One of the more stark statistics in modern healthcare is the estimate that for 90 percent of prescribed drugs, between 30 and 50 per cent of patients will not respond to treatment, while others will see no benefit or could even have an adverse reaction. Of the £595 billion global spend on pharmaceuticals in 2011, an estimated £393 billion was used for therapies which did not produce the desired effect.
This presents often severe difficulties for the patients involved and adds an extra cost burden to already financially stressed health services and is one of the issues being addressed by the Northern Ireland Centre for Stratified Medicine in Derry.
The new £11.5 million centre, which is a collaborative project between the University of Ulster's Biomedical Sciences Research Institute, C-TRIC (the Clinical Translational Research and Innovation Centre) and the Western Health and Social Care Trust, is the only one of its kind on the island and will put the University of Ulster at the leading edge of pioneering research into chronic degenerative diseases.
The establishment of the centre has also enabled the university to offer the first BSc honours programme in stratified medicine in either the UK or Ireland. This three- year course brings together biomedical and ICT elements to give graduates a combination of expertise in the areas which underpin this emerging field of medicine.
"Stratified or personalised medicine is an emerging practice of medicine which examines our genetic make-up along with clinical data to better prevent, diagnose and treat disease at an individual patient level," explains Prof Tony Bjourson, director of the university's Biomedical Sciences Research Institute and head of the new centre.
“The ‘one size fits all’ approach to medicine does not work because when it comes to drugs, one size does not fit all. A personalised approach to patient care holds huge potential for developing new diagnostic and treatment pathways for human diseases.”
Genetic make-up
The centre will undertake research in areas such as heart disease and stroke, diabetes, bone disorders, inflammatory diseases, mental health, dementia and cancer. "In the same way that we all have different risks of developing disease, we also differ in how we will respond to drugs because of our genes and our environmental exposures," says Prof Bjourson. "By building up an understanding of the 'strata' of responses and the genetics of the diseases, medical researchers can now create more personalised and effective forms of treatment."
One example he cites of a drug which is greatly influenced by a patient’s genetic make-up is codeine. “What happens when we take codeine is that an enzyme in our liver converts it into morphine and it is that morphine which relieves the pain. However, between 5 per cent and 10 per cent of the population do not have that enzyme and the drug is useless to them. Then there are other people who have too many of those enzymes and convert the codeine into morphine much too quickly put them at risk or a life-threatening overdose.”
The same liver enzymes activate Tamoxifen, a drug commonly used to treat a particular form of breast cancer, and some patients will not be able to convert it to the active form of the drug, resulting in them deriving less clinical benefit. Genetic testing can ensure that these drugs are given only to patients who will benefit from them.
Dr Maurice O’Kane, Western Trust head of research and development and chief executive of C-TRIC, points to MODY (maturity onset diabetes of the young) as another example of a condition which can be addressed by stratified medicine.
“People with diabetes get treated with different medicines according to the type of diabetes they have. If they have MODY they will not necessarily respond to insulin. They can respond well to a tablet and have no need to inject insulin. Identifying MODY early in a patient can have an enormous impact on their quality of life.”
He also points out that stratified medicine could help rescue promising drugs which might otherwise have failed at the clinical trial stage. “If a drug is tested and it turns out to only be effective for 25 percent of the patient population it will fail the trial. But if you can stratify the patient population even before you conduct the trial and only offer it to those who will benefit from it the drug can succeed.”
The centre also has quite significant economic potential beyond the creation of 22 high-end jobs, including 15 lecturers in stratified medicine. "What is being done here is a bit like flying the plane while you're building it," says Susan Whoriskey, MIT entrepreneur in residence. "The centre has the research component, the translational component, and the research component. Having all three of these gives C-TRIC considerable power and will attract industry partners."
Attract researchers
Bjourson agrees. "We have created a critical mass of capability within Northern Ireland in terms of delivery in this area. We have the research capability and the means to attract FDI.
“People talk about the shortage of IT and computing skills but there is an even greater shortage of graduates with biomedical and computing skills. Graduates from the new course will have those skills and we are creating a valuable research community in the area as well. Pharmaceutical and diagnostic companies will take advantage of the existence of these skills and come here to work with us.”
Dr O’Kane believes that the centre will also attract top researchers to work in Derry, further strengthening it as a hub for this activity and a location for related industry partners. “One of the great things from the hospital perspective is that the new centre will help us attract and retain high calibre staff because it is conducting leading edge research here in Derry. Normally you would need to offer special incentives to get these people to come here, but I don’t think that will be the case any more.”
To learn more about the Northern Ireland Centre for Stratified Medicine go to c-tric.com.
