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Army STARRS study further using one of the most powerful investigative tools available to DOD and VA researchers: the TAGC at USU, one of only four academic whole-genome sequencing centers in the United States, and the only one within the federal system. The goal of the new Collaborative Health Initiative Research Program (CHIRP) is to explore the genomic relationship between PTSD and cardiovascular disease. “There actually may well be a very powerful genetic basis to this association,” said Art Kellermann, M.D., M.P.H., dean of USU’s F. Edward Hébert School of Medicine. “The genes that are involved and activated by PTSD may turn out to be many of the same genes involved in risk factors for cardiovascular disease.” The ability to sequence a genome, however, is only part of the equation; the ability to detect and understand correlations among the millions of genes sequenced during a study by the TAGC is enabled by extraordinary computing power. This explains why the VA recently partnered with the Department of Energy, where 32 of the fastest 500 supercomputers in the world reside, to comb through data from the MVP cohort. At USU, the work of analysis and interpretation is done by an installation known as the Bioinformatics Core. Kellermann looks forward to being able to produce actionable clinical data through the CHIRP program for Army STARRS participants. “We’re currently standing up that capability,” he said. “If it turns out you have a heightened risk of coronary artery disease, we want to be able to get in touch and work with you to help prevent the heart attack you might otherwise be facing a few years down the road. That’s where the power and ultimate utility of precision medicine will come from.” Another USU-led precision medicine initiative, the Surgical Critical Care Initiative (SC2i), is designed to study biomarkers associated with wound infection. “If we can develop a biology-based approach that looks
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■■ As part of the 2016 Nationwide Access Stand Down event, the William Jennings Bryan Dorn
VA Medical Center, Columbia, South Carolina, hosted an informational open house offering information ranging from improvements to patient care and nursing services to veterans benefits in general, Feb. 27.
at inflammatory biomarkers, exudate from the wound, quantitative cultures, and a number of other factors using machine learning,” said Kellermann, “we’ll have a much higher rate of accuracy and competence for decisionmaking on wound closure. We’ll give better care to soldiers, it will cost less money, and we’ll have better outcomes.” The combination of capabilities emerging in the VA, the Military Health System, and the federal government have ushered in a new era of discovery. “We’re able to do things we would only have dreamed about doing a few years ago.” One of the most exciting frontiers in precision medicine is the potential for generating exact genetic copies of tissues that might be used to model treatments for individual patients. The first successful attempt to do this, using induced pluripotent stem cells (iPS; cells that can be modified to grow into any kind of tissue desired), was in 2006. “With iPS cells,” Kellermann said, “you could program cells with a genetic biochemical makeup to grow into tissues, and test them for drugs or treatments,
and know exactly what’s going to happen before you expose a patient to that. And we’re actually doing some really cool work in bio-printing here where we’ll be developing an artificial gut or artificial lung in order to do that kind of testing.” Bio-printing copies of a person’s tissues for testing drugs may sound far out – but it’s around the corner, Kellermann said, and, like the other innovations introduced by precision medicine, it promises to bring optimum care to warfighters and veterans. “At the same time, the discoveries are going to benefit civilian medicine in the United States and around the world, very much like advances in combat and battlefield care have advanced civilian trauma surgery,” he said. “We’re working closely with Walter Reed, NIH, our colleagues at the VA, and military hospitals around the country – a health care system with millions of beneficiaries, a global reach, and a diverse population of people who represent all the different groups that make America great. It’s exciting to think of what we can do with this.” 39