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New lab is leap forward for personalized medicine

July 8, 2014

Kia Zellars is a research assistant at a new automated biomarker lab at the Columbia, S.C., VA Medical Center. (Photo by Matt Splett/USCSM)

Kia Zellars is a research assistant at a new automated biomarker lab at the Columbia, S.C., VA Medical Center. (Photo by Matt Splett/USCSM)

Long before he was an accomplished neuroscientist, Dr. Francis G. Spinale was just another medical student doing his internship. What he saw in those early days, though, would lead to his spearheading the development of an automated biomarker lab that could impact VA care nationwide.

"We were giving doses of medicine to children that were really just scaled down versions of adult medicine," remembers Spinale, now a staff physician at the WJB Dorn VA Medical Center in Columbia S.C., and distinguished professor of personalized medicine at the University of South Carolina. "It was generic, one-size-fits-all medical therapy. I wanted to see personalized treatment strategies. Of course, we didn't have the tools at our disposal then that we do now. With this equipment, personalized treatment is becoming a reality."

The equipment Spinale is talking about is a high-intensity automated biometric profiling system recently installed at Dorn. Using robotics allows the lab to measure up to 90 protein signatures out of just a thimbleful of blood. These protein signatures, or biomarkers, are the downstream effects of DNA.

The ability to measure and affect proteins

Think of it like this: If DNA is the blueprint for a building; proteins are the actual construction workers. While DNA can't be modified, according to Spinale, modern medicine can control proteins. "We can measure those proteins in the bloodstream. That not only improves our diagnostics, but will also allow us to tailor therapy to affect them."

Protein biomarkers, which are signature patterns of proteins, can tell a lot about people—not just about their potential disease risks, but about their responsiveness to specific treatments. For example, some patients respond poorly to blood thinners or cholesterol medicine. With the knowledge the gene profiling system provides, doctors will be able to identify those patients before they write a prescription.

Spinale offers an additional example: "Look at heart resynchronization therapy. Unfortunately, we put these devices into everyone with a certain type of heart failure and essentially we hope for the best. If we could tell which patients wouldn't benefit from it or [which] might do worse, then we could use personalized medicine and not only improve patient outcomes, but more efficiently use taxpayer resources for what is a very costly procedure."

Although there are several similar labs available to VA in other parts of the country, this is the first in the Southeast to feature robotics and high throughputs.

How big a difference do the robots make? "We can get the full panel back in an hour," says Spinale. "We'll be able to offer up quick diagnoses and more efficient delivery of care. We hope this will decrease wait times and increase the speed with which we deliver care to Veterans."

Partnership between VA, medical school

Because the system has the capacity to look at clusters of biomarkers, doctors will be able to get a better picture of a patient's overall health. "We're way past one protein measurement. We've found there's no magic molecule that we can measure to know everything," says Spinale. "We're looking at clusters or cassettes of proteins that give us a very specific map or signature of a patient. With this [new lab], we can do that practically and efficiently. That's why this is important."

"This new facility represents the close partnership between the faculty at the University of South Carolina School of Medicine in Columbia and the clinicians and staff at the DORN VAMC," says Dr. Marlene Wilson, who is the department chair of pharmacology, physiology, and neuroscience at the school. "We are jointly developing state-of-the-art methods for early prediction and personalized treatment for diseases that affect not only Veterans, but South Carolina patients as a whole.

"Once we establish the protocols necessary for shipping and maintaining samples, we will make it available to investigators throughout VA. More importantly, it can serve as a prototype for other facilities to develop their own robotic systems."

Dr. K. Sue Haddock, chief of research at Dorn, adds: "Personalized medicine is the next frontier for treating the Veterans who have served our country so well. We are excited about this advancement."

Spinale's team hopes to have the system fully operational and available to VA investigators in the region by fall 2014.

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