Dr. Stephen Kingsmore – a vision for transforming medicine with rapid genome sequencing (Part 2)

That is half two of our interview with Dr. Stephen Kingsmore, MD, DSc, President and CEO of the Rady Pediatric Genomics and Techniques Medicine Institute. Dr. Kingsmore spoke on the inaugural Precision Medicine Leaders Summit last summer time. We spoke with him about his program for rapidly sequencing the genomes of sick youngsters and what he’s wanting for within the area of subsequent era sequencing and genomics. (Additionally see Half One of many interview.)

AllSeq: Driving down the price of sequencing has been the most important push for the NGS market up till now, whereas you seem to have been focusing totally on velocity. Do you are feeling these two areas are the ones that still want probably the most improvement, or are other elements turning into more essential?

Dr. Kingsmore: Yeah, I feel different things are greater elements. A minimum of in my mind they’re. We nonetheless want prices to return down, especially genome prices and especially considerably rapid genome costs. In order that’s still a massive situation. But now you realize our focus needs to turn an terrible lot to schooling and engagement of sufferers and their households and health care providers. The brand new bottleneck is that we don’t have educated personnel to ship genome sequence info to patients, and we don’t have patients who perceive genome sequencing to know whether or not to decide on it or not. I feel that the tools that we’ve got work pretty darn properly. Now we have to work out the right way to make this better match into traditional medical follow, which is wholly unprepared for this. From our digital medical data, to our methods of getting reimbursement, to the practicalities of how any given affected person in any given clinic have the ability to profit from this.

AllSeq: What are the most important elements stopping NGS from being more extensively adopted in the clinic?

Dr. Kingsmore: I feel primarily our fast next huge thing is getting well being care suppliers snug with this. And meaning going out talking to them and listening to them and providing some instructional instruments, and then making what we do rather more understandable. As a result of proper now it’s pretty arcane and medieval. Our genome reviews are actually robust for anybody to know, by no means mind a busy health care practitioner. And then what do they really do with that knowledge? And there are solely eleven hundred medical geneticists in all the United States. That’s not going to work as a supply answer. These guys are lots busy even before we’re in an period of genomes. There aren’t very lots of them they usually’re working pretty exhausting. So how can we take this into the medical mainstream? So much then comes to figuring out other well being care suppliers who can step into that gap. Individuals like nurses, and social staff and other well being care providers, and type of a staff based mostly strategy. Similar with genetic counselors – there’s solely two and half thousand genetic counselors in the whole United States. We’d like other individuals to be able to do genetic counseling. So these are the practical issues and the factor about genomic medicine, precision medicine, no matter you need to name it, is it’s virtually totally only achieved in tertiary educational medical centers. So when you’re not a affected person at a type of, you don’t get in on this. And secondly, it’s virtually solely solely accomplished in white people – wealthy white people with medical insurance – personal medical insurance and that’s a large difficulty here in San Diego the place fifty seven % of our sufferers are Hispanic-Latino. Only three % of the sequenced genomes are Hispanic-Latino. So there’s an immense situation with well being disparity getting worse with precision and genomic medicine quite than better. So these are pressing issues that we need to tackle they usually’re not straightforward to fix. It signifies that we’d like each doc and each software to be in Spanish and we’d like bilingual individuals and we’d like them additionally to be ethnically and racially attuned to totally different communities and totally different learning types. These are real sensible problems. Truthfully the bottleneck shouldn’t be
“Gee, I need a better Illumina sequencer.” It’s all of those different problems within the health care financial system that’s actually struggling a little bit anyway.

AllSeq: In addition to the uncommon childhood illnesses that you simply’re working with, NGS is beginning to be adopted in the clinic for NIPT and cancer. The place do you assume we’ll begin seeing NGS adopted subsequent?

Dr. Kingsmore: I have to confess that our focus is pretty much all on two of those areas of most cancers testing and rare genetic illnesses as a result of the early proof is that this works. But as I said, the problem that we’ve is that solely zero.001% of the population who need it are getting it, and so how can we fix that? So I truthfully don’t actually need a new software area. I want the ones that we’ve been doing for the final five years to get scaled up. I don’t need to do thirty-five babies in a NICU over the subsequent three years. We now have 3800 admissions every year, so we have to develop up one hundred fold in our throughput. In neuro-developmental disabilities, we need to go up in all probability a thousand fold from where we are as we speak. And that’s going to create an awful lot of latest issues and problems and options. It’s going to be very thrilling.

AllSeq: When talking about medical sequencing, individuals are occupied with the genome moderately than the transcriptome. How would you fee the importance of the 2 for medical purposes?

Dr. Kingsmore: We had a baby that we enrolled in our research yesterday who has one-half of their brain inflamed and is in a coma. And, yes, we’re decoding that child’s genome. But we really are considering to ourselves, “Wow, I wish we could get a brain biopsy and sequence the baby’s brain transcriptome. And also use RNA sequencing to look for pathogen signatures.“ So yes, it would be beautiful to do that. I, together with a guy called Mike Seldon at U.C. Davis, have an NIH grant which asks “Can we marry exome sequencing with RNA sequencing? Does it work, and does it help us?” It ought to actually help particularly with variants of uncertain significance the place we’re simply unsure whether what we’re seeing in the genome is sufficient to trigger a phenotype. You understand wanting at the RNA appears to be a very smart strategy in serving to make that decision. So I feel that’s a nice concept. The difficulty all the time is that each of those ideas takes ten, twenty, fifty million dollars to go from being an concept to being a practical, rugged factor that we will deliver to bear. And I do marvel perhaps whether the metabolome or the proteome may bounce in there before the transcriptome as cheaper ways to get the identical sort of data. So it’s going to be a very, very fascinating next five years as we start to marry several types of genomic knowledge in the clinic.

AllSeq: Do you assume using NGS will take off within the ‘direct to consumer’ area?

Dr. Kingsmore: I do really feel fairly strongly about (this area). I came to the states from Ireland because I do consider in capitalism. I do consider that we’d like business corporations to begin to substitute educational groups, as a result of they only do things better at scale. However you recognize the thought of direct-to-consumer for genomic medicine, particularly for pediatric genomic medicines or decoding youngsters’s genomes, is something that provides me shivers. It actually does concern me. And not as a result of the companies will do a dangerous job, however often because what usually can occur in that state of affairs is that medicine gets bypassed. And if that occurs then it by no means turns into mainstream medicine. It turns into various medicine and we’ve seen that with new thrilling developments throughout society during the last fifty years. And I don’t consider in the long term it’s going to be in one of the best pursuits of youngsters with disease. I feel that the medical system is the confirmed main path to deliver medical advances to satisfy public need, and I have a big worry that medicine is wholly unprepared for genomics. And on this struggling and that vacuum there would be the temptation to only bypass the docs and take it straight to the affected person, and that in the long run that’s not the joyful marriage we need to see. Trendy medicine works. Genomics presents a solution to make trendy medicine work higher and that partnership really must be reaffirmed between the patient, the physician, and the know-how guys. It’s worrisome for me – to the extent that we behave in aggressive conduct, “Gee I want to be the first to do that.” The drive really is especially as a result of we acknowledge there’s a vacuum. Solely by regularly making progress and getting it on the market and making sure it’s anchored in the medical mainstream can we sort of forestall that vacuum turning into a real problem.

AllSeq: Have you ever truly heard individuals talking about wanting to make use of direct-to-consumer genomics the pediatric area or is that just a fear that you’ve?

Dr. Kingsmore – I feel there’s a very lively want to try this on behalf of economic entities. They should justify to shareholder expectations, and clearly reimbursement is a matter. They’re not completely satisfied normally with the speed of adoption of checks and so there’s a big, big kind of strain on them to hurry the system up, and so it makes eminent logic to get the general public to start to demand it, and then to satisfy that demand. And that leads to higher sales of exams. The problem with that can be although that you simply by-step the medical mainstream they usually might by no means catch up. There are simply so many examples of that previously, that that’s my worry.

AllSeq: Do you assume that’s more more likely to happen within the pediatric area or is that simply your concern because that’s where you’re targeted?

Dr. Kingsmore: Nicely I don’t really feel quite so strongly about direct-to-consumer for adults, as a result of adults are consenting individuals and, heck, if they want a genome, why shouldn’t they get a genome? Because a genome speaks to more than simply illness: it could actually just be personally enriching to look by means of your personal genome and ponder. It speaks to the essence of life. But for an acutely unwell youngster, mother and father need all the help they will get. They discover a medical system bewildering at occasions to navigate with a sick youngster. They’re not resource-rich. We would like genomes to develop into a helpful, easy-to-navigate factor inside the medical mainstream, fairly than make the whole system a bit more complicated and a bit more fragmented. So I feel they’re a very special case. And really, there’s some sort of a need for custodianship. The thought of just letting unfastened a whole youngster’s genome and all of its info can also be ethically worrisome, because we’re really focusing solely on “Your child is ill. I’m going to look in the genome only for something that could be causing your child’s disease. I’m not looking at whether your child is likely to have a high I.Q. or likely to develop alcohol dependence.” However that info is in there. It’s quite ethically worrisome to think about that just being liberated into the general public direct-to-consumer market.