How is your research/technology relevant to personalised medicine?
Hepatitis C virus (HCV) infects millions of people globally and causing liver cirrhosis, liver failure and hepatocellular cancer. Our consortium is large and multi-disciplinary; 21 partners that span academia, science, industry and clinicians. The consortium is developing high-throughput viral sequencing, integrated with host genetics, immune parameters and biomarkers and embedding these in clinical studies.
The aims of the consortium is to use these parameters to optimise treatment outcomes for patient with HCV in response to therapies in this exciting new era of directly acting anti-viral therapies; in practice this means identifying host and viral factors that help to predict which patients may be best treated with specific drug combinations given for the right duration of time. A further aim is to identify the sub group of patients who will in the future develop liver cancer and other negative clinical outcomes. To achieve these aims we work closely with HCV research UK, biobanking blood samples from 41 NHS sites across the UK, and we embed our studies in large clinical studies through collaboration with industry or through grant funded academic clinical studies.
What are the challenges to getting your research/technology into widespread use, and is that the aim?
Yes, ultimately we want to make a difference to patients and this will require wider deployment of technologies, and we work constantly to keep this at the forefront of decision making. For example, we have developed new technologies for HCV viral sequencing-but deploying this widely means properly integrating with NHS structures. Taking new technologies from a research environment through to a clinically accredited lab with all the appropriate checks in place is a major undertaking. There are many additional challenges: By its nature the work is multi-disciplinary, taking researchers beyond their comfort zone. Personally I think that this is something to be embraced and can lead to major advances. For example, the integration of viral and host genetics is specific to personalised medicine in infectious disease, but traditionally these fields have been distinct disciplines (virology and clinical genetics).
The management and annotation of very large datasets in clearly a challenge for us. It is important we get this right-not only for our own work-but so that we can leave behind a “library” of data that can be used by others in the future. For us a key challenge has been adapting to a rapidly changing field as new anti-virals are developed. Essentially this means taking a visionary approach-trying to predict what the state of the art might be five years from now-staying ahead of the game so that the personalized approach stays relevant.
What can be done to make the most of the opportunities for personalised medicine to improve health and healthcare?
I think that many people, outside the field, think that personalised medicine is what doctors do anyway. But I have come to learn that this is not true. Personalised medicine requires a whole amourt of skills; asking the right clinical questions and recognising an opportunity for taking a personalised medicine approach, familiarity rather than fear of genomics data, data management and integration of large datasets requiring bioinformatic and statistical tools, governance issues around informed patient consent, data control and incidental health related findings. These are just some examples requiring the education of health care workers, scientists in the field, ethicists and the public. Setting in place structures to support the development of personalised medicine across disciplines will be key. Building confidence in the public perception of personalised medicine will grow, but only if data management is properly governed. I believe that enthusiasm for the field will continue to grow as more real life examples of personalised medicine making a difference to health become apparent. After all-we each want the medicine that works for us-personally.