Genomic Information and the Importance of Communication

Communicating clinically useful results both to doctors and patients will drive success

genomics-communications-hannes-smarasonAround the world, researchers and clinicians are taking on the challenge of integrating genomic analysis into medical practice. Physicians and patients are increasingly aware of the potential utility of genomic data. As genomics continues to become a more powerful tool in healthcare, there is a clear and compelling need for a commitment to excellence in communication.

At WuXi NextCODE, we are proud to provide sequencing and analysis resources that help doctors:

  • Shorten diagnostic odysseys, as I have discussed here; and
  • Improve treatment choices, as I have discussed here.

Maximizing the opportunities afforded by the ‘big data’ of genomics necessitates collaboration and communication, which I discuss in more detail here. As part of our genomics business, we are dedicated to the highest standards of communication – indeed, we view effective communication as central to how our technologies will improve health in both the near and the long term.

The task of harnessing the vast and expanding quantity of genomic data to improve clinical care requires interpretation and discovery powered to translate the data into clinically useful information. Leveraging that information to improve patient outcomes also requires clear and accurate communication:

  • Between researchers and clinicians;
  • Between specialists in different medical fields;

And, increasingly,

  • Between doctors and patients.

As the recent CLARITY Undiagnosed competition highlighted, applying genomic data to medical practice involves interpreting the sequenced genomes and identifying molecular diagnoses – and a third step: communicating clinically useful results both to doctors and to patients.

The CLARITY challenge winners, including WuXi NextCODE, were explicitly recognized for the quality and clinical utility of their reports.

Studies and surveys have shown that many people favor greater access to genetic information. Individuals want analysis of their genomes in order to:

  • Reveal their unique risk factors for inherited diseases;
  • Pinpoint a diagnosis if they are ill; and
  • Guide their decisions if they are seeking treatment.

Genomics is helping to inform patients in all these ways.

In addition, genomics demonstrates enormous potential to empower individuals.

The hundreds of thousands of people who purchase genomic testing through direct-to-consumer businesses like 23andMe are demonstrating a robust enthusiasm for gathering genomic information. And patients enrolled in clinical trials and donors participating in population-wide genomic studies express a desire to be more informed. Patients and consumers consistently seek resources that transform their personal genomic signatures into information they can use to make better healthcare and lifestyle decisions.

And most patients and consumers are willing – often eager – to share their genomic information to aid medical research and discovery. 23andMe reports, for example, that 80% of its customers consent to share their genomes for research.

It is unmistakably clear that, in the not-too-distant future, every individual in many countries around the world will have their genome sequenced. Throughout a person’s life, medical professionals will be able to access genomic information to guide health decisions – from identifying inherited conditions to assessing risk for complex diseases to calculating appropriate treatments, drugs, and even dosages for truly personalized healthcare.

The more effectively we communicate – the more we share information within the research community and parlay that into clinically useful information for patients – the greater the benefit to all.

As much as people understandably prefer simple, definitive answers to questions about their personal health, the information that genomics provides can be complex and even ambiguous. A genetic variant might be identified, for example, that can be tied to family medical history and translated into a probability or likelihood. This was the case for Angelina Jolie Pitt, who noted in her New York Times piece that her genomic analyses “gave [her] an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.” Percentage risks are nuanced, and individual perceptions of acceptable risk vary considerably. It is therefore difficult to define precisely the circumstances under which a genetic variant becomes clinically actionable.

Or a genetic variant might be identified which gives physicians clues but does not explicitly identify a specific disease. For example, a patient seeking a diagnosis may have a genetic variant that correlates to a number of diseases involving dysregulation of lipid metabolism. Identifying the variant provides physicians and caregivers with a clear direction for further analysis and treatment, but does not yield a conclusive diagnosis or prognosis.

Or a genetic variant might be identified which has yet to be understood as causing or playing a role in disease. Such a variant may occur by chance and have no medical relevance, or its meaning may be uncovered as science in the field advances. But for the person who is having the genomic information analyzed today, it offers no actionable information.

As all of these examples illustrate, effective communication about genomic information can be a significant challenge. There is a risk that poor communication will be a barrier to the adoption of genomic medicine, but if we strive to communicate clearly with patients and the public, our successes will likely accelerate more widespread use of genomics. The role of genomics in transforming health care will grow exponentially as we all endeavor to improve communication with patients, their families, and the public at large.

Our work at WuXi NextCODE is advancing the transformation of medical practice through genomics. As part of that vision, we recognize the critical importance of facilitating effective communication among all stakeholders. We provide the resources that enable researchers and clinicians to identify disease and inform treatment decisions. And we strive to add additional value by communicating about genomic information accurately and proactively, all with the ultimate goal of meaningfully improving patient outcomes.

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2015: An Inflection Point for Genomics Adoption Around the Globe

2015 genomics hannes smarason

2015 is shaping up to be a significant year in the advancement and adoption of genome sequencing and personalized medicine around the globe.

The year 2015 is shaping up to be an inflection point in the advancement and adoption of genome sequencing and personalized medicine.  While private initiatives are often the centerpiece of media coverage, leading governments clearly have advanced a number of important initiatives this year.  Indeed, many governments around the globe are actively promoting widespread utilization of genomics, supporting academic research, establishing industry guidelines, and raising public awareness.

Governments Serving as Catalysts for Genomics Progress

The efforts of officials worldwide to engage with and support the private sector’s tremendous potential have helped to make 2015 a significant year for expanding the use of genomics in clinical care.  A few highlights of 2015 include:

— In the U.S., President Obama made precision health one of the centerpieces of his State of the Union address in January. Obama’s administration kicked this effort off by requesting a $215M investment in a Precision Medicine Initiative with the following key attributes:

  • The cornerstone of Obama’s proposal is the plan to collect and analyze genomic data from a million or more volunteers;
  • The initiative further supports genomics through expanded research into the genetic mutations that drive cancer;
  • Additional funding is earmarked to maintain databases and develop industry standards.

— Germany and the U.K. expanded eligibility for government-funded genetic testing for breast cancer patients.

— Israel announced its intent to establish a government-sponsored genetic database.

— Through the National Institutes of Health and the National Cancer Institute, the U.S. federal government proposed dozens of new funding opportunities to support research in genetic sequencing and analysis.

— Japan launched an Initiative on Rare and Undiagnosed Diseases to provide genomic analysis and expert consultation for up to 1,000 individuals with childhood onset of undiagnosed conditions.

— Through Genomics England (which I described in further detail here), the U.K. Department of Health tapped WuXi NextCODE and others to begin interpretation in its groundbreaking 100,000 Genomes Project.

In news today, the trend toward globalization of genomics continues, as private sector leaders aligned to meet the needs of the forward-looking government health initiatives of Qatar:

— WuXi NextCODE and the Sidra Medical and Research Center partner to power population genomics and precision medicine in Qatar. Our partnership will:

  • Facilitate clinical diagnostics;
  •  Accelerate research; and
  • Support the Qatar Genome Project.

As I have discussed in an earlier post, large-scale population studies are an essential step in harnessing the power of genomics to improve health worldwide.  Since WuXi NextCODE’s foundational heritage as part of deCODE Genetics’ landmark analysis of Icelanders, we have always developed the tools to help translate sequence data into precision medicine on a large scale.  In our work with Genomics England, our collaboration with Fudan Children’s Hospital to diagnose rare diseases in China, and now our partnership with Sidra, the team at WuXi NextCODE is leading the effort to realize the potential of genomics on a truly global scale. The increasing interest in supporting those efforts shown by leading governments across the globe is helping to drive the successful use and application of genomics worldwide.

Genomics for Rare Diseases: Going Global and Shifting the Care Paradigm

The use of genomics in rare disease diagnosis and treatment is going global

The benefits of genomics in rare diseases are increasingly making a difference to patients, their families, and their physicians, and they are being scaled globally.

The trend of accelerating the use of genomics in rare disease diagnosis and treatment is going global, driven by the important goal of reaching all people around the world, no matter where they live.

Active programs have now been deployed and exist in many populous countries around the world.

For instance, WuXi NextCODE has established active collaborative efforts in three continents, most recently adding Fudan Children’s Hospital as a partner in its efforts to lead whole genome diagnostics for rare diseases in China.

Over the coming weeks, I expect WuXi NextCODE to continue have news of its dedicated efforts to spread the application of genomics for rare diseases to all geographies.

Diagnosing Rare Diseases: Genomics Shifts the Paradigm

Rare diseases are an area of significant advancement for genomics, as the opportunity for improved diagnosis and treatment through the use of genomics is truly remarkable.

According to the National Institutes of Health (NIH), there are over 7,000 rare diseases affecting between 25 and 30 million Americans, which is nearly 1 in 10 people, making the overall prevalence of rare diseases significant. Since NIH believes that approximately 80 percent of rare diseases have genetic origins, the potential for genomic sequencing, interpretation, and analysis to offer a solution here is truly game-changing.

Every day there are new cases of children with “unknown” diseases, many of which are likely related to a hereditary genetic disorder. Sadly, these children and their families often spend years undergoing testing and experimental treatments for a wide range of diseases in an attempt to properly diagnose and treat them; usually, this so-called “diagnostic odyssey” is accompanied by a very high financial and emotional burden.

Genomics offers the potential to deliver a correct and precise diagnosis for rare diseases that have identifiable genetic causes. Indeed, case studies are rapidly accumulating that show that, by offering genomic sequencing and analysis services to patients with a suspected rare genetic disease, mutations that might be causing the disease may be identified, and thus correct treatment can be employed much earlier to eliminate the burden of a long-term diagnostic and treatment odyssey.  A recent article in Bloomberg BusinessWeek highlighted medical histories of two patients who recently received a diagnosis informed by genomics. In both these representative examples, genomic analyses provided an end to the burden, cost, and stress of their multidecade-long diagnostic odyssey:

  • Jackie Smith, 35, spent the 32 years from age 3 unable to receive a correct diagnosis that could account for her weak limbs and turned-in ankles, despite seeing many doctors on numerous occasions. Indeed, Jackie’s parents were told to “take the 3-year-old girl home and enjoy her while they could” …”[her disease] would probably kill her before she was old enough to drive.”  This past February, using genomic interpretation and analyses from Wuxi NextCODE, Claritas Genomics definitively identified her condition as centronuclear myopathy in less than three weeks.
  • Dustin Bennett, 24, would tremble and violently jerk for hours or days at a time and had been developmentally delayed since childhood. After dozens of doctor visits and incorrect diagnoses—seizures, muscle disorders, mental health problems—a Mayo Clinic genomic-based analysis showed he has episodic ataxia type I, a neurological disease characterized by hours-long attacks with no clear trigger. Dustin, a 24-year-old who functions at a first-grade level, is now on the second round of a medication doctors say should help reduce the frequency and severity of his episodes.

The benefits of genomics in rare diseases – to individuals, their families, and their physicians – are increasingly making a difference to patients.  These benefits are being seen in case after case – and they are being scaled globally, as leading medical centers in many countries around the world are using genomics to support their efforts in diagnosing and treating rare diseases.  I believe passionately in the game-changing potential of genomics to help rare disease patients and I am dedicated to advancing world-leading genomics globally to uncover new solutions for patients.

Genomics Offers Game-Changing Solution to Rare Disease Diagnosis, Costs

Hannes Smarason Wuxi NextCODE

As genomics is used more and supported by ever-more robust analysis and interpretation, its potential to offer a solution to diagnosing rare diseases is truly game-changing.

I believe strongly and have previously blogged on the potential for genomics to shift the care paradigm for rare diseases, and here I’d like to detail in particular the huge potential value genomics can add to rare disease diagnosis. According to the National Institutes of Health (NIH), there are over 7,000 rare diseases affecting between 25 and 30 million Americans, which is nearly 1 in 10 people, making the overall prevalence of rare diseases significant. Rare diseases can be chronic, progressive, debilitating, disabling, severe, and life-threatening.

When a patient presents with a spectrum of unusual symptoms, a costly scramble naturally begins to diagnose the patient’s disease. Some people refer to this diagnosis process for rare diseases as a “diagnostic odyssey,” as patients and their families are subjected to test after test while being handed from one doctor to another, oftentimes to medical centers far from their home. Too often, this odyssey yields no concrete diagnosis or—worse—misdiagnosis. The direct medical costs can be significant, and the indirect costs—the frustration and disillusion felt by the patients and the family—can be extraordinary.

Since NIH believes that approximately 80 percent of rare diseases have genetic origins, the potential for genomic sequencing, interpretation, and analysis to offer a solution here is truly game-changing. A recent article in Bloomberg BusinessWeek highlighted medical histories of two patients who recently received a diagnosis informed by genomics. In both these examples, genomic analyses provided an end to the burden, cost, and stress of their multidecade-long diagnostic odyssey:

  • Jackie Smith, 35, spent the 32 years from age 3 unable to receive a correct diagnosis that could account for her weak limbs and turned-in ankles, despite seeing many doctors on numerous occasions. Indeed, Jackie’s parents were told to “take the 3-year-old girl home and enjoy her while they could”…”[her disease] would probably kill her before she was old enough to drive.”  This past February, using genomic interpretation and analyses from Wuxi NextCODE, Claritas Genomics definitively identified her condition as centronuclear myopathy in less than three weeks.
  • Dustin Bennett, 24, would tremble and violently jerk for hours or days at a time and had been developmentally delayed since childhood. After dozens of doctor visits and incorrect diagnoses—seizures, muscle disorders, mental health problems—a Mayo Clinic genomic-based analysis showed he has episodic ataxia type I, a neurological disease characterized by hours-long attacks with no clear trigger. Dustin, a 24-year-old who functions at a first-grade level, is now on the second round of a medication doctors say should help reduce the frequency and severity of his episodes.

As genomics is used more and supported by ever-more robust analysis and interpretation, I expect these types of clear successes to become even more commonplace. And the value to the healthcare system and the patient is clear, expressed powerfully in the Bloomberg BusinessWeek piece:

While there isn’t yet a cure, Smith is participating in research that may one day lead to treatments or more supportive care. “Just being connected feels good. I felt alone for a long time,” she says. “And I want to do it for the bigger picture, too. Not just for myself, but so I can be counted.”

 

Bringing Together Core Technologies Unlocks Genomic Data to Improve Healthcare

genome analysis technologies

Within the “3-legged stool” of genomics-enabling technologies, lower-cost genome sequencing has reached a point of strong commercial viability, and the remaining two legs—genomic analysis tools database storage—are rapidly evolving to support the use of genomic information in medical care.

The adoption of genome sequencing technology is rapidly expanding as medical centers around the world embrace its utility in informing healthcare decisions—an emerging reality of personalized medicine.

There are three important areas of technology that are driving the use of genomic data in healthcare:  genome sequencing, genomic analysis tools, and database storage.

The first of these—genome sequencing—has advanced to the point that it is more widely accessible, with the cost of sequencing at nearly $1,000 or less. This lower cost of genome sequencing has reached a critical milestone to enable the use of sequencing as a mass-market product for medical care.

The second and third core genomic technologies—genomic analysis tools and database storage—are in the midst of evolution. Their progress and integration are critical for the next stage of adoption of genomic data into health care.

The rapidly evolving legs of the “3-legged stool” of genomics technology are genomic analysis tools and database storage.

  • Genomic Analysis Tools: Since the human genome was first sequenced more than a decade ago, an increasingly robust body of research has showcased the links between mutations identified in the genome and disease risk. Informatics tools have been developed by medical centers and genomics companies to apply to whole-genome samples. Increasingly, these genome analysis tools will need to adapt to the steady pace of new genomic linkages to disease and to operate at a level approaching “big data.”
  • Database Storage for Human Genomes: There are a growing number of robust databases of human genomes, including data for healthy people or those with certain diseases. When properly analyzed, these databases offer the potential to provide the medical community with a reference library against which to compare genetic data. Large-scale, high-quality databases are an essential element to cross-reference a patient genome to guide more informed medical decisions.

Recently, two leading genomics companies—WuXi and NextCODE Health—have combined their technology capabilities in these two areas. WuXi has industry-leading capabilities to analyze, store, and manage the vast amounts of genomic data. NextCODE Health brings a leading-edge system for sequence-based clinical diagnostic applications and genome analysis.

The combination of WuXi’s foundational genomic database storage and management and NextCODE’s sophisticated genome analysis tools will integrated the key components that are most rapidly evolving to apply genomics to medical care.

Initiatives like these advance the state-of-the-art in genomic analysis and database storage, bringing us to the heart of helping the world to fully harness personalized medicine and providing tools directly to doctors to provide better diagnostics and treatments to patients.

The progress to date has been amazing. Yet the opportunities ahead are even more extraordinary to improve the speed, accuracy, and accessibility of genomic information to improve human health.

Genetics-Based Advances in Rare Diseases: Ideas into Action

NextCODE Health-Claritas Genomics

Claritas Genomics and NextCODE have established a collaboration to support rare disease clinical care.  Combining robust sequencing with integrated diagnostic capabilities, the partnership aims to accelerate and augment the services provided to leading pediatric care organizations.

Today we have a tremendous opportunity to use the data being generated from genome sequencing to address the mysteries of rare genetic diseases affecting children. Though these diseases individually are rare, according to Global Genes, an estimated 7,000 different types of rare diseases affect more than 30 million people in the U.S., roughly half of whom are children.

To conduct diagnostic testing for pediatric genetic disorders, leading children’s hospitals are collaborating with specialized laboratories, including Claritas Genomics, a recognized leader in specialized pediatric genetic testing affiliated with Boston Children’s Hospital, part of the Harvard Medical School system.

The real opportunity lies in the analysis of raw genomic sequence data to identify patterns or markers of a rare disease. While it has been theoretically possible to use genomic sequencing to diagnose most rare diseases, a major hurdle has been in integrating dynamic informatics tools that can quickly interpret the data into accurate diagnostic insights and, ultimately, treatment options.

This is why Claritas Genomics and NextCODE have today established a collaboration, enhancing their collective capabilities to support rare disease clinical care. Combining robust sequencing with integrated diagnostic capabilities, the partnership will aim to accelerate and augment the services provided to leading pediatric care organizations.  Claritas has established a wide range of tests for genes known to be associated with pediatric disorders, which NextCODE is integrating into its clinical interface, resulting in accurate, reliable clinical reports. Learn more about NextCODE’s pioneering activities here.

Enabling this rapid, integrated approach to genomics-based care for rare diseases holds great promise for the community and for the many families who are anxiously seeking answers to these mysterious diseases.

Advancing Autism Research By Sharing Genomic Data Online: The Simons Simplex Collection

THE NEXTCODE Exchange is hosting the Simons Simplex Collection (SSC), a global resource for research on autism spectrum disorders comprising genomic data from nearly 2,800 families.

THE NEXTCODE Exchange is hosting the Simons Simplex Collection (SSC), a global resource for research on autism spectrum disorders comprising genomic data from nearly 2,800 families.

Autism research is underway around the world to better understand the genetic basis for the disease, which is difficult to diagnose and has limited treatment options. With vast amounts of data being generated, the answers to this challenging disease may lie in the consolidation of this global data.

The newly launched NextCODE Exchange (read the release here) may be a critical solution in changing how autism is diagnosed and treated. The Exchange is hosting the Simons Simplex Collection (SSC), a global resource for research on autism spectrum disorders comprising genomic data from nearly 2,800 families.

With the Exchange, the SSC will be accessible to the world’s autism researchers to harmonize the growing body of relevant genomic data. By enabling the rapid analysis of massive amounts of sequencing data followed by instant collaboration and validation of findings, the availability of the SSC and other hosted data will accelerate the pace of discovery in this field.

This simple concept is likely to help usher in a new era of genomic medicine, offering global access to data that can answer questions to some of today’s most challenging diseases.

Learn more about the NextCODE Exchange and the Simons Simplex Collection here.

Maintaining Momentum Post-ASHG: Maximizing the Value of Large Genomic Databases

The newly launched NextCODE Exchange provides a browser-based hub for multi-center sharing and collaboration on collective data from massive whole-genome databases like the Haplotype Reference Consortium (HRC).

The newly launched NextCODE Exchange provides a browser-based hub for multi-center sharing and collaboration on collective data from massive whole-genome databases like the Haplotype Reference Consortium (HRC).

The American Society of Human Genetics (ASHG) meeting convened this week in San Diego, bringing together genetics experts from around the world to discuss programs with great potential to advance genomic-based medicine in the years to come.

To maintain the momentum generated this week, we need to find ways to integrate these important ideas, insights and programs, and to maximize the use of the massive databases that have been launched to support research on cancer, rare diseases and other pressing health topics.

One of the databases unveiled during the meeting was the Haplotype Reference Consortium, which aims to become the world’s most comprehensive database of genetic variations. Large databases like the HRC, along with several others already underway, can be tremendously helpful to researchers finding answers to some of the most challenging diseases. But there remains a significant bottleneck: these large, cumbersome databases cannot easily be shared and manipulated, limiting their utility for broad, multi-center genomic research.

The solution lies in the newly launched NextCODE Exchange (see release here). This browser-based hub allows for the sharing and harmonizing of massive whole-genome databases like the HRC to accelerate research. The integrated architecture allows users to visually confirm and validate findings in raw sequences, collaborating and sharing with others around the world who may have complementary research underway.

The momentum generated during ASHG will be multiplied by sharing and learning from the world’s collective genomic data on the NextCODE Exchange. Learn more here.

Imagine the Potential: The World’s First Online Hub for Global Genomic Data Access

The NextCODE Exchange, a new browser-based hub, allows for real-time sharing of whole genome collections in a simple, consistent format.

The NextCODE Exchange, a new browser-based hub, allows for real-time sharing of whole genome collections in a simple, consistent format.

The field of genomic medicine is rapidly advancing as the research community becomes more comfortable manipulating genomic data with the goal of discovering insights about disease causes and risks. Yet each database is hosted within separate organizations, organized in unique ways and vastly too cumbersome to easily share with others who may be working on similar research.

This weekend a new tool launched to enable just that. The NextCODE Exchange (see release here), a new browser-based hub, allows for real-time sharing of whole genome collections in a simple, consistent format.

The availability of this Exchange is a critical advance in extending the utility of genomic data by allowing organizations around the world to access and harmonize large complementary datasets, potentially multiplying their study data sets to gain more reliable insights than ever before.

Already, numerous organizations are participating in the NextCODE Exchange to add and share their genomic data, including clinicians and researchers affiliated with Boston Children’s Hospital, University College Dublin, Queensland Institute of Medical Research (Australia), and Saitama Medical University (Japan).

As new institutions look to the Exchange to share genomic data, this hub holds significant potential to help advance progress in genomic-based medicine.

Learn more about the NextCODE Exchange here.

Global Projects Move Genomic Medicine to the Next Level

nextcode-genomics-england-hannes-smarason

NextCODE takes top marks in Genomics England analysis and interpretation “bake-off:” NextCODE’s proven population-scale platform delivered the best results in rare disease and cancer clinical interpretation, as well as secondary analysis and variant refinement.

New genomics-based technologies and tools are making their way into a range of exciting research programs and clinical studies around the world. Leading-edge organizations are quickly adopting hardware for sequencing and systems for collecting genomic data. Now, the focus has turned to analysis and interpretation – the critical component necessary to gain the insights from the sequence data that will transform medicine.

Earlier this year, Genomics England announced investments for broad sequencing and analysis of 100,000 human genomes. At the time, Genomics England had selected Illumina as its sequencing partner and was coordinating resources and centers to support the effort, including resourcing for analysis and interpretation. [See blog post here]. Other initiatives, such as the Qatar genomics program and the initiatives by Longevity and Regeneron also represent the accelerated progress in seeking medical advancements from genomic data insights. [See blog post here.]

This week, Genomics England announced a select group of companies with advanced capabilities to move to the next stage of evaluation to provide clinical interpretation for the 100K Genomes Project. At the tip top was NextCODE, which received top marks by Genomics England for its analytical capabilities across all the categories evaluated: rare disease interpretation, secondary pipeline analysis and cancer interpretation. [See press release here.] The company’s advanced Genomically-Ordered Relational database, or GOR, combined with its clinical and discovery interfaces offer the most advanced and reliable capabilities to support the ambitious tasks undertaken by Genomics England, and are already proven at population scale. [Read more on the GOR database here.]

The coming months will be a very exciting time for genomic medicine, with interpretation taking the spotlight as we take leaps toward the next stage of personalized medicine.