On 6th December 2013, more than 100 delegates gathered at the Royal Institution of Great Britain for the 2nd Innovation Academy event, hosted by GSTS Pathology. With the theme ‘Personalized Medicine: today’s reality, not just a promise for tomorrow’, the meeting examined advances in three key clinical areas - auto-immune conditions, infectious diseases, transplantation, and oncology.
Fiona Carragher, Deputy Chief Scientific Officer for England, opened the event, saying: “I am really pleased to be introducing this meeting, where the focus is on what can already be achieved for patients through the application of current genetic knowledge. Looking ahead, I am sure research will continue to provide our healthcare system with new ways of working – and genomics and personalized medicine will remain at the forefront of developments.”
Therapeutic drug monitoring (TDM) in auto-immune conditions
Opening the first session of the day, Prof David Perrett, William Harvey Research Institute
Barts & the London School of Medicine & Dentistry, reminded delegates of the goals of personal medicine – providing the right drug, at the right dose, at the right time, and for the right patient. The way individuals process everything from food to pharmaceuticals is under genetic influence and it’s now very clear that one size does not fit all. Monitoring an individual’s response to drug therapy is therefore an important aspect of personalized medicine. Examples explored during the TDM session were: the use of thiopurine drugs for the management of chronic inflammatory bowel disease (Dr Jeremy Sanderson, Consultant Gastroenterologist, Guy’s and St Thomas’ Hospitals); and how biologic drugs, specifically those targeting TNF alpha, have revolutionized treatment in immune-mediated inflammatory diseases (Zehra Arkir, Principal Clinical Scientist, GSTS Pathology).
Infectious diseases and transplantation
Dr Siobhan O’Shea, Principal Clinical Scientist at GSTS Pathology, chaired the Innovation Academy’s second theme – infectious diseases and transplantation. Invasive fungal infections in patients being treated for hematological malignancies are associated with increased morbidity and mortality, explained Prof Robert Flanagan, Consultant Clinical Scientist, King’s College Hospital NHS Foundation Trust. He concluded by saying that targeted prophylactic antifungal therapy clearly benefits from TDM, to monitor adherence and optimise dosage. Next, Dr Malur Sudhanva, Consultant Virologist, GSTS-KingsPath, took delegates on a whistle-stop tour of virology’s emerging technologies and developments at GSTS designed to improve efficiency within the laboratory system. These high throughput genotyping methods also have a broader application to pharmacogenetic testing.
In transplantation, the presence of antibody specific to donor-presented HLA, has long been a barrier. Dr Olivia Shaw, Clinical Scientist, in the Clinical Transplantation Laboratory, GSTS Pathology, described a testing strategy developed to identify which patients will benefit from antibody removal and to what level, allowing the tailoring of treatment for each donor - recipient pair.
The afternoon session focussed on oncology and was chaired by Dr Khalid Tobal, Consultant Clinical Scientist, GSTS Pathology. The availability of new pharmacological agents targeting specific genetic mutations means cancer treatments can be directed to those most likely to respond and benefit, and unnecessary side effects are minimised. Dr Colin Spraggs, Senior Director and Genetics Therapy Area Head, GlaxoSmithKline Research and Development, provided an overview of the drug discovery/development process and the DNA sequencing technologies that make possible this personalized approach to treatment.
Dr Tony Marinaki from the Purine Research Laboratory, GSTS Pathology, showed how testing for pharmacogenetic markers in patients treated can reduce the incidence of severe toxicity to fluoropyrimidine therapy. Prof Flanagan showed how an oral dose of tyrosine kinase inhibitors can give rise to markedly different plasma concentrations in different patients and highlighting the need for close monitoring of drug levels. Dr James Spicer, Consultant in Medical Oncology, Guy’s and St Thomas’ Hospitals, described how receptors such as HER2 and EGFR have a central role in the development of many malignancies and are the target of a number of therapies. Molecular analysis at the tumour level can predict an individual’s response to such therapies and be used to monitor their impact.
The concluding talk by Oliver Smith, Director of Strategy and Innovation, Guy’s and St Thomas’ Charity, whose organization makes grant funding available to support improvements in local healthcare delivery through the application of innovation, rounded off an Innovation Academy event that showcased the application of innovation to deliver real healthcare solutions today.
For further information on this and future Innovation Academies, visit: www.gsts.com/innovationacademy
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