Are we heading for a MinION movement in healthcare? Clive Brown, CTO of Oxford Nanopore Technologies, talks to PharmaTimes about the Internet of Living Things.

PT: In a nutshell what is the USB stick DNA sequencer all about?

CB: The MinION is a portable real-time nucleic acid sensor that can be used for sequencing, biomarker sensing and quantification directly from nature. The total costs of ownership are very low, and anybody can run the system. Streaming data analysis is provided by cloud based services. The system is designed to be manufacturable at scale, so enabling sequencing of anything, by anybody, anywhere. Other similar devices are possible in future, that may be, for example, runnable from a smart phone. They may also be embedded in other household or work place devices and appliances.

PT: What has it got to do with the Internet of Living Things?

CB: Any living thing, or system of living things, can be connected to the internet via the MinION or by any similar real-time DNA sensing devices. Think about a device performing a real time inventory of living systems, perhaps blood, food production lines, ecosystems etc. This is designed to stream to cloud based analysis services and thence tracked both over time, by location and other related data. The biological state of anything, then, becomes an extension of the internet. Analytics based on such stateful data streams can provide a new layer of intelligence about natural systems. We are calling this The Internet of Living Things.

PT: Why is this significant? How could it revolutionise healthcare?

CB: Of course the devices can be used to measure any useful nucleic acid biomarker or panel of diagnostics and they can do so in any setting. That is all fine, well established and quite safe. But imagine instead if millions of people all over the world, under a subscription, were inventorying their own biological state by using these devices to measure the contents of their blood every month. Over time that becomes a very powerful data set. 

Healthcare is just one application though; equally, water sources, food supplies, hospital air and many other systems can be frequently sampled and sequenced - also allowing their state to be trended, tracked and predicted.

For example, my dentist in Oxford is very keen to try a device. Prescribing antibiotics for infections costs the NHS a lot of money – in the UK, 50 million antibiotic or antibacterial prescriptions are dispensed a year. Very often the wrong one is prescribed and the patient has to return to their doctor or dentist. There is also some risk the patient goes on to develop serious complications if given the wrong one. Imagine instead if a dentist could swab the infection in the surgery, put it into a MinION-like device (once approved) and know within minutes what the dental infection is and what antibiotics it is susceptible to allowing the patient to leave the surgery with a treatment that works first time. The same is true of course in hospitals and primary care.  Good for the patient - also saves a lot of money.

PT: Why do we need this?

CB: It should be clear from trends in this field over the past ten years or so that DNA sequencing is becoming the biological readout of choice.

PT: What is the likelihood this technology will become reality?

CB: It is already a reality. The technology is now in the optimisation phase and will only get better. If you are asking how long before it reaches a clinic - then I think that is different question, but it will be in many other non-clinical environments first.

PT: What obstacles are there?

CB: Now, there are very few obstacles we believe. We need to make the systems easier to run, and more reliable. Then the technology will be used more, for existing and new applications.

PT: How might the pharmaceutical industry tap into this?

CB: That is a very broad question perhaps best asked of a pharmaceutical company. Suffice to say, I doubt they can afford to ignore this technology.

PT: What are your predictions for the future?

CB: More and more useful information will be derived from DNA information that has been sampled 'live' from biology. In one case that will be blood or other body fluids. The idea of a static 'genome', that you are born with, that is immutable and allows accurate predictions about your health will be at least complemented, and possibly even replaced, by dynamically changing nucleic acid data measured over time as your life proceeds.

Nanopore systems will be developed that can also write DNA, driving synthetic biology.

Based on real time sensing from blood, systems will be derived that allow the patient or any natural system to be treated and perturbed in response to those data. These sensing machines may even be online, allowing near real time feedback, rather like dialysers or 'homeostatic restorers'. Circulating tumour DNA can already be seen to change during cancer resection, giving a near real time assay of the completeness of the resection - as a very crude example.

Other analytes will also be characterised in nanopore devices, like proteins. 

The existing sequencing technologies, and whole genome sequencing (WGS) performed mainly at centralised facilities, will become a niche.

People will develop and commercialise their own assays on the nanopore platform, for their own applications, rather like programming a new iPhone App.

Clive will be speaking alongside other medical and healthcare technology gurus at this year’s Wired Health conference on 24 April. For more information or to book tickets click here.