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Presented by Gregory Downing, Ph.D. at the Nonclinical Studies Subcommittee of the Advisory Committee for Pharmaceutical Science March 9, 2000. NIH Research Activities - Biomarkers and Surrogate Endpoints. BIOMARKERS NIH RESEARCH INTERESTS. Emerging bottlenecks in drug discovery
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Presented by Gregory Downing, Ph.D. at the Nonclinical Studies Subcommittee of the Advisory Committee for Pharmaceutical Science March 9, 2000
BIOMARKERS NIH RESEARCH INTERESTS • Emerging bottlenecks in drug discovery • genomics, combinatorial chemistry, high throughput screening technologies • Improve efficiency of clinical trials • Speed translation of basic science • New challenges • chemoprevention, gene therapy, vaccines • Public health issue
NIH INITIATIVES • May 1997 Pharmaceutical industry meeting • November 1997 Clinical Trials: Looking to the Future • May 1998 Biomarkers Issues Identification Meeting • July 1998 Definitions Working Group • April - September 1998 Informational Meetings with Academic Centers Research and Pharmaceutical Industry
NIH INITIATIVES (cont.) • September 1998 - March 1998 • Disease Specific Roundtable Discussions • December 1998 - Clinical Trial Design and Biostatistics Workshop • April 1999 - Multidisciplinary Conference http://biomarkers.od.nih.gov • Specific Initiatives • NIEHS Markers Meeting November 1999
DEFINITIONS Biological Marker (Biomarker) - A characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Biomarker Definitions Working Group - 1998
DEFINITIONS Clinical Endpoint - A characteristic or variable that reflects how a patient feels, functions or survives. Surrogate Endpoint - a biomarker intended to substitute for a clinical endpoint. A surrogate endpoint is expected to predict clinical benefit (or harm, or lack of benefit or harm) based on epidemiologic, therapeutic, pathophysiologic or other scientific evidence. Biomarkers Definition Working Group -1998
USES OF BIOMARKERS • PRE-DEVELOPMENT STUDIES • Correlate with diagnosis and prognosis • Investigate pathophysiologic mechanisms • PRE-CLINICAL STUDIES • Confirm activity IN VIVO • Explore concentration-response relationships • PHASE I-II CLINICAL STUDIES • Evaluate activity • Develop dose-response relationships
USES OF BIOMARKERS • PHASE III CLINICAL STUDIES • Stratifying study populations • Conducting interim analysis of efficacy/safety • Applied toward regulatory approval • CLINICAL PRACTICE • Establish diagnosis • Monitor treatment response • Use as prognostic or predictive measure
Biomarkers and Surrogate Endpoints:Clinical Research and ApplicationsApril 1999 • PK/PD Markers • Biomarkers of Toxicity and Surrogates for Safety
KEY RESEARCH GAPS • Lack of full utilization of available toxicity markers • “Awareness gap” - emphasize need for improved measures of safety biomarkers • Need to develop data associating particular genes/proteins/small molecules to human pathology • Coordinated effort to relate animal toxicity markers to human responses • Need for key organ system toxicity markers
BEST OPPORTUNITIES FOR DEVELOPING TOXICITY MARKERS • Relate alterations in signal transduction and other pathways to clinical toxicology of particular agents • Define genes related to human toxicology • Development of HTS to correlate gene expression with protein expression as they relate to toxicological responses to drugs
USE OF EMERGING TECHNOLOGIES • Develop and apply analytical tools to discover small molecular markers to assess drug toxicity • Utilize imaging technologies to understand toxicology mechanisms at the molecular, whole organ, and whole body level • Expand application of cDNA array technologies and proteomics • Clinical technologies – less invasive tools • Use of humanized transgenic animal models to evaluate ADME and molecular/tissue/organ specific toxicity
Research Infrastructure Needs • Stimulate collaboration among sectors of the biomedical research enterprise to develop and evaluate toxicity markers • Establish a consortium of public and private institutions • Utilize funding strategies and networks for marker evaluation (similar to NCI)
NIH Research Initiatives • Cancer Biomarkers Research Laboratories • PET ligands for neuroimaging • Pharmacogenomics • Neuroinformatics initiative (NIFTI) • Osteoarthritis Initiative • Diabetes markers • Imaging programs for urologic disorders • Immunomodulatory markers • Cardiovascular markers • Hematologic disorders • Toxicity markers • Chronic lung diseases
An infrastructure for supporting collaborative research on molecular, genetic and other biomarkers in early cancer detection and risk assessment. Discovery, technology development, clinical validation 17 development labs, 6 validation labs, 12 clinical/epidemiology centers Ovarian, prostate, lung, liver, colon, breast Cancer Biomarkers http://edrn.nci.nih.gov
Osteoarthritis Initiativehttp://www.nih.gov/niams/news/oisg/index.htm • Identify and evaluate biomarkers as candidates for OA surrogate endpoints • Prospective natural history cohorts • Public-private partnerships • Evaluate: • Biochemical markers • Structural markers - (radiographs, MRI, OCT) • Genetic markers
Next Steps • Organization of Information (Bioinformatics) • Nosology, classification, characterizing disease course • Establish/maintain biomarker electronic catalogues • Improve linkage of biomarkers to clinical information • Establishment of web based knowledge centers • Categories: • Disease • Technology • Cell/Tissue/Organ • Name of marker (protein, antibody, gene, etc.) • Others • Issues: Access to data, identifying data sources
Next Steps • Research resources • Specimen and image repositories • Assay validation laboratories • Comparison of biomarkers (cross-validation) • Epidemiologic/longitudinal disease cohorts • Expand/extend laboratory technologies to clinical measures (accuracy and precision) • Technical expertise • Expand clinical research capacity • Integrate new disciplines