As a partner of the Precision Medicine Leaders Summit, we’re interviewing Alex Dickinson on his views about clinical sequencing. Dr. Alex Dickinson is Illumina’s senior vice president of strategic initiatives. His responsibilities include nation-scale DNA sequencing projects with a focus on how those programs will integrate with and improve national healthcare systems. Previously, Alex formed and led the team that created BaseSpace, Illumina’s cloud computing platform, now the world’s leading solution for genomic data processing and storage. Alex joined Illumina when the company acquired Helixis, a molecular diagnostic company he co-founded with Nobel Laureate David Baltimore. Alex was also the co-founder and CEO of Luxtera, a leading supercomputer chip company. He began his career as a researcher at AT&T Bell Labs and has been awarded over 40 US patents covering a range of inventions including the camera and fingerprint technologies widely used in smart phones. He holds a Ph.D. in electrical engineering from the University of Adelaide, Australia, and an MBA from Columbia University in New York.
AllSeq: You’ve been involved in the genomics space in a number of different ways, including diagnostics and bioinformatics. What’s your role now at Illumina?
Dr. Dickinson: For about the last two years I’ve been leading our efforts to partner with governments and large institutions to build population-scale sequencing efforts. Our model is the Genomics England 100K genome project where Illumina has partnered with Genomics England to bring whole genome sequencing to the UK National Health Service.
AllSeq: NGS is starting to be adopted in the clinic, with NIPT, cancer and rare childhood diseases being the first examples. Where do you think we’ll start seeing NGS adopted next?
Dr. Dickinson: Firstly I’d note that those three aren’t in the same bucket. NIPT is well along in terms of clinical adoption, whereas cancer and rare disease are only just starting out, typically being available only at quite sophisticated facilities. Looking to the future it’s pretty clear (by our spinning out Grail) that we’re very optimistic about the potential for liquid biopsy.
AllSeq: What are the biggest factors preventing NGS from being more widely adopted in the clinic?
Dr. Dickinson: With our sample-to-answer solutions and technology leadership, we expect our oncology revenue to grow even as reimbursement and regulation play out over time. For example, this quarter saw a rebound in oncology testing shipments during the second quarter, which grew at more than 4 times the rate of total company revenue growth, albeit from a small base.
AllSeq: What are your thoughts on targeted sequencing vs exome vs whole genome?
Dr. Dickinson: Right now each has it’s place in the tradeoff between information content and price. Over time the price of the three should begin to equalize and that tradeoff will become less necessary.
AllSeq: Illumina has been instrumental in driving down the cost of sequencing. Do you feel this is still the area that needs the most improvement, or are other factors becoming more important?
Dr. Dickinson: Other factors are definitely increasing in importance – for example complete informatics solutions for clinical applications. I think the end-state is exemplified by MRI machines. The customer expects and receives a fully integrated system that gives them all the hardware and software they need to get from the patient test to the clinical report; and ideally that system is in turn integrated into their institution’s EMR.
AllSeq: Do you think clinical sequencing will be dominated by ‘point of care’ (POC) devices or by more centralized services?
Dr. Dickinson: I think it’s fair to assume that sequencing will encompass both models. At one end for example screening liquid biopsy will require massive amounts of sequencing and doesn’t require short turn-around-time, so that is a natural for centralization. Strain testing for infectious diseases on the other hand requires only a small amount of sequencing (bugs are simple) and the physician needs the answer very rapidly – so POC is both feasible and necessary.
AllSeq: Do you think the use of NGS will take off in the ‘direct to consumer’ space?
Dr. Dickinson: Yes – arrays are great but by their nature limited in what they can report out (pre-selected SNPs). We spun out Helix to create an ecosystem that makes NGS economical in the consumer space by providing low cost exomes that deliver far, far richer data than an array.
AllSeq: What do you think are still the biggest unmet needs across any of the genomics markets?
Dr. Dickinson: I think we need to get to very large scale (millions of genomes) faster in order to be able to truly interpret the genome for the best possible patient treatment. The existing sequencing databases are still very small so we need to grow them faster and encourage sharing of data to allow research in the resulting larger datasets. At Illumina we’re doing everything we can to help with speed and scale and it’s been exciting in recent months to see Vice President Biden evangelizing sharing. As recently as a year ago I couldn’t imagine a US Vice President working to drive change in the formally obscure field of genotype and phenotype database sharing.
You can see Alex at the Precision Medicine Leaders Summit discussing how to utilize available tools and technologies in an effective manner within the development of Precision Medicine based products. Be sure to register with AllSeq’s discount to save 10%.