Medicine is getting personal: British genomic pioneers can lead the world
21 Dec 2020
It’s hard to believe that a year ago, the term Covid-19 did not exist in our vocabulary.
In only a handful of months, a respiratory virus has swept the world, killed 1.5 million people, wrecked lives and livelihoods, and caused economic contractions not seen in centuries. True, some countries have handled things far better than others, some far worse.
The news in recent weeks that novel vaccines are clinically effective at protecting us from the virus and are set to be rolled out to populations in a matter of days and weeks is remarkable for so many reasons. The first is of course the possibility of life returning to something reflecting normal, but also the astonishing speed with which the world has mobilised to produce, test, verify, approve and manufacture a new vaccine.
The emergency use approval of various Covid-19 vaccines is not the only medical development of note in recent days. The NHS in England is to trial a blood test designed to detect more than 50 types of cancer. Created by California-based Grail, the test – known as a liquid biopsy – will be trialled on 165,000 people to determine its effectiveness in identifying the genetic markers of cancers to catch them far earlier in their development.
We are at the precipice of enormous change in the delivery of treatments and prescription of drugs, thanks to advances in genomics. In 2003, The Human Genome Project published the complete genome sequence for human DNA. The knowledge and opportunity that this has unlocked is now on the cusp of delivering real-world treatments in our hospitals – from cancer to heart disease.
On average there are 367,167 new cancer cases a year in the UK, and 2.5 million people living with cancer. Early diagnosis of new cases and of recurrence is one of the best tools we have to save lives. For many cancers, at present, diagnosis begins with taking a biopsy of the suspected cancerous cells to examine them for malignancy. This process – effectively snipping a lump of tissue – is invasive, and often painful. We tend only to become aware of a cancer when it has grown to a visible size on a scan, but we should be able to catch them earlier than that.
Cancer that’s diagnosed at an early stage, when it isn’t too large and hasn’t spread, is more likely to be treated successfully. According to Cancer Research UK, more than 9 in 10 bowel cancer patients will survive the disease for more than 5 years if diagnosed at the earliest stage. 90% of women diagnosed with early stage breast cancer survive the disease for at least 5 years compared to 15% diagnosed with the most advanced stage of the disease. More than 80% of lung cancer patients will survive at least a year if diagnosed early, compared to 15% diagnosed at the most advanced stage.
Medtech innovators in the UK
Liquid biopsies are a new field of medicine made possible by the work that has gone into deciphering the human genome – and offer the prospect of faster and earlier diagnosis of cancers. But it’s not just Californian companies leading the way in the research and development of personalised medicines. Britain, as we have seen throughout the pandemic, is home to world-beating medtech innovators and developers that should be championed and supported to grow.
One example is Inivata. Its liquid biopsies identify residual DNA that enters the bloodstream from cancers elsewhere in the body. Identifying cancer through blood tests is far less invasive than traditional biopsies. Understanding the genome of the specific cancer and the patient makes it extremely sensitive, particularly in aftercare, and can detect recurrence of cancers at a far earlier stage than standard detection, meaning interventions can take place far earlier.
See how Inivata's biopsy works
Beyond cancer treatment
Genomic medicine is making strides in many other specialities. Silence Therapeutics is another UK company working on advancing personalised treatments in the UK. It uses the body’s own capability of interfering with RNA to ‘switch off’ genes thought to be causing disease. It is working on therapies to tackle the genetic causes of cardiovascular disease – something that affects 20% of the population. Silence Therapeutic’s technology can be used to engineer short interfering ribonucleic acids (siRNAs) that bind specifically to and silence, through the RNAi pathway, almost any gene in the human genome to which siRNA can be delivered.
Personalised medicine, thanks to advances in genomics, could be transformative for healthcare in the coming decades. We need mechanisms that encourage more of our research departments, start-ups and disruptors working in the field to commercialise, scale and find a market for their innovations and products.
Until now our national approach to supporting R&D has focused on sending money the way of large incumbents – such as big pharmaceutical companies. That method does produce results – just look at AstraZeneca’s and Pfizer’s role in the development of Covid-19 vaccines – but it means we are missing out on the talents and technologies of so many of our small businesses and cutting edge research teams (after all it was Oxford University’s talents and BioNTech’s innovations that led to the breakthrough in the vaccine mission).
We need to introduce new funding mechanisms into the mix, that outside of a global crisis, level the playing field for these new and less well-known entrants – challenge prizes are one such method that achieve just that.
In July, we published the Great Innovation Challenge. We looked at the impact that ambitious challenge prizes have already had in medicine, including the KidneyX and Redesigning Dialysis Prizes in nephrology. And of course, we know from our own exciting work delivering the £8m Longitude Prize, how effective challenge prizes are in spurring medtech innovation, in this case in the development of novel diagnostics to tackle the rise of antibiotic resistant infections.
The Great Innovation Challenge recommended that the UK pursues opportunities to advance innovation in personalised medicine – not just for the benefit of innovators but for patients and doctors too. Since then we have worked to explore the concept further, and recommend more specific ways in which challenge prizes in personalised medicine can be put to great effect in curing rare and hard to treat diseases.
Challenge prizes for personalised medicine
2020 will be a landmark year
It feels like change is in the air on many issues – not least in the focus on innovation’s role in delivering a green economic recovery. Innovation and innovators are poised to do far more than help deliver net zero, we are on the cusp of a revolution in medical treatment, to advance recoveries of an altogether different kind.
It’s almost 20 years since the human genome was decoded, only now are we beginning to see the likes of liquid biopsies entering the mainstream treatment arsenal. If the multiple Covid-19 vaccines set to be rolled out in the coming months teach us anything, it is that with the right funding, support and market promise, the medtech industry can move far faster than this.
There are many lessons to be learnt this year, the capacity of the medtech community to respond at such speed with the right support must be one of them. An ongoing series of well-funded challenge prizes, promoting innovation in personalised treatments for rare and difficult to treat diseases, can advance those British medtech innovators who are at the vanguard of cutting-edge medicine – like Inivata and Silence Therapeutics – to establish them as the next generation of global medtech powerhouses.