A new revolution in Life Science and Healthcare called “Microbiome”

Any new development in life science and healthcare starts with baby steps and slowly but surely takes the world by storm. Whether it is small molecule based, high-end genomics guided targeted cancer therapy or the immuno-checkpoint inhibitors which are taking cancer treatment to the next level of personalization and precision.

In the last decade one small buzz word has created quite a noise and is bringing hope that indeed wellness and personalized treatment is a possibility – enter the world of the “microbiome”. The term microbiome means the entire genome of the microbiota ecosystem. The advent of microbiome research parallels the advancement in next generation sequencing (NGS). Before NGS came into the picture, microbiology-based study could rely only on culturing microorganisms in the lab which had its own drawbacks. Now, with advanced sequencing technologies and smart algorithms it is possible to dissect the microbial ecosystem without the need to culture microorganisms in the lab.

Human intestine harbors the maximum number of commensal organisms which are into a delicate relationship with the host. It is therefore not a surprise that maximum gut microbiota based studies are published which look into how gut microbiota plays an important role in human health and wellness.

Do you know:-

Ø   Metagenomic sequencing of fecal samples has identified 3.3 × 10⁶ nonredundant  microbial genes from up to 1,150 different species, outnumbering human protein-coding genes by about 150-fold

Ø     Each person is estimated to host at least 160 different species 

Ø  In 2007, only 14 NIH grants contained the word “microbiome” in their titles or abstracts, and the number went up to 1,043 in 2017

Ø   More than 10000 papers published in the last 3 years on “gut microbiota”

With new studies and developments in the gut microbiome space, it would suffice to say-

“If eyes are the windows to the soul, then gut microbiome is the window to your health”

The industry has also taken a leaf and are dwelling into various aspects of the microbiome space. Companies like Leucine Rich Bio (India), Day Two (Israel), Viome (USA), UBiome (USA), Microba (Australia) etc. are taking the developments in the research to consumers directly by providing easy to use at home gut health tests. And there are companies like Enterome (France), Vedanta Bioscience (USA), Seres Therapeutics (USA) etc. that are looking into tapping the therapeutic potential of the microbiome and thus bringing new paradigms in treatment of various type of cancer, IBD, IBS etc.

Investors especially in the Western world have and are putting lot of faith in these new age companies. Most notably Seventure Partners that have funded a slew of microbiome companies in Europe and the US.

Although, lot many research and studies will be needed in future to validate the interesting leads that the microbiome domain throws up yet it is pertinent that all stakeholders especially clinicians and investors in Asia also support this with less skepticism and more openness as the success of the microbiome can lead to a new era of healthcare and wellness

 

$1000 genome,$1 M interpretation theme – fact or fiction?

Everyone agrees that sequencing the whole human genome, which was a bottleneck a decade back, is no longer the “rate limiting” step in our endeavor to realize the ultimate goal of ‘personalized medicine’. The main hurdle to achieve the true potential of our genome is to unlock the secret by powerful analysis tools. In other words, the next decade may well be the decade of bioinformatics/bio-IT. Having said that, there is a school of thought that paints an alarming scenario. It envisions that genome interpretation would be very costly and might take the possibility of personalized medicine a bit farther from reality. However, skeptics argue that this is an alarmist viewpoint and this might not be the reality.

The truth, according to me, lies somewhere in between. Yes, there is a huge potential and a gap in  understanding of the genome. In the last few months, dozen start-ups have come up that are looking to exploit this space. So, venture capitalists need to be assured that their investment is in the right domain and would reap benefits in the long run. So, part of this $1M interpretation theme might come from analyzing the future of Bio-IT space. At the same time, a lot of the processes might get automated and streamlined, hence the true figure might come to a much more manageable level. Like any industry, many of the start-ups would fold up if their software do not come to the real expectation of the key stake holders, and I mean not only the bio-IT folks but physicians, geneticists, care givers and ultimately the patients.

Also there is another point that I would like to make – for proper analysis and interpretation, we need proper data, now since the genome sequencing cost is coming down, many clinical trials or even basic research can enroll a high number of subjects. This would ultimately help fine tune the analytical ability of the software to predict diseases or treatment outcomes in a more professional and authoritative way. This would lead to less cluttering of the Bio-IT space with better and authentic Bio-IT tools.

Ultimately, the “final frontier” of personalized medicine is not only about the hardware and the software  looking for answers in isolation but a conjoined effort to understand the human genome.

Personalized Medicine – Ethics Vs Need

In this era of modern genomic tools, it is getting pretty much apparent that we are closing in on a scenario where in the genome of an individual can be sequenced in a matter of few hours. Question 1)– What do we intend to do with it? Question 2)- Sequencing is just one part of the puzzle but do we actually understand the finer details? Now, assuming that the bioinformatics hurdles are taken care of, then with the important data in hand how do we proceed? How much do we disclose to the patients? How much should the physicians or relatives know? Well, in other words it is the ethics versus need debate. Recent article in American medical news throws some light on this (http://www.ama-assn.org/amednews/2012/04/02/hll20402.htm)

Step towards personalized medicine is not only about the hardware/software part of it but also it is about proper training at physician, geneticists and lab scientists’ level. First is to have a meaningful understanding of the data which can be made ‘easy to understand’ for the care giver (physicians). Then comes the question of what sort of data should be discussed with the patient and their relatives. This is a tricky scenario as unless we as scientific community is absolutely clear of the data and the predisposition risks therefore, I guess it would not be good idea to share such info with patients as they would be upset and would get scared. 

There is a section in the community that believes that family history of the patients should be looked into and only diseases which a patient is predisposed to should be looked into in detail. I would presume it is a thought in the right direction; however, it defeats the whole purpose of whole genome sequencing. Also, as our genome stores a treasure trove of data, it is important to know what else we are predisposed to apart from what our family history suggests! Another ethical issue which might crop up in the near future is that people may want to see the ‘genome map’ of a prospective partner before marriage to avoid getting genetic diseases in the offspring. Now, this might be good but it might lead to all sort of complications and less randomization of the gene pool!!!

Finally, if the people are made more aware, whole genome sequencing, in the future would let us take preventive measures knowing what is in store for us (not astrologically but genetically) and be better prepared for any eventuality.