HealthTech Talks Genomics Transcript

SPEAKERS

Dr Megan Robertson, Sean Grimmond, Natalie Thorne, Kathryn North, Welcome to Country

Welcome to Country 00:00

We acknowledge the traditional Aboriginal owners of country throughout Victoria, Australia, and their ongoing connection to this land. We pay our respects to their culture, and their Elders past, present, and future.

Dr Megan Robertson 00:22

Hello everyone, and welcome to Global Victoria Healthtech Talks, a show that's about healthtech, business and opportunities in Melbourne and across Victoria in Australia. Victoria has a unique and globally competitive healthtech ecosystem. That's thriving and open for business in this podcast series will provide insights into the strengths within our ecosystem that are attracting global attention. Want to explore the expertise, engage with experts, identify markets or learn about how you can team up with top Aussie healthtech companies? Then you're in the right place. I'm your host, Dr. Megan Robertson and today on Global Victoria Healthtech Talks, we're covering the fascinating topic of genomics.

Dr Megan Robertson 01:20

Today, I will be speaking to three experts in the field of genomics. First will be Professor Kathryn North, Director of the Murdoch Children's Research Institute (MCRI). My second guest is Dr. Natalie Thorne from the Melbourne Genomics Health Alliance. And my third guest is Professor Sean Grimmond. Director at the University of Melbourne Centre for Cancer Research. My guests today will share their insights and perspectives on the sector, and explain the strengths and capabilities of Victoria's genomics ecosystem. First up today is Professor Kathryn North. Kathryn is the Director of the Murdoch Children's Research Institute, known locally as the MCRI, and she's the David Danks Professor of Child Health Research at the University of Melbourne. Kathryn trained as a physician, neurologist and clinical geneticist, and was awarded a doctorate for her research in neurogenetics. She's a national and international leader in genomic medicine, and has received several awards, as well as being appointed Companion of the Order of Australia for eminent service to genomic medicine. Hello, Kathryn , thank you very much for being here.

Kathryn North 02:35

Good morning, Megan. It's great to be here.

Dr Megan Robertson 02:37

So today we're talking about genomics. So to begin with, could you give us an overview of what genomics is and what we do in genomics in Victoria?

Kathryn North 02:46

Certainly, genomics refers to our whole genome. And if you think of your genes, as the recipes for proteins in the body, that that's our recipe book, what has really changed over the last decade or two is our ability not just to look at one of those recipes, one of those genes at a time, there has been a major, major progress in being able to sequence all of our genes, and to use that information for more targeted care. But also for prediction and prevention. I think the genome is huge. That's the other thing we've had to deal with in terms of the amount of data involved. A human genomes equivalent to 1000 copies of "War and Peace". And there's a lot of stuff we don't know about in there as well. But the learnings that we've taken in our research, and now translation into clinical practice has been immense.

Dr Megan Robertson 03:45

Now, genomics is very strong in Victoria, and you've been involved with many of the platforms and facilities. Tell us about those in Melbourne?

Kathryn North 03:55

So, um, as you said, in my background, a clinician and I looked for a look after and have looked after for many years, children with rare diseases that have a genetic basis, things like muscular dystrophies, spinal muscular atrophy, causes of intellectual disability. In our practice, say, you know, 20 years ago, we could maybe come up with a diagnosis in around 10% of those kids. And what we've really looked to do, here in Melbourne, is working together across the state, to look at how we can gather, share a bit of analyse genomic data, so that we're increasing that diagnostic rate for those kids with rare disease, but then making sure that we can take that into clinical practice. And we've done that initially by forming the Melbourne Genomics Health Alliance, which Natalie is a major part of, which was really then starting to test and demonstrate the value of genomics as a, you know, a frontline test for different disease groups. And one of the first studies we did, which was actually self-funded by the institutions involved was to look at kids presenting the childhood syndromes. And just to give you this is such a great example. Because by by looking at that, and initially 100 kids and what their diagnostic odyssey was like, often over years, using standard approaches, we got a diagnosis getting around 10%, and a cost per diagnosis of all the tests that were involved of $26,000 per diagnosis, then we in the same group introduced genomic testing. And what we found is the diagnostic rate, and this just happened over 18 months, went from 10% to 55%. The cost per diagnosis went from $26,000, down to $6,000. So demonstrating the value of with we start to implement this disruptive technology into our healthcare system, we've got clinical utility and cost effectiveness. And that we've we've now sort of scaled out what we do in Melbourne, which is, I think, been our approach. To develop national networks, we now have the Australian Genomics Health Alliance, which involves 100 institutions around the country, all the clinical and laboratory services, all of the major research institutions, over 450 investigators, so that we now have national networks to deal with this. And we've been successful, for example, in putting up that business case to government, getting MSAC approval, and now the testing for childhood syndromes and intellectual disability as a Medicare item. So there's equity of access. So that's, I think, the model of what we've been aiming to do. And at the same time, leading from Victoria, bringing together a national network, that means that Australia now functions as a single cohort of 26 million people, and that we have clinical recruitment sites and staff on the ground in every state and territory.

Dr Megan Robertson 07:03

That's just an amazing program, isn't it? And through the MCRI leading this, you also have extensive international collaborations, which I expect are very important in rare diseases.

Kathryn North 07:13

Absolutely. So I became involved quite early on around the same time we're setting up Melbourne Genomics Health Alliance, with what's called the Global Alliance for Genomics and Health, and Sean's also been very involved in that as well. And it's the same sort of thing as we've done around Australia, except it's across over 100 countries around the world, because everybody is dealing with "how do you take this disruptive technology into practice?". Particularly for rare disease and for cancer in the first instant instance, but eventually for prediction and prevention. So the Global Alliance's focus is, how do we responsibly share clinical and genomic data on many, so that we're much more accurate in in predicting for an individual. And so it's this wonderful network, I'm vice chair and have been since around 2014, of this amazing network of geeks around the world who are all working on all the problems that we need to solve, to make sure that we can cope with this huge amount of data, how we analyse it accurately how we all speak the same language, so that we can use that for patient care, either at a clinical grade. You need to be able to rely on results, to use them in clinical practice.

Dr Megan Robertson 08:35

You raise a really interesting issue there, which is as our knowledge of genomics has increased, the need to be able to analyse that huge amounts of data, particularly if we're talking across national and global networks is huge. How does Melbourne go in terms of bioinformatics and assisting you in that sort of cutting-edge AI to be able to look at these huge data sets?

Kathryn North 09:02

Well, it's a great strength of Melbourne, and Natalie will be able to talk about that as well, Sean very specifically. But the way I see it is suddenly it's not a clinician with a patient. When we're doing genomics, it's the clinician, the scientist, and the bioinformatition is working as a holy trinity to to actually be able to take that data and get an accurate report at the at the end. That is understandable, that's direct, but is also demonstrated on very strong evidence. And I think we've all over the last decade, really invested in and increased our capability from a bioinformatics perspective. And really, what we're doing here in Melbourne is you know, it's it's best in world. We're really admired for the approach that we've taken, particularly the patient-centric approach as well. So that we work closely, as I talked about the Global Alliance, what we've been able to do, as we've been developing our ecosystem here is to learn from best practice in every country, we contribute to that best practice. But we also identify and bring it in. So everything that we've built, is used utilising international best standards. Genomics, England is probably the gold standard, they started five years before us and made a huge investment in sequencing 100,000 genomes, but we were able then to come in, learn from as, as Mark Caulfield would say, learn from their mistakes, and make sure that we were starting from a very strong baseline here. But then making sure that we as a country also have a coordinated national approach.

Dr Megan Robertson 10:53

So it's a team sport isn't it?

Kathryn North 10:55

Absolutely.

Dr Megan Robertson 10:56

It takes everyone sitting behind you, as the clinician to inform what you're talking to your patient about. And I suppose that's the really strong thing about the network in Melbourne, is that you've got that whole team based here. It's highly experienced, and you get that classic bench-to-bedside sort of approach, but it's also back to the bench. So you're informing the scientists, they're informing you, the bioinformatics is all linked into that, and we get an outstanding response. And result. That's just amazing.

Kathryn North 11:30

I must say, I've, you're obviously very familiar with what happens in genomics in different countries around the world, because we've also bought together around 30 countries that have these national initiatives. What I find in Melbourne is this incredible spirit of collaboration. We're all ambitious, we all want to be the best, we don't do anything unless we have international international input, and international and national leadership.

Dr Megan Robertson 12:00

So to bring you back home, the Murdoch Children's Research Institute, is the largest child health institute in Australia, and one of the top three Child Health Research Institutes worldwide, measured by research quality and impact. What are the other areas of research strength that the MCRI?

Kathryn North 12:17

Well, we're actually established, interestingly, as the Genetics Institute back, you know, 35 years ago. So it's really in our, our fabric and our makeup. And we also have, as a wholly owned subsidiary, the Victorian Clinical Genetic Service, which provides both clinical and laboratory diagnostics for genomics. So it's just as you said, it's this virtuous cycle of research, how do we get it quickly into clinical practice, we're co-located with the Children's Hospital. So we have the clinicians, the scientists, the bioinformaticians, working side-by-side, all on the same campus. So that's been a great strength. What we also then look at is beyond genomics in a number of different ways, because we're still hitting 50% or 60%, diagnostic rates for many childhood disorders. So we're looking at that other 40%. And you then need to bring in what we call multiomics. So looking at protein levels, looking at metabolism so bringing together a team there, and then thinking how we model these diseases to understand disease mechanism? And most importantly, how do we develop novel therapies. So I think the big thing that we're doing that's relevant to this is our work in stem cell medicine. And we're really amassed an internationally recognised group of stem cell scientists who are able to, you know, we could take blood from you, we could switch it into a pluripotent stem cell. But from that we could make your beating heart tissue, we could make mini kidneys, we could even make mini brains, but we use that to one look at disease mechanism. And then secondly, use high throughput drug screening to look at effective therapies. So that that is really one of our that's that works hand in hand with our genomics work. Then one third major area I'll talk about is how do we then think at a population level? How do we think about prevention and early intervention? And genomics has a part to play because so many of the disorders are a combination of gene and environmental, nature and nurture. So we also work at a population scale with really large birth cohorts and we've got one running in Victoria now called Generation Victoria, where we're recruiting across all 60 birthing hospitals across Victoria. The babies that happens to be the COVID generation because we've been recruiting, recruiting throughout COVID and also the mums and the dads. So it's a young adult cohort as well. With all the associated biospecimens that are collected as part of routine practice. This is creating it's think of it as a birth cohort equivalent of the UK Biobank. But this is adding, for us, a wealth of both genetic and environmental and clinical data on a whole generation of Victorians, that then is going to have great power for us to start to look at the use of genomics for reproductive carrier screening, in terms of risks in pregnancy, even to newborn screening to the prediction of cancer risk, the applications are endless. But this is a platform that I think will underpin much research, but also have a great value in terms of industry partnerships.

Dr Megan Robertson 15:47

Quite remarkable. So you're collecting, effectively a biobank of 60 to 70,000 babies who are born each year in Victoria.

Kathryn North 15:57

Yeah, over a two year period and their parents. So the way it is feasible is that we are we get consent, soon after birth, because we also do the Victorian Infant Hearing Screening Program, that gives us the consent to collect all the specimens that were collected on the mum during pregnancy, and including fetal ultrasounds as well, then the newborn screening cord blood, we're also organising and getting breast milk samples, stool samples, the parents each do a cheek swab, so we've got their DNA as well. And then because of our system, here, we have maternal child health nurses, every child gets 10 visits. But we're also using them as part of collecting data from a research perspective. And this is all done in partnership with the Victorian Government who have been incredibly supportive, and enables us also to have data linkage to our really rich data sets around, you know, Pharmaceutical Benefits around Medicare hospital visits, we've got we're putting into this studies around major modern epidemics, as in which includes COVID now of course, but allergy, obesity, risk of cardiovascular disease, mental health, and also the risks of kids in very disadvantaged environments, looking at their brain development. And this is partnering with the Victorian Government. We're looking at now now and how we can bring evidence-based policy into practice, at scale.

Dr Megan Robertson 17:33

So this is much more than just a biobank. It's a really enriched cohort data set.

Kathryn North 17:38

Yes.

Dr Megan Robertson 17:39

And I'm very interested to hear that you've had strong support from the government.

Kathryn North 17:43

Yes.

Dr Megan Robertson 17:43

Because I think that's something that's very important in the health and medical research sector in Melbourne and Victoria, is that it does have strong support from not only our health institutions and organisations, but right up to the government and policy level. So that's very reassuring to hear.

Kathryn North 18:00

Yeah, we actually had the Minister for Medical Research at The Institute twice yesterday on one on stem cells and one on pediatric cancer. And it was their engagement and their pride in what we achieved in Victoria is palpable.

Dr Megan Robertson 18:15

So conducting clinical trials, particularly with children, can present substantial challenges, including difficulties with recruitment and ethical considerations. How do you and your team at the MCRI navigate that process?

Kathryn North 18:31

Well we bring it all together. We bring the capabilities together in our Melbourne Children's Trials Centre. But I must say front and foremost of anything we do, whether it's in genomics, where there's a huge amount of personal information, or in stem cell medicine, and looking potentially to regenerative medicine, first and foremost, with everything is looking at the ethics, protecting privacy and data security, and making sure we've developed dynamic consent platforms because the patient, the individual, it's their data. And we really find that by working in partnership with the patients and their families, and helping them understand the benefits of what we're doing. They're very, you know, they're very engaged and really quite excited by what we're doing. I think it's very interesting, again in the first stage of the Melbourne Genomic Study, that very original study, looking at the first 1000 patients there, they had their consent. And these are patients that are arriving with either rare disease or cancer, for example. But we went back to them a year later to make sure that they to ask them, whether they still understood what their consent meant, and whether they felt adequately informed and we had like a 96% / 97% positive response. So if you do it properly, and you put the patient and the family first, that in engagement I think works very well.

Dr Megan Robertson 20:02

Fantastic. Thank you so much. We'll chat again later, Kathryn when we get back to the panel discussion. Thank you very much. We'll be back in a moment with my next guest from Melbourne Genomics Health Alliance, Dr. Natalie Thorne.

Dr Megan Robertson 20:21

Australia's Research and Development Tax Incentive provides up to a massive 43.5% cash refund, which is available to both local and international companies.

Dr Megan Robertson 20:39

I'm here now with Dr. Natalie Thorne Lead of Genomic Information Management at the Melbourne Genomics Health Alliance. Natalie is a Certified Health Informatician, works in pathology informatics, and holds a PhD in data science and bioinformatics. Her career began in research before she joined the Melbourne Genomics team to develop GenoVic, a clinical grade system for genomic testing. Now she's leading a team to mature and expand GenoVic as a sustained shared genomic information management system for Victoria. One that can enable better care for thousands of Victorians and open the door to precision medicine. Hello, Nat.

Natalie Thorne 21:21

Good morning.

Dr Megan Robertson 21:23

Now Melbourne Genomics Alliance is a collaboration between 10 member organisations, including hospitals, universities and academic institutions. Can you tell us a bit about the aim of Melbourne Genomics, who's involved and why it was created?

Natalie Thorne 21:36

Yeah. Well, back in 2013, when we're all thinking about this genomics revolution that was coming, it was pretty clear that we needed to take a holistic approach to that. So we couldn't just figure out how to do genomic tests, we need to figure out how to do it in practice. So it meant we needed to involve hospitals and research organisations and laboratories. So we got together across the Parkville Precinct initially. And some of the leading hospitals, academic institutions and the universities, CSIRO got together and formed a collaboration. And so they really contributed their own funds to get genomics in the clinical sense off the ground here in Melbourne. And so what that meant is that there was a very intentional approach to bringing together clinicians and bioinformaticians and genetic counsellors and people who work in cancer and all of the different facets of the whole healthcare system that would be needed to get their heads together and figure out how we actually make what is actually really big changes to make genomics happen.

Dr Megan Robertson 22:48

You mentioned the Parkville Precinct, and that I think is an important strength of Melbourne is our very strong precincts. So the Parkville Precinct, of course, is based around the University of Melbourne, Melbourne is one of only three cities in the world to have two universities in the top 100 in the world, Melbourne University being one of them and Monash University being the other. So the Parkville Precinct sits on the edge of the central business district. It's really one of the one of the drivers, if you like, of our health and medical research sector across the state, based around Melbourne University. It includes a world renowned research institutes, including the Walter and Eliza Hall Institute, commonly known as WEHI, The Florey Institute, The Doherty Institute for Infectious Diseases, the MCRI, which we've just heard about from Kathryn, and also major hospitals. So the Royal Melbourne, the Royal Children's, Peter McCallum Cancer Center, and had a bit of a stretch out to St. Vincent's Hospital too. So why is it so important that we begin to embed genomics into our health system and what will change pay for health care from this, both locally and globally?

Natalie Thorne 23:59

Yeah, and just to come back to the Parkville Precinct because it started there, and it's, as you say, it's a really rich, connected network of institutions and hospitals and and you mentioned quite a few of them. And when we got funded by the state government to actually really get Melbourne Genomics to take off, we expanded that alliance and included Peter Mac, Monash Health, Austin Health, and in fact now we even have Alfred Health as a user of our system GenoVic. So it started here in Parkville. But that network, that rich network that we have here, really led us to expand that once we got funded.

Dr Megan Robertson 24:40

So I think you've raised a really important point that the Parkville Precinct, although it's where we're all based, is actually only one of the precincts in Melbourne and Victoria. We have a very strong precinct also around Monash which also includes the Monash Medical Centre and the Monash Children's Hospital and also The Alfred Health had a number of other associated metropolitan and regional hospitals who all link in. So these two networks, although they're geographically separate, actually work together very strongly. One of the highlights of the Melbourne and Victorian health and medical research ecosystem, is it connectedness. It's almost like family. So although there can be a little bit of sibling squabbling between Monash and Melbourne precincts, it's really a very cohesive group. And everybody knows each other and works so strongly together.

Natalie Thorne 25:33

Yeah, absolutely. And I guess one of the benefits of genomics has been the way that it's been able to galvanise those connections, and not just the connections that happen through research, but the connections, the clinical networks that we've been able to establish here. And by by bringing together those research and health connections across broadly across Melbourne, and now we're starting to really get further out across the state. That's where you start to really see how we're going to actually make genomics happen for people no matter where they live across the country.

Dr Megan Robertson 26:10

So why is it important that we embed genomics in our healthcare system? We're talking about access? What change is that going to bring for people when they seek healthcare and assistance, both locally, and more importantly, globally? How's that going to change the environment for healthcare?

Natalie Thorne 26:26

Yes, I mean, we've done a lot of work that has investigated, as Kathryn said, all these different conditions where we know now how genomics can make a difference. And the challenge now is, if you live in Warrnamboo,l or Wodonga, or Orbost, or wherever you are in Victoria, we want to make sure that, that you can access the same quality of genomic-based care wherever you live. And so now the challenge is how do we equip the workforce, the clinicians that live in these places, so that they know how to order these tests, they can recognise when patients need these tests, and how to use the information from genomic tests and the care of their patients. So it's really about that equity, of access, but that same quality of care across the state? Because we now know how genomics makes a difference. It's about how do we make that accessible everywhere?

Dr Megan Robertson 27:22

So from your perspective, what would you say are the strengths and capabilities of Victoria's genomics ecosystem?

Natalie Thorne 27:31

One of the things that's so great about what we've done here in Victoria, is we started really early, we were the one of the first, I think, actually, we were the first genomics initiative in Australia. And one of the first to get recognised with funding from our government. So very early on, not only did our hospitals and academic institute's recognise the importance of investing, but our state government did. And because of that, it means that we were very early on thinking about how we needed to do this. We designed it very specifically, and as Kathryn alluded to, we could see overseas what some of the other initiatives were doing, and where we could potentially do better. And so we specifically focused on that multidisciplinary approach, and looking at the whole of the system. So what that means is that we were looking at how clinicians were ordering the tests, what systems were, how the samples needed to be shipped around, what actually made something that was working well in a research setting actually happened in a routine way in laboratories, with all of these different disciplines working together. It's such a multidisciplinary approach. So by intentionally designing the way that we did all of these clinical studies, we were able to learn how to work together and learn how to bring those disciplines together. So that was one of the other strengths. I think the other approach is that we brought an intentional focus around learning about how to do implementation. So we weren't relying on these changes to happen by chance. We were designing implementation studies. And so we've actually developed a lot of expertise here in Melbourne, around the science of how you implement something into clinical care. And that's been a really big strength because it means with the things that we've learned, we've published and we've shared with the global community. And people from across the world, look at our results that don't just look at the diagnostic rate and the kinds of tests that we're doing, but they look at how we've implemented, what we've learned, what they need to do to put in place so that they can make genomics a reality in their countries too.

Dr Megan Robertson 29:46

Now you mentioned a multidisciplinary approach, which is always aspirational, often quite difficult to do, because the groups come together, almost with a different language. But the other group that you've consulted since the inception of the Melbourne Genomics Alliance is your community advisory group. Now, why was it so important to get the community engaged early and bring them along on this journey?

Natalie Thorne 30:10

Look, the community advisory group have been amazing, we have spoken to them at every point in the process. Because at the end of the day, genomic testing is all about people getting genomic tests when they need it, and getting the care that they need from those tests. So if we don't understand what they need, if they don't understand what genomics is all about, how are they going to trust it? How are they going to be able to benefit from it. So we've had the community advisory group, particularly in our first program, advising us on and being involved in discussions around every different aspect from some of the bioinformatics work, to how labs do their testing, to how they like to be consented for tests, how they like to receive results, lots of different aspects. And it really, it really makes us think about how we communicate about what genomics is as well be very specific about in a really plain, simple, language, what is it that we're doing and why are we doing this? So that it makes us really focus? And on the core of what matters?

Dr Megan Robertson 31:21

That brings us back, I think, to Kathryn's point about the focus of the genomics is the community and the patients, it's making sure that they are at the centre of what we do. I mean, it's a it's an academically fascinating area and I'm sure as a bioinformatician, and a clinician, it's fascinating academically. But really, the importance of this is being able to link it to the patients and the community. So in 2019, Melbourne Genomics launched GenoVic which you mentioned before, can you tell me a bit about that? What is it and what does it do?

Natalie Thorne 31:57

So GenoVic is a clinical grade system that allows us to support the labs to do these genomic tests. So we talked, and Catherine talked about how complex this data is, it's really big. It's really complicated. And of course, many years ago, we figured out how to analyse this data to do a genomic testing research, what we now needed to do is figure out how we could do these genomic tests that have all of these complex steps - where we got data coming in and go into the next tool, and then into the next tool - how we could do that in a way where multiple laboratories could do the various different kinds of genomic tests that they needed, but also enable the data that comes out at the end of that to be stored in a way that was consistent, so that we didn't have these silos of different pockets of data being held by all these different laboratories, and they're not able to be used effectively and efficiently for research use afterwards. So GenoVic essentially supported, well actually does support, five laboratories to do these genomic testing, and that, that ranges from pediatric testing for rare diseases to adult genetic conditions and cancer conditions as well. So it's a highly flexible, highly modular system, that supports labs do these testings, but it also stores this data in a way that's consistent, and meets the security standards and the robustness that is needed for a clinical grade system. And effectively, what it's really doing is connecting those existing pathology systems, that you know are there to track samples and make sure the tests get done well, as well as the electronic health medical record system. So the electronic systems in hospitals, it's that glue, that missing piece between pathology and the hospitals, that enables us to make genomics a reality, but also make genomic data available to labs and to hospitals.

Dr Megan Robertson 33:58

So that's very much like what Kathryn was talking about with her two year birth cohort. What you've got is not just a genomics database, it's enriched by the clinical information and the other pathology information, which must be fabulous as a bioinformatician? To have access to that sort of data must be fascinating?

Natalie Thorne 34:19

Yeah, and, and that's, that's the vision at the moment, we haven't quite got there. And as you can imagine building a clinical grade system that meets that vision. It takes a lot of work. So what we're doing right now is actually designing that final bit that will allow us to bring in that rich clinical information and have that come directly from the electronic medical health records. And that's the part where we're now taking genomics and making it fit in the digital health system. And so we're bought in digital health experts now, we've just we've revamped our team, so we're bringing in people that are experts in those electronic medical health record systems, so that we're now actually being able to take GenoVic into the digital health system.

Dr Megan Robertson 35:07

So you're sounding like a startup, they're moving into the scale-up phase, you've got your minimum viable product. And you now are in an iterative process, adding things in.

Natalie Thorne 35:15

Absolutely, we've got an established system, it's supported over 10,000 tests. Now we're moving and growing so that we can scale-up and really take it to the point where it's going to be able to have that impact that we need it to have. Not just support labs to do their testing, but really grow that database, if you like, of rich genomic information and the associated clinical information that's available so that patients can have their DNA information that's been stored in their health system available for different kinds of tests on their, on their DNA, at different points in their life.

Dr Megan Robertson 35:55

What an aspiration. Thanks, Natalie. That is absolutely fascinating. We'll be back to talk to you during the panel session.

Natalie Thorne 36:02

Thank you.

Dr Megan Robertson 36:09

Catch us on Twitter, at Global underscore Vic.

Dr Megan Robertson 36:16

My final guest today is Professor Sean Grimmond. Sean has been the Director of Cancer Research at the University of Melbourne Centre for Cancer Research since its establishment in 2016. He holds a PhD in genetics and is internationally recognised as a pioneer of whole genome and transcriptome sequencing. He currently co-chairs the Victorian Comprehensive Cancer Centre's (VCCC) Precision Oncology Program. In December 2019, he pioneered the University of Melbourne Illumina strategic partnership, and is the Academic Lead of the Advanced Genomics Collaboration, a five year program promoting innovations in biomedical genomics, supported again by the Victorian Government. Hello, Sean, thanks for chatting with us today.

Sean Grimmond 37:03

Hey, Megan, thanks very much

Dr Megan Robertson 37:05

Sean, as Director of the Cancer Research Centre at the University of Melbourne, how do you see the intersection of genomics and cancer? And how does this translate into your work with precision oncology?

Sean Grimmond 37:18

Yeah, so maybe I should start by saying that when when we think about cancer, it is a genetic disease, cancer arises through the accumulation of damage to your genetic blueprint. Sometimes you inherit that from family members. Sometimes you acquire that over your life. So to really understand cancer, you need to be understanding your DNA and the damage that it's taken to make that cancer grow. In terms of the UMCCR (University of Melbourne Cancer Research Centre) at the and the work that we're doing there, we very much focused on looking and understanding how your genetic blueprint can influence different aspects of of cancer, from what you may inherit from your family through to how do we decode a tumor, one patient at a time, try to understand its root causes, try to see how we can improve the diagnosis compared to the traditional approaches? And how can we then use that information to make better decisions for those patients as they go through their cancer care?

Dr Megan Robertson 38:21

Thanks, Sean. So that's a very complex area of precision oncology. How do you tease apart those different influences in someone's genome?

Sean Grimmond 38:31

Yeah, so I think we break it down into a number of different questions. The first one that I think is where we've seen the most activity is right at that coalface that a patient presents with a cancer. And the oncologist is trying to make a decision about what therapy you want to use, and just be comfortable that that tumor really has come from is the tumor they think that they're going to treat. So in that respect, we're looking for very specific events within that, that genetic blueprint, looking for the presence or absence of those, and then you are able to report that back to the doctor, which gives them confidence as to this actually is a breast cancer. And it is this particular piece of the machinery in the cells that is broken, that is leading to that that's tumor's development. And in some cases, those types of events. We know that there are a specific Achilles heel that we have a targeted drug that we can then pursue. So in that case, it's looking for those needles in the haystack of all the other damage that that cancer cells pick up over time. When we want to start to get into the questions of has this tumor arisen through something you've inherited. We know that there are some genes that are very potent in making that happen. You may have heard of BRCA1 or 2, which are very well known in the media about increasing your risk of breast cancer. We're able to go and scan those genes very similar to what's been done in the rare genetic disease contexts looking for those events. But then also we recognise that even though there may be some families that don't have a very high risk of cancer, they may have a heightened incidence. And so we're now starting to understand that, in fact, there can be an interplay of multiple genes within your genetic blueprint that can increase that risk from above the population background. So they're different questions and you ask this enormous amount of data, you run different approaches to actually decode each one of those for the patient.

Dr Megan Robertson 40:28

So from this perspective of precision oncology, what are the most important strengths in Victoria and Melbourne's ecosystem that support your work?

Sean Grimmond 40:37

Yeah, so I mean, I think as you're hearing from all the work here, all of this work is based on on teams of quite diverse areas working together. In terms of cancer treatment, we clearly see genomics playing a key role in diagnostics. So traditionally, we we diagnose cancer, based on where it is located and then we use a 300 year old instrument, being the microscope, to physically look at those cells, and we will mark some of those cells, and then we'll make a decision. Now, in many cases, that's more than sufficient. But in far too many cases, there is ambiguity about what is the actual diagnosis of that tumor, and in some cases, no, no amount of microscopy will help you decide. Now, that can be a really important question when you're choosing the path for that patient. But crucially, here, it could also influence what drugs are available for that patient on the PBS (Australian Pharmaceutical Benefits Scheme). So we really require more precision around that. So give you an example, the types of work that we're doing within the UMCCR in partnership with our colleagues at Peter Mac, we are running programs where where there are patients with diagnostic ambiguity, we are able to take those in and then add the DNA scan, if you like the DNA scope, as the next way to scan those tumors, to remove some of that ambiguity, and give people confidence how to go forward. So and the other example, of course, is large teams working together. As you mentioned, I'm involved in the VCCC Alliance's Precision Oncology Program. So across that particular network of hospitals, were able to provide molecular testing for challenging cases, and then see how this can help this standard of care.

Dr Megan Robertson 42:23

So the Victorian Comprehensive Cancer Centre (VCCC) has really transformed cancer care in Melbourne in that it's brought together a wide range of tertiary and metropolitan hospitals. How have you seen that impact on your work and your capacity to actually influence and assist with patient management across Victoria?

Sean Grimmond 42:46

Yeah, so I mean, the the VCCC Alliance is extremely exciting place to work. It's one of the reasons why I returned, the primary reason why I return back to to Australia to drive these sorts of activities is that that Alliance gave you leading hospitals, excellent clinical care, a platform for for clinical trials, and the integrated health care teams that would be able to take genomic data, and then see how they could use it to make better decisions. So you need all of those parts together, in order to make this worthwhile. There is nothing worse than providing a genetic test for a patient where you can find that there may be there is a an Achilles heel there that may be exploited by a drug that is currently out there and on trial. But if you can't get access to that patient, you're not doing them a service. So the VCCC's been a great place as an exemplar of how to really pioneer these approaches.

Dr Megan Robertson 43:47

You mentioned clinical trials, and really clinical trials in haematology and oncology, across Victoria is a strength. So led through the VCCC, but also particularly one of the silver linings from COVID if you like, has been our improved decentralisation of clinical trials, so that the VCCC hospitals actually reach out into the full population of Victoria and often into southern New South Wales to actually offer treatment to those patients who are in difficult circumstances and need access to really very specific therapies.

Sean Grimmond 44:25

Yeah, that's absolutely right. I think it's important to recognise that the rarer plenty of cancers are actually quite uncommon and rare, and therefore, you actually will find that patients will aggregate to referral centres. So the offerings that we're having here, where there may have been enabled by the VCCC the catchment can be anywhere over Victoria. We have large programs which are run out of UMCCR are partnering with groups within Parkville which are able to consent patients and perform these sorts of studies on anyone across Australia that fit those particular cancer types. And I think that anyone, anyone who in the business knows that when you're working with some of them, the rarer cancers, which we know less about, those teams across the country work very closely together.

Dr Megan Robertson 45:15

I suppose one of the other benefits in Victoria, with your expertise leading into the clinical care, is that we have excellent expertise in phase one or early phase trials in particular, which can enable access to really important drugs, and enable access to important populations for groups wanting to test early phase drugs.

Sean Grimmond 45:36

Yeah indeed. So in terms of the phase one drugs, so making that first step to see whether a brand new drug, and more and more of them are being specifically targeted to a specific mutation that genomics will define, allows you to see whether they're going to be successful. And then if they are, they'll go through more and more rigorous testing. We have great systems here to do that here in Victoria. But we also have some wonderful national efforts now that are accelerating, getting drugs into this country to enable those trials driven through genomic testing. So Omico is a perfect example of that. I think that is allowing us to show more and more utility of genomics. But the question still remains, then how do we actually expand that out from the early phase ones testings where we're, you know, we're, we're signal seeking to show this drug might be useful in the future? How do we get the system of care that you've been hearing from, from Natalie and from Kathryn?

Dr Megan Robertson 46:34

So just to go on to a different thing, you're the Academic Lead of the Advanced Genomics Collaboration? So tell me a little bit about that. What is it and what's its aim?

Sean Grimmond 46:44

Yeah this, this is an exciting initiative that's a little different. It comes from a partnership that we have with Illumina, which is one of the world's premier genome sequencing technology companies actively involved in a lot of precision health activities, as well. And what we've looked to do there is establish a number of key platforms that we need for carrying out genomic investigations to improve human health. And then also see how we can prime the pumps for innovation projects, to enable new services, new products, commercial outcomes coming from those sorts of studies.

Dr Megan Robertson 47:20

So you talked previously about precision oncology or precision medicine, it's a term that's often thrown around, it means something slightly different to almost everybody. What is precision medicine, in your view? And is it more than just treatment?

Sean Grimmond 47:36

So I'll give you my definition. I think this is obviously something that is often discussed between scientists and others. For me, precision cancer care, or precision medicine, is where we base the treatment of the diagnosis and the treatment of that disease, based on the root causes the root molecular causes of that disease in that individual. We don't base it on on the tissue, we base it on those precise things. In terms of cancer, this is where we're decoding those diseases, as they're based on genetic damage one patient at a time. And then we go on further from there.

Dr Megan Robertson 48:16

What about prediction?

Sean Grimmond 48:18

Yeah!

Dr Megan Robertson 48:18

And risk analysis for family members, for example?

Sean Grimmond 48:21

Indeed. So when you as I was talking about before, when we look at a patient, we now have the means to be able to, to diagnose and maybe select optimal therapies if they're there. But we're also able to, now we've seen the advancement of using these approaches to determine the overall risk of that that patient, that patient's chances having that cancer, the chances of that cancer coming back. And indeed there can be work there where you can start to get information as to the relative risk for the that that individual, we do have the ability now to start to prospectively or predict what will someone's risk would be of cancer prior to them having it. It's work that for some cancers is working exceedingly well. It's cancers that if for some cancers, we have that, so that it works universally well. In some of those studies, however, it's far, the genetics has been well defined for individuals like myself, but for others that have a different ethnic background, we still have work to do to really get that fit for clinical care.

Dr Megan Robertson 49:28

I suppose that's another strength of Melbourne, in terms of this research, is that we do have a very wide ethnic mix, which gives us a wide genetic background. So the opportunity, if you like, to look at some of these across a very broad ethnic range.

Sean Grimmond 49:47

Yes. So I think we are and this is one of the real importances of, maybe we'll get on to the session later on. But the likes of the Global Alliance for Genomics and Health is we need to be able to aggregate these sorts of data so that we can derive benefit for every person on the planet. And it's not just going to be driven for people who have a Caucasian background, for instance. So and then indeed, when you look at Australia, we are multicultural. So it's even more important if we want to start taking this into the point of care. So I think there's excellent inroads being made there and it's only through collaboration in our region, and indeed, essential work that's going on to to make sense of First Peoples in our region, that we can really bring that that more equity to those sorts of studies. I do think at this point of care of the cancer and the diagnosis, as you're really trying to pinpoint some things that are quite specific, matching them to drug for instance, those things are pretty straightforward. And we're using them...daily.

Dr Megan Robertson 50:51

So a final question, as a basic scientist, how exciting is it for you and your team to be involved in something that links so closely into actually seeing effects? Being able to daily see the growth and the expansion of the basic science impacting clinical care? If I look back on medicine, when I started 30 years ago, plus, cancer as you say, breast cancer was one disease, it's now transformed, really, and teams like yours have been pivotal for that.

Sean Grimmond 51:28

Yeah, look, I think that I mean, I'm really feel very privileged to have the, the role that I have these days, and the work that I'm doing is, is both fascinating, but also an incredibly exciting thing to do, because we are we very much are focused on cancers of unmet need. So the patients that have been left behind, we've seen fantastic advances for some cancers, survivals of more than doubled in 20 years. But there's way too many where we just haven't seen those advances, genomics gives us an opportunity to start to actually move that dial on those where we haven't seen something for some decades. And I'm working with large, interdisciplinary teams that believe, have the same commitment.

Dr Megan Robertson 52:12

So once again, that brings us back to the importance of the network, doesn't it. And it's that bench-to-bedside and back to bench, that iterative process that virtuous cycle that is so important and gives Melbourne its strength in this area.

Sean Grimmond 52:29

That's absolutely true. I mean, I see that every week within the molecular tumour board that's run at the VCCC, where you have experts in genetics, in pathology, in oncology, in genomics, bioinformatics, all around that table, discussing these findings. You know, integrating those into all the other clinical information and considerations you have at that patient, and then seeing how you can start to improve decision making. It's a very exciting place to be.

Dr Megan Robertson 53:04

More than one third of Australian clinical trials activity takes place in Victoria. Pharmaceutical and biotech companies across the globe, recognise Australia's impressive capability and many have chosen to undertake trials here in Melbourne, and across Victoria.

Dr Megan Robertson 53:32

We've learned a lot about the genomics ecosystem in Melbourne and Victoria today. And we've had some wonderful insights from a number of different perspectives. Now, we will finish up with a short panel segment with all of today's guests. Welcome back, everyone. We've heard a lot today about precision medicine. But it does mean something slightly different to everyone. Maybe I'll ask each of the panel members for their definition on precision medicine.

Kathryn North 53:57

My view of precision medicine and precision clinical care is really to remove the trial and error, both from our diagnosis and treatment. So that we're getting the right diagnosis first up and targeting for that patient what is going to be the most likely, successful treatment.

Dr Megan Robertson 54:17

So earlier you mentioned some work in epilepsy and genetic predispositions to epilepsy. Tell us a little about that and how your definition of precision medicine works in that group of patients.

Kathryn North 54:29

I think this is part of a study that started in Melbourne and went nationally, where we thought we needed to use genomics to target and help to treat the most critically ill children. So we formed a collaborative network around all of the paediatric and neonatal intensive cares around the country. We're the first country to do that. And we realised that we couldn't wait for weeks, or sometimes months, to get a diagnostic result. We needed to get it down into less than a week. What we've been able to do, by turning our labs into 24/7, rather than Monday to Friday 9 to 5, is to have a three-day turnaround for a genomic test for these critically ill infants. And that's led to a 50% diagnostic rate and changed the care for those kids in 75% of cases. The example I'll use is epilepsy. And a young patient I'm thinking about, who presented in the first week of life just with constant seizures, constant epilepsy and fitting. Had to be intubated, had to be tube fed. Usually the approach, and I talked about trial and error, is you know you started drug if that doesn't work, you add another drug, etc, etc. What we were able to do was to do genomic testing, and within three days provide the results back to the clinicians, and and to his parents. And for that particular genetic change, there was a known drug that had been shown to be most effective. Within three days of him receiving that drug, his seizures stopped, and haven't recurred. He's maintained on that treatment. But the most important thing is the natural history for kids with this disorder is to become very intellectually disabled. And now at two years of age, he's developing normally. Since that patient, we've now got, you know, at least 10 other patients over the last year with that same result. So this is...it's changing lives.

Dr Megan Robertson 56:37

That's a remarkable insight. Thank you, Kathryn. Now, Nat, over to you, what's your definition of precision medicine?

Natalie Thorne 56:45

Yeah, I mean, I guess I like to think of it more broadly as precision health care. And from the perspective of being a data scientist and working more on the systems that underpin genomics, what I like to think about is how genomics is one part of the bits of information that we need to bring together to inform on someone's health care. And it's all about what are the pieces of information, we need to tailor how we care for people. And so genomics is a really important part of that. But we need to figure out how we bring genomics together with other really important healthcare information. Could be information that someone collects on their mobile phone. It could be cancer registry information. There's a whole lot of really rich sources of healthcare information that together, with genomic information, can really help us tailor the way we care for people.

Dr Megan Robertson 57:44

Thank you. And Sean, over to you. What's your definition?

Sean Grimmond 57:48

Yeah. So I think I've described you before that, that I see this understanding the root causes of the disease in an individual, and then basing their their treatment on that is a clear distinction between some of the traditional medicine where we're basing it on the organ where the disease is lying, and we rely on prior experience of large populations, to decide whether we'll use one drug over another. We're now thinking about going to that very precise, making sense of the individual and weighing and balancing. I think the other things that should be added to that piece, which really fills it out to this issue of precision medicine or precision care, is that we can start to better understand risk for a variety of diseases. We can also start to flag in advance whether a drug is likely to be effective, or there could even be an adverse side effect to that. So there's an aspect around pharmacogenomics, which is another addition, which can make things more precise. And I think the other thing I'd add is that we're now seeing some really unique assays for cancer surveillance and screening, which are based on molecular tests that are sniffing out those key root causes of those diseases as a very precise test for that individual.

Dr Megan Robertson 59:07

So you mentioned pharmacogenomics, your team have a program going in palliative care, which is one aspect of oncology but not something we typically associate with genomics. Can you tell us a little bit about that program?

Sean Grimmond 59:20

Yeah, sure. So I mean, UMCCR is looking at all different aspects of the patient path. And indeed, in terms of palliative care, if people have we've been unsuccessful, their cancer has progressed even with the likes of targeted therapies. Analgesia for those patients and keeping them comfortable is absolutely key. There it is very empirical, the way we go about and traditionally would do that. So Professor Jen Philip, who is based with my centre and also at St. Vincent's is really trying to see if you can start to use the patient's genetic blueprint to preferentially select what will be the optimal therapy there when it comes to analgesia for those patients, the quality, the change of a quality of life there is really quite enormous.

Dr Megan Robertson 1:00:06

So that's interesting, it takes it from the epilepsy example is in a one-weeker to the other end. And that's where Nat you are talking about that genetic information being able to be reused and looked at across the lifespan.

Kathryn North 1:00:20

We're certainly from the children's cancer perspective, also applying this pharmacogenomics understanding that genetic susceptibility to having the long-term adverse effects that we see when kids can receive chemotherapy or radiotherapy. So we're coupling that with stem cell modeling of of their own tissues, and looking at the effects of these drugs, and then the genomic nature, their own genomic nature, so that we can really target their therapy to minimise those long-term side effects. Because so many kids can get heart failure or kidney failure because of their treatment. And we're really focusing on a long and healthy life rather than living with the side effects of their therapies.

Dr Megan Robertson 1:01:10

So this is fascinating. So genomics, as we grow in our knowledge of genomics, it's actually impacting all aspects of care. We tend to think of it in very specific rare disease or cancer, but it actually covers the whole spectrum of your health care, or your health life, as we get more and more information that's going to permeate more deeply into all aspects of care and medication choice and life choices as we go forward. Now, you've all described a really remarkable network in Melbourne and across Victoria. It's clearly very interlinked. It's very fast moving, it's cutting-edge, it's globally relevant, how to people outside who want to collaborate, get access to the system, to the network, how do they come in and join us? Nat, we might go to you first.

Natalie Thorne 1:02:02

Yeah, well, I think it's been mentioned before, how important it is that the data that we're generating from genomic testing is available, so that it can inform on patient's care throughout their life, and can also be used for research. And so being able to share data is really important. And from my perspective, one of the things that we're really interested in, is working with people who can help us on that journey for how we connect our systems, across the country and internationally. So that we can share data for research and to have that learning and those discoveries come back into healthcare. And of course, one of the challenges of doing that as well is that those other kinds of datasets, and those discoveries can be really hard to incorporate back into something that can be used in a robust way in the clinical setting. So sometimes, like you might have, we've all had experiences of downloading an app on our phone, and it'd be a little bit buggy, and it looked like it was going to be really good. And it worked when they first developed it. But then there was a problem with it when you tried to use an indifferent setting. And the same thing can happen when we try to bring in something that has been working quite well in one setting for research, but making that happen on a wide scale, clinically, that can be hard. And so the more that we can work together to make our systems talk to each other means that we're going to have more consistency in those systems. And then it's going to be easier and quicker for us to bring in all of these other kind of bells and whistles and new discoveries to make them actually work routinely for healthcare. So we're really interested in working with people who'd like to help us on that journey of connecting up our systems.

Dr Megan Robertson 1:03:51

Thank you. Now, Sean, you've got extensive international links already. How does someone who doesn't have a link with you get in and access, or how do they approach you? How do they get access to all the the platforms and work that you've got?

Sean Grimmond 1:04:06

Yes. So where we are at the moment, certainly the VCCC alliance with the hospitals that it's covering gives us a large catchment for the particular studies. There are a number of other funded, either from philanthropy, or from the various funding sources running large, genomically empowered clinical trials. The Medical Research Future Fund, for example, is providing a number of those studies. So these are very much driven by their doctors, their treating physicians that will be looking and reaching out to having people engage in these studies. And as I was saying, we are certainly focused on patients that have been in the more challenging cases where they're either very rare, they're very aggressive, they're resistant. So we're having them channeled in through the clinicians. Unfortunately, we're in a situation that here in Australia, we do not have routine molecular testing for cancer. And so we're really relying on those programmatic studies. There is a good network here working between ourselves, the Monash partners, Comprehensive Cancer Centre as well, where we work on those. The study that we have... So I guess that's the first point of call that if there are people who want to know more about this, it's talking to treating clinicians, or indeed, they can reach out to us at UMCCR to find out the types of activities that are happening.

Dr Megan Robertson 1:05:34

Thank you. And Kathryn, obviously, I think you mentioned earlier that MCRI is really the Melbourne hub of a global research institute. Tell us about that? Tell us about how people collaborate with you and your groups?

Kathryn North 1:05:47

Ah yes, so collaborations the name of the game, we've heard about the Melbourne Genomics Alliance, we've also partnered up across all the different states to create the Australian network, and then feed into the Global Alliance. And I co-chair what's called the Genomics and Health Implementation Forum, which is bringing together 35 different countries who are doing national initiatives. And everything we do is about that safe and responsible sharing of clinical and genomic data. That's, that's the name of the game. I think within Australia, and you talk about, you know, increasing the access to this knowledge, I see that we sort of started genetics was within the specialist geneticists, as we've then moved out with and engage with other specialists, so we have cardiac people who we immerse and train so their understanding is in neurology in immunology, in cancer, you know, bringing all the sub specialties along. But as we're now moving out into using the genomic information for prediction and prevention, we now then work with the GPs (General Practitioner Drs) for pharmacogenomics, we'll be working with the pharmacies, we also have an amazing consumer advisory group. So we partner, with the lay organisations, with the patient groups, and then we get out there and talk about genomics in the general public. And I must say, one of the very few good things about COVID was we had our politicians standing up every day going, we're waiting for the genomic testing, so at least come into the public vernacular, but it's, it's going to be part and parcel of our medical record, it's going to sit there and I would see, eventually, we'll all have our genome sequenced at some stage, and our clinicians, and now doctors, and even ourselves, will be able to dip into it to ask specific questions relevant to your clinical problems throughout life.

Dr Megan Robertson 1:07:51

As a final question to each of our panel members. If you could share one thing with the world about Victoria, Melbourne and genomics, what would it be? Kathryn to you?

Kathryn North 1:08:03

Well, that's a great question. And I must say that any one of us could work anywhere in the world. But I cannot imagine a better environment to be doing health and medical research than what we have in Melbourne. It's the collaboration, its excellence. It's a drive this vision. There's great support from our government, and really great links with industry. And Melbourne is one of the most livable cities in the world. So it's it's the package.

Dr Megan Robertson 1:08:37

Sean, over to you.

Sean Grimmond 1:08:38

Yeah, I think that Kathryn really summarised that beautifully. I think the other thing that I would add is just the sheer breadth of expertise that we have here within this, this city, all in close proximity. That is another real strength here, because I think what you're hearing about now, we've talked about genomics, the reason why it's come about is because it is, you know, it's bringing together chemistry and big data and nanotechnology and engineering to make that equipment. And then you're trying to find the way that you will then integrate that into a vibrant healthcare system. It's an incredibly complicated thing to do. And the technology is always advancing, as are all the new drugs. There's very few communities that can think about how they, they manage that in real time, as well as you know, testing and proving that this is a is worth doing going forward. So yes, I think that's probably one of the biggest things here is just that sheer breadth of capability,

Dr Megan Robertson 1:09:35

The depth of knowledge, and the breadth of capability, as you say, and the government support, I assume, enables you to keep your infrastructure cutting-edge.

Sean Grimmond 1:09:45

Absolutely. Absolutely. So the Victorian Government has been very supportive, always has been, and always someone who's lived in other states. It's always been looked at rather jealously, so...yeah...

Dr Megan Robertson 1:09:56

It's nice and Nat, finally, over to you.

Natalie Thorne 1:09:59

Oh well, I'm gonna think Kathryn and Sean have have put it really well. I mean, essentially, this is a medical biomedical precinct and I don't just mean Parkville, but that the precinct across Melbourne. It rivals any other precinct in the world. And so you can access any part of what's needed to do this from the hospitals that are leading hospitals that we have the academic expertise and research expertise, there really is everything here. And I think the other thing I would add, in addition to what Kathryn and Sean have just said, which may not sound like a strength, but I think is really quite unique for us is that we have a devolved healthcare system here in Victoria, it means we don't have a central pathology or a centralised health system. The beauty of that is that all the systems we're designing, are designed to cater for all those different hospital environments and different laboratories. So it means we're designing from the get go for a system that's going to scale across other jurisdictions in Australia. And I think that is a real strength that needs to be sort of recognised is the the fact that we are designing something that's going to scale.

Dr Megan Robertson 1:11:19

Thank you, Kathryn, Nat and Sean, for your time and insights today. It's been a fascinating discussion, I've learned a hell of a lot, and I hope our listeners have to.

Dr Megan Robertson 1:11:33

If you like what you've heard today and are keen on more information, then check out the links and information in our show notes. And remember, Victoria is a great destination for all things healthtech. We're open for business, and only an email or phone call away. I'm Dr. Megan Robertson. Join me in the next episode of Global Victoria Healthtech Talks.