“How Systems Medicine and Emerging Technologies Will Transform Healthcare”
Centerpiece Conversation with Leroy Hood, President, Institute for Systems Biology; hosted by Mark Anderson
New for of diagnostics — P4.
- Medicine is an informational science — its complexity is bewildering. Evolution isn’t directed, it takes a very wandering course. Eg. Stick insects The only way you can understand it is through data-driven approaches. There are two types of biological information — environmental and from within the genome. The collision of the two is where medicine comes in. Genomes are the key to figuring out the complexity of disease in the future.
- Systems approach to disease– global/holistic. Most MDs study individual things, but we try to carry out systems based medicine. To understand how medicine works, you need to look at the entire system, not just a piece of the puzzle. A disease is a property of the network, not any one gene or part of the human system. That’s a problem many mds are still struggling with. Studied diseases in mice and determined four major networks that explain disease. First time its been done. Biomarkers have failed because theres been no logic to their selection. With logic, biomarkers allow docters to predict disease 2 weeks before any symptoms and can distinguish close types of neurological diseases just based on blood. Each subtype of disease has a system.
There will never be a worthwhile single parameter diagnostic. PSA,w hen combined with 4 other molecules, is a terrific marker of prostate cancer. But not without them. Guessing optimal number of biomarkers will be about 5-8. Working on lung cancer markers. Start with 400 markers, that are parsed to
1. Early diagnoses, stratify complex diseases, assess disease progression, follow response to drugs and follow recurrences.
MA: Patterns are the best way to think about the world. Lots of data and statistical patterns is the best technique for understanding the world.
LH: In biology and medicine, the level of info you need depends on what you want to understand. In medicine, diagnostics is exactly that. But if you want to understand mechanisms of disease, you need to understand higher level systems. Grand challenges of 20th century — complexity. For every single scientific discipline. But in biology, it has four pillars that will let us solve our challenges.
Fundamental societal problems — healthcare, environment, etc, every one is susceptible to that kind of approach. My own institute is just getting started on applying same medicinal techniques to the environment. Trying to harness power of microbes to deal with issues of environment. Will be able to reengineer microbes to get them to do whatever they want to do.
P4 Pilot — How do we actually bring to patients?
Need really big strat. partnerships. Needed skills and materials and big funding. Now have partnerships with Grand ?? of Luxenburg. Wanted to shift dependence to biotech. $150 million in funding allowed us to get to the place where they’re ready to move to patients.
P4 institute recruits major clinical centers to pilot the program: Ohio State Medical School (care provider to all employees). Want to develop metrics to create envelope of wellness for each individual to understand their wellness slope.
Heart failure: talking to several other major centers. Want to have 4-5 centerw with 2-3 pilots to convince skeptics about P4 medicine. Already talked with 3 key Luxemburg ministers and if P4 succeeds, it will be brought to Luxemburg. Hope to be well into doing it with them in 3 years. Would like to think seriously about making Luxemburg the IP healthcare capital. Looking at Microsoft, Google, Oracle of world and despair: thinking too small. We will be buried in data points with patients. Luxemburg is small enough to institute the idea and fascinated with it. “Its a little bit like Iceland, . . . but Luxemburg has money”
MA: What’s next?
LH: In 8-10 years, will be able to ID 50 blood markers that specifically address each of your 50 different organs and will have a longitudinal assessment for each of these 50 different organs based on yearly measurements. Developing chips to be able to do that. Conventional antibodies won’t even remotely be able to keep up with demand. Will be able to see subtle initial transitions from wellness to disease.
Cost is horrendous today, but with chips, think they can do measurements for pennies a measurement. Genome cost has moved from 1-2 billion to $3000. It will become a part of medical record and an invaluable tool in healthcare.
Essential that this data be possible so that it will be mined to create medicine of the future. This will require laws to prevent insurance manipulation. Patients must realize that it is their societal duty to make their info public so that medicine can continue and help their kids and grandkids.
How much personal info do you give financial companies? Enormous because of convenience of CC. Medicine of future is much more compelling.
Integrated diagnostics — systems strategy for selecting biomarkers.
MA: What’s the field like?
LH: Institute is alone in commitment to gathering global data sets and integrate it into predictive and actionable models. Created a truly cross-disciplinary environment, where scientists communicate and work together very effectively.
MA: Treatment: what do you see?
LH: Fundamental revolution in drug selection. Drug companies select drugs for certain targets, but they’re terrible at selecting targets. Systems biology has new rationale for this– could we put together 2-3-4 drugs that could make that network perform in a better way.
When you walk in you’ll have annual blood test. MD will id funny things and do an intensive study of individual organs. Then invivo agents will be able to precisely target disease.
Ty Carlson: Pharma companies won’t like you. You’re a threat to the status quo. Any response to the industry?
LH: Took work to big pharma. Four out of four couldn’t have been less interested. Every sector of the healthcare industry, especially drug companies will have to restructure their business plans. There will be dinosaurs that wont make it. An enormous medical revolution is approaching and to what extent will old companies be able to adapt. Often the young ones come up and eat their breakfast.
Lorinda Rowledge: Prevention?
LH: P4 will demystify disease and provide metrics for assessing wellness. In next 10-15 years, there will be a whole new industry created around wellness. Interesting to speculate about new players. It may not be any of the common players in health. Nestle, Coca Cola, etc have all set up big institutes to think about health. We’ll be able to do things on molecular, cellular data that will add dimensionality to that. Positive feedback in the ability to assess how what you’re doing to yourself affects your health will increase. We’ll be much more likely to listen to health advice, when we have instant feedback.
Former company Rosetta used DNA arrays to assess disease mechanisms in animal models. Discovered set of RNA parameters that never fit pre-conceived disease notions. There are 20 or so of these that predict physiologic age, eg. you could be 70 with physiologic age of 50.