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Implementing Genomics and Precision Medicine in Canada

Dr. Catalina Lopez-Correa

CSO & VP Sector Development at Genome British Columbia

6th Munich Biomarker Conference

November 30th, 2016

Why Genomics?

“What physics was to the 20th century, biology will be to the 21st” The Economist, Jun. 2007

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Canada’s Genomics Enterprise

• 6 regional Genome Centres

• 10 Genomic Innovation

Network Nodes

• 210+ large-scale research

projects/initiatives funded

across all life science sectors

• 45 HQP on average,

per project

• 58+ companies created

or enhanced

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Genome BC - History

• Co-founded by the late Dr. Michael Smith, Nobel Laureate, Genome British Columbia was formed in July 2000

• Vision: Genome Sciences will revolutionize many aspects of our lives and provide solutions to humankind’s challenges.

• Four strategic plans to date:

• Plan 1 (2001-2005); $107M - complete (Provincial contribution - $27.5M)

• Plan 2 (2005-2010); $316M - complete (Provincial contribution - $75M)

• Plan 3 (2010-2015); $340M - on track (Provincial contribution - $85M)

• Plan 4 (2015-2020); $306M - launched (Provincial contribution requested - $85M)

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Genome BC – Investment portfolio

• Cumulative portfolio of $710 million in genomics research projects and science and technology platforms:

• Current Platforms: Genome Sciences Center (GSC) Proteomics

Metabolomics

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ACADEMIA

INDUSTRY GOVERNMENT

Sustainable Investment for

Economic Cluster Development

Genome BC - Catalyst role

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SOCIETY

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Genome BC - Investment Sources

Provincial 25%

Federal 45%

Provincial Funding Objectives • Match BC’s key economic

priorities.

• Attract co-investment, including from users to help realize the benefits from commercialization.

• Partner with a broad cross-section of provincial universities and colleges.

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International, Industry &

Institutional 30%

Genome BC - Funding Continuum

Discovery Research Applied Translational

Genome BC invests in critical space along the research funding continuum to bring genomics discoveries from

the bench into real world applications

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Commercialization

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Many Partner Co-Investors Worldwide (300+), e.g.:

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2000-2005 Plan

Building the

Foundation

2005-2010 Plan

International

Recognition for

Excellence

2010-2015 Plan

Strategic

Investment for

Applications

2015-2020: Meeting User Needs Through a Sustainable Pipeline

Discovery 90%

Applied 10%

Discovery 63%

Applied 30%

Translation 7%

Discovery 41%

Applied 37%

Translation 22%

Translation 35%

Applied 35%

Discovery 30%

2015-2020 Plan

Sector-driven

User Co-investment

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Building a Future: Genome BC 2015-2020

• Invest $340M into Discovery, Applied and Translational research key

to Life Sciences jobs plan

• With $85M from the Province, attract $255M from partner co-investors for genomics R&D

• Focus on sector-driven research to deliver economic and social benefit of BC

• Continue to enhance BC’s national/international competitiveness for scientific excellence in genomics

• Drive opportunities for BC through 2020 and beyond

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Genome BC’s 2015-2020 Plan – Key Themes

Maintaining a world-class genomics region

• Enhance BC’s capacity for world-class genomics research • Balance a portfolio of discovery and user driven applied and translational research • Support BC’s research universities, research institutes and teaching hospitals • Attract and support the best talent

Building BC’s bioeconomy and engaging with sectors

• Attract federal and other co-investment, including private and foreign funds • Increase interaction with industry, users, and investors in key sectors • Engage with industry through Public/Private Partnerships, such as

sector innovation centres • Target investment through sector specific programs

Education

• Continue to enhance the education of the next generation of genomics scientists

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Companies Advanced by Genome BC (38) 38 Companies Advanced by Genome BC:

Connecting User with

Researcher

Genome BC Programs: GeneSolve

User

Sector Challenge

Academic Solutions

Finalize the Project

Academic Scientist

•Panel Review • Funding

• Deliverables

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Examples of communities throughout the province where Geneskool Workshops have been presented.

Abbotsford

Burns Lake

Campbell

Castlegar

Chetwynd

Coquitlam

Dawson

Fort Nelson

Fort St.

Fraser Lake

Haida Gwaii

Invermere

Kamloops

Kelowna

Mackenzie

Nanaimo

Nelson

North Delta

North

Parksville

Prince George

Quesnel

Richmond

Surrey

Terrace

Vancouver

Williams Lake

Clinton

Port Moody Burnaby

Chilli

wack

Comox

Fraser Lake

Langley Mill Bay

Richmond

Surrey

Cortes Island

Chemainus

Chilliwack Parksville

Fraser Lake

Richmond Surrey

Coquitla

m

Chetwynd Mackenzi

e

Fort St. James

Invermere

Haida Gwaii

Fraser

Valley

North Delta

Education

Inspiring the next generation of scientists

Geneskool Workshops for students across BC

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Educating Leaders in BC

2015

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GENOME BRITISH COLUMBIA

PRECISION MEDICINE PROJECTS

Cumulative investment in 145 projects • 53 Active

Total $352.5M: GBC $69.3M with Co-investment $283.2M

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Prevention Prognosis Treatment

Diagnosis

Genomics

First Nations

Biobank

RapidOMICS Genomics for

pharmacists Biomarkers for COPD

Management

Prenatal

Screening

Non-invasive prenatal testing (NIPT) Researchers: Francois Rousseau, Sylvie Langlois

Safer prenatal screening solution (each year 10,000 amniocentesis cause the loss of 70 healthy fetuses). NIPT is revolutionizing prenatal care.

New genomic technologies allow the detection fetal genetic abnormalities in maternal blood. Equip decision makers, pregnant women and their partner to make informed choices pertaining to prenatal genetic screening and diagnosis. High demand from the public for test coverage of NIPT – health care decision-makers will use project results to decide on coverage policies.

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From years to days: RapidOmics Researchers: Jan Christilaw, Jan Friedman, Alison Elliot and Horacio Osiovich

Genetic disorders are a leading cause of infant mortality and make up a large percentage of the patients in BC NICU’s

An accurate and rapid diagnosis can guide treatment decisions but this is currently a significant challenge RapidOmics: pilot study exome sequencing 25 trios (baby + parents) provide results in 5-7 days This proof-of-concept could replace hundreds of different tests, improving outcomes and saving the system money

BC pharmacists leading precision medicine Researcher: Corey Nislow

Approximately 50% of all emergency department visits each year are due to adverse reactions to medications in adults aged 50 and over

Across BC, 33 community pharmacies have taken part in North America’s first project to implement pharmacogenomics

Extract DNA from Saliva, sequence DNA and prescribe

the right drug to the right patient at the right time

and right dose

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Combatting “lung attacks”

• Blood test that will identify patients at high risk for Chronic Obstructive Pulmonary Disease (COPD).

• Marker panel is in development; refining selected markers.

• Test will improve treatment, lead to patients with fewer attacks and reduced hospitalization and emergency visits.

The project is led by Dr. Don Sin, St. Paul’s Hospital, University of British Columbia

Leading the world in HIV/AIDS research Researchers: Julio Montaner and Richard Harrigan

In Canada over 70,000 people are infected with HIV and nearly $1 billion is spent on HIV drug cocktail therapies each year

The BC Centre for Excellence is HIV/AIDS is leading the world to reduce HIV/AIDS global burden

by 90 % in 2030

Genome BC is supporting the BCCfE in developing an HIV drug-resistance test, real-time drug resistance surveillance and better methods for personalizing treatment of HIV based on each patient’s unique DNA

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The Personalized Onco-Genomics (POG) Program Researchers: Janessa Laskin and Marco Marra

This BC Cancer Agency project looks at the specific mutations that cause cancer.

350 patients have received personalized treatment, based on their DNA

representing 50 different cancer types.

The next phase: More patients, more cancers

Doctors can then customize treatment

options to target those mutations,

increase efficacy and reduce overall cost

Path to the clinic

Centre for

Clinical Genomics

“Test” e.g.

Hereditary cancer panel

Oncopanel

Myeloid Panel

Ethics

Privacy

Economic evaluation

Populations

(BC and beyond)

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Genome BC’s strategy for investment in health

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Invest in genomic health research across diseases based on merit and potential impact

Enable targeted application of genomics at the level of populations Genome BC

focus areas MIND THE GAP

External guidance Research Oversight Committee

Common requirements

Cancer Infectious diseases

Rare diseases Pharmaco-genomics

Oversight Committee

Funding / partners

Genome BC, Genome Canada, CIHR, Industry partners, other partners

Stakeholder Research

Establish Health Sector Task Force

Consultations

Draft Health Sector Strategy

Health Sector Strategy

Genome BC Health Strategy

Rare diseases

Pharmacogenomics

Infectious disease

Cancer

Exemplars

Genome BC Health strategy

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Total GBC investment in four priority areas

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Infections Diseases

Cancer

HIV (UPP), Bridges (PP)

POG (SI), BIX (PP)

Rare Diseases

CAUSES (SI), iTarget (SI)

Pharmaco- Genomics

DynaCare (GAPP), BCPharma (UPP)

$2,6 M

$0.4 M

$1,7 M

$0,6M

Total GBC investment ~ $5,4M

Implementation Barriers

1. Lack of coordination and centralization

2. Need to stablish an official mechanism of Genomic Data Sharing (GDS)

3. Bioinformatics focusing mostly on research instead of data interpretation and data integration into the clinic

4. Limited number of Genetic Counselors & Bioinformatics (interpretation)

5. Several EHR systems are being used (work in isolation and implementation varies greatly between regions)

6. Lack of unique/harmonized system to evaluate new technologies (NICE, FDA)

7. Education of health care providers

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Crosscutting Areas to Accelerate Implementation

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Cancer

Education of Heath Care Providers

Infectious Diseases

Rare Diseases

Pharmaco- Genomics

Big Data (Data integration, data sharing)

Infrastructure (Biobanking, Sequencing, etc)

Delivery/Access (policy, reimbursement, economics, etc)

Implementation

Requirements for success

1. Scientific understanding and technical capabilities

2. Alignment and prioritization

3. Health information technology tools and infrastructure

4. Clinical and laboratory infrastructure and capabilities

5. Regulatory guidelines

6. Harmonized ethical consent

7. Privacy / anti-discrimination policies and legislation

8. Reimbursement guidelines

9. Healthcare professional capacity, awareness, training and adoption

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Capabilities / Resources

Patient Adoption

Provider Adoption

Aggregating, Integrating and Sharing Data

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International Colaborations

Genome BC & Genomics England Collaboration

Finalize exemplar and business plan

1. Build expert working group 2. Generate candidate exemplars 3. Expand / assess top 2-3 ideas 4. Refine and prioritize exemplars 5. Identify exemplars for collaboration

1. Build oversight committee 2. Review proposed exemplars 3. Develop business plan** 4. Harmonize data sharing tools

and processes

1. Solidify partners and funding

2. Develop agreement amongst partners

3. Implementation of pilots

Disease

Indication

Phase 2: Implementing Pilots (Dec 2015-Dec 2016) 32

Phase 1: Implementing the MOU

(Sept-December 2015)

Develop projects Projects Identify mutual

interests

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Infectious

Pilots

Review Launch Concept Submission Resubmission

/ Review

Rare Review Launch Concept Submission Resubmission

/ Review

Cancer Review Launch Concept Submission Resubmission

/ Review

Bio-

informatic

s

Review Launch Concept Submission Resubmission

/ Review

Pilots Status

Steering Committee Meeting (Monthly)

MOU Advisory Council meeting (February, March, May, October)

Activities

A very long SAGA…

The CEO of an Icelandic

gene-hunting company says

he is able to identify everyone

from that country who has a

deadly cancer risk, but has

been unable to warn people of

the danger because of ethics

rules governing DNA research

MIT Technology Review, 2015

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The Global Alliance was formed to help

accelerate the potential of genomic

medicine to advance human health.

Brings together over 400 leading

institutions working in healthcare,

research, disease advocacy, life science,

and information technology.

Framework of harmonized approaches to enable the responsible, voluntary, and secure sharing of genomic and clinical data Data Overload – Informatics

Big Data

Questions?