Rare diseases and open access.

Ive found myself completely mesmerized by the open access/open science debate. As a recovering bench scientist, it has made me think about a variety of things but one that is really interesting is the implications for Rare disease research and speed of turning great benchwork into viable drug targets. Ill deal with the larger debate on open access separately but I wanted to put forward something today(Feb 28th 2015 Rare disease day). 

2016 update: In my opinion not much has change in Rare diseases in the last year. There have been some moves forward but like anything in the drug and/or therapeutic research- it is time consuming. I hope that the silence is because we are getting to the point where folks have rolled up there sleeves and are working not talking. 

I am really excited about the prospects for increasing the speed that potential drug targets can go from bench to bedside. The new technologies (gene sequencing, clinical data) can provide faster turn around time through efficient data sharing and new genomics technology. The real potential pay off is through new clinical data that will be available once EMR is implemented widely. The value of that much data combined with the new genome sequencing technologies can really provide some much needed guidance about the genotype phenotype relationships that may link certain rare diseases. I say may since it will really come down to data quality and wide dissemination of that data. Getting clinical data into the hands of molecular biologists and biochemist who can do the bench research is vital to drug design. 

2014 Update: With the roll-out of ACA starting to happen and the FDA crackdown on 23andMe. The landscape for studying and curing Rare Diseases just got a little better. For more information on the 23andMe nonsense there is plenty of information on the imbroglio but this one from the Huffington Post is the least sensationalist. My opinion is that the FDA made a decision based on the specific businesses lack of response it is not an indictment of consumer genetics or any paternalistic over-reach. Mathew Herper has a really great analysis of the stupidity and or hubris that 23andMe showed.  The Global Genes Project has a nice blog on the relationship between Rare diseases and ACA. 

The bad news is that the sequester has set research back years if not decades and may have very well rob a whole generation of scientists of their careers (this author included). Tom Ulrich of Boston Children Hospital has a nice blog on the subject.

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2015 Update: The new interesting initiative is precision medicine in US. I really am proud of the way Global Genes Project is coming along. I was briefly involved when Nicole Boice started the initiative. I look forward seeing how it continues to grow in 2015. I think it does a great job of keeping the conversation on awareness and providing a site to aggregate "best practices" for the Rare disease community. 

I really hope that the continued access to healthcare that we started to see in 2014 continues. The key will be what do we do with the basic information that clinics gather about their rare diseases patients? How do we make that shareable across clinics. This in my opinion will be the key to consistent diagnosis and clear symptons, which will then better inform scientists of which genes contribute to the phenotype. This is the basis of drug discovery and treatments. 

Right now is a real nexus of information due to the convergence of new technologies with "new" fields of studies. Epigenetics is the study of how and why genes get turned, the best analogy is: if the whole genome is the book of life, genes are the words and epigenetics is the sentence, paragraph and chapter structure that gives the words meaning. The other area is off-shoot of stem cell research; induced pluripotent stem cells (iPSCs). iPSCs as the name implies are induced to become stem cells from a variety of other cell types, the most clinically relevant being skin and blood. While the debate rages iPSCs and their value for replacing non-working cells with new ones [regenerative medicine] one thing that is not in doubt is the power of these cells for modeling disease. iPSCs can be made from patient samples and then shared with other researchers. This may seem trivial but the more people looking at the same model the quicker the core problem can be found. If done right the sharing of the iPSCs to researchers who use different techniques (biochemists, molecular biologists, cancer, etc) will provide a 360 degree view of the disease. 

Update 2014: Unfortunately it seems that iPSC research is becoming marred with scandal. The new "most promising" discovering may be "less real" than one would hope.....Paul Knoepler has a blog on the subject. BTW if you have any interest in stem cells you should follow Knoepler's blog he is an excellent writer and a top notch scientist.

Update 2015: I think we are past the really bad period, unfortunately it has also diminished the enthusiasm for iPSCS as models. Although I am not surprised, it has recently been shown that iPSCs form different sub-types of cells based on their tissue of origin (see here for neural and here for heart). This seriously limits the usefulness of iPSCs for drug discovery and would just exacerbate the reproducibility issues that are plaguing science in general but particularly stem cell research. 

Once this happens it's likely that links will be found that can make drug discovery and testing palatable for biotech and big pharma. Drug discovery is expensive but if the community can gather enough information about the molecular and biochemical characteristics of rare diseases then the existing "orphan drugs" can be tested against the characteristics rather than any single disease. 

Update 2015: The orphan drug area is one where we are starting to see movement. The recent announcement by the CF foundation recieving $3.3B for the patent rights to Kalydeco. It is an interesting approach that should be considered by any rare diseases group looking to expand support and the potential therapies for their disease. 

As always the caution is who should get the money, how do you ensure that the cost of the drug to sufferers is appropriate? If the foundation funds the study (in part) do they have an obligation to ensure that the cost of teh therapy be reasonable to the average person?

The elephant in the room is of course paying for all of this. Scientists need to be able to publish to get grants to pay for post docs and reagents. While there is some money available from disease foundations but it doesn't cover all the costs that a lab needs to run. That is the job of the NIH. However their mandate really requires that grants are given out based on WIDE applicability of the research and the grantee's history of research in that area. Unfortunately this model does not serve the rare community very well nor does it foster the wide range of scientific endeavor. There hundreds of examples where a rare disease has lead to unique insight into a biological pathway that was key to some cancer or other disease. 

Update 2014: Rare disease research will survive but we need to start to fast track new funding models that focus on highly innovative projects. We know what hasn't worked we need some research that is different.

Update 2015: Unfortunately I can't say there has been too much movement on this. Frankly scientific funding is horrible right now. I think for rare disease foundations there is an opportunity to foster young scientists to be advocates and invested in their disease but this requires a new way of thinking about how to fund rather then WHAT to fund.