When it comes to bringing pharmacogenomics to the mainstream, three heads may be better than one. Or at least that’s what the state of California and the National Institutes of Health are betting on.
Recently, the University of California, San Diego, collected $7.5 million in matching funds from California and federal coffers to create a pharmacogenomics and toxicogenomics research epicenter that can supplement curricula from the university’s medical school and newly created school of pharmacy with information about these emerging fields.
The goal, according to the head of the program, is to create a corps of physicians and pharmacists that not only are not only literate in the technologies and applications of pharmacogenomics, but also can work together in the real world to apply this knowledge to patient care.
A favorable side effect from this experiment might also be a louder call for greater investment in pharmacogenomics products — from molecular diagnostics to cohort-based therapeutics — and thus greater use of genotyping and gene-expression tools.
“This is brilliant and logical,” said Bill Craumer, a spokesman for Illumina, whose headquarters in San Diego are a short walk from the UCSD campus. “It has a ‘What’s taken them this long?’ feel to it.”
Though still embryonic, the program will use part of the NIH’s $3.7 million grant to build a facility on the UCSD campus in which most of the pharmacogenomics research will take place, according to Palmer Taylor, professor of pharmacology and dean of the UCSD School of Pharmacy and Pharmaceutical Sciences. UCSD also plans to receive additional NIH funding to help pay for certain research projects, he said.
Specifically, the NIH cash will help build a warren of basement labs that will perform transgenic-animal research, analytical research, mass spectrometry, and small-scale sequencing on tissue samples collected by the UCSD medical school. Some of the money will also pay for 38 new faculty members, 15 of whom will conduct research that will “directly relate” to basic or clinical pharmacogenomics and toxicogenomics, Taylor said.
Taylor said the school is expecting to receive other funds to pay for instruments, including genotyping platforms, gene-expression technology, and proteomics tools such as mass spectrometers.
One person who has shown considerable interest in the new facility is Craig Venter. Taylor said his school and Venter’s Center for the Advancement of Genomics have penned a preliminary agreement to collaborate on certain projects.
Venter, who received his PhD in physiology and pharmacology from UCSD, broke ground at the new facility recently. According to Taylor, TCAG will provide UCSD its sequencing and analytical muscle, while TCAG will gain access to UC San Diego’s academic health-sciences center and its database of patient records, including DNA and therapeutic and disease outcomes. Taylor said TCAG will not directly contribute funding to UCSD’s pharmacogenomics project.
“The basic idea is patients’ phenotypes will be done within our patient base,” Taylor told SNPtech Reporter. TCAG will be involved in the “extensive sequencing” of candidate genes that both groups, to-gether with the medical pharmacy schools, will have identified. The groups will co-analyze these genes.
Taylor, who was visiting with Venter in TCAG’s Rockville, Md., headquarters last week, said teams from both groups have already identified candidate genes and have organized a patient database. He said the genes are mostly related to hypertension and pre-hypertensive states. Taylor said the teams are “just at the beginning stages” of collecting and sequencing patient DNA. (During several speeches to lay audiences in the past, Venter has said that his genome, one of several sequenced by Celera, contains mutations linked to cardiovascular disease. A TCAG spokeswoman did not return an e-mail seeking comment.)
A clear advantage of the UCSD facility will be logistical: It will give students in the school’s medical school and newly launched pharm-acy school the opportunity to link the products of their curricula with pharmacogenomics — something that is seldom, if ever, done at other medical or pharmacy schools.
Taylor said the “ultimate goal” is to familiarize medical-school and pharmacy-school students and newly minted MDs and PharmDs with the technology, mechanics, language, and applications of pharmacogenomics. Ultimately, he said, he wants all of the university’s life-sciences students to think within a pharmacogenomics rubric.
“The initial goal,” he explained, “is largely set up on a research basis” — the kind of work that will involve mostly fellows and PhD students. “But eventually, the outcome for the patient has to be … ‘How can you take this information [and] package it in such a way that it is understandable to the physician and the pharmacist, and develop [it] that so it can get to the individual patient, and [to] the interface between the patient and the practitioner.’
“I can envision a time when that information would be back-up information that any professional would have,” much like existing patient case files today, he said. “The whole gamut of this activity [pharmacogenomics research] has to involve the entire health-sciences center, because we can’t do the research in an ivory tower, and not have the means to disseminate that to practitioners,” Taylor said.
The current class of the UCSD School of Medicine, which has been around since 1972, has 122 students in its current class. The School of Pharmacy and Pharmaceutical Sciences, which was founded last year, will eventually have 60 students per class, said Taylor. Both schools also plan to offer PhD cour- ses, which Taylor said will eventually carry 200 combined students per class. He said the new pharmacy school will offer a pharmacogenomics-heavy curriculum in the third academic year.
Pharmacogenomics “will become a central knowledge base [for pharmacists] in the future,” said Taylor. “The whole field of pharmacogenomics has got to become integrated more into both the pharmacists’ and the physicians’ curriculum.”
To be sure, many US-based medical schools offer at least classes, and at most dedicated curricula, that focus on genetics or pharmacogenomics. The medical school of the University of Vermont, for example, has recently retooled its curriculum from the ground up and now offers a genetics track that runs through all four years of its MD program. In fact, Alan Guttmacher, deputy director of the National Human Genome Research Institute — and an early and vocal supporter of including genetics in medical-school curricula — was the school’s director for genetics at one time. In addition, the National Institute of General Medical Sciences has a pharmacogenomics-related educational network, which comprises half a dozen universities — UCSD being one of them.
Taylor said UCSD’s project, which by most accounts appears to be the first of its kind in the country, emphasizes pharmacodynamics, the branch of pharmacology that studies the interaction between drugs and tissues and organs, rather than pharmacokinetics, which studies the actions of a drug in the body, including the processes of absorption, distribution, and excretion.
Another advantage Taylor points to is what he calls the “co-education” of pharmacy and medicine students. “What we have done … is set up our coursework so that the pharmacy students take about 40 percent of the same clinical courses as the medical students,” he said. These courses include physiology, biochemistry, cell biology, pharmacology, and microbiology, he said.
“There are common courses where we think the knowledge should be essentially the same, and then there are areas where the two groups should be specialized,” he said.
Illumina’s Craumer put it more succinctly: “Pharmacogenomics has always been considered the haven of researchers as opposed to clinicians. And the reality is that you have this convergence. If a physician is practicing clinical medicine and doesn’t have a handle now or really soon on what’s going on in the world of genomics, he’s going to be obsolete.”