At the last two International Myeloma Working Group Summits, two new technologies were featured: 1) CRISPR gene editing, in 2018 and 2) Deep Learning/Artificial Intelligence, in 2019. Recent news reports tell us that improvements in these technologies can really enhance applications to cure diseases, including myeloma.

New CRISPR tool

CRISPR is the gene-editing tool that can be used to switch out bad gene mutations and replace them with good gene sequences. A new “prime editing” technique was unveiled at a meeting at Cold Spring Harbor Laboratory. According to STAT, genetic engineer Fyodor Urnov of UC Berkeley was very excited by the technique. “I can’t overstate the significance of this,” he said.

The new technique’s inventors, Dr. David Liu of MIT and Harvard’s Broad Institute, and Dr. Andrew Anzalone, a post-doctoral fellow and senior author of the recent Nature paper on the subject, say it has the potential to correct 89 percent of known disease-causing genetic variations or mutations, which is pretty remarkable!

Implications for MGUS, SMM, and myeloma

So, how can this apply to myeloma? By studying the onset of myeloma at the earliest time points, crucial “driving” mutations can be detected. Later in the disease, the many mutations that emerge would be very challenging for any potential gene edits. In the IMF-supported iStopMM project in Iceland, we are studying earlier and earlier cases, and will, hopefully, identify a few gene abnormalities amenable to correction. 

Time will tell. But the idea of eliminating early mutations that lead to the onset of myeloma is truly tantalizing.

In addition, the same kind of technology is being used to tweak the activity and specificity of immune T-cells (like CAR T-cells) to greatly improve anti-myeloma activity. At this point, the opportunities are mainly limited by our ability to explore new ideas in the setting of myeloma.

It seems that others are very interested in the iStopMM and IMF Black Swan Research Initiative approaches to identifying disease in its earliest stages. This week, the International Alliance for Cancer Early Detection announced a new $52-million project to assess precancerous growths. The idea of early detection and potential curative intervention is a strategy that resonates in 2019 and should have great impact in the future.  

Deep Learning and Artificial Intelligence 

This was the title of a very creative presentation by Dr. Casey Greene of the University of Pennsylvania at the IMWG Summit in June of this year in Amsterdam. The question posed was: How close are we to being able to apply computer technology to large, complicated patient data sets in the so-called real-world setting? 
The answer has come sooner than we thought. According to a recent report in Salon, quantum computers are starting to solve real-world problems. Google’s Sycamore 53 qubit quantum machine has opened the doors to a new era of computing. The startling news is that the computer solved a problem in 200 seconds which would take even a supercomputer 10,000 years! 

Quantum computing is not easy at this point. But now, as The New York Times reports this week, huge investments are pouring in to solve the many technology challenges that currently limit broader applications. Because so many calculations can be done at once, observers now predict that “these findings could slingshot humanity’s understanding of best building materials for space or provide insights into cures for a range of illnesses.” Google’s latest exercise has brought quantum computing to our doors. When and how it will enter is still to be seen. But it is no longer IF but WHEN. 

Bottom line 

New technologies can indeed lead to breakthroughs, and we in the myeloma community must be ready to apply these exciting new tools to prevent disease onset and provide the best treatments for myeloma patients.


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