Dr Ramesh Hariharan, CEO, Strand Life Sciences, elaborates on his company’s future projects, growth strategies and more, in an interview with Usha Sharma
Tell us about the Strand Life Science’s strategic partnership with Quadria Capital and how will this partnership enable preventive healthcare?
Strand Life Sciences is an investee of Quadria Capital and we partnered with them in early 2018. The partnership was made with a view of redefining precision medicine by increase the accessibility and affordability of Strand’s key technology. Given their deep operating knowledge and experience of building healthcare businesses around the region, we felt that they were the right partner to help launch Strand into its next phase of growth.
Strand’s technology includes cutting-edge genomic tests for both preventive and diagnostic applications. Preventive applications include testing individuals for inherited risk of cancer (10 per cent or so of all breast and ovarian cancers have an inherited cause), so they can take preventive and prophylactic measures. Strand has a leadership position in India on this test.
Quadria’s investment has helped Strand with continued R&D to reduce the cost of this testing down to a fraction of western costs. Another emerging preventive application is that of the use of a liquid biopsy (a blood draw) for the early detection of cancer. As is well known, cure rates and survival in cancer are highest when detected early, and reduce sharply if the detection happens late. Quadria’s investment has also helped Strand continue it’s R&D programne. Strand’s first publication on this topic has just appeared in press and shows that ~35 per cent of a wide range of cancers can indeed be detected at a very early stage from just a blood draw. Strand is now in the midst of its next study on this theme, in collaboration with key academic groups in the US.
Are more and more practitioners depending on genetics to decide their treatment protocols? If yes, please elaborate and if not, what’s hindering them?
Yes. The use of genetics is increasing growing across oncology and obstetrics. For instance, the use of BRCA gene testing and testing of mutations in related genes has become standard worldwide for determining whether a breast or ovarian cancer patient should be treated using a class of drugs called PARP inhibitors, which have been approved by the FDA for BRCA mutated cancers. It is standard to test every lung cancer patient for EGFR mutations and treat them with EGFR inhibitors (or which there are multiple generations, successively targeting more mutations). Of course, gene sequencing for rare disease diagnosis and the subsequent use of pre-natal testing to determine the health of the foetus has become very standard and indeed there isn’t another way to ensure the child born is disease free.
There are other emerging applications, whose growth is currently challenged by various factors. For instance, a much broader range of mutations can be explored for targeted treatments in cancer. However, the efficacy of this process is not well understood and the rather large range of mutations and genes requires large clinical trials, which are hard to conduct. A vibrant clinical research environment can help separate the wheat from the chaff here. Of course, India presents an added challenge that molecularly targeted treatments are often very expensive given typical affordability patterns.
We have been hearing about the role of Exosomes in cancer treatment, can you throw some light on it? Can you tell us about Strand Life sciences endeavours in this area?
Exosomes are cellular organelles that carry RNA. Exosomes from dying cancer cells are released into the bloodstream (just as DNA from dying cancer cells is released). By drawing blood, extracting this DNA and RNA (from exosomes), and sequencing these to identify cancer-causing mutations, one can in principle detect cancer early. I mentioned Strand’s first publication on this topic has just appeared in press and shows that ~35 per cent of a wide range of cancers can indeed be detected at a very early stage from just a blood draw. This publication uses DNA alone; we are now in late stages of R&D with our DNA/RNA combined product that uses exosomes to obtain RNA. The advantage of adding RNA to the mix is that some mutations, particularly those that involve splicing and pasting of multiple genes, are best detectable from RNA.
The company is involved in molecular research, undertaking sponsored research projects for pharma and biotech companies, give us a brief insight on it and what are the outcomes expected from these projects?
Strand aims to carve out a very unique niche in the area of clinical research. This is a niche that combines deep expertise in laboratory analysis and in bioinformatics, with a large hospital network in India. The combination of all three elements is rare and much needed, given how clinical research is moving towards more detailed molecular measurements as well as careful analysis of the resulting data. The large pool of patients in India coupled with the high quality R&D platform at Strand provides a unique answer to the general problem of patient access which plagues the industry. Finally, patients in India get access to cutting-edge and otherwise unaffordable therapies in this process, providing the social impact that we seek in everything we do.
A few examples of projects and outcomes. One of our projects seeks to establish that the presence of oral cancer can be detected from the saliva itself (thus rendering frequent biopsies unnecessary). Another project tries to determine whether patients in India respond well to cancer therapies that suppress immune system brakes and thus enable the immune system to attack cancer cells (the topic of this year’s Nobel prize, by the way). A third project tries to establish if patients with Chronic Obstructive Pulmonary Disease have a certain immune signal that can be targeted by specific drugs.
Tell us about the emerging trends seen in the biotech industry. What are the challenges and opportunities associated with it?
There are three key trends with much promise for the future.
The first is the use of drugs/vaccines and other bioengineering methods that spur the immune system to attack and kill cancer cells. Cancer is a dynamic adversary and the use of versatile and adaptive immune system as compared to a static drug is seen as more powerful approach. This approach has seen success in some cancers like melanomas, where a fraction of patients who do not respond otherwise show a sustained response. The main challenge here is to determine who will respond and who won’t. This needs much clinical research.
The second is the use of a method called CRISPR/CAS to edit DNA in living systems to correct problematic mutations. In principle, stem cells from the bone marrow can be taken from a thalassemic patient (one in 25 in India is a carrier of a thalassemia mutation, so roughly one in 2500 births is at risk), the DNA edited to correct any problematic mutations, and then the stem cells injected back, thus providing a one-time lifelong cure. Contrast this with the monthly blood transfusion and associated complications due to iron build up leading to organ failure. The main challenge is to show that these methods are safe from other side effects and work reliably.
The third I have already referred to earlier, is the early detection of cancer from easily accessible samples like blood, saliva, urine and stool. The main challenge here is to prove in larger clinical studies that this early detection does not lead to false alarms and that it indeed leads to improved survival.
Artificial Intelligence (AI) is going to play an important role in healthcare, how keen is Strand Life Sciences on it?
Strand has been using AI right from its inception, and much before AI in its modern form became popular. We use AI to extract information from the medical vast literature, to distil down the large number of genetic variants each person has down to a meaningful few, to automate and aid complex manual processes like pathology to diagnose cancer.
Tell us about the company’s future plans?
We have built a solid and differentiated platform for diagnostics and clinical research built on the three pillars I mentioned earlier: bioinformatics, molecular measurement, and the clinical network. Our immediate plan on the commercial front is to focus on expanding our sales, marketing and operational reach.
Technology wise, we are investing in a number of areas which include early detection of cancer from blood and saliva, the use of digital pathology to provide expert and sometimes automated diagnosis, molecular profiling of markers of immune response etc. We also continue to invest in further cost optimisations of our multi-gene diagnostic tests.