in this area. The Qatar Foundation functions as a comprehensive ecosystem created to unlock human potential. The Foundation’s ecosystem includes 13 mainstream and specialized schools that offer students opportunities to study precision medicine. The robust health and academic ecosystem in Qatar has been essential to driving research in genomics and precision medicine.

Lashuel discussed the work of the Qatar Research Development and Innovation Council, which is responsible for funding projects throughout the country in precision health. Over the past decade, the Council has invested approximately $100 million in research in this area. Additionally, the Qatar Precision Health Institute has a number of related efforts underway, such as the Qatar

Genome Program, the Qatar Biobank population-based cohort study, and other related studies. Lashuel spoke about the different aspects of the precision health ecosystem in Qatar. To support these efforts, the Ministry of Health in Qatar will be launching the e-Health Hub, a national hub that will integrate health records from all private and public hospitals into one electronic health record system. Lashuel highlighted that one of the key institutions working towards translation of genomic research into novel therapies is Sidra Medicine⁵ in Qatar, which also includes a national genome sequencing facility.

Building local synergies and fostering collaborations within a coordinated ecosystem are essential for impactful international partnerships, Lashuel said. International partnerships foster mutual learning and create synergies that amplify impact. Lashuel also emphasized the importance of competitive collaboration, noting that it is crucial to leverage healthy competition to foster innovation while collaborating on shared goals. He highlighted the many benefits of this type of collaboration, such as shared resources, accelerated progress, mutual learning and the ability to bridge knowledge and infrastructure gaps. He added that competitive collaboration can be developed through cross-border initiatives in precision health regional consortia and data-sharing platforms.

DISCUSSION

Haj moderated a panel discussion following the presentation. During the session, Lashuel and participants discussed the need to include patients in the design of research, particularly those from underrepresented and lower-income communities. One participant discussed the importance of developing citizen scientists who can contribute to research by sharing data, including through wearables. Similarly, Lashuel said that there is a need to invest in research in lower income countries that do not have the resources to build precision medicine programs. Working collectively, we have an opportunity to move the field forward, he said.

Another participant asked how precision medicine research or innovation can impact the economy of a country. Lashuel responded that in Qatar, the main entity driving research is the Qatar Foundation. However, there is now an effort to leverage private sector support. There is also a law that will likely pass that will devote a percentage of gross domestic product (GDP) in Qatar to support research (currently 0.7 percent, with the goal of 2.5 percent of GDP). Lashuel added that there is a need to consider leveraging resources and capabilities in the region to increase the visibility of this part of the world in the fields of genomics and precision medicine.

Additionally, one participant noted that the path to precision medicine starts from genomic medicine, but it goes through the environment and environmental health sciences. They asked Lashuel how the need to understand environmental factors is being addressed in Qatar. He responded that the Qatar Foundation, including through its Computing Research Institute, is currently developing a focus on the environment, energy, and biomedical research. The Foundation is also working collaboratively with other international organizations, such as the U.S. Centers for Disease Control and Prevention (CDC), to study the interface between climate change, environment, and health. Environmental exposures, air pollution, and heat are all significant factors for the population of Kuwait and the region.

DAY 2: OPENING REMARKS

Dr. Salman Al-Sabah, Kuwait Authority for Medical Responsibility, opened the second day of the workshop by summarizing the discussions from the first day for the attendees and introducing the opening speaker for the second day of the workshop.

Plenary Session: Understanding the Burden of Disease by 2050

Dr. Ali Mokdad, University of Washington, presented the burden of disease estimates by 2050. The Institute for Health Metrics and Evaluation (IHME) at the University of Washington is responsible for the development of the GBD, which provides a comprehensive and comparable picture of mortality and disability across countries. The GBD quantifies health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities eliminated. It is supported by 13,618 collaborators in 164 countries and territories.

By 2050, data from the GBD indicates that life expectancy is expected to continue to grow in all regions around the world, despite increases in temperature and rising BMI, Mokdad said. However, most of the future health burden

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will be determined by how much progress countries can make in addressing well-established risk factors, such as smoking, air pollution, diet, vaccination rates, and health system quality and access.

The GBD also indicates that fertility rates are declining everywhere but remain above replacement in 45 percent of 204 countries, Mokdad noted. The rates will be close to 100 percent in 2100. Fertility remains high in places that will be the most heat-stressed and poor, shifting a higher number of the world’s births to increasingly vulnerable conditions. Climate change is creating this dynamic and will directly affect health. Due to increased heat, some locations, for example, Sahel and parts of India, are likely to have large populations in inhabitable places, leading to mass out migration and geopolitical instability.

Mokdad said obesity is also steadily increasing around the world. This increase will slow or even reverse the decline in cardiovascular diseases and contribute to rising deaths from some cancers. There is an urgent need to experiment using different options to limit the increase in obesity.

The primary threats to health, Mokdad said, include

• Malicious AI,
• Antimicrobial resistance,
• Pandemics,
• Threats to reproductive rights,
• A lack of policy response to aging,
• Mental health issues,
• Climate change and food insecurity,
• Diabetes and obesity,
• Environmental pollutants, and
• Conflict.

Addressing these challenges requires crosscutting solutions, such as new forms of global and regional cooperation, the development of resilient health systems, enhanced trust between individuals and between governments and communities, and a focus on adaptation and managing migration in high-risk locations.

In the United States, the GBD indicates that there will be a continual decline in life expectancy. To reduce the disease burden in the United States, Mokdad noted the need to close the education gaps—both between boys and girls, and between disadvantaged populations and the rest of the United States; to address the nexus of obesity, diet, and physical activity; and to reduce other key risk factors, such as tobacco use and high blood pressure.

On the other hand, Kuwait’s population has a high life expectancy (82.8 years), Mokdad said, and it will continue to increase by 2050. Given the high rates of some diseases in the country, Mokdad noted strategies to reduce disease burden, such as addressing other key risk factors such as obesity, diabetes, tobacco use, and high blood pressure. Local experimentation is also needed to determine what is effective to improve health at the community level. There is also a need to focus on early disease detection.

DISCUSSION

During the discussion, one participant asked what factors have led to the high life expectancy in Kuwait. Mokdad responded that the country’s health system works well and that there is virtually no drug use, and also very limited use of alcohol or smoking. Every Kuwaiti has access to healthcare, he added, and that Kuwaitis have also done an excellent job in providing health education and creating a strong social support system.

Another participant asked Mokdad if GBD will be adding genomic and proteomics data. Mokdad responded that the GBD is not able to incorporate data that is not available in every country. However, IHME is exploring adding other measures to the GBD, such as sleep, more environmental factors, and animal health.

SESSION III: POINT-OF-CARE TECHNOLOGIES FOR THE ADVANCEMENT OF PRECISION HEALTH

The planning of this session was led by workshop planning committee members Dr. Hutan Ashrafian, Imperial College London and Flagship Pioneering, and Dr. Susan Sumner, University of North Carolina at Chapel Hill. Ashrafian introduced the panel discussion, noting that point-of-care technologies can be transformative in precision medicine. The convergence of big data and molecular technologies has fostered this movement, along with

opportunities to gather more data, including through wearables.

Dr. Kathleen Barnes, Oxford Nanopore Technologies, discussed reducing the risk of disease through early detection and precision medicine tools at the point of care. She discussed her work on preemptive pharmacogenomics to prevent adverse drug reactions, including a study of 1,456 drug–gene interaction clinical decision support alerts for 1,249 unique biobank participants. The data were used to determine that anyone with an ischemic event should have genotype testing to guide clopidogrel use, given the potential for side effects or other drug reactions.

Precision medicine can fill important gaps, Barnes said. Current anti-cancer drugs are only effective in 25 percent of patients, and 65 percent of cancers are diagnosed at stages 3 or 4. These technologies can help to address the rate of adverse drug reactions, which are the fifth leading cause of death. While precision medicine tools continue to be used in treating diseases, they also have potential in prevention and prediction of diseases.

The principles of population health are driving precision health, including health equity, data, and technology. These are all needed to achieve health care transformation and effective precision medicine.

Barnes also discussed her company’s efforts to develop technologies to support precision medicine, such as rapid tumor methylation profiling during brain surgery and pathogen profiling at the bedside in intensive care units, among others. The company is also working to map epigenetic modifications across 50,000 samples to create a globally accessible dataset. This and other efforts will advance the understanding of epigenetics in cancer, neurological disease, and other common complex diseases. Precision health is the future of medicine, Barnes said, and it is in demand by practitioners and patients.

Dr. Vasilis Vasiliou, Yale School of Public Health, introduced the concept of translational exposomics as a key framework for advancing precision health. He emphasized that while genetic factors alone do not account for the majority of disease burden, they can interact with the exposome (the totality of environmental exposures across the life course) to influence health outcomes. Exposomics is a multidisciplinary approach that integrates advanced analytical technologies, bioinformatics, epidemiological methods and artificial intelligence to comprehensively characterize these exposures and their biological effects over time.

Omics technologies, including genomics, proteomics, and metabolomics, are central to exposomics research, enabling detailed molecular profiling to elucidate how environmental exposures modulate biological pathways and contribute to disease risk. Exposomics analyses contribute to the development of precision environmental health tools and personalized interventions by identifying modifiable exposures and associated biomarkers. Vasiliou noted that ongoing research is applying exposomic methods to a range of diseases, including Alzheimer’s disease.

He also discussed his research on oxidative stress and the antioxidant defense system, highlighting their role in the pathogenesis of liver disease and diabetes.

Dr. Fawaz Alzaid, Dasman Diabetes Institute, discussed multiparametric profiling of diabetes at the point of care. He began by noting that there is no shortage in point-of-care technology for diabetes, particularly as data can now be shared from devices to the cloud (see Figure 1).

There is significant data that can be accessed which can inform precision medicine around diabetes, Alzaid said. For example, researchers have broken the disease down into subtypes to determine clinical parameters and are using this information to direct patients to more precise care. Another approach is focused on examining the heterogenicity of glycemic phenotypes in type 1 diabetes. Researchers have identified six variables for the glycemic phenotype and can use that information to inform management. Researchers have also examined immune correlates of diabetes status and complications, which help predict the risk of complications.

DISCUSSION

Ashrafian moderated this panel discussion. One participant asked why panelists thought that the available evidence on diabetes and obesity was not being translated into the clinic. Alzaid responded that once tools are developed with rigorous data, these can be made open access. With open access data, physicians and clinicians

will be more likely to act. Clinicians will move once the evidence is there.

Another participant asked about the barriers to the adoption of precision medicine. Barnes responded that a key challenge is incomplete evidence and lack of information about health economics. Vasiliou noted that harmonization of data is also an issue as is the cost of necessary hardware.

COLLABORATIVE DISCUSSION SESSIONS

On the second day of the workshop, participants took part in three concurrent collaborative discussion sessions, each focused on a key topic of the workshop: chronic metabolic diseases, AI and point-of-care technologies, and genomics. These breakout sessions provided an opportunity for smaller group discussions, enabling participants to engage more deeply with other subject matter experts and explore ideas for future research collaborations.

Chronic Metabolic Diseases

Dr. Donna Ryan, Pennington Biomedical Research Center, session moderator, led a collaborative discussion focused on advancing precision medicine for chronic metabolic diseases. Dr. Barrak Alahmad, Harvard T.H. Chan School of Public Health/Ministry of Health of Kuwait, served as the session rapporteur. Participants identified several related needs, such as promoting health improvement in Kuwait and beyond by targeting precision medicine approaches to metabolic disease, based on the high prevalence of metabolic disease burden and the high prevalence of metabolic disease complications in Kuwait and the region. Importantly, there is a critical mass of physicians and scientists in the region along with research resources to accomplish a research agenda in precision medicine. However, success in achieving that agenda depends on overcoming barriers and obstacles to success, including lack of public understanding and support for research, administrative hurdles, and academic silos. Creating new career pathways for physician scientists and early public involvement in clinical research projects is needed to assure broad public understanding and endorsement.

Breaking silos and increasing collaboration was a topic discussed during the session, particularly creating clear academia–industry–government partnerships with the goal of driving innovation and increasing funding. Training in management and leadership was also identified as a need, particularly around communication skills for researchers and clinicians. Pilot grants and joint

publications could also serve as starting points for new collaboration.

Participants also discussed data and research infrastructure needs. For example, there is a need to improve disease outcomes through passive and active surveillance using existing data sources such as insurance claims and hospital admissions in Kuwait, as well as other routinely collected administrative data in Kuwait Ministry of Health. Expanding and integrating genomics and biomarker research in multiple cohorts in Kuwait and other countries would also be useful, particularly with the long-term goal of developing open-access, decentralized data platforms.

AI and advanced analytics were also discussed as opportunities to improve predictive models for disease diagnosis, management, and prognosis related to chronic disease. Deep phenotyping could be used to move beyond BMI/A1C as a more nuanced measure of disease. To support subtyping of metabolic diseases, participants discussed improving the understanding of disease subtyping within the Kuwaiti population and comparing to emerging datasets from other countries.

Point-of-Care Technologies and AI

Dr. Saeed Hassanpour, Dartmouth College, session moderator, led participants in a collaborative discussion on point-of-care technologies and AI. Dr. Dari Alhuwail, Kuwait University/University of Dundee, served as the session rapporteur.

Participants discussed potential “shovel-ready” projects that could have immediate clinical relevance for the field. One such example included assessing sleep quality in hospitals through AI. The hospital environment and patient protocols make it difficult for patients to sleep, which can be critically important for their recovery and health outcomes. For example, hospitals usually have harsh lighting, high noise levels, and have protocols in place that require clinicians to wake up patients regularly to conduct routine tests.

Participants spoke about the use of AI to monitor and evaluate sleep quality using data from wearables, under-bed sensors, and other commercially available devices. These technologies could provide objective metrics on patient sleep disruptions and their correlation with health outcomes. One participant highlighted the importance of selecting wearable devices that are accurate, affordable, and have long battery life—features that make them suitable for broad deployment in community or institutional settings. Future studies might also track environmental factors such as noise levels, temperature, and air pollution, providing evidence to inform improved hospital protocols. For instance, patients undergoing elective procedures who do not require frequent overnight monitoring may benefit from less disruptive routines. Additional related areas could include examining sleep metrics and pain, narcotic use, and recovery trajectories.

Participants also discussed opportunities to pilot the use of a multilingual chatbot developed through large language models (LLMs) and AI to enhance the patient intake process. This technology could collect and analyze medical intake data, replacing standard patient intake forms, and be tailored for Arabic-speaking populations.

Environmental health monitoring was another topic of interest. Participants discussed conducting environmental health monitoring which could allow for tracking real-time environmental exposure and health differences from expat (a person residing outside their native country) experiences and supported tracking exposures. One participant suggested comparing the sleep patterns of Kuwaiti students while abroad versus when they are in Kuwait as a way to explore the influence of the exposome. It was highlighted that understanding how environmental and lifestyle shifts affect sleep physiology could offer valuable insights into how precision medicine can move beyond genetics, incorporating real-world context to deliver more culturally and geographically tailored health interventions.

The need for data expertise and computing power as well as implementation standards to launch point-of-care technologies was noted. Participants also highlighted the need for training programs for clinicians to expand their exposure to AI/digital tools. Collaborative cross-border research with U.S. institutions was also emphasized. This could include initiating joint research proposals with U.S. academic or clinical partners on point-of-care sensors.

Genomics

Dr. Stacey Gabriel, Broad Institute, session moderator, led participants in a collaborative discussion focused on

expanding genomics research in Kuwait. Dr. Hamad Ali, Kuwait University/Dasman Diabetes Institute, served as the session rapporteur.

During the session, participants noted that there is significant interest in integrating genomics into health care in Kuwait, particularly to assess cardiometabolic diseases given their high prevalence in the country. Additionally, Kuwait is the last GCC nation without an official national genome initiative. Given this gap, participants emphasized the need and urgency for a phased, collaborative genomics–exposomics program rooted in Kuwait’s clinical and public health priorities—particularly cardiometabolic and rare diseases. Participants discussed the importance of including rare disease patients and families in the genome program. The focus of this “Kuwait Genome Exposome Program” should be broad, including genomics, exposomics, and other multi-omic measures, such as proteomics and microbiome and metabolite measures.

Lessons learned from Qatar’s existing genome program can inform this program’s development. Initial phases should prioritize biobank creation, leveraging existing hospital and genomic research facilities, community engagement, and low-cost sequencing pilots before gradually scaling to a national platform. The program can initially utilize existing data from hospitals and small studies to support its research.

Biobank creation is a critical first step to developing this program. As one participant noted, there are significant limitations to the current collection of biological samples in Kuwait. However, a larger centralized biobank could address these gaps and advance health research significantly for the country. There is already some biomarker data being collected in Kuwait, including deep phenotyping, microbiome markers, etc. Patients who have provided biological samples have received information about their results, including counseling. Ancestry information is also available, which patients have appreciated.

In addition to the current experience, it will also be important to leverage resources, capacity, and knowledge from neighboring countries. Additionally, integrating biobank and cohort building with the local hospital systems was discussed.

Regarding data governance, ethics, and data sharing, participants reinforced the need for transparency and proposed emulating Qatar’s approach to sharing results. Discussions emphasized that the participants in any relevant programs must be fully informed and consent with opt-ins for sensitive findings. Participants highlighted that a national genome project must be built on solid legal and ethical foundations to ensure the protection of participants’ rights and data security.

Training and workforce development related to genomics were also discussed, particularly the importance of developing regional talent in bioinformatics, counseling, sequencing technologies, and AI. Training could occur through collaboration with U.S. institutions for joint Ph.D. programs. It is also critical to train future talent via research-integrated programs and incentives.

To expand regional and international collaboration in this area, participants discussed the creation of a GCC-wide genomics council for data standardization and program alignment. There was also conversation about building on existing partnerships with Qatar, Oman, UAE, and U.S. universities.

Participants also discussed the need to secure funding through modular proposals and international grant partnerships and increase public participation about efforts related to genomics through education, incentives, and transparency.

Debrief from the Collaborative Discussions

Moderators from each session provided the following summary of the collaborative discussions to all the workshop attendees.

Ryan shared ideas which were discussed by the session participants for advancing precision medicine for chronic metabolic diseases. Participants identified several related needs, including data on deep phenotyping, the addition of environmental and occupational measures, and improvements in data gathering and processing.

There is also a broader need to further precision medicine research in Kuwait on type 2 diabetes. The local population and providers in public health and hospitals should be engaged in this work. Industry partners should also be more actively involved, particularly as funders and col-

laborators. As a first step, Ryan noted the need to develop an overarching plan to promote research on precision medicine in Kuwait alongside a comprehensive clinical research roadmap.

Hassanpour shared the discussion highlights from the point-of-care technologies and AI collaborative session. In terms of high-level issues, participants discussed the need for data expertise and computing power as well as implementation standards to launch point-of-care technologies. More omics data as well as training and education opportunities are also necessary to advance point-of-care technologies in Kuwait.

Regarding specific project ideas, Hassanpour discussed focusing on areas such as ambient sensing, pollution, environmental factors affecting sleep, and smart sensing technologies. Additionally, there is a need for collaboration between the U.S. and Kuwait to gather omics data.

Gabriel shared that the genomics collaboration session participants discussed the need for a Kuwaiti national genome program focused on noncommunicable and cardiometabolic diseases. The focus should be broad and include genomics, exposomics, and other multi-omic measures, such as proteomics and microbiome and metabolite measures. This program should be implemented as a phased approach, beginning at the university and hospital levels and focusing on diabetes.

She added that there is also a need to develop a biobank. Leveraging resources, capacity, and knowledge from neighboring countries will be important in creating a biobank and a related genomics program. For example, Qatar’s work in this field could serve as a model; Kuwait could emulate their efforts related to data sharing. A collaboration with the United States to support an exchange of talent through Ph.D. and training programs could also be useful.

CLOSING REMARKS

Workshop planning committee co-chairs Al-Sabah and Haj closed the workshop by thanking participants for attending the event and contributing their ideas for future collaborations. The committee members also thanked the organizing staff from KFAS and the National Academies for their efforts in making the workshop a successful event.

DISCLAIMER This Proceedings of a Workshop—in Brief was prepared by Jen Saunders and Komal Syed as a factual summary of what occurred at the workshop. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

PLANNING COMMITTEE Salman Al-Sabah (Co-Chair), Kuwait Authority for Medical Responsibility; Fawaz Haj (Co-Chair), University of California Davis; Hutan Ashrafian, Imperial College London and Flagship Pioneering; Stacey Gabriel, Broad Institute; Ahmad Nabeel, Imperial College London; and Susan Sumner, University of North Carolina at Chapel Hill; the National Academies’ planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Lucas Berenbrok, University of Pittsburgh; and Aly Khan, The University of Chicago. Marilyn Baker, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSORS This workshop was supported by a grant from the Kuwait Foundation for the Advancement of Sciences. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

NATIONAL ACADEMIES STAFF Dalal Najib, Senior Director; Komal Syed, Program Officer; Arianne Gandy, Senior Program Assistant.

KFAS STAFF Abrar Almoosa, Manager, Research Capacity Building; Ghada Faraj, Associate Officer I.

SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine. 2025. Promoting Knowledge Exchange and Collaboration Between Kuwait and the United States: Precision Medicine: Proceedings of a Workshop—in Brief. Washington, DC: National Academies Press. https://doi.org/10.17226/29197.

For additional information regarding the workshop, visit https://www.nationalacademies.org/our-work/precision-medicine-promoting-knowledge-exchange-and-collaboration-between-kuwait-and-the-united-states-workshop-series

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