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O i i d Ch llOpportunities and Challenges for Scientific Ingenuity in g y
Health Care
Dr R.E.W. (Bob) Hancock, Centre for Microbial Diseases and Immunity ResearchCentre for Microbial Diseases and Immunity Research
University of British Columbia,
Why Innovation?Because Health is a moving targetBecause Health is a moving target
• Aging population• Disease does not recognize borders• Fixing one problem reveals othersg p• Wellness vs. Cure.
Preventative medicine is more cost effectivePreventative medicine is more cost effective.• Population-based vs. personalized medicines
H lth i i b i i i l i t t• Health economics is becoming increasingly important in richer nationsT d t t d lif t l d t b• Tendency to move towards lifestyle drugs may not be sustainable
Health is a moving target - Age
• Life expectancy is increasing• Location Location Location• Location, Location, Location• Age is a major factor in Health
Health is a moving target - Antibiotics• Microbial resistance
( tibi ti / ti i l)(antibiotic/antiviral)• Dry pipeline• Emerging problems,Emerging problems,
Bioterrorism• Void in public policy
Ch i D hi• Changing Demographics (aging, travel, climate, immuno-compromised i di id l i l )
12
16
Dev
elop
ed
individuals, animals)
0
4
8
Tot
al N
umbe
r D
Total # NewAntibacterialAgents (5 yearintervals)
01983-1987
1988-1992
1993-1997
1998-2002
2003
From IDSA “Bad Bugs No Drugs”
Health is a moving targetB d id di tiBedside diagnostics
Hydrogels etc can screen f illi f diff tfor millions of different biomolecules (DNA, proteins, etc.) in a single sample make possible the development ofpossible the development of low-cost clinical bedside diagnostics.
Remote monitoringMicrofluidics
Health is a moving target – CancerSurvival improving but early diagnosis, cancer type and Drug resistance are issues
1950 - 2007
Health is a moving target – Drug Reactions
Rates by sex
Rates by Age
Technology Advances that will drive H lth I tiHealth Innovation
Personalized medicinePersonalized medicine
But is it sustainable?
Principles of PharmacogenomicsGenetic Predisposition
Technology Advances Health Innovation
NodeNode
InteractionInteraction
i / f i iSubset of the Interactions involved in Innate Immunity
(Innate DB)
Innate Immunity/Inflammation is complex Considerable complexity - Multiple receptors, signal
transduction pathways, positive and negative regulators; h d d f t i i d d d(Innate DB)
Drawn using the Cerebral plug-in of Cytoscape: Barsky, Gardy
and Hancock
hundreds of proteins induced or suppressed. InnateDB/Cerebral provides framework for
understanding immunomodulator therapeutics (IDRs)
Technology Advances that will drive Health InnovationHealth Innovation
"Right now, day in and day out, we can perform 400,000 reads of 250 bases each with an accuracy of 99 % b " i h l h l & 4 4 if99.5% or better," Michael Egholm, VP R&D, 454 Life Sciences
Th SOLiDThe SOLiD system achieves 4 gigabases of sequence per
Gigabase sequencing
sequence per run
Technology Advances that will drive Health InnovationHealth Innovation
High throughput sequencing makes sequencing of individual patientsequencing of individual patient genomes possible - 1000 genomes project announced Jan 23, 2008project announced Jan 23, 2008
Can rapidly assess single nucleotide polymorphism (SNP) variationpolymorphism (SNP) variation within patient genomes
SNPs are mutations. Combinations SNPs are mutations. Combinations of SNPs determine health or disease, drug reactions, metabolic rate, susceptibility to infection, heart disease, cancer, etc
Technology Advances that will drive Health Innovation – Lab on a chipHealth Innovation Lab on a chip
This lab-on-a-chip is a miniaturized, portable version
Siemens molecular diagnostics system
Protein Purification
atu ed, po tab e ve s oof a blood-count machine
Three primary components of Sandia's Chemlab
Microfluidics
system fit inside a snow-pea pod. The components (from left to right) include a surface wave acoustic sensor array, a preconcentrator to absorb or adsorb chemical vapors, and a gas-chromatograph column.
Barriers to InnovationBarriers to InnovationTimelines are long; Costs are very high Timelines are long; Costs are very high g; y gg; y g
I d Di (3 11 )
Number of Drugsin each phase
Academic Academic Discovery Discovery (3(3 10 yrs)10 yrs) Industry Discovery (3-11 yr)
Preclinical (1 yr)
in each phase10,00010 15
(3(3--10 yrs)10 yrs)
Preclinical (1 yr)
Phase I (1 yr)
10-156
Phase II (1 yr)
Phase III (3-4 yr)
4
1
The Drug The Drug Discovery Discovery
ProcessProcess
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15YEARS
( y )
Govt Review (2-4 yr)
1ProcessProcess
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 YEARS
Cost ~ $800 million per drug
Barriers to InnovationBarriers to InnovationThe Development GapThe Development GapThe Development GapThe Development Gap
DiscoveryViable
OpportunityDEVELOPMENT GAP Opportunity
Issues Issues Risk
Previous approach was
Capability Funding
to spin off a company
This is the next frontier: This is the next frontier: Our approach Our approach -- Centre for Drug Research & DevelopmentCentre for Drug Research & Development
Barriers to Innovation Barriers to Innovation Approach of CDRD to the Drug Development GapApproach of CDRD to the Drug Development GapApproach of CDRD to the Drug Development Gap Approach of CDRD to the Drug Development Gap
Clinical TrialsPre
Research IntensiveResearch Intensive
Division of Drug Target Identification
LeadDiscovery
TargetConcept
ValidatedTarget
HitDiscovery
OptimizedLeads
Clinical TrialsCost: $200-800M5-8 years
Pre-Clinical$2M
Division of Drug Screening
Division of Drug Target Identification
Division of Drug Design & Synthesis
Division of Drug Delivery
“ Drug discovery in the academic
ValueValue
Division of Drug Evaluation“... Drug discovery in the academic setting is urgently needed to explore alternative paradigms in the currently very inefficient drug
$50-100 K $200 K $50-70 M$8 M
ValueValue discovery process.” AS Verkman
Canadian Government approach to Health Canadian Government approach to Health Inno ation ResearchInno ation Research
GovernmentGovernment
Innovation ResearchInnovation Research
TaxTax Revenue
EconomyEconomy Investment$$$$
Training,Products,
$$$$
UniversityUniversityProducts,Expertise
NCE G C d CFI CRC CIHR NSERCNCEs, Genome Canada, CFI, CRCs, CIHR, NSERC,were all created or expanded to address these issues
A Concerning TrendC di B d t J 2009Canadian Budget Jan 2009
• No new funding for Genome Canada cf. $120M last gyear
• The granting councils (CIHR, NSERC, SSHRC) will see budget cuts of $147 9-million over three yearssee budget cuts of $147.9-million over three years.
• “Strategic reviews” at Health Canada and the Public Health Agency of Canada will result in cuts of $167.8-
illi th i l di $6 3 illimillion over three years, including $6.3-million through “refocusing research to take advantage of advancements in science”.
• New money for infrastructure and scholarships• In the USA almost $16 billion of Obama Stimulus
package appropriated for R&D; $9 9 billion towardpackage appropriated for R&D; $9.9 billion toward the conduct of R&D (mainly basic research)
Opportunities and Challenges for Scientific Ingenuity in Health CareScientific Ingenuity in Health Care
• Health issues change over time and demand i i d/ di l hinnovative and/or new medical approaches
• Technology Advances have the potential, if appropriately applied, to revolutionize Health pp p y pp ,Care
• The timeline for development of new medicines are very long and the process costlymedicines are very long and the process costly
• Canada has installed many innovative mechanisms for stimulating scientific ingenuity to improve our economy (and healthingenuity to improve our economy (and health care)
• The most recent budget is concerning in this dregard.
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