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: Good evening and welcome to this special Arizona's future edition of Arizona Horizon. I'm Ted Simons. First, a look at how cutting-edge Genomics research is being conducted on a daily basis in downtown Phoenix at the translational Genomics research institute or T-Gen. We spoke with Dr. Michael Berens, T-Gen's deputy director for research resources.

Ted Simons: Good to have you here. There is 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 have learned how to read it.

Ted Simons: Is it like digitizing or digitalizing the human body?

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

Ted Simons: The high school biologies. The impact of genome impact on neurological disorders and diseases. What's happening downtown?

Michael Berens: Wow, it's an exciting time. I think one of the most exciting thing that we have seen in the last maybe two or three years is that of T-Gen, has been a strategy to better understand people who let us look at their genetic code in the context of how their memory works, so T-Gen has a website that's called mindcrowd.org. We have had over 30,000 people come onto that website, and they take a memory test, very simple, and 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. There have been some amazingly exciting things. We're very interested in the healthy aging brain, as well as the brain that does not age well. We all know people with dementia, Parkinson's, Alzheimer's Disease, so looking at the extremes, we gain 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 that the whole Arizona community should be proud of T-Gen's center for rare childhood disorders. These are families with children that were on medical legacies looking for some diagnosis, and now T-Gen is 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 the rarity, and we can find guidance on how to better care for those little ones, so that is a huge blessing for the state.

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

Michael Berens: Athletes, but just humans on the planet get bumped, 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 descriptive, and the neurologists and the E.R. staff have to work with kind of soft metrics, but we're looking for biomarkers that might be a saliva test to determine how severe of a head injury should an athlete not re-enter a game, take some time off, so we think that we're going to have healthier people as we understand the markers for the bumps.

Ted Simons: In coming years, the athlete gets injured and goes to the sidelines and do a swab activity, and you might be able to in the coming years try to figure out whether 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, you would want to know, and let them get back into the game when they are recovered from those.

Ted Simons: The pathogen studies, it sounds like to valley fever, the plague, all things in between.

Michael Berens: It's a diverse team that work with us as part of T-Gen's program at T-Gen north, our pathogen genomics division, we work with the Flagstaff community and 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 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 it's a bug, it's bad, don't let it in, but, having healthy microorganisms, or healthy micro-biomes, can have huge influences on gastro-intestinal health, so that's a fantastic resource that leverages the strength of T-Gen.

Ted Simons: The whole pro-biotics thing there.

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

Ted Simons: And again, as far as the Genomic impact, and things like kidney disease and diabetes, did the Genomic impact on those -- what are you seeing out there?

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

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

Michael Berens: That's correct. That's a whole range of who is most vulnerable and there is grades of that, 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 T-Gen approaching cancer research? Is it with an elephant gun? Or are you starting to narrow things down there?

Michael Berens: I really hope when people look at what T-Gen is doing in 2014, and we look in the rear-view mirror down the road, we'll go wow, they got out their lasers, and we took a very fine look at what makes a tumor vulnerable to the therapies that we have today, and how do you get the right chemotherapy or the right targeted therapeutic to the specific patients so that you are most likely to hurt the tumor without hurting the patient. 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 the 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, exposed to more environmental agents, cosmic rays, and various things, and so, those genomes or cancers are complicated, and it's tough to say who is the driver event, and what do we design the therapy around. Tumors in children tend to be what we call quiet. There is very little noise. It's hard to decide well, how is that even a cancer? So, it's an amazing contrast between pediatric cancers and adult cancers, but every time that 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: That's interesting because I think most people think when you are born, you have got your Genomic makeup, and your human genome is set in stone. It never changes. Are you saying that it does change?

Michael Berens: Well, it does. Our genome is affected by environmental agents, by our diet. Not necessarily the sequence of the genome that those are mutations 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 restructuring to take place. Just terribly damaging events in a very complicated system, and those changes point us in the direction on how to treat the disease.

Ted Simons: So, when this is -- this is fascinating stuff. So when you consider the future. We are 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, but also, a genomic fingerprint of the disease. Did it come from my mom and dad, so we have certain insights, but if there is 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, our training physicians of tomorrow will be groomed for this practice.

Ted Simons: Well, indeed, it is exciting. Great information. Good to have you here.

Michael Berens: Wonderful to be here. Thanks.

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

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