Upstream of early — getting at disease before it’s even diagnosed: Noubar Afeyan

Projects in NASH and cancer show how Flagship is exploring major diseases pre-diagnosis, in the realm of ‘health security’

Flagship Pioneering founder and CEO Noubar Afeyan is eyeing the frontier of disease as protecting health in a pre-diagnostic state, part of a concept of “health security” that he’s increasingly focused on. Talking for the first time publicly about a project in NASH, Afeyan outlined the way Flagship is applying this principle in disease areas where the health impact can translate to a meaningful economic impact as well. 

On The BioCentury Show, Afeyan discussed the contours of health security, which he described as working upstream of disease, before the process starts, and sees that kind of protection and pre-emption in health as analogous to physical protection or national protection — other forms of security. 

The pandemic brought to the surface the importance of protection and reducing the risk of disease, an area where Afeyan had a front-row seat to the issues in play as the chairman of  Moderna Inc. (NASDAQ:MRNA). While he’s “proud broadly of the industry” and what it achieved, he says it’s too soon to know whether biotech and other sectors will take lasting lessons from the experience. 

But the idea of using molecular science to make precise interventions is extensible to other diseases.

Investing in disease prevention has run aground because it can take over two decades to demonstrate a reduction in risk, but data sources such as electronic medical records can be used to create actionable insights in a much shorter time frame.

Afeyan disclosed a project in non-alcoholic steatohepatitis looking at biomarkers that could signal an individual is within, for example, a year of diagnosis. “What we’re finding is that the early, early manifestations of the pre-disease condition look nothing like the later stage disease,” he said. “The pathways are different. The targets are different. Therefore, what we’ve also found is that certain treatments that people thought would work in later stage NASH actually might work well in pre-NASH conditions.”

He gave an example of using a biomarker to identify individuals within two years of diagnosis. “If we could make that segmentation and go after a cohort, let’s say within a year, and show that we can delay [disease] by a year or two years, the economic impact of that, the health impact of that, I think is measurable.”

In another example, Afeyan described a project of portfolio company  Harbinger Health Inc. looking at blood based biological signatures that can be diagnostic tools in cancer. Most circulating tumor marker tests, he said, are detecting later stage cancer early. Rather than looking for stage 3 or stage 4 cancer, “what you’d really like to do is to find stage one cancer. And this biological marker set, we believe, does that.” He added, “We’re taking another step of saying, could we find stage zero cancer?”

Afeyan also discussed the state of funding, and how he sees company creation and growth evolving as the market emerges from the downturn. In addition, he discussed risk in drug development and how biotechs operate; the idea that the timelines can be shortened; and how he sees AI and machine learning altering the trajectory in the industry — a development he sees as “inevitable.”