Since its inception, the IU Grand Challenge Precision Health Initiative (PHI) has not only been about discovering better treatments, cures and ways to prevent some of the state’s most devastating diseases – it's also been about educating the next generation of researchers and health care providers on how to use some of PHI’s most powerful tools, such as genetics, genomics, and informatics, to improve the health of patients.
The pharmacogenomics program, led by Todd Skaar, PhD, focuses on one of the leading scientific areas of precision health, identifying genetic markers that help predict which medicines are the most likely to work well for each individual patient, and just as importantly, which patients are most likely to experience side effects. With support from the Precision Health Initiative, the pharmacogenomics program is providing some of this critical information to patients. Specifically, a recent PHI pharmacogenomics study led by Michael Eadon, MD, notified IU Health patients with hypertension about their genetics that signal a high risk of progressing to chronic kidney disease. A previous study showed that returning this information resulted in patients and their providers working better together to control the patient’s blood pressure. Many patients who are getting pharmacogenomic testing at IU Health to guide prescriptions of their cardiovascular medications are also now receiving information about how to use those results for their future healthcare.
Also, under the PHI pharmacogenomics program, Emma Tillman, PharmD, PhD, is leading a pharmacogenomics training course for pharmacists and other providers. This course includes a variety of work-study exercises followed by an eight hour in-person (or Zoom) meeting led by Tillman.
“One of the most exciting parts of this course is that participants get to use their own genetic test results,” said Skaar.
Pharmacists also receive 20 hours of Continuing Pharmacy Credit for completing the course.
PHI co-leaders of the triple negative breast cancer disease research team, Milan Radovich, PhD and Bryan Schneider, MD, occasionally identify mutations as part of their precision genomic clinics that signal the potential for other diseases. Because they sequence entire genomes, as opposed to snips or small pieces of genetic information, as done in the PHI pharmacogenomics program, this information may have nothing to do with the patient’s cancer, but it may also carry important information for that patient’s health. Since this information may not be anticipated, giving it back to patients raises all types of ethical considerations.
“Providing genetic information is similar to unlocking an attic. There are some things in there you are happy to find and other things you wished you hadn’t,” said Radovich.
In order to help researchers, confront ethical questions such as this, led to the first course of the IU Grand Challenge Precision Health Initiative being created.
“The first precision health initiative course we held was to educate researchers about how to conduct research ethically,” said Peter Schwartz, MD, PhD, director of the IU Center for Bioethics and Associate Professor of Medicine at IU School of Medicine. “Spring term 2020 was its third year, and once again it was filled to capacity.”
Schwartz co-leads the Education team for the Precision Health Initiative with Zachary A. Weber, PharmD, BCPS, BCACP, CDCES, FASHP, Assistant Dean for Education, Interprofessional Practice and Education Center. Weber focuses on precision health initiative education for undergraduate and graduate learners in multiple health science programs at IU and partnering institutions, while Schwartz focuses his efforts on graduate students (MA and PhD) and licensed practitioners.
Data and Informatics
IU has long been a leader in super computing, which allows for incredible informatics capabilities, or the ability to generate knowledge through data. Co-led by Kun Huang, PhD and Yunlong Liu, PhD, the data and informatics pillar has created the precision health cloud for storage of critical patient data and information crucial to finding better treatments for the identified diseases within PHI.
During the COVID-19 hibernation, Huang and Liu were asked to create an online course for trainees that would provide basic training in using bioinformatics tools. They came up with an 11-week short course, called “Elements of Bioinformatics for Biologists.” The course includes short video modules consisting of a combination of lectures and hands-on demonstrations, as well as recorded weekly Q & A sessions. All videos are available on demand through IU’s Canvas and a dedicated YouTube channel. The objective of the course is to provide basic bioinformatics knowledge for wet-lab trainees that will help them communicate effectively with computational scientists. To date, over 250 faculty, staff and trainees have taken the course.
Through the use of genetics combined with informatics, PHI researchers are able to discover information about diseases not known before. For example, prior to PHI, breast cancer used to be identified as breast cancer, simply because it was initially found in the breast. Now through the use of genomic information, made possible through PHI precision genomics clinics, PHI researchers have discovered that often these same tumors aren’t breast cancer at all, but instead, are ovarian or other types of cancer – based on the genomic material found within the tumor – that just happened to first appear in the breast. This information has changed the way cancer is being diagnosed and treated.
All of these discoveries, and those to come, create the need for new or better medicines designed especially for individuals. In addition, the pharmaceutical industry is always looking for more researchers who want to work in industry, which requires specialized drug discovery training. That’s why Andrew Dahlem, PhD, chief of the division of clinical pharmacology and Alan Palkowitz, PhD, senior research professor of medicine in the division of clinical pharmacology, both Lilly veterans, have worked together to create a drug discovery and development course at IU, which serves as a doctoral minor to augment a PhD, with a master’s program in the works.
These two interconnected courses span the process of drug discovery and development and provide a high-level opportunity to understand drug discovery and development, including the business, ethical, and legal aspects associated with making medicines. The first semester course focuses on the process of discovering a clinical candidate for a disease target. The second semester looks at developing that candidate molecule into a potential medicine.
“We are changing the way we deliver medical education through the IU Grand Challenge Precision Health Initiative,” said Carmel Egan, PhD, operations director for PHI. So far, we have made a tremendous impact at the graduate level.”
More to Come
Weber is working on a set of modules covering precision health for use in multiple different health sciences programs, for students learning to be doctors, nurses, physician assistants, physical therapists, etc., at multiple different schools at IU. These modules will include a video that explains how genetic information and environmental factors influence a person’s health. The toolkit will also include a learning module for students that gives them the opportunity to interpret genetic information within an electronic medical record.