Arizona’s Future: The Future of Medicine

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Much of the future of medicine is in determining how our genes contribute to sickness and how they can be used for wellness. Cutting-edge genomics research is being conducted on a daily basis in downtown Phoenix at the Translational Genomics Research Institute, or TGen. Dr. Michael Berens, TGen’s deputy director for research resources, will discuss the myriad of research going on at the facility.

Ted Simons: Tonight's edition of Arizona's future looks at how cutting-edge genomics research is being conducted on a daily basis in downtown Phoenix at the Translational Genomics Research Institute or TGen. Dr. Michael Berens, TGen's deputy director for research resources is joining us now. It's good to have you here. There's so much to get to, but let's start with the definition. What is the human genome?

Michael Berens: Well, we all have one. We're humans. It's really our code of instructions of how we move from being a single cell at conception to becoming a complicated self-renewing human being. It's our genetic instruction. We believe it's the medical textbook of the future as we've learned how to read it in the last years or so.

Ted Simons: Is it pretty much like digitalizing, digitize, whatever the word is, the human body? It sounds like that's what it involves.

Michael Berens: Well, it's the code behind what we see in the human body. A digital code, for the computer people in the audience, there's a zero and a one. The genetic code has instead of just two components, it has four. There's four building blocks to make up the genetic code, and it's very similar to that. It's very easy to read now that we've sequenced it, and it's exciting. It gives us a way to look at human disease.

Ted Simons: The high school biology, it's starting to rear its ugly head. The impacts of genomics research on neurological disorders, neurological diseases, what's happening downtown?

Michael Berens: It's an exciting time. I think one of the most exciting things that we've seen in the last maybe two to three years to come out of TGen has been a strategy to better understand people who let us look at their genetic code in the context of how their memory works. TGen has a website that's called, and we've had over 30,000 people come onto that website, and they take a memory test, very simple. And then we can follow up and ask them for a cheek swab where we can get DNA and we can start to look for events that would correlate with memory behavior and there have been some amazingly exciting things. We're very interested in the healthy aging brain as well as the brain that doesn't age well. We all know people with dementia, Parkinson's, Alzheimer's looking at the extremes, we get great insight into the genetic basis of those disorders.

Ted Simons: And I would also imagine things like autism, bipolar involves kids, as well.

Michael Berens: It does. Understanding how the brain develops has a lot to do with how it functions. I'm very proud, and I think the whole Arizona community should be proud of TGen's center for rare childhood disorders. These are families with children that have been on medical legacies, looking for some diagnosis, and now TGen's able to sequence the genetics of the kids and the family and start to identify events that could account for those problems, many, many times diseases that we don't even have a name for because of their rarity and we can find guidance on how to better care for those little ones. So that is a huge blessing for this state.

Ted Simons: Also, I understand looking for biomarkers as far as concussion-related injuries are concerned to athletes and those who wind up with head-related injuries.

Michael Berens: Well, athletes, but just humans on the planet that get bumps, fall off a bicycle or have some kind of altercation, we're very interested to know how severe was the event? Right now, it's very descriptive, and the neurologist and the E.R. staff have to work with soft metrics, but we're looking for biomarkers that might even be a saliva test to determine how severe a head injury, should an athlete not reenter a game? Take some time off? So we think we're going to have healthier people as we understand these markers.

Ted Simons: In coming years, athlete gets injured, goes to the sidelines, do a little swab activity, and you might be able to, in the coming years, try to figure out if that athlete should be back on the field or not?

Michael Berens: Correct. We want to keep athletes healthy and strong and if there's been a severe event, we want to let them know and get them back in the game when they're fully recovered from those.

Ted Simons: The pathogen genomics studies in Flagstaff, what's that all about? That sounds like it's everything from valley fever to HIV, to the plague, all points in between.

Michael Berens: Well, it's a phenomenal, focused, but very diverse team that works with us as part of TGen's program at TGen North, our pathogen genomics division. We work with the Flagstaff community and with Northern Arizona University on these pathogens. Actually in our body, Ted, there are more microbes than there are cells that are me. It's a little bit of a bizarre thought, but there are lots of microorganisms, some of them are critical for the health of my body. We tend to think if it's a bug it's bad, they won't let it in, but having healthy microorganisms can have huge influences on gastrointestinal health and we want to learn better about how these things work so that's a fantastic resource that leverages the genomic strength of TGen.

Ted Simons: That's the whole probiotic thing there, right?

Michael Berens: Correct. Well, that's the strategy. If you have a healthy gut, you're going to have a much healthier body.

Ted Simons: And again, as far as the genomic impact and things like kidney disease and diabetes, the genomic impact specifically on those. What are you seeing out there?

Michael Berens: Well, we're better understanding subgroupings of a disease. So diabetes affects 26 million people in the United States. That's massive. If we could understand subgroupings and patients who respond to behavioral modification or behavioral input versus those who need real restrictive dietary regimens, those would be very helpful and give us more success in helping people get through that lifestyle kind of disease that that can represent.

Ted Simons: Kind of understanding why some people who are diagnosed with diabetes, they go on a diet, everything kind of gets back to normal or at least is treated, and some folks, you just can't seem to treat them.

Michael Berens: That's correct. That's the whole range of who's most vulnerable, and then there's grades of that and so we want to better understand how we can better bring the right medicine to the right patient based on genomics.

Ted Simons: Let's talk about cancer research. How is TGen approaching cancer research? Is it with an elephant gun, are you starting to narrow things down there?

Michael Berens: I really hope that when people look at what TGen's doing in 2014 and we look in the rearview mirror down the road, they'll go wow, they got out their lasers and we took a very fine look at what makes a tumor vulnerable to the therapies we have today and how do you get the right chemotherapy or the right targeted therapeutic to the specific individual patients so that you are most likely to hurt the tumor without hurting the patient. And that's a fantastically exciting opportunity.

Ted Simons: Does that opportunity change when you deal with kids as opposed to the folks in middle age, as opposed to folks in later age?

Michael Berens: It actually does. The genetic noise in a cancer, in an older person, is large. There are an enormous number of genetic events in cancers from older people. We've been around a longer time. We've been exposed to more environmental agents, cosmic rays, various things, so those genomes of those cancers are very complicated. It's tough to say who's the driver event and what do we design the therapy around? Tumors in children tend to be what we call quiet. There's very little noise. It's hard to decide how is that even a cancer? So it's an amazing contrast between pediatric cancers and adult cancers, but every time we study the whole genome of a cancer we learn about the disease and we learn about things that can affect the next patient. So it's so important that these patients who to me are the heroes, they help us understand the disease.

Ted Simons: Well, that's interesting. I think most people would think when you're born, you got your genomic makeup, and your human genome is set in stone and never changes. Are you saying it does change?

Michael Berens: Well, it does. Our genome, it's affected by environmental agents, by our diet. It's not necessarily the sequence of the genome, but they modify how the genes can get informed or unpacked to be used by cells. In the case of cancers, there are frank mutations and rearrangements and restructuring that takes place, just terribly damaging events in a very complicated system and those changes point us in the directions of how to treat the disease.

Ted Simons: This is fascinating stuff. So when you consider the future, our series looking at the future of a variety of things. When you look at the future of medicine, what do you see?

Michael Berens: Well, I hope that my kids have physicians that are trained in the practice of precision medicine, that they understand that you get a histological or the tissue diagnosis of the disease, but also, a genomic fingerprint of the disease. Did it come from my mom and dad so we have certain insights, but also if there's changes in the disease tissue, what can be done specifically to match a therapy to that event? And so I'm excited. Our Arizona medical schools are training physicians of tomorrow who are going to be groomed for this kind of practice.

Ted Simons: Well, it indeed is exciting. Great information, good to have you here, thanks for joining us.

Michael Berens: Wonderful to be here.

Dr. Michael Berens:Deputy Director for Research Resources, Translational Genomics Research Institute;

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