Spotlight: Eric J. Topol wants to prevent your heart attack while changing the future of healthcare
Heart attack. No two words cause as much anxiety and fear. Heart attacks often come on seemingly without warning, and by the time you have symptoms it can be too late. What if you had advance notice, weeks or months ahead, that something was happening in your cells that could result in a heart attack?
Eric J. Topol is the Founder and Director of the Scripps Translational Science Institute (STSI) and a practicing cardiologist with Scripps Clinic whose principal scientific focus has been on the genomic and digital tools being developed to individualize medicine, known more familiarly as personalized or precision medicine. A pioneer in the field of cardiovascular medicine, he has published over 1,100 peer-reviewed articles as a researcher, and with more than 170,000 citations, is one of the top 10 most cited researchers in medicine.
Going beyond symptoms
Despite advances in modern medicine, it is difficult, if not impossible, to predict a heart attack if there have been no pre-diagnosed symptoms. Topol’s research is focused on genetic biomarkers for heart disease to identify pre-symptomatic changes far in advance of a heart event. Biomarkers can indicate a genetic predisposition to a disease, and can be used to trace changes at the cellular level that occur when an artery has become clogged.
As opposed to current approaches that assess lifestyle and health risk factors as predictors, or treat patients based on symptoms that have already become present, Topol looks deeper in search of cellular cues that an artery has been damaged, the first stage in a series of processes leading up to a heart attack.
With over three million people entering emergency rooms each year for heart attack symptoms like chest heaviness and pain, healthcare costs are enormous. Topol’s research has focused on the genomic signature of the cells from a damaged artery wall in order to design a blood test that can quickly determine if someone is at risk of heart attack far in advance of expensive treatments.
Predicting heart attacks using precision medicine
When an artery is damaged, most likely as a result of cholesterol, a crack develops. The body’s immune system recognizes the injury, and sends cells to repair the damage. However, over days or weeks, a clot forms as the body attempts to seal up the artery. This healing process is detrimental as the cholesterol plug eventually blocks blood supply to the heart causing pain and heart attack.
When this process happens, the cells that are shed from the artery wall are conspicuous since they differ from healthy blood cells, and have a specific genetic signature. Researchers are able to easily identify these cells, but there is no real-time test for these cells to be given to predict a heart event. Topol’s futuristic vision is the creation of a test that would monitor the blood to detect these cells using nanochip technology.
This nanochip would be inserted in the blood, such as in a vein at the wrist, to identify the specific cells present in the bloodstream. The nanochip would alert doctors that the cells were present, enabling them to intervene early to prevent the development of symptoms that lead to heart attack. This personalization is at the core of precision medicine, which aims to customize healthcare by tailoring medical decisions, practices and products to the individual patient. It takes into account the individual, and understands that the “one-size-fits-all” current approach to medicine is severely flawed.
Topol and his group are very close to developing the precision medicine nano-sensor blood test. The technology could also be used to detect other diseases like cancer and diabetes. Another goal of Topol’s research is the development of a preventative heart disease vaccine that could transform heart disease by targeting the immune system’s response to injuries in the arterial walls.
The future of digital medicine
In 2016, Topol was awarded a $270M grant from the NIH to lead a significant part of the Precision Medicine Initiative, a research program that involves a group (cohort) of at least one million Americans. Topol’s precision medicine approach can also be called digital medicine, because the technology he would use in the blood is basically a tiny machine that would produce digital data. Topol hopes to see a continued “digital revolution” in the healthcare industry that will transform the way we identify, treat and manage disease.
A proponent of electronic medical records, Topol advocates making medical records easily accessible to doctors in real-time, as well as being accessible to patients. In many ways, progress for creation and adoption of new digital health technologies is too slow, and not even on par with the rate of smartphone technology. Topol has stated that it’s up to consumers to demand development of digital technologies. From that perspective, Topol is both guru and innovator, whose vision of personalized medicine is poised to change the future of healthcare.
Digital revolution in antiquated health-care industry a major operation. (2012, July 4). In Financial Post. Retrieved from http://business.financialpost.com/technology/digital-revolution-in-antiquated-health-care-industry-a-major-operation
Eric Topol. (n.d.) In Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Eric_Topol
Eric Topol MD. (n.d.) Scripps Translational Science Institute https://www.stsiweb.org/about/faculty/topol-eric/