Gabriel Perna | July 21, 2021
Thanks to COVID, there is increasing excitement over the use of genomics in clinical care, as evidenced by the large investments that health care organizations are making. But genomics isn’t the only “omics” making waves in precision medicine.
In general, precision medicine is a catchall for a broad range of services, explains Clay Smith, MD, Director, Blood Disorders and Cell Therapies Center and Medical Director, University of Colorado Health and CU Innovation Centers. At CU Innovation Centers, this includes using AI and other computational tools for imaging, drug discovery, cancer treatments and predictive tests. It also includes the multi-omics, and specifically, proteomics to determine a patient’s risk of cardiovascular and other diseases.
“We have been using a lot of exciting technology where you can look at single, individual cells and collect data. We call this multi-omics data. You can use computational tools, such as machine learning, to look for novel targets and resistance cells, develop companion diagnostics, and hopefully develop clinical decision support tools so clinicians can get the right drug to the right patient at the right time,” Smith says.
Usage of multi-omics, particularly as it relates to individualized treatment plans, is a strategy that’s prescribed by Jeff Moses, President of GATC Health, which offers a suite of digital neural networks designed specifically to leverage “omic” datasets to provide insight into human biology. He says the company looks at genomics, along with proteomics, microbomics, transcriptomics and viromics in its AI-powered platforms to discover a more inclusive vision of a person’s health as well as to identify potential interventions and therapeutics for diseases.
“DNA is a blueprint, it’s not the finished product. There are so many other factors that go into what makes up our [human biology],” says Moses. “Most AI platforms in the genomics space think in linear algorithmic terms. They think in math. While that can be good for some things, it doesn’t give you the full picture.”
Drug discovery and effectiveness
The single-cell multi-omics market is valued at $2.45 billion—but with the potential to grow to nearly $14 billion by the end of the decade, according to a report from Allied Market Research. Moreover, researchers are increasingly using single-cell multi-omics to inform the study of tumor progression, including cancer cell diversity and evolution.
One promising area where the other “omics” can make waves is in drug discovery. Researchers at the University of Sussex have in the past found multi-omics approaches effective in the search for new anti-tuberculosis drugs. GATC has a collaboration with Liquid Biosciences, which has a biomarker discovery platform, where the two companies share data to identify new and existing molecules that can be used in development of drugs and therapeutics.
Moses says that not only can this information improve the effectiveness and safety of medications, but it can speed up the process in which drugs go to market. Since it was announced in January of this year, the collaboration was able to discover three molecules that can be used to treat heroin addiction in a matter of weeks. “I have been told it takes 7-million-man hours to get a drug to market. Our efforts shaved 1.5 million off that cycle,” Moses says.
Speaking as a clinician, Smith at UC Health says too much time is used to get people on the right treatments by trial and error. He says that if there could be more direct information on what medications are likely to work for an individual patient, it would be transformational.
“There are so many extra side effects that people get that they don’t need since they aren’t on the right drugs. There are delays in treatment in getting the right drug. It’s hugely wasteful from a financial standpoint for everyone, especially patients,” Smith says. “[This data can lead to] better outcomes, fewer side effects, less delays in getting to what works, and hopefully much better stewardship of money that goes into paying for all this.”
COVID and dynamic tests
The COVID crisis has shown the need for the speed in which vaccines and drugs are developed. The rapid development of COVID vaccines, for example, would not have been possible without the combined proteomics and genomics approach against SARS-CoV-2, says Vijay Kumar, Department of Pharmaceutical Sciences, College of Pharmacy, The University of Tennessee Health Science Center in a recent NCBI publication.
The processing power to measure proteins has only gotten stronger, according to Roy Smythe, MD, CEO of SomaLogic. For its part, SomaLogic’s proteomics-based platform is currently able to measure 7,000 proteins simultaneously and Smythe said that will increase to 10,000 next year. Moreover, he says that the pandemic has showed how unhealthy the overall population is in the developed world and why precision medicine needs to be more precise.
Roy Smythe, MD, SomaLogic
“If this pandemic had been 15 percent more lethal, two or three million [Americans] would have died, the majority of which had pre-existing conditions that weren’t being managed well. It shows you how important it is to understand everyone’s individual biology so that you can maximize treatments,” Smythe says. “There is a large percentage of people in the world that would be willing to take better care of themselves if they had really objective information.”
When it comes to diagnostic tests, Smythe says that genomic data can equivocally reveal people’s risk for 5 percent of diseases, such as breast cancer, but proteomic data can be used for predisposition to disease based on genetics and environment or environment alone. This accounts for the other 95 percent of diseases, Smythe says, which can lead to less general risk factors and educated guessing among physicians.
“Genes don’t change. The genes you have are the genes you have at age 5, 15, 25, etc. Your proteome, the product of those genes, is always changing,” Smythe says. “The genome is not dynamic, but the proteome turns over 40,000 times in your life, based on the half life of proteins. Proteomics can give you contextualized information.”
Smith at UCHealth agrees with the notion that dynamic tests are the future because while “DNA is the blueprint of everything that happens in cells and organisms,” a lot happens from that blueprint changing on a constant basis. For instance, he says that tests that look at DNA, RNA and protein within individual cells, such as the single-cell multi-omics, can reveal insights on cancer that were not previously possible because the disease is caused by a small number of cells.
Advice for the fast followers
Overall, Smith says that using these precision medicine diagnostic tests to discover the right treatments for the right patients will be a fundamental tenant in the future of medicine. He says that health care organizations need to invest in this philosophy and build out teams that can develop and leverage these tools.
“That means maybe changing some of the paradigms we have used on the academic medicine side. We have to recognize, value and move towards using multi-disciplinary teams in researching and integrating precision medicine. We have to take these fairly complicated technologies and simplify them enough to make them usable within the workflow of a busy clinic and inpatient unit,” Smith says. “And we have to figure out how the savings from getting the right treatment to the right person can offset the investments we’re making in these tools.”
Smythe is perhaps even more bullish about the future of multi-omics, genomics, proteomics and other “omics” in delivering more personalized medicine to patients. He says that health care organizations must follow the sector closely and those who invest and adopt the most effective tools will be the winners.
“The health care delivery systems that use these tools, integrate these tools first will be the leaders. In the past, it’s who can have the most machines in a building. That’s not the future of health care,” Smythe says. “If you’re not part of this trend, you’re going to end up losing market share. It’s fine not to make investments right now. It’s fine to be a fast follower. But don’t ignore it. Pay attention to it. Make sure someone at your organization is charged with keeping up with these precision health technologies and tools so that you’re ready to adopt them when the time is right.”