GENOMICS Precision medicine: paving the way to better healthcare in

Dr Lotfi Chouchane tells International Innovation about Qatar scientists’ groundbreaking efforts to bring precision medicine to the nation, outlining the potential advantages it holds and the challenges that lie ahead

Precision medicine represents a tailored small size of the Qatari population and the lagged behind. This is reflected in the modest response to an individual’s healthcare needs. recent launch of Qatar Genome Project will presence of biotech companies in the Qatar What are the more specific benefits of this reinforce the implementation of a precision Science & Technology Park. approach for a population such as that medicine programme. of Qatar? What are the challenges surrounding What were the main objectives of launching precision medicine, including cultural The Qatari population is small, comprising the Qatar Genome Project? misconceptions and difficulties in about 300,000 individuals. We showed capacity building? recently that it is genetically diverse; at Qatar not only wants to provide accessible least three different genetic signatures were healthcare services to the entire population The most challenging task is how to convince identified, reflecting the history of human but also to deliver precision medicine and healthcare practitioners of the attractiveness migration to Qatar. Similar population healthcare services managed according to of precision medicine for their daily practice. stratification is expected to be found in other world-class standards. The Qatar Genome Without their buying into it, it would be difficult (GCC) populations. Project is an ambitious programme that to make patients adhere and contribute to the This genetic diversity will undoubtedly aims to provide whole genome sequences success of the programme. have significant implications in terms of for the entire Qatari population to deliver precision medicine. personalised healthcare. It will chart a Misperception of genomics studies by the roadmap for future treatment through community and fear of stigmatisation can be Why do you think the implementation of a precision medicine. an additional challenge. That being said, based precision medicine programme is likely to on my own experience, patients in Qatar are succeed in Qatar? Could you discuss the correlation between very respectful of their physician’s opinion and the integration of genomic technologies keen to participate in medical research. Islamic There are many factors. The mainstay and healthcare, and the development of a studies scholars could enlighten the community being the vision and the commitment from knowledge-based economy? about the benefits of precision medicine and the leadership of the country to dedicate dissipate any concerns regarding compliance to resources for the implementation of world- The conception of multiple research centres their beliefs and Islamic principles. class standards in healthcare, higher and branch campuses of prestigious education and research. The conception of universities embodies the national vision to With the launch of the Qatar Genome Project, the by the Father Emir turn Qatar into a knowledge-based economy new avenues could be opened for the biotech HH Sheikh Hamad Bin Khalifa Al-Thani on par with the most technologically advanced and pharmaceutical industries. The effective and HH Sheikha Moza Bint Nasser was the countries. In order to implement this vision, application of precision medicine in Qatar could initial translation of this vision. Currently, Qatar has committed 2.8 per cent of its improve population health and the development world-class healthcare and research Government revenues to R&D. Qatar has of a knowledge-based economy. Seeing Qatar facilities are available. Furthermore, Qatar already made significant achievements in as a potential hub to GCC and other markets, is attracting, through various initiatives and several disciplines such as engineering, biotech and pharmaceuticals companies from projects, world-renowned physicians and computing, transportation and information the US and Japan have already expressed their researchers who in turn are heavily investing technology, but, due to the complicated interest in setting up joint business ventures in local capacity building. Finally, the infrastructure required, biotechnology has in Qatar.

www.internationalinnovation.com 1 Genomic signature and diseases

Researchers at Weill Cornell Medicine-Qatar are collaborating with colleagues, at both the national and international level, to bring world-leading precision medicine to the Qatari population

QATAR MAY BE small, but it boasts the According to the World Health Organization inducing brown fat production in adults, third largest natural gas and oil reserves in (WHO)’s most recent statistics, 73 per cent of which could have therapeutic potential for the the world. This wealth has enabled Qatar to Qatari men and 70 per cent of Qatari women treatment and/or prevention of obesity and build up a high-income economy and achieve are overweight. obesity-associated conditions. the highest per capita income globally. As a result of this, in the space of just a few Obesity is associated with dangerous Chouchane is quick to underline that any generations, Qataris’ lifestyles and diets have conditions such as diabetes, cardiovascular findings to emerge from this work are also changed significantly. Unfortunately, some of disease and cancer, and as such represents likely to have impact at the individual level: these changes have had negative impacts on a major threat to the population. “The lack of “The ultimate goals of these studies fit those of public health. knowledge about genetic and environmental precision medicine,” he asserts. risk factors in certain populations that Precision medicine is a healthcare model in are disproportionately affected by obesity, CANCER IN QATAR which care is personalised to the patient, with such as the Qatari population, is a critical Another area in which Chouchane feels therapies and treatment plans being selected unmet research and public health need,” precision medicine could bring about based on individual genetic, molecular or Chouchane states. significant health benefits in Qatar is the cellular factors. At Weill Cornell Medicine- treatment of cancer. Breast cancer is a Qatar, Dr Lotfi Chouchane, a professor of Work is therefore underway to address particularly prominent example, as it is genetic medicine and immunology, is one of this knowledge shortfall. Chouchane and the most frequently diagnosed malignant a growing number of health professionals his colleagues are engaging in extensive disease affecting Arab women. Importantly, dedicated to the promotion of precision collaboration, both with other leading institutes breast cancer has been shown to manifest medicine in Qatar as a tool for tackling some of in Qatar and further afield, with the aim of itself differently among Arab women than in the country’s most urgent health challenges. identifying epidemiological risk factors and European and US populations; women in Arab genomic signatures associated with obesity populations are more likely to be diagnosed OBESITY: A GROWING PROBLEM (both its onset and progression) in the Qatari with breast cancer at a younger age, to be One major public health concern in Qatar is population. Additional research is also in at a more advanced disease stage at first the rapid increase in the prevalence of obesity. progress to identify molecules capable of presentation and to have a larger tumour.

2 INTERNATIONAL INNOVATION QATAR HEADING TOWARD PRECISION MEDICINE The reasons for these racial disparities are diverse, and include a range of socioeconomic, OBJECTIVE psychological, environmental and genetic To establish precision medicine as a healthcare model factors. Chouchane’s research focuses largely in Qatar to address urgent health challenges such as on the genetic aspects of breast cancer in Arab cancer, obesity and diabetes. populations. For example, his group recently PARTNERS discovered that a specific protein – known as Sidra Medical and Research Center, Qatar • Hamad BAD protein – plays a significant role in the Medical Corporation, Qatar • Primary Health Care survival and renewal of certain cancer stem Corporation, Qatar • Supreme Council of Health, Qatar cells, even following conventional anticancer • Qatar Biomedical Research Institute (QBRI), Qatar • treatment, and that high levels of BAD Hamad Bin Khalifa Al-Thani University (HBKU), Qatar expression are linked with increased likelihood • Weill Cornell Medicine, USA • Broad Institute, USA of cancer recurrence. • Brown University, USA • Houston Methodist, USA • New York Medical College, USA • Icahn Institute for Genomics and Multiscale Biology, USA • Mount Sinai School of Medicine, USA • School of Medicine, Breast cancer is the most Shanghai Jiao Tong University, China • University of Monastir, Tunisia • University of Sousse, Tunisia • frequently diagnosed malignant Institut Pasteur of Tunis, Tunisia • Université Saint- Joseph, Lebanon • College of Medicine, King Saud disease affecting Arab women University, Saudi Arabia • Faculty of Medicine, King Abdulaziz University, Saudi Arabia • Centre of Arab Genomic Studies, United Arab Emirates • Princess Al- Importantly, in a healthcare model in which Jawhara Center for Molecular Medicine, precision medicine is incorporated, an individual patient’s BAD profile would be FUNDING used, together with other relevant factors, Weill Cornell Medicine-Qatar to identify an optimal treatment strategy. Qatar National Research Fund (QNRF) “Precision medicine should not only rely on the genomic and clinical investigation in a Sidra Medical and Research Center given patient or group of patients with breast Qatar Biomedical Research Institute cancer, but rather employ a more holistic approach including patient-doctor relationship, CONTACT epidemiological data collection, awareness Dr Lotfi Chouchane campaigns, screening and early detection,” Professor of Genetic Medicine; Chouchane suggests. Professor of Microbiology and Immunology; Characterisation of undifferentiated and mature human Assistant Dean for Basic Science Curriculum SGBS adipocytes. Chouchane has also collaborated with Weill Cornell Medicine-Qatar colleagues in Qatar to successfully identify, PO Box 24144, Education City, , Qatar using high-throughput genomic analyses, molecular –omics data on all Qataris, with a a set of genes differentially expressed in view to paving the way for developments in T +974 4492 8320 breast tumours from Arab populations – a precision medicine. E [email protected] finding that could pave the way for future http://bit.ly/LotfiChouchane developments in breast cancer prevention and Launched in 2013, the Qatar Genome Project treatment strategies. has already achieved a number of important LOTFI CHOUCHANE received his milestones, including the development of PhD in Immunology from the Institut THE QATAR GENOME PROJECT cutting-edge facilities at Qatar Biobank and the Pasteur of Paris and the University In an effort to learn more about the diseases Sidra Medical and Research Center. At present, of Paris VII. Following a four-year affecting the local population and how best to a pilot-phase study aimed at optimising the postdoctoral position at the National treat them, Qatar launched an initiative to map systems and procedures needed for the project Institute of Allergy and Infectious Diseases, National out the genome of the entire Qatari population. is underway. Institutes of Health (NIH) in the US, he obtained his DSc in Human Genetics and Immunology. He then joined To date, no Arab population has been included A HEALTHIER FUTURE the National Institute of Medical Research in Paris as a in any of the large-scale international In spite of significant advances in this area, visiting scientist. His current research interests include genomic consortiums, including the HapMap the implementation of a precision medicine the genetics and immunology of multifactorial diseases Project and 1,000 Genomes Project. As such, model in Qatar is not without its challenges. including cancer, obesity and diabetes. Chouchane is a although high-throughput technologies Public and stakeholder education is essential member of several organisations, including: the Human such as next generation DNA sequencing if all sectors of Qatari society are to become Genome Organization (HUGO), the scientific advisory are available, they are overwhelmingly being aware of the possibilities represented by board of Qatar Biobank and Qatar Genome Project, the applied to populations of European, American precision medicine. Other obstacles relate to Qatar National Cancer Research Strategy, the advisory or Asian ancestry. Until these technologies practicalities, such as the capacity building board of the Centre for Arab Genomic Studies of Dubai are applied to Arab populations, lifesaving required when dealing with a project of such a and the Immunoscore consortium. insights relating to the onset, pathogenesis, large scale. diagnosis and treatment of common diseases like cancer and diabetes cannot and will not However, Chouchane is positive that precision be achieved. medicine has the potential to significantly impact the Qatari healthcare system. “I think This dearth of data relating to Arab populations there are several benefits of precision medicine has led stakeholders in Qatar to collaborate for the Qatari population, and that many factors on the Qatar Genome Project – a programme will contribute to the success of an attractive aimed at developing genome sequence and programme in Qatar,” he confirms.

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