Next-generation sequencing (NGS) can aid law enforcement in solving decades-old cases and provide justice for victims. There is a higher chance of finding a perpetrator when NGS data is used, as opposed to the traditional DNA profile. In this interview, Alexis Garloff talks to News-Medical about her next-generation sequencing research and the applications in forensics, particularly in sexual assault cases.

Can you explain the work undertaken at TU Human Remains Identification Laboratory (THRIL)?

THRIL provides state-of-the-art DNA extraction, quantitation, and next-generation sequencing analysis services for human body fluids and human remains in historic and cold cases. Contract and collaborative work are directed by Dr. Kelly Elkins and Dr. Cindy Zeller. We have had research collaborations with several law enforcement agencies and external laboratories.

What is next-generation sequencing, and how does it improve on prior techniques?

Next-generation sequencing is a massively parallel technique used to rapidly perform targeted or whole genome sequence of human, animal, plant, bacterial, and viral samples. With NGS, we analyze the full sequence of the loci to be compared,  providing significantly increased discrimination power. This is different from traditional DNA typing methods, such as capillary electrophoresis, which analyze the relative length but not the sequence of genetic loci. 

Because we're analyzing the genetic sequence itself, NGS helps us gain information on samples we could not gain with prior techniques. For example, it can detect single nucleotide polymorphisms (SNPs), estimate ancestry, physical characteristics, determine genetic genealogical connections, and much more (Elkins 2021). NGS opens up a whole new world for forensics.

What are the “real-world” applications of these techniques?

NGS is capable of producing accurate and abundant information about a DNA sample in addition to the traditional forensic markers called short tandem repeats (STRs), so if a complete STR profile cannot be generated from evidence then NGS can be used to gain additional insight.

For example, NGS can be used on historic human remains to aid in facial reconstructions, differentiate twins where one twin has been suspected of a crime, or help solve cold cases by providing new leads. This technology is being used to solve cases that are decades old.

It is also helping to identify unidentified human remains in missing persons investigations. According to the National Missing and Unidentified Persons System (NamUs), 4,400 unidentified bodies are recovered in the US every year. Every year, the number of human remains and missing persons grows. NGS can put names to these remains.

How can next-generation sequencing help survivors of sexual assault?

NGS is a more sensitive and discriminatory technique that does not require a large sample size; therefore, there is a much higher chance of getting a profile from the perpetrator to enter into the Combined DNA Index System (CODIS).

However, the utility of the CODIS database can be limited. According to the Department of Forensic Sciences in Washington, DC, CODIS only helps 15 percent of sexual assault kits. Unless the perpetrator has previously submitted a DNA profile, it is likely that the DNA evidence will not be linked back to a specific individual.

Additionally, a complete STR profile might not be recoverable with certain cases so having the ability to gain additional information, such as identity-specific SNPs, ancestry and phenotypic information, or genetic genealogical links, can increase the chance of finding the perpetrator.

NGS technology allows law enforcement to collect more data in more novel ways. While the tenets of criminal investigation endure, law enforcement has more technology and tools to help them to collect data and solve crimes (Kelly Elkins, 2022). By implementing NGS into sexual assault cases, voices can be returned to the nameless, cold cases can find closure, and backlogs can be reduced.

What improvements still need to be made to these procedures?

Most forensic labs do not have NGS capabilities in-house, though that's starting to change. Reporting nomenclature still needs to be standardized, and lab analysts need to be trained in this new technology.

NGS produces much more data than traditional DNA typing, and labs need to develop protocols and obtain funding to store it.

What is Linens for the Lionhearted, and how is it helping survivors?

When a victim of sexual assault or domestic violence seeks treatment, a rape kit is most often collected and submitted as evidence, along with the victim's clothing and other personal items. In certain scenarios, the victim's bedsheets are collected as evidence, leaving the individual with a bare bed and the task of purchasing a new set of sheets (and these incidents occur at all times of day and night).

Linens for the Lionhearted is a community outreach project I created which provides a brand new set of bed sheets to victims of sexual assault or domestic violence.

The sheets are available in various sizes and are provided free of charge to victims who seek treatment at Mercy Medical Center. With the help of forensic nurse examiners and bed sheet donors, the victims are treated with care and provided with multiple resources, which help provide peace of mind in a time of distress and discomfort.

Image credit: Verogen

How did Mercy Medical Center become involved with Linens for the Lionhearted?

After doing some research and making some phone calls, I learned that Mercy Medical Center in Baltimore, MD, has a specific unit dedicated to treating sexual assault or domestic violence victims. The unit is composed of forensic nurse examiners that provide immediate care and treatment to victims.

Debra Holbrook, the director of forensic nursing, and I set up a way to donate the sheets safely. Debra was very interested in helping me start this project, and she provided me with a space to store the sheets. Since I started the project in late August, we have helped several victims.

Is the kind of care for survivors offered by Linens for the Lionhearted something that has been overlooked in the past and why was this?

I have only read one article about a female crime scene technician who started a “linen closet” within the crime laboratory. She would leave the sheets on the scene if it occurred in the victims’ bedroom.

Many people are unaware of the disruption associated with being a victim of such crimes unless they work in the field and see it first-hand. The need for clothing donations has been addressed, but the need for a new set of bed sheets has not been considered.

Linen donations eliminate one task that the victim would have to eventually complete, which is sometimes impossible given the time of day the incident occurred.

Many people do not consider what is taken from the victim if they decide to press charges against the perpetrator. Although it may seem like a simple enough task to buy a new set of sheets, it is not always easy for a victim of sexual assault or domestic abuse, and that is why it is important to donate such items.

Several resources are provided to these victims, and the Forensic Nurse Examiners at Mercy provide exceptional care. With the help of Linens for the Lionhearted, victims can rest on a new set of bedsheets.

Can you explain what it means personally for you to be involved in Linens for the Lionhearted?

Ever since I was young, I always had a passion for helping others. As a kid, I used to say, “I want to be an artist for sick people.” As an adult, although I have not pursued a career in artistry, I am still pursuing a career in a field that allows me to help my community.

Once I read an article about a female crime scene technician who started a similar project in a different state, I knew this type of resource could benefit large volumes of victims in Baltimore. I had the knowledge and resources available, so I put them to good use and brought the concept to life in Baltimore.

I am grateful for the people who have helped me establish this project, particularly the nurses that provide care to the victims. I am saddened by the volumes of victims within Baltimore that experience such crimes, but I will do everything in my power to alleviate any amount of stress on them that I can.

Linens for the Lionhearted allows me to help, advocate, and support victims of sexual assault and domestic violence. Although I am saddened that these crimes take place in my community, I am relieved to know that I can play a part in alleviating some of the stress that victims face.

Moving to Baltimore after being born and raised in a small town in Delaware, I realized how many connections I could make that would ultimately help me make a big impact on my community. I love the city of Baltimore, and I am beyond thankful to have the ability to help my community.

How can people help support Linens for the Lionhearted?

The donation system for Linens for the Lionhearted is set up like a wedding registry. Those who are interested in donating a set of sheets can visit the Amazon registry, select the sheet set they would like to donate, and deliver it to the registry address.

The sheets are delivered to me, where they are then sorted and delivered to Sexual Assault Forensic Examination (SAFE) units within hospitals. There are various other resources needed by victims, such as clothing, shoes, and feminine products.

Although Linens for the Lionhearted aims to provide bedsheets, we are also dedicated to raising awareness and advocating for victims through our social media accounts and would appreciate all community help in sharing our message.

How would you like to see this project grow in the future?

Regarding long-term growth, I would love to provide victims in every state with a set of brand-new bedsheets. I hope to connect with hospitals across the country and dedicate a storage space for sheets so all victims can access them.

I would like to partner with hospitals in every state and have sheets sent directly to their units if they have the storage and a safe, direct delivery system to victims.

I am hoping to expand Linens for the Lionhearted all over Maryland and the eastern shore. I am looking for hospitals that have a SAFE unit, or a unit dedicated to treating sexual assault and domestic violence victims. These units might even be within police departments. The easiest way to deliver the sheets is to connect with the individuals who collect rape kits when a victim seeks treatment.

If you or someone you know is interested in donating a set of sheets to a victim in need, the link to the Amazon registry is: https://www.amazon.com/registries/custom/4YIM93DN44PP/guest-view

If you want to partner with Linens as a hospital anywhere in the east coast, or if you are interested in starting your own branch of linens, contact Alexis at [email protected]

Linens for the Lionhearted has an Instagram account (@linensforthelionhearted), which posts content dedicated to spreading awareness for victims.

The SAFE unit at Mercy Medical Center also accepts donations such as feminine products, new clothing, sandals, and toiletries.

About Alexis Garloff

While at Towson University, Alexis focused on broadening her knowledge on the different aspects within forensic science, such as crime scene analysis, forensic toxicology, forensic DNA analysis, and forensic anthropology. In addition to her coursework, she works in the Towson University Human Remains Identification Laboratory, as well as assists in the Towson University Forensic Anthropology Laboratory. As a senior, Alexis completed research titled, “A Comparison of Four DNA Extraction Methods to Extract Genomic DNA from Human Body Fluid and Fly Artifact Samples” and presented this work at the 74th Annual American Academy of Forensic Science Conference in Seattle, Washington. During her undergraduate career, Alexis worked as an undergraduate learning assistant for an upper-level Molecular Biology course, where she led tutoring/study sessions and engaged in academic discussion with students. Alexis is the founder of a community outreach project, Linens for the Lionhearted, which provides brand new bed sheets to Sexual Assault and Domestic Violence victims. In May of 2022, Alexis graduated with her Bachelor of Science in Forensic Chemistry, with a concentration in DNA analysis and a minor in Molecular Biology, Biochemistry and Bioinformatics. She is in the accelerated Bachelors to Masters program at Towson University, with intended Master of Science in Forensic Science degree completion Fall of 2023. In the future, Alexis aims to work as a DNA analyst for a regional crime laboratory, and eventually gain enough experience to work for a federal agency. Alexis is passionate about her education and career, and is devoted to helping others in any way that she can.

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