Flomics Biotech is developing novel blood-based diagnostic tools for a broad range of complex diseases. Their proprietary technology accurately identifies RNA pattern changes associated with disease states in a fast, cheap and non-invasive way. In this interview Founder & CEO Joao Curado explains how the company’s technology actually works, and foresees a bright future for medical diagnostics.
What let you to start Flomics Biotech, and how has it evolved since then?
During my PhD in computational biology, I was studying the effects of splicing in Histone modifications. It was a very basic research project, but I was already involved in transcriptomics, in the study of RNA, which I continued to develop in my postdoc career. That’s when I decided to take this knowledge that I generated with some of my colleagues and apply it to a more translational project, called Flomics Biotech.
We developed a Multi-Purpose liquid biopsy test. It is a blood-based test that combines cell-free RNA sequencing and data analysis with machine learning to detect patterns in blood plasma RNA quantities and their association with certain diseases.
We try to detect multiple types of cancer, namely colorectal cancer, lung cancer, breast cancer, prostate, and pancreatic cancer. These 5 types of cancer are our first targets. We are currently under development but we already have very promising preliminary results. We are currently validating our technology and preparing for clinical trials to start in 2023 to get the CE market certification and bring this test to the diagnosis market.
How does your liquid biopsy test work?
To perform a Flomics’ liquid biopsy, the patient needs to go to a medical doctor, whether in a hospital or a diagnostic laboratory. Then the sample needs to be sent to a Flomics facility or any kind of partner laboratory that operates with our protocol to generate the data at the highest standard. All the data analysis is performed in the cloud.
We developed a cloud-based platform that can take the raw data out of the sequencing machine, and output a simplified sample report that is understandable by medical doctors and even patients. Since cloud implementation is normally the bottleneck in this type of data analysis technology, we aim to have a global presence very soon. We just need to find these local laboratories that can generate the data, and all interpretations will be controlled by us right here in Barcelona.
What kind of information can you get from those tests?
Our goal is to offer a tool for any asymptomatic individuals that are at risk, either because they have reached a certain age or have a high incidence of cancer in their family. Before having any symptoms, they can do a proactive, preventive type of test with Flomics technology, just to make sure that everything is fine.
For example, if we detect an arrangement in their RNA profile that is associated with a colon cancer, they would instantly be directed to a colonoscopy, or whatever is the standard diagnosis method, to make sure that everything is fine.
How are your tests different from genetic predisposition tests?
Since we are focusing on RNA, we’re not talking about predisposition. It’s about identifying a molecular signature in our blood, of something that’s already happening in the body, such as remote tissues or organs. If we detect it, it means that something is already going on, so it’s not like you have higher chances of developing it in the future, but more like a snapshot of your current health status.
The predisposition tests can be interesting. In some cases, you can act proactively, like with breast cancer, but depending on your lifestyle and many other factors, it might evolve into a disease or not.
That is why we decided to bet on the more dynamic nature of RNA molecules because we don’t want to be calculating percentages, probabilities, or odd ratios. We want to be sure that we are detecting something that is actually happening, but early enough so that it’s easy to cure. You just have surgery and remove the disease cells and you are good to go.
The time to get tested depends on the disease. For cancer, age is definitely a risk factor. We are targeting people over 55 years of age because that’s when the chances of developing cancer ramp up. Otherwise, you might be testing a lot of people that actually suffer from minimal risk. Since these types of tests also have some costs, we’re trying to place it where their impact is maximized.
How is this different from standard oncological diagnosis tests?
Currently, there are no tests available to detect multiple types of cancer from a blood sample with high accuracy. What we have in most of the countries is individual tests for each type of cancer. Colon cancer screening is made through the detection of blood in the feces, which is also non-invasive, but the accuracy is very limited and specific for one single disease. Some cancers, like pancreatic cancer, don’t even have a screening method.
We are building a new market for a new product opportunity, but we are not the only ones doing it. Other liquid biopsy companies are now trying to enter this market because it’s a huge unmet need, but they’re not yet able to replace the current solutions in terms of market acceptance.
These tests are minimally invasive and that’s a big difference. We want to have one test that targets the five types of cancer that I mentioned. Looking forward, we also want to expand to other types of cancer, and even outside of oncology.
The advantage of using cell-free RNA for diagnosis is that we are not relying on the detection of mutations that normally trigger oncological diseases. We are actually detecting some aberrant levels of expression which represent molecular changes that are associated with external stimuli or external challenges that the cells are facing at that moment. This can be provoked by many other diseases besides cancer cells. For example, there are some studies now showing that it’s possible to detect depression. A person with a diagnosed depression has a different transcriptomic profile and a different pattern of RNA expression in their blood. It’s not yet validated for diagnosis, but the association has already been detected.
How can cross-testing of RNA and DNA shed light on a person’s condition?
That’s a very important point. I don’t think that RNA is the Holy Grail and will be the only molecule to be monitored. I think it will be the integration of the different signals that come from the RNA, DNA, proteins, or micro RNA combined that will get the most accurate diagnosis.
At Flomics, our expertise is on RNA, so this is the technology we are pushing forward. Since it is less developed in the market and in the scientific community, we feel like we can have a more important role here than if we started working with DNA where there are a lot of other competitors who are much more advanced in this process.
At the end of the day, it all comes down to data. We just want to provide a layer of information coming from RNA. Then, there’s the layer of information coming from other metabolites or nucleic acids that are being measured. The integration of all this data is what performs the diagnosis. We will have more and more diagnoses of data that are made by machine learning computers. Although Flomics is mainly focused on RNA, we could easily start incorporating other sources of information as well.
How can this technology change the medical world?
First of all, we will be able to catch many more of the diseases on time, when treatment is still easy to obtain. This will free our medical doctors for more complex procedures like surgical intervention or other types of patient follow-ups while leaving diagnosis for something a bit more automated. I think that will make a big difference.
In the future, we’ll have more and more monitoring of our fluids; not only the RNA but also DNA, proteins, and metabolites in a non-invasive way, or minimally invasive ways, while extracting more impactful information for clinical practice.
How do you envision the future of liquid biopsies in five years from now?
I think in five to ten years from now, these tests will be widely implemented. Currently, we are seeing the first companies in the field of liquid biopsies using any kind of sequencing technology for early detection of diseases. In five years from now, it will be a bit more extended. The breakpoint where it will really start going to everyone is when it becomes available in all different locations and to every person at any social status.
The adoption will be slower than we would like because of the price. These tests are still expensive. Sequencing technologies are getting cheaper but not at the speed we anticipated. That said, paving the path for implementation is absolutely necessary. As soon as we start to scale up the number of tests, it will also help to push the prices down.