STORM, Strategic Toolkit for Omics-driven Rheumatology in Mexico, is a RheumAI pharmacogenomics project designed to improve drug selection and toxicity surveillance in Mexican rheumatology. It combines regional ancestry, genetic variants, clinical variables, and Monte Carlo simulation to represent treatment-response uncertainty without replacing clinical judgment.

Project scope

STORM would move from an exploratory evidence model to a prospectively validated research platform:

- Maintain the structured Mexican pharmacogenomics evidence base.

- Validate a targeted panel covering drug metabolism, toxicity, biologic response, and rheumatic-disease susceptibility.

- Study a Maya–Mestizo rheumatology cohort from Mérida.

- Compare predicted and observed allele frequencies.

- Associate genotypes with treatment response and adverse effects.

- Replace literature-based estimates with Mexican cohort data.

- Produce STORM v4, scientific publications, and a research-use clinical interface.

Priority drugs include methotrexate, azathioprine, sulfasalazine, tacrolimus, rituximab, mycophenolate, cyclophosphamide, JAK inhibitors, and selected biologics. Initial genes include `TPMT`, `NUDT15`, `MTHFR`, `CYP2C9`, `CYP3A5`, `NAT2`, `FCGR3A`, `FCGR2A`, and immune-pathway variants.

Development plan

Phase 1, completed foundation

- Structured evidence synthesis.

- Regional ancestry model.

- Monte Carlo engine.

- Interactive research calculator.

- Identification of pharmacogenomic gaps.

Phase 2, pilot validation

- 50 participants.

- Targeted panel of approximately 30 genes and 45–50 variants.

- Agena MassARRAY or equivalent platform.

- Comparison of STORM predictions with observed genotypes.

- Estimated duration: six months.

Phase 3, expanded validation

- 200 participants, including the pilot cohort.

- Illumina Global Screening Array plus custom STORM content.

- Molecular ancestry analysis.

- Prospective clinical outcome tracking.

- Recalibration into STORM v4.

- Estimated duration: 12 months.

Existing cost estimates

- Phase 2 genotyping: $7, 750–$9, 500 USD

- Phase 2 all-in cost: $10,300- 14,650 USD

- Phase 3 genome-wide genotyping: $16,000–$21,000 USD

- Complete Phase 2 and Phase 3 program: $41,000–$53,000 USD

A budget-constrained alternative would genotype 250 participants using only the targeted MassARRAY panel for approximately $6,750–$10,500 USD, excluding some operational costs. This would validate the main STORM markers but sacrifice genome-wide discovery.

Main deliverables

- Mexican and Maya–Mestizo pharmacogenomic reference dataset.

- Empirically calibrated STORM v4 model.

- Validated targeted research panel.

- One pilot manuscript and one expanded-cohort manuscript.

- Grant and institutional partnership package.

- Research-use software for ancestry-adjusted interpretation.

- Foundation for later clinical validation and regulatory review.

The clinical project would be led by Dr. Erick Adrián Zamora-Tehozol, rheumatologist and principal investigator, through RheumAI. Until prospective validation is complete, STORM remains an exploratory research and decision-support project, not a validated prescribing system.