Imagine being able to anticipate a heart attack before it happens. Or knowing that cancer is forming in your body—long before any scan could pick it up. Or what if a 15-minute test could let you know if a prescription drug will be effective—and ensure you that there won’t be major side effects—before taking it?
The examples stated above are just a few potential applications of technological innovations that could significantly improve how medicine, writ large, is practiced, explained Eric Topol, MD, Scripps Health chief academic officer at the Qualcomm Life Media Day last week in San Diego.
Earlier this month, Scripps Health (San Diego), a nonprofit, integrated health system that treats a half-million patients each year, received a $3.75-million grant from the Qualcomm Foundation to advance a number of promising technologies such as the ones cited above.
One of the first projects to be supported by the funds is a long-range clinical research study of a mobile software platform developed by AirStrip Technologies Inc. (San Antonio). The study, led by Topol, will analyze how mobile patient monitoring influences everything from clinical decision-making to the duration of a hospital stay.
|Earlier this year, Eric Topol was named the most influential physician executive in health care by Modern Healthcare.|
Embedded nanosensors is another application Scripps is hoping to advance, which could be used to “put your bloodstream under continuous surveillance,” Topol explained. This technology could be used to detect problems like heart attacks before they occur. Each year more than 813,000 people die from heart attacks in the United States, according to the American Heart Association. Heart attacks are, in fact, still the leading cause of death and disability throughout the Western world. “You also have a large number of strokes and most of these are from the same mechanism—a crack [in the plaque] in an artery,” Topol added. “What is interesting, is that everyone used to think that a lot of cholesterol has to build up to cause a heart attack. But these cracks in the artery are occurring at sites where there is only minor cholesterol buildup. That is why they are so hard to predict.”
“Nothing has worked to date to predict a heart attack all of these years,” Topol explained. Hopefully, that will change before long with the advent of embedded nanosensor technology, he said. To understand how the technology would work, note that once a crack in vulnerable plaque forms, it can take weeks before it ruptures and causes a heart attack. Over a period of time, cells are shed from the inner lining of the artery wall into the bloodstream. These could be detected just as sensors in your car can detect car problems like tire pressure and engine trouble, Topol explained.
Scripps has shown in hospitals throughout San Diego that blood samples drawn in the early minutes following a heart attack contain a significant number of cells that are released from an artery supplying the heart muscle. “They are very sick looking cells as compared to people who are healthy. There is a log order more of these cells [in patients with severe heart disease].” Researchers at Scripps have Sequenced these cells and have done gene expression tests on them.
“The next step is that we can take this gene signature and couple that with a sensor,” Topol said. Scripps is working with nanofabrication expert Axel Scherer, PhD of Caltech to test a sensor 90 microns. “The idea is that we can inject this [sensor] into the vein in the arm and it will get lodged distally down in the tip of a finger and it will be in constant communication with a smartphone and it will tell us whether or not we have these cells that we have a genetic signature on are starting to appear in someone who is at high risk for a heart attack,” he added.
|Last week, Qualcomm invited a number of journalists to their headquarters to learn about Qualcomm Life's recent collaboration with Scripps and a number of other companies active in the digital health sector.|
The same technology can be applied to cancer. “That is going to be our next big application,” Topol said. “It turns out that in almost everyone with cancer, the first thing that happens as the cancer is starting to get routed, there is some free circulating DNA in the blood and that is long before you could detect cancer via a scan of any kind,” he explained. “When there is free DNA in the blood, you can pick that up using the same technique.”
“What we are envisioning is a whole new series of apps. A heart attack app, a cancer app, and, in fact, a lot more,” Topol said. “There will be one for transplant rejection.” He noted that the while the technology likely not be commercialized in the immediate future, the groundwork that makes it possible is ready now. “We have got the sensors, the genomic signatures to prove that works, that it is durable and how long it will work.”
Scripps is also working in the field of pharmacogemonics to determine how drugs personally interact with individuals—to avoid major side effects and to make sure that the medicine is being given to the right person at the right dose and that it is going to be effective. “We are all individuals and we all react to medicine very differently and some will call horrendous side effects,” Topol said. “If you are the wrong match, some will cause the drug not to work.”
Consider the role drugs play in drug-eluting stents in combatting clots. Stents are put into more than a million people in the United States each year. Nearly 2.5 million are used annually worldwide “Because it is metal, sitting in an artery, it could develop a blood clot. Or, if there is just one little strut that is exposed that didn’t get a lining on it, at any point, it could develop a clot,” he said. “When a clot forms in a stent, the person either dies or has a heart attack. It is a catastrophe. It turns out that the medicine is used historically all these years to prevent clotting of a stent is Plavix, which, until recently in May, when it went generic, it was the second most successful drug ever,” he explained. “As it turns out also, one third of people can’t respond to Plavix. It is an inactive drug and they lack the ability to metabolize it to make it active, so basically it is a placebo. How would you like to have a stent put in and then take a placebo to prevent a blood clot?”
“What we are envisioning is a whole new series of apps. A heart attack app, a cancer app, and, in fact, a lot more.” —Eric Topol, MD
Scripps was the first to introduce routine genetic testing to test for the gene that is responsible for the activation of the drug. “We have been doing that of October 2009 but only a handful of centers in the U.S. are doing that. The FDA has a black box warning clopidogrel (Plavix). But physicians are not adhering to this,” Topol said.
A more graphic example of the role of genetics in medicine is Stevens-Johnson syndrome, which is a possibly fatal skin dehiscence that can occur after a patient taking the drug Tegretol (Carbamazepine). The drug is commonly used for indications like diabetic neuropathy, seizures, and bipolar depression. “The chance of dying if you get this [disease] is one in four. The chance of getting [Stevens-Johnson syndrome] from the medicine is one in 1000,” he said. “But there are hundreds of thousands of people taking this drug. Interestingly, we know the gene variant that predicts who is going to get this. No one in this country is tested. In Taiwan, everyone has to get tested or they won’t fill a prescription for Tegretol.”
|Chris Toumazou, PhD of DNA Electronics presented at TEDMED in 2011, explaining how low-cost analog semiconductor devices can mimic biological processes.|
One company targeting problems such as these is DNA Electronics, a spin off of the Imperial College in the United Kingdom. “A brilliant engineer named Chris Toumazou, PhD has designed a USB device where you take a cheek swab or a saliva sample and put it in the USB device,” Topol said. Within 15 minutes, the technology determines the relevant genotype for interactions for Tegretol, Plavix, or other drugs. “Whatever you want, you can get,” Topol said. “This is really exciting because we are not in an era where everyone is going to get their whole sequence done,” he added. “We are testing this now and trying to get it into high gear to get it to the pharmacy. Pharmacies love this because they will do the genotype and the person waits 15 minutes and they can shop around. We are into it because we think it is going to promote precision prescription drugs,” he said. “And we also know there is $350 billion per year of prescription drugs in this country and at least one third of it is waste or, worse than that, hurting people.”
Brian Buntz is the editor-at-large at UBM Canon's medical group. Follow him on Twitter at @brian_buntz.