AsianScientist (Jan. 26, 2018) – Modern medicine is built on a profound understanding of diseases. However, some illnesses are more difficult to diagnose and treat than others, and cancer ranks among the most complex of diseases. With the number of new cancer cases expected to rise by about 70 percent over the next two decades, there is a clear medical need to gain deeper insights into this malicious malady and develop better therapies.
Currently, the gold standard of cancer diagnostics is histological analysis of tumor biopsies. Typically, pathologists stain these precious biological samples with specific dyes to gain a ‘sneak peek’ at the microscopic features of a patient’s tumor. Each tumor biopsy is a treasure trove of useful information, yet, conventional histology methods only allow oncologists and cancer researchers to access a limited portion of that information.
“Think of this as shining a flashlight into one corner of a dark room,” said Dr. Gideon Ho, the co-founder and CEO of HistoIndex. “You can see what’s happening in that corner, but you are blind to other events in the room that might be affecting what happens in that corner.”
Maximizing the amount of information gleaned from each tumor biopsy thus represents the next frontier of cancer diagnostics.
Seeing is believing
In the same way that we engage multiple senses to more accurately perceive the world, a multi-pronged approach to cancer diagnostics is needed. This entails gathering visual data from tumor biopsies and delving deep into the genetics of the tumors.
With its fully automated, quantitative, objective and stain-free 2D/3D imaging system—the Genesis®200—HistoIndex tackles the first half of the problem by capturing a broad range of visible features in tumor biopsies. By removing the need for staining and relying on machine vision for image analysis, the system improves the accuracy of cancer diagnosis and is better at predicting clinical outcomes than traditional methods.
More importantly, the Genesis®200 allows clinicians and researchers to view and evaluate not only the cancer cells in the tumor, but also the tumor microenvironment (TME), including the extracellular matrix, or scaffolding, which surrounds the cancer cells. Recent research has demonstrated a strong link between the properties of the TME and cancer malignancy.
In a clinical trial with the Singapore General Hospital (SGH), together with Dr. Yu Weimiao and Dr. Laurent Gole from the computational bioimage analysis unit of the Institute of Molecular and Cell Biology (IMCB), and Dr. Bernett Lee of the Singapore Immunology Network (SIgN), the Genesis®200 system revealed that some parameters of a special collagen pattern within triple-negative breast cancer tissue have the discriminate power to predict patient survival. This observation provides a novel criterion for classifying breast cancer patients, in addition to the existing hormone-based profile.
“By quantifying the amount and architecture of the collagen in triple-negative breast tumor sections, we were able to predict patient outcome,” said Ho. “The Genesis®200 is capable of discerning more than 100 other collagen-based parameters in the TME, so we’re just scratching the surface of possible clinical insights.”
Seeking synergy in sequencing
Being able to visually inspect a tumor is useful, but interrogating the genome of cancer cells could further allow researchers to tease out vulnerabilities in the tumor. Because the imaging process of the Genesis®200 is non-destructive, the sample remains intact and can be used for subsequent analyses, such as next-generation sequencing (NGS).
“Instead of looking at one gene at a time, NGS will give a snapshot of the whole genomic profile of a patient’s tumor,” said Ho. “If we couple this with the imaging data from the Genesis®200 and clinicopathological parameters, we can derive a holistic understanding of what drives tumor malignancy.”
Hence, to create an integrative diagnostics platform for molecular cancer research, HistoIndex has teamed up with Pathomics Health, a digital healthcare solutions company headquartered in Kuala Lumpur that provides clinical testing, digital pathology imaging, and NGS services. The joint laboratory is located at the University of Malaya and will work closely with both public and private oncology centers locally and in the region.
Dr. Ron Tan, Scientific Consultant at Pathomics Health, said that HistoIndex’s state-of-the-art diagnostic imaging capabilities complement cutting-edge genomic sequencing technologies and will help establish a new standard in cancer diagnosis and research.
“This integrated workflow is an epitome of a ‘1+1 = 3’ scenario, where a single piece of unstained tissue can be processed to provide extensive content and structural information histologically and also at the genomic level,” Tan explained. “Combining that with the expertise and interpretation from the clinicians at the University of Malaya, the generated data can be translated into clinically actionable outcomes targeted to the individual patient.”
The long-term goal of the partnership is to enable personalized medicine, where anticancer treatments are customized for patients based on their tumor profile.
“A persistent problem in cancer therapy is the variability of patient responses to the same drug,” said Ho. “Our integrative diagnostics approach will lead the shift away from a one-size-fits-all treatment regime and optimize therapy for cancer patients.”
Asian Scientist Magazine is a media partner of HistoIndex.
Copyright: Asian Scientist Magazine; Photo: SGH, IMCB and SIgN. Second harmonic generation/two-photon excitation microscopy multiplex images were merged by Dr. Laurent Gole.
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