Heartening Therapies

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The concept once seemed futuristic: medical decision-making hinged on an individual’s genetic makeup rather than population statistics. But today, the hope of personalized medicine is being pursued at labs around the world, most drastically shaping the field of oncology. Next in line for its clinical adoption? The field of cardiovascular medicine, predicted a group of doctors, scientists, business leaders, and government officials who convened at The George Washington University, Jan. 6, for a Personalized Medicine Coalition (PMC) Conference called, “New Frontiers in Personalized Medicine: Cardiovascular Research and Clinical Care.”

“Although there are many conferences on personalized medicine, this is the first one we know of that has been organized solely to examine how personalized medicine is reshaping our understanding and treatment of a single indication, in this case, cardiovascular disease,” according to Edward Abrahams, Ph.D., president of PMC.

The day-long event was hosted in collaboration with GW’s Richard B. and Lynne V. Cheney Cardiovascular Institute, the American College of Cardiology, the American Medical Association, and the National Heart Lung and Blood Institute. GW’s Richard Katz, M.D., Bloedorn Professor of Medicine and division director at the Cheney Cardiovascular Institute, served as a conference co-chair, and Tim McCaffrey, Ph.D., professor of Medicine and director of the Division of Genomic Medicine, was featured on a panel about emerging technologies in cardiovascular care.

According to the American Heart Association, more than one in three American adults live with at least one type of cardiovascular disease, including high blood pressure, coronary heart disease, stroke, and heart failure. To make matters worse, many patients do not respond — or demonstrate adverse reactions — to cardiovascular drugs, both harming patients and costing the U.S. health care system billions of dollars. At the conference, participants framed personalized medicine as a promising solution to both problems.

“There is an opportunity for some of the current personalized medicine technology to address some of these [cardiovascular problems] at a low cost and reduce the overuse of expensive technology,” said Victor Dzau, M.D., president and CEO of the Duke University Health System and chancellor for health affairs at Duke University, who delivered the opening keynote address.

Dzau detailed four areas of opportunity for personalized medicine, including enhanced patient engagement, tailored prevention, improved diagnostic decisions, and tailored therapies.  He also highlighted key challenges to the adoption of personalized cardiovascular medicine in the clinic, including the tendency for technology to outpace biology and for information to outpace “the evidence for usage.” The simultaneous need for funding to produce evidence and evidence to secure funding is a paradox that also needs to be addressed, said Dzau. 

“We have to work together to find ways to get useful data, to get evidence that this is making a difference, to get payers to pay for it, and ultimately to have this in your treatment algorithm so that patients can indeed benefit from all the research you are doing,” he concluded. 

During a panel led by Katz, participants addressed current clinical applications of personalized approaches to cardiovascular medicine.  The anti-clotting pharmaceutical, Warfarin, for example, can be more effective when personalized medicine is used to determine an individual’s dosage. AlloMap, a new diagnostic, was also presented as a promising and non-invasive way to monitor the likelihood of rejection in heart transplant recipients. Using a blood test rather than a biopsy, AlloMap has the potential to be both more comfortable for patients and more profitable for payers, supported Pierre Cassigneul, president and CEO of Expression Diagnostics (XDx), the company that developed AlloMap.

McCaffrey later spoke about deep sequencing, a new process for analyzing the genome believed to be promising for the future of cardiovascular care.  Using emerging deep sequencing technologies, the genome can be read more completely and with greater accuracy than with more conventional techniques. “The first genome took ten years and three billion dollars. As of today, you could sequence a person in about ten days and for about three thousand dollars…[and] within a year or two, you’ll be talking about hundreds of dollars and a matter of hours for a full genome sequence,” said McCaffrey. “It’s truly transformational.”

“This is a topic that, at least in cardiovascular medicine, is just emerging,” concluded Jack Lewin, M.D., CEO of the American College of Cardiology, who delivered a keynote address. “It’s just becoming of great value to the future. It’s not a new topic…but we are now in an era of science and information technology where we have the chance to move forward in a bold and brilliant way with personalized medicine.”

The conference was supported in part by Quest Diagnostics, Iverson Genetics, Kleiner Perkis Caufield & Byers, XDx, ARCA biopharma, Feinstein Kean Healthcare, Mohr Davidow, Tethys Bioscience Inc., and WomenHeart.

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