Why Europe needs to go big on single-cell medicine

Hundreds of researchers, clinicians and industry leaders from all around Europe are today presenting a new vision of personalised, “cell-based interceptive medicine” that they say can discover disease quicker and save the continent billions of euros.  

The LifeTime Strategic Research Agenda, published Monday, presents a 10-year plan for nurturing the latest single-cell biology breakthroughs and related technologies, to track, understand and treat human cells throughout an individual’s lifetime.

The methods to capture the full complexity of cell types, and how disease manifests in the body, offers the possibility to detect problems long before symptoms show. “Nowadays if you have a symptom that’s severe – say it’s blood in your urine – you go to your GP and tests are done. If you have bad luck, it’s a major disease,” said Nikolaus Rajewsky, scientific director of the Berlin Institute for Medical System Biology (BIMSB) at the Max Delbrück Center for Molecular Medicine.

“Whatever happens next is expensive, and invasive procedures are needed. There might be no cure at the end of this difficult process,” said Rajewsky, who is coordinator of LifeTime, the EU-backed community of more than 100 European research institutions and hospitals.

LifeTime proposes a different approach to medicine, where patients with, for example, a genetic risk can be monitored at the level of the individual cell. By going down to this level of detail, diseases will be detected and intercepted much earlier, before the onset of symptoms and organ or tissue damage occurs.

“Technology can now rapidly analyse large numbers of cells, allowing scientists to more easily identify different cell types found in tissue samples and to study molecular mechanisms in individual cells at an unprecedented resolution.” says Geneviève Almouzni, the other coordinator of LifeTime currently director of research at France’s National Centre of Scientific Research (CNRS), and honorary director of the Research Center at Institut Curie, Paris, France.

This research generally is known as “single-cell omics” science and helps, for example, to understand how immune cells fight infection or how cells respond to treatment. This knowledge is necessary to find new ways to treat diseases.

“Specialists say Alzheimer’s disease presents itself 20 years earlier in cells. It becomes much more difficult to stop disease when cells have moved along a disease path for 10 years or more,” said Rajewsky. “By detecting disease cells much earlier, we can bring patients back to health. It’s a different clinical reality and this is what we call interception” both coordinators added.

Aside from the obvious health benefits, there are also big economic gains to be realised. At present, healthcare costs are only going in one direction, with the number of people above the age of 65 predicted to double in Europe by 2050.

“The economic impact could be tremendous with billions of euros saved from productivity gains simply for cancer, and significantly shortened ICU (intensive care unit) stays for COVID-19," said Geneviève Almouzni.

A stream of publications and intellectual property is flowing on the back of what Rajewsky calls these “incredible molecular microscopes”. The competition is already hot, with the US and China investing in huge single-cell initiatives such as the Human BioMolecular Atlas Program, the Human Tumor Atlas Network and the 10 Million Single-Cell Transcriptome Project. Private funders, including the Wellcome Trust and the Chan Zuckerberg Initiative, are prominent backers.  

“We’re discovering things that have never been seen before but if we don’t move fast, we know the US will be very quick in conquering this field,” said Rajewsky. “The risk is we end up paying others for these techniques when we should have been creating them ourselves.”

The COVID-19 crisis has changed the world enormously, Almouzni says. “In a way it may help us realise that we need a new approach. We have well-annotated health records in Europe. We could absolutely find a way to federate them, at the EU level. After what we’ve seen with COVID-19, it’s worth taking this idea seriously.”

Almouzni sees a healthcare system – that could materialise in the near future – where people “proactively” visit their doctors for a cellular examination. “You don’t wait until symptoms show. And if you can prevent the most adverse situations – that will be, for sure, not only a great economic outcome but an enormous benefit for better and extended living quality for all citizen,” she says.

‘Huge potential win’

The LifeTime strategy advances a vision for personalised, single-cell treatment in five major disease classes: cancer, neurological and neuropsychiatric diseases, infectious, chronic inflammatory, cardiovascular and metabolic diseases.

“An undertaking as far-reaching as realising cell-based interceptive medicine across Europe can’t be achieved by cutting-edge research alone,” the plan says. Making it a reality depends on creating, integrating and applying “breakthrough digital and biomedical technologies”. These could be developed through multidisciplinary research programmes that bring together single-cell tech and computational experts, mathematicians, engineers, disease modellers and clinicians.

It’s clearly a case of profiting from a pan-European scale, the two coordinators agree. To come up with its 10-year agenda, the initiative organised multiple meetings and workshops, stakeholder interviews, an impact study and surveys between March 2019 and June 2020.

To help create start-ups in the field, the plan also foresees a new early stage investment fund, alongside earmarked EU research grants. And because the field is generating data at a nearly unprecedented rate, LifeTime recommends developing new tools to process standardised information for inclusion in electronic health records.

Many things have to move together for Europe to make the most of cellular medicine, including the uptake of artificial intelligence and continual upgrading of high performance computing. There also has to be a greater willingness to share electronic health records, which raises questions of standards, definitions and data annotation – issues that could require further legislation.

Improving cancer diagnosis accuracy by 40 per cent would save up to €840 million in Europe by reducing prescriptions of incorrect treatment, the LifeTime strategy says. And if Alzheimer’s disease can be delayed by five years in early-onset patients – those younger than 65 – more than €20 billion could be saved, the plan adds.

Almouzni points to exciting single cell biology work underway in labs right across Europe, including in Belgium, Greece, Poland, Italy and Spain…

“We have pioneers here and they want to stay and build this community. I don’t think we’re destined to be following anyone. We have a chance to be competitive. If Europe wants to do it, it’s now,” she said.

The coordinators point out there is a huge potential win here from a humane perspective, as well as big revenues if Europe becomes a dominant player in the field.