A slide from J. Craig Venter's recent study on facial prediction presented at the Summit Conference in Los Angeles on Nov. 3, 2017.
Renowned genetics pioneer Dr. J Craig Venter is no stranger to controversy.
Back in 2000, he famously raced the public Human Genome Project to decode all three billion letters of the human genome for the first time. A decade later, he ignited a new debate when his team created a bacterial cell with a synthesized genome.
Most recently, he's jumped back into the fray with a study in the September issue of the Proceedings of the National Academy of Sciences about the predictive potential of genomic data to identify individual traits such as voice, facial structure and skin color.
The new study raises significant questions about the privacy of genetic data.
His study applied whole-genome sequencing and statistical modeling to predict traits in 1,061 people of diverse ancestry. His approach aimed to reconstruct a person's physical characteristics based on DNA, and 74 percent of the time, his algorithm could correctly identify the individual in a random lineup of 10 people from his company's database.
While critics have been quick to cast doubt on the plausibility of his claims, the ability to discern people's observable traits, or phenotypes, from their genomes may grow more precise as technology improves, raising significant questions about the privacy and usage of genetic information in the long term.
J. Craig Venter showing slides from his recent study on facial prediction at the Summit Conference in Los Angeles on Nov. 3, 2017.
(Courtesy of Kira Peikoff)
Critics: Study Was Incomplete, Problematic
Before even redressing these potential legal and ethical considerations, some scientists simply said the study's main result was invalid. They pointed out that the methodology worked much better in distinguishing between people of different ethnicities than those of the same ethnicity. One of the most outspoken critics, Yaniv Erlich, a geneticist at Columbia University, said, "The method doesn't work. The results were like, 'If you have a lineup of ten people, you can predict eight."
Erlich, who reviewed Venter's paper for Science, where it was rejected, said that he came up with the same results—correctly predicting eight of ten people—by just looking at demographic factors such as age, gender and ethnicity. He added that Venter's recent rebuttal to his criticism was that 'Once we have thousands of phenotypes, it might work better.' But that, Erlich argued, would be "a major breach of privacy. Nobody has thousands of phenotypes for people."
Other critics suggested that the study's results discourage the sharing of genetic data, which is becoming increasingly important for medical research. They go one step further and imply that people's possible hesitation to share their genetic information in public databases may actually play into Venter's hands.
Venter's own company, Human Longevity Inc., aims to build the world's most comprehensive private database on human genotypes and phenotypes. The vastness of this information stands to improve the accuracy of whole genome and microbiome sequencing for individuals—analyses that come at a hefty price tag. Today, Human Longevity Inc. will sequence your genome and perform a battery of other health-related tests at an entry cost of $4900, going up to $25,000. Venter initially agreed to comment for this article, but then could not be reached.
"The bigger issue is how do we understand and use genetic information and avoid harming people."
Opens Up Pandora's Box of Ethical Issues
Whether Venter's study is valid may not be as important as the Pandora's box of potential ethical and legal issues that it raises for future consideration. "I think this story is one along a continuum of stories we've had on the issue of identifiability based on genomic information in the past decade," said Amy McGuire, a biomedical ethics professor at Baylor College of Medicine. "It does raise really interesting and important questions about privacy, and socially, how we respond to these types of scientific advancements. A lot of our focus from a policy and ethics perspective is to protect privacy."
McGuire, who is also the Director of the Center for Medical Ethics and Health Policy at Baylor, added that while protecting privacy is very important, "the bigger issue is how do we understand and use genetic information and avoid harming people." While we've taken "baby steps," she said, towards enacting laws in the U.S. that fight genetic determinism—such as the Genetic Information and Nondiscrimination Act, which prohibits discrimination based on genetic information in health insurance and employment—some areas remain unprotected, such as for life insurance and disability.
J. Craig Venter showing slides from his recent study on facial prediction at the Summit Conference in Los Angeles on Nov. 3, 2017.
(Courtesy of Kira Peikoff)
Physical reconstructions like those in Venter's study could also be inappropriately used by law enforcement, said Leslie Francis, a law and philosophy professor at the University of Utah, who has written about the ethical and legal issues related to sharing genomic data.
"If [Venter's] findings, or findings like them, hold up, the implications would be significant," Francis said. Law enforcement is increasingly using DNA identification from genetic material left at crime scenes to weed out innocent and guilty suspects, she explained. This adds another potentially complicating layer.
"There is a shift here, from using DNA sequencing techniques to match other DNA samples—as when semen obtained from a rape victim is then matched (or not) with a cheek swab from a suspect—to using DNA sequencing results to predict observable characteristics," Francis said. She added that while the former necessitates having an actual DNA sample for a match, the latter can use DNA to pre-emptively (and perhaps inaccurately) narrow down suspects.
"My worry is that if this [the study's methodology] turns out to be sort-of accurate, people will think it is better than what it is," said Francis. "If law enforcement comes to rely on it, there will be a host of false positives and false negatives. And we'll face new questions, [such as] 'Which is worse? Picking an innocent as guilty, or failing to identify someone who is guilty?'"
Risking Privacy Involves a Tradeoff
When people voluntarily risk their own privacy, that involves a tradeoff, McGuire said. A 2014 study that she conducted among people who were very sick, or whose children were very sick, found that more than half were willing to share their health information, despite concerns about privacy, because they saw a big benefit in advancing research on their conditions.
"We've focused a lot of our policy attention on restricting access, but we don't have a system of accountability when there's a breach."
"To make leaps and bounds in medicine and genomics, we need to create a database of millions of people signing on to share their genetic and health information in order to improve research and clinical care," McGuire said. "They are going to risk their privacy, and we have a social obligation to protect them."
That also means "punishing bad actors," she continued. "We've focused a lot of our policy attention on restricting access, but we don't have a system of accountability when there's a breach."
Even though most people using genetic information have good intentions, the consequences if not are troubling. "All you need is one bad actor who decimates the trust in the system, and it has catastrophic consequences," she warned. That hasn't happened on a massive scale yet, and even if it did, some experts argue that obtaining the data is not the real risk; what is more concerning is hacking individuals' genetic information to be used against them, such as to prove someone is unfit for a particular job because of a genetic condition like Alzheimer's, or that a parent is unfit for custody because of a genetic disposition to mental illness.
Venter, in fact, told an audience at the recent Summit conference in Los Angeles that his new study's approach could not only predict someone's physical appearance from their DNA, but also some of their psychological traits, such as the propensity for an addictive personality. In the future, he said, it will be possible to predict even more about mental health from the genome.
What is most at risk on a massive scale, however, is not so much genetic information as demographic identifiers included in medical records, such as birth dates and social security numbers, said Francis, the law and philosophy professor. "The much more interesting and lucrative security breaches typically involve not people interested in genetic information per se, but people interested in the information in health records that you can't change."
Hospitals have been hacked for this kind of information, including an incident at the Veterans Administration in 2006, in which the laptop and external hard drive of an agency employee that contained unencrypted information on 26.5 million patients were stolen from the employee's house.
So, what can people do to protect themselves? "Don't share anything you wouldn't want the world to see," Francis said. "And don't click 'I agree' without actually reading privacy policies or terms and conditions. They may surprise you."
Today's podcast guest, Dr. Renee Wegrzyn, directs ARPA-H, a new agency formed last year to spearhead health innovations. Time will tell if ARPA-H will produce advances on the level of its fellow agency, DARPA.
Listen on Apple | Listen on Spotify | Listen on Stitcher | Listen on Amazon | Listen on Google
How will the agency figure out which projects to take on, especially with so many patient advocates for different diseases demanding moonshot funding for rapid progress?
I talked with Dr. Wegrzyn about the opportunities and challenges, what lessons ARPA-H is borrowing from Operation Warp Speed, how she decided on the first ARPA-H project that was announced recently, why a separate agency was needed instead of reforming HHS and the National Institutes of Health to be better at innovation, and how ARPA-H will make progress on disease prevention in addition to treatments for cancer, Alzheimer’s and diabetes, among many other health priorities.
Dr. Wegrzyn’s resume leaves no doubt of her suitability for this role. She was a program manager at DARPA where she focused on applying gene editing and synthetic biology to the goal of improving biosecurity. For her work there, she received the Superior Public Service Medal and, in case that wasn’t enough ARPA experience, she also worked at another ARPA that leads advanced projects in intelligence, called I-ARPA. Before that, she ran technical teams in the private sector working on gene therapies and disease diagnostics, among other areas. She has been a vice president of business development at Gingko Bioworks and headed innovation at Concentric by Gingko. Her training and education includes a PhD and undergraduate degree in applied biology from the Georgia Institute of Technology and she did her postdoc as an Alexander von Humboldt Fellow in Heidelberg, Germany.
Dr. Wegrzyn told me that she’s “in the hot seat.” The pressure is on for ARPA-H especially after the need and potential for health innovation was spot lit by the pandemic and the unprecedented speed of vaccine development. We'll soon find out if ARPA-H can produce gamechangers in health that are equivalent to DARPA’s creation of the internet.
Show links:
ARPA-H - https://arpa-h.gov/
Dr. Wegrzyn profile - https://arpa-h.gov/people/renee-wegrzyn/
Dr. Wegrzyn Twitter - https://twitter.com/rwegrzyn?lang=en
President Biden Announces Dr. Wegrzyn's appointment - https://www.whitehouse.gov/briefing-room/statement...
Leaps.org coverage of ARPA-H - https://leaps.org/arpa/
ARPA-H program for joints to heal themselves - https://arpa-h.gov/news/nitro/ -
ARPA-H virtual talent search - https://arpa-h.gov/news/aco-talent-search/
Dr. Renee Wegrzyn was appointed director of ARPA-H last October.
Tardigrades can completely dehydrate and later rehydrate themselves, a survival trick that scientists are harnessing to preserve medicines in hot temperatures.
Formulating biologics to withstand drying and hot temperatures has been the holy grail for pharmaceutical researchers for decades. It’s a hard feat to manage. “Biologic pharmaceuticals are highly efficacious, but many are inherently unstable,” says Thomas Boothby, assistant professor of molecular biology at University of Wyoming. Therefore, during storage and shipping, they must be refrigerated at 2 to 8 degrees Celsius (35 to 46 degrees Fahrenheit). Some must be frozen, typically at -20 degrees Celsius, but sometimes as low -90 degrees Celsius as was the case with the Pfizer Covid vaccine.
For Covid, fewer than 73 percent of the global population received even one dose. The need for refrigerated or frozen handling was partially to blame.
The costly cold chain
The logistics network that ensures those temperature requirements are met from production to administration is called the cold chain. This cold chain network is often unreliable or entirely lacking in remote, rural areas in developing nations that have malfunctioning electrical grids. “Almost all routine vaccines require a cold chain,” says Christopher Fox, senior vice president of formulations at the Access to Advanced Health Institute. But when the power goes out, so does refrigeration, putting refrigerated or frozen medical products at risk. Consequently, the mRNA vaccines developed for Covid-19 and other conditions, as well as more traditional vaccines for cholera, tetanus and other diseases, often can’t be delivered to the most remote parts of the world.
To understand the scope of the challenge, consider this: In the U.S., more than 984 million doses of Covid-19 vaccine have been distributed so far. Each one needed refrigeration that, even in the U.S., proved challenging. Now extrapolate to all vaccines and the entire world. For Covid, fewer than 73 percent of the global population received even one dose. The need for refrigerated or frozen handling was partially to blame.
Globally, the cold chain packaging market is valued at over $15 billion and is expected to exceed $60 billion by 2033.
Adobe Stock
Freeze-drying, also called lyophilization, which is common for many vaccines, isn’t always an option. Many freeze-dried vaccines still need refrigeration, and even medicines approved for storage at ambient temperatures break down in the heat of sub-Saharan Africa. “Even in a freeze-dried state, biologics often will undergo partial rehydration and dehydration, which can be extremely damaging,” Boothby explains.
The cold chain is also very expensive to maintain. The global pharmaceutical cold chain packaging market is valued at more than $15 billion, and is expected to exceed $60 billion by 2033, according to a report by Future Market Insights. This cost is only expected to grow. According to the consulting company Accenture, the number of medicines that require the cold chain are expected to grow by 48 percent, compared to only 21 percent for non-cold-chain therapies.
Tardigrades to the rescue
Tardigrades are only about a millimeter long – with four legs and claws, and they lumber around like bears, thus their nickname – but could provide a big solution. “Tardigrades are unique in the animal kingdom, in that they’re able to survive a vast array of environmental insults,” says Boothby, the Wyoming professor. “They can be dried out, frozen, heated past the boiling point of water and irradiated at levels that are thousands of times more than you or I could survive.” So, his team is gradually unlocking tardigrades’ survival secrets and applying them to biologic pharmaceuticals to make them withstand both extreme heat and desiccation without losing efficacy.
Boothby’s team is focusing on blood clotting factor VIII, which, as the name implies, causes blood to clot. Currently, Boothby is concentrating on the so-called cytoplasmic abundant heat soluble (CAHS) protein family, which is found only in tardigrades, protecting them when they dry out. “We showed we can desiccate a biologic (blood clotting factor VIII, a key clotting component) in the presence of tardigrade proteins,” he says—without losing any of its effectiveness.
The researchers mixed the tardigrade protein with the blood clotting factor and then dried and rehydrated that substance six times without damaging the latter. This suggests that biologics protected with tardigrade proteins can withstand real-world fluctuations in humidity.
Furthermore, Boothby’s team found that when the blood clotting factor was dried and stabilized with tardigrade proteins, it retained its efficacy at temperatures as high as 95 degrees Celsius. That’s over 200 degrees Fahrenheit, much hotter than the 58 degrees Celsius that the World Meteorological Organization lists as the hottest recorded air temperature on earth. In contrast, without the protein, the blood clotting factor degraded significantly. The team published their findings in the journal Nature in March.
Although tardigrades rarely live more than 2.5 years, they have survived in a desiccated state for up to two decades, according to Animal Diversity Web. This suggests that tardigrades’ CAHS protein can protect biologic pharmaceuticals nearly indefinitely without refrigeration or freezing, which makes it significantly easier to deliver them in locations where refrigeration is unreliable or doesn’t exist.
The tricks of the tardigrades
Besides the CAHS proteins, tardigrades rely on a type of sugar called trehalose and some other protectants. So, rather than drying up, their cells solidify into rigid, glass-like structures. As that happens, viscosity between cells increases, thereby slowing their biological functions so much that they all but stop.
Now Boothby is combining CAHS D, one of the proteins in the CAHS family, with trehalose. He found that CAHS D and trehalose each protected proteins through repeated drying and rehydrating cycles. They also work synergistically, which means that together they might stabilize biologics under a variety of dry storage conditions.
“We’re finding the protective effect is not just additive but actually is synergistic,” he says. “We’re keen to see if something like that also holds true with different protein combinations.” If so, combinations could possibly protect against a variety of conditions.
Commercialization outlook
Before any stabilization technology for biologics can be commercialized, it first must be approved by the appropriate regulators. In the U.S., that’s the U.S. Food and Drug Administration. Developing a new formulation would require clinical testing and vast numbers of participants. So existing vaccines and biologics likely won’t be re-formulated for dry storage. “Many were developed decades ago,” says Fox. “They‘re not going to be reformulated into thermo-stable vaccines overnight,” if ever, he predicts.
Extending stability outside the cold chain, even for a few days, can have profound health, environmental and economic benefits.
Instead, this technology is most likely to be used for the new products and formulations that are just being created. New and improved vaccines will be the first to benefit. Good candidates include the plethora of mRNA vaccines, as well as biologic pharmaceuticals for neglected diseases that affect parts of the world where reliable cold chain is difficult to maintain, Boothby says. Some examples include new, more effective vaccines for malaria and for pathogenic Escherichia coli, which causes diarrhea.
Tallying up the benefits
Extending stability outside the cold chain, even for a few days, can have profound health, environmental and economic benefits. For instance, MenAfriVac, a meningitis vaccine (without tardigrade proteins) developed for sub-Saharan Africa, can be stored at up to 40 degrees Celsius for four days before administration. “If you have a few days where you don’t need to maintain the cold chain, it’s easier to transport vaccines to remote areas,” Fox says, where refrigeration does not exist or is not reliable.
Better health is an obvious benefit. MenAfriVac reduced suspected meningitis cases by 57 percent in the overall population and more than 99 percent among vaccinated individuals.
Lower healthcare costs are another benefit. One study done in Togo found that the cold chain-related costs increased the per dose vaccine price up to 11-fold. The ability to ship the vaccines using the usual cold chain, but transporting them at ambient temperatures for the final few days cut the cost in half.
There are environmental benefits, too, such as reducing fuel consumption and greenhouse gas emissions. Cold chain transports consume 20 percent more fuel than non-cold chain shipping, due to refrigeration equipment, according to the International Trade Administration.
A study by researchers at Johns Hopkins University compared the greenhouse gas emissions of the new, oral Vaxart COVID-19 vaccine (which doesn’t require refrigeration) with four intramuscular vaccines (which require refrigeration or freezing). While the Vaxart vaccine is still in clinical trials, the study found that “up to 82.25 million kilograms of CO2 could be averted by using oral vaccines in the U.S. alone.” That is akin to taking 17,700 vehicles out of service for one year.
Although tardigrades’ protective proteins won’t be a component of biologic pharmaceutics for several years, scientists are proving that this approach is viable. They are hopeful that a day will come when vaccines and biologics can be delivered anywhere in the world without needing refrigerators or freezers en route.