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Into the gaps
PHOENIX, Ariz.—In what they call "a focused look at the gaps in clinical medicine where biomedical research can make a difference," the Translational Genomics Research Institute (TGen) and Geisinger Health System recently announced the signing of a strategic research agreement.
The pairing brings together the genomic and proteomic research expertise of nonprofit biomedical research institute TGen with the clinical and research expertise of Geisinger, a non-profit medical and insurance provider based in Danville, Pa. The duo's first planned project will focus on the causes of obesity, diabetes and other metabolic conditions. Researchers plan to look in particular at the possible genetic reasons why so many Americans are overweight, and why diet, exercise and in particular, bariatric surgery, may fail to significantly reduce excess weight in some patients.
"What a lot of people don't appreciate is that while bariatric surgery is very effective, many patients begin to gain weight again six or more months after the procedure, and sometimes not only gain back everything, but exceed their original weight," notes Dr. David Carey, director of the Sigfried and Janet Weis Center for Research, which is located on the Geisinger campus. "It's a lot of work and expense to go through bariatric surgery, so we are looking in particular at ways to predict which patients are most likely to fail the procedure."
Carey notes that preliminary work has been done on known genetic factors that explain part of the "weight re-gain problem and deal with metabolism, but we also want to look at genetic factors that might affect eating behavior and other issues as well."
Geisinger's strength, according to Carey and TGen President and Research Director Dr. Jeffrey Trent, is its integrated healthcare delivery model, non-transitory population and advanced electronic health record (EHR) with nearly two decades of data.
"We have a large and stable population, many of them with at least four-year follow-up, and while it's not necessary 'easy' to pull data from the EHR, it's much easier than in the days of paper-based records," Carey says, noting that Geisinger only recently made the transition from a clinical focus to having a full-fledged research program. "We're still small, but we're also very focused."
"Merging Geisinger's wealth of clinical information with our genomic and proteomic expertise should provide researchers a richer framework for exploring the genetic origins of disease, and hopefully lead to improved treatments and outcomes," he notes.
Although future projects haven't been solidified yet, Carey says that prostate cancer is one of the next likely areas for the TGen-Geisinger team to tackle, and psychiatric disease is also high on the list.
Preliminary discussions, which Carey says began around a year ago, have also covered the possibility of such research topics as congestive heart failure, abdominal aortic aneurysms and the potential side effects of prescription drugs.
"Geisinger as a healthcare system is one of a very few today whose motivation is inclusive of directing genetic and genomics information into their clinical execution process. TGen as a research institute is one of a few whose scientific focus runs toward medically actionable questions," Trent says. "We have a common mission to make major advances against complex diseases, and are working together on strategies for applying the advanced genomic profiling technologies to individualized healthcare delivery, with an initial focus on diabetes, obesity and oncology."
Dr. Glenn D. Steele Jr., Geisinger's president and CEO, for his part, looks forward to ways in which the partnership will take advantage of Geisinger's "unique research structure" and attractive patient population to "allow us to test and apply new clinical translation theories to patient care."
Dr. Johanna DiStefano, director of TGen's diabetes, cardiovascular and metabolic diseases division, will lead TGen's efforts to understand the genetic basis of obesity and liver disease. She says research strategies would capitalize on the synergistic strengths of a large multidisciplinary research program in obesity at Geisinger.
Carey predicts that once they hit full stride in their partnership, Geisinger and TGen will probably end up covering a handful of study areas—perhaps as few as two or as many around a half-dozen—which would run simultaneously.
In this partnership, TGen also plans to bring to bear its collaboration with the Partnership for Personalized Medicine (PPM), which includes TGen, Arizona State University's Biodesign Institute and the Fred Hutchinson Cancer Research Center. The PPM's mission is to improve medical outcomes and reduced costs through more effective diagnosis of disease risk, early stage, and matching patients to therapies.