Clinical OMICS

JAN-FEB 2019

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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www.clinicalomics.com January/February 2019 Clinical OMICs 11 News Inova committed itself to precision medicine with the hiring of John E. Niederhuber, M.D., EVP and CEO of Inova Translational Medicine Institute (ITMI), founded in 2011. The Washington, D.C.,– area health system took proverbial baby steps: With 20,000+ births a year, Inova reasoned, it made sense to start with genomic re- search projects for newborns, specifically preterm babies. "We wanted to dedicate our resources to a field where not a lot had already been done," recalled Franziska Moeckel, Inova's assis- tant vice president, Personalized Health. Inova launched a congenital anomaly study that has since been rolled into the Environmental Influences on Child Health Outcomes (ECHO) research initiative led by The Icahn School of Medicine at Mount Sinai. Inova was awarded $9.5 million in NIH funding in 2016 to study environmental influences on the health of children as a partner in the Icahn Mount Sinai-led consortium. Suchitra K. Hourigan, M.D., ITMI's director of microbiome research, is leading studies into the microbiome as well as a clinical trial (NCT03298334) assessing the health of newborns delivered via Caesarian section who were randomized to receive vaginal seeding. "Our initial focus on newborns allowed us to really prime our system to adopt to this new field of precision medicine," Moeck- el said. "We had to educate physicians. But we also had to look at our EHR, our operations, the way we bill and our billing in general, marketing and communications, legal, risk management. We are using the system we have put into place, and all the learning we have had along the way, for areas that have higher, more immedi- ate clinical utility." Inova built out its College of American Pathologists (CAP)–ac- credited Inova Genomics Laboratory, which includes a MediMap clinic staffed by genetic counselors, medical geneticists and other professionals. The lab launched its first pharmacogenomic test in 2014, assessing the response of cardiac catheterization patients to the anticoagulant drug Plavix (clopidogrel). A pilot study showed 20% to 30% of patients had a mutation resulting in an inactive form of the enzyme that activates Plavix; they were prescribed an alternate medication. Inova sped up testing in 2017 by switching DNA collection from a blood draw to a cheek swab. A 50-patient pilot launched through Inova Schar Cancer Insti- tute's Breast Cancer Program is assessing newly-diagnosed breast cancer patients undergoing mastectomy with or without recon- struction using Inova's MediMap Plus genetic test to analyze 25 genes that influence response to 146 prescription drugs across 14 categories. Other pilots are evaluating behavioral health and or- thopedic patients. Moeckel said Inova's precision medicine challenges have included: • Research curation and review; • Data collection, storage, management, integration, and especially protection; • Reimbursement from payers; and • Delivery of precision medicine services. While many services are in-house, Inova partners with Veritas Genetics to offer whole genome sequencing and interpretation, and is joining University of Virginia to develop the Genomics and Bioinformatics Research Institute (GBRI). GBRI will be within Ino- va's Center for Personalized Health, a 117-acre former ExxonMobil campus in which Inova is investing $1 billion. Inova says its precision medicine commitment remains strong under President and CEO J. Steven Jones, M.D., who succeeded J. Knox Singleton in April 2018. —Alex Philippidis At Inova, Precision Med Started with Baby Steps Inova is investing $1 billion to develop the Inova Center for Personalized Health on the 117-acre campus that formerly housed ExxonMobil. department rose to fourth in the nation in NIH funding. The precision medicine program also began leverag- ing big data in biomedical research, and built the Minerva supercomputer, among the largest supercomputing facili- ties of any U.S. academic medical center. Minerva has more than 12,000 compute cores, a number Margolin said will be expanded significantly. "Eric Schadt contacted me when he knew he would be transitioning to Sema4 and was looking for people who could succeed him. He knew about my work and thought that I might be a good person to carry on what he built before me," Margolin recalled. "We always shared the same philosophy of promoting open science and trying to push the boundaries of big data as applied to medical research."

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