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Genefron Personalized Medicine Diagnostic July 2013 Because Response to Interferon is Personal Genefron LTD Team Genefron Ltd. is an Israeli based, privately held company company that specializes in the development of in-vitro diagnostic kits for personalized medicine. Our Team: CEO Yaniv Kotler, MSC, LLB Bioinformatics Management – Yoav Smith, PhD (Genomic Data Analysis Unit, Hebrew University, Jerusalem) Business Development – Jack Lahav, Livingston NJ. CFO - Orit Kotler, MBA. Project Manager - Shlomo Pundak, PhD Clinical trials – conducted at : Sheba Medical Center, Tel Aviv, and Shaare Zedek Medical center, Jerusalem. Hepatitis C virus (HCV) INF signal INF treatment Direct Antiviral Agents Pi’s, Pol-i. INF induced genes personal gene expression Innate immune response: RNAase, Ubiquitin etc INF induced genes - PGE (personal gene expression) INF signal Nucleus Personal gene expression signature mRNA Proteins – virus degradation The Problem and the Technology 1.5% of WW population is infected with HCV. Currently only about 50% of the Caucasians, 30% of Asians and 80% of the Afro-Americans a HCV patients are non responders to the PEGylated IFNa treatment. Non-responders and relapsed patients report severe adverse effects and incur long and expensive treatments with minimal clinical results. Genefron’ s qRT PCR Diagnostic kit, IFR10, from liver tissue or blood samples measuring INF personal gene expression (PGE) signature can identify responders /non responders with ~ 96% accuracy will have an immediate and profound influence on MDs' decision of a specific patient optimal treatment, feasible outcome and cost. IFR10 Diagnostics kit Massive Data-Methylation, DNA, RNA,MICROARRAY, SNP …It’s for Giants Bioinformatics Genefron’s breakthrough discovery is a verifiable and highly accurate platform algorithm for scanning extremely large databases that can be applied into various fields. This algorithm is designed to find mathematical connections and characters allowing identifying the desired group within the tested large databases. Using our algorithm, we examined results from microarray data experiments by comparing responders to non responders and searching for a small list of genes and their particular importance within the liver tissue to the IFN responsiveness and consequently the treatment’s ultimate outcome. Team Race Algorithm outcome Gene race Top 10 genes Results of gene expression analysis 3 situations: Healthy - No infection = no Personal Gene Signature (PGE) After Infection = “natural” PGE: non responders = high genes expression Responders = low gene expression After Infection + INF treatment = max PGE 600 500 gene expression level 400 300 200 100 0 INF Non Responders healthy responders HCV Test Validation & Verification The personal genomic expression (PGE) signature was verified on data from more than 160 HCV type 1 patients studies from Canada, USA, EU and Japan. The PGE signature has been verified on FFPE liver tissue (23 samples). Proof of concept has been achieved on the actual qRT-PCR procedure 36 Swiss patients. Diagnostic kit ingredients and PGE signature have been verified on frozen tissue samples for FDA and CE certification 95% 89% 95% 95% HCV Responders vs. Non responders Identification using PGE Example 1: We have used our algorithm on published RT PCR data (Dill et. al. Lausanne SW, 2011) which included 27 patients (X axis), RT-PCR – liver tissue, HCV Type 1 prior to PEG INF treatment. The patients presents various PGE signature (Y axis). The results identified 2 major groups responders (red) and non responders (blue) in 96% accuracy. 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Personal Gene Expression . ROC curve Random classifier Cut-off point ROC curve Random classifier Cut-off point 1 0.8 0.6 0.4 0.2 0 0 0.5 1 False positive rate (1-Specificity) Mirrored ROC curve True positive rate (Sensitivity) True positive rate (Sensitivity) ROC curve 1 0.8 0.6 0.4 0.2 0 0 0.5 1 True negative rate (Specificity) Example 1: Dill et.al. Lausanne SW, 2011. data after analysis ROC curve Genefron invention in HCV treatment – Liver Biopsy Identified PGE signature by qRT PCR about 95% accuracy + cost efficiency Genefron Diagnosis test II for non responders for Treatment prediction with a defined treatment Genefron diagnostic TEST I: kit used prior to treatment Diagnosed HCV patient Responder IFNα protocol Non responder DAA+ IFNα Personal treatment protocol per PGE with IFNα (low cost) Personal treatment protocol per PGE Personal Treatment Adjustment Personal Treatment Adjustment Using the PGE of a patient and a second novel algorithm we are developing a new method for adjustment of Personal Treatment (PT) including Interferon with/without combination of the new DAA medications. This approach will give the physician a new tool to tailor a specific treatment course base on the genomic information of the patient. Cost efficiency – Israel (example) SOC in Israel: IFN treatment (estimated 2000- 2500 patient per year), Budget ~$30M If negative IFN+DAA (512 patient per year), Budget ~$12M Potential saving: We estimate that at least 96% of the non responders can skip IFN treatment . ~ 1200 patients X $15K =$18M Test cost ~$600. ($1.5M). Saving of $16.5M Global market $2.9 B is INFα (mostly for HCV) WW market. $1.3 B saving today USA +EU can save today ~$1B$. $20B global market for hepatitis C therapies expected to be by the end of the decade – meaning $17.3B expense on DAA (nature) Using our technology can reduce dramatically the market to ~$11B. More PGE Signature Implications Multiple sclerosis (MS) patients may be treated by IFN-b. We have identified the responders and nonresponders patient populations correlates to MD diagnosis.14 before 24hr after 12 10 WW market $5.6B. Estimated saving: $1.2B 8 6 4 2 0 nr_1 nr_2 nr_3 nr_4 nr_5 nr_6 nr_7 r_1 r_2 r_3 r_4 r_5 r_6 before r_7 r_8 MS patients- the graph represent 15 patients (X axis) PGE Signature Genes (Y axis) before and 24h after IFN-b treatment. Notice the expression “shutdown” in the non responders: Algorithm implications Dengue Boxplot of 3 genes (g1-g3, X axis) expression (QRT-PCR units) in PBMC samples of 9 patients, 4 days post infection comparing uncomplicated cases vs. Dengue syndrome shock patients. The red line resemble the average expression of the group Healthy volunteers 7 healthy volunteers (X- axis) donated PBMC samples before treatment with Poly C adjuvant and PBMC samples were taken 24 h post treatment. The change (delta E) in expression (Y axis) was measured in 4 genes (g1-g4). Note i307, i308 as non responders for future IFN treatment. Genefron LTD overview Genefron Intellectual property (IP) includes: 1 granted patent 2 PCT applications 3 patent application in various stages All granted exclusively to Genefron by the Hebrew University in Jerusalem, Israel. CE: Genefron has passed BSI (Notified body) for obtaining CE mark. Expected date 1/9/13 FDA: Pre IDE meeting was held with the FDA. The company intends to begin its PMA route in 07/13, in full cooperation with the FDA CLIA : Genefron intends to market its product using CLIA route in the second half of 2013