Translating Genomics to Patient Care
Pradip De and Nandini Dey spend their workdays in next-door offices in the Avera Cancer Institute, combing through reams of published literature, or in a lab growing tumor cells – only to poison them with different chemotherapy regimens and combinations of targeted therapies.
This married couple immigrated to the U.S. from India nearly 20 years ago to live their shared dream of conducting translational research. Beyond pursuing their love of science they have one goal: More happy endings for cancer patients.
De and Dey are senior scientists with the Molecular and Experimental Medicine Program at Avera Cancer Institute Sioux Falls.
“Translational research is translating the genetic changes that occur due to disease into a situation, or stage of the drama, in which we understand why it is happening. Because if we know why it is happening, we know how to attack it,” Dey said. “Unless we know why these cells begin behaving in such an erratic way, in the case of cancer, we cannot kill them.”
Behind the scenes experts
That’s much more complex than it sounds. “We have to find where it happened,” De said. “Was it in the DNA, which is our genetic code or blueprint? Or was it in messenger RNA? Or in the proteins through which a genetic trait is actually expressed?” De and Dey are the among the “behind the scenes” experts in Avera’s genomic medicine program. Once they have a computer analysis of a patient’s genomic sequencing, they can study the specific genetic changes that took place between normal DNA and cancer DNA.
Their next step is searching the published literature – what they call “50 years of information that our collective brain has produced,” Dey said. Not their brains alone, but their colleagues from throughout the years and across the globe.
“We see a picture develop. Some parts are shady, and some parts are clear. The clear part gives us direction as to where the tumor is heading,” Dey said. “The shady part remains. That’s where research comes in. We put our sweat and toil toward making that shady part clear. The ideal day when we know the total picture is the day when we’ll know how to make happy endings.”
De and Dey are not as concerned about where the cancer originates – for example, the breast or the ovary – as they are about the genetic changes that have taken place. “Cancer is a genetic disease. We know that if we can find out the driver for a particular cancer in an individual patient, we then can figure out the precise way to treat the disease customized for that particular patient. The daunting task is to identify the driver mutations for the particular tumor in the context of alterations of many other genes occurring simultaneously in the tumor mass and to choose the perfect drug to target that driver gene,” De said.
Search and destroy
The research scientists play one role in this mission to search and destroy cancer cells. “It is a coordinated effort of everyone in the team,” De said. Casey Williams, PharmD, puts his knowledge of approved cancer drugs, possible side effects and interactions to work in recommending a course of action, and the medical oncologist then is able to determine the treatment regimen for the patient.
In the meantime, De and Dey continually conduct laboratory research to bring more discoveries to light. “Our goal is to make the shady parts clear. That’s the happy day,” Dey said.
And when they hear back that a patient is “cancer free” – even if for a time, “that’s the joy of our work,” De added.