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Innovative Techniques to Reduce the Burden of Chronic Disease

An Interview with Mr Teemu Suna, CEO of Nightingale Health Ltd.

Written by James Coker  Reporter, European Medical Journal  @EMJJamesCoker

Disclosure: This is a non-commercial feature.

Nightingale Health Ltd. is an organisation that is becoming increasingly synonymous with global efforts to combat chronic disease. The Finnish-based biotech company has developed a unique metabolic profiling technology that measures blood biomarkers to detect early signs of conditions such as cardiovascular disease and diabetes. The impact this technology could have on both an individual and a wider societal level is vast, potential leading to a dramatic lowering of the burden that chronic diseases place on healthcare systems the world over. Nightingale recently announced a collaboration that will see them analyse the metabolic profiles of 500,000 blood samples from UK Biobank, the world’s largest health database. With such a large sample to analyse and discover patterns within, the partnership could have major implications in the treatment of metabolic diseases.1 Recently, the European Medical Group sat down with Nightingale Health CEO and Founder, Mr Teemu Suna, to find out more about this collaboration, gain greater insights into the technology used, and hear his general opinions on the best methods of preventing chronic diseases.

Inspiration

Mr Suna is highly passionate about finding ways to solve the chronic disease crisis, which is one of the biggest issues in modern healthcare. A recent joint report from the Organisation for Economic Co-operation and Development (OECD) and European Commission estimated that the premature deaths of 550,000 people of working age across European Union countries from chronic diseases, such as heart attacks, strokes, diabetes, and cancer cost these economies an average of EUR 155 billion or 0.8% of GDP annually.2 The Finnish entrepreneur views many healthcare systems as being reactive in the management of chronic illness, treating people once they have already become sick rather than focussing on keeping people healthy in the first place. This is where technologies that can accurately predict disease early on, such as that developed by Nightingale Health, have a big role to play. “The challenge with preventative medicine is that you need technology to predict the onset of disease and you need to be able to do the prediction in the scale of 10 years before onset,” said Mr Suna. “There are several healthcare reforms ongoing across Europe with governments thinking about how to restructure healthcare in order to improve efficiency. This is, of course, necessary but it’s not the solution because the fundamental problem doesn’t change with healthcare reform; we need technologies that changes the set up in disease diagnosis and support.”

Company Focus

The founders of Nightingale have a range of backgrounds; some solely from the world of science and research and others, like Mr Suna, who have business and computer technology experience. This combination of knowledge appears to be the basis for the success of the company. Mr Suna explained that the technology was initially targeted towards the scientific research community when the company was founded in 2013, but this gradually evolved to include a healthcare focus. “It’s the combination that matters and we believe that’s our strength,” he commented. “We need to be strong in research, in academia, and in science to demonstrate that this technology actually works. The world of healthcare is very different as there is a lot of regulation and a lot of existing processes and workflows that we need to respect, so we need to be very good in this area as well. And then when putting these two things together we believe there is a very real possibility to initiate major change for healthcare all over the world.”

Current Diagnostic Tests

Mr Suna explained how the current diagnostic techniques for chronic disease are old and often unreliable, involving a series of individual biomarker tests; however, the complex nature of conditions such as cardiovascular disease and diabetes mean that these tests can be inefficient in predicting their onset. An example of this is the cholesterol test, frequently used by physicians, with studies displaying that a very high percentage of patients hospitalised after a heart attack have cholesterol levels indicating they are not at risk of a cardiac event.3

Metabolic Profiling Technology

Mr Suna argued that doctors instead need to be able to look at the molecular profiles more broadly to make an accurate assessment. This is what is offered by Nightingale Health’s metabolic profiling technology for measuring blood biomarkers, powered by nuclear magnetic resonance (NMR) spectroscopy. A regular blood sample can be put inside a high frequency magnet; the magnetic field then causes the molecules in the blood to resonate. This resonance is recorded, and the data are quantified into molar units. Overall, over 220 biomarkers can be obtained from just one blood sample, providing much broader insights for doctors; examples of these biomarkers are glucose, amino acids, and lipids. “We don’t even need to train the medical doctors again like in genetics; you need to train them to understand the data, but they know the biomarkers. The difference is just that you get a broader picture of the metabolism at once. Another interesting point is that in many countries we provide the 200 metabolites with the price of the cholesterol test, so it’s very affordable, affordable enough to be used in public healthcare,” Mr Suna elucidated.

Research Impact

There has been a number of positive outcomes in the use of the technology according to Mr Suna, both from a research and healthcare perspective. One of the many new research findings from the biomarkers revealed has included improved knowledge of the relationship between different types of amino acid and complications in Type 2 diabetes.4

Clinical Impact

Mr Suna also informed us that a clinical pilot in Finland is currently ongoing to assess the clinical potential of the technology. In assessing the risk of cardiovascular disease in a cohort of participants, doctors have been able to analyse apolipoprotein levels through Nightingale’s technology, in addition to usual assessments such as the cholesterol test. Apolipoprotein assays can be more accurate than standard blood cholesterol tests, as they report on the number of lipoprotein particles rather than measure the amount of circulating cholesterol: the concentration of atherogenic particles is regarded as more significant than the amount of cholesterol contained in them in predicting the risk of cardiovascular disease.5

Reaction from Patients

A particularly noticeable observation from this pilot study has been the enthusiastic reaction by the participants themselves; Mr Suna told us they have been highly motivated to make lifestyle changes that improve their health when they are able to clearly see the effect that these changes have had on the risk of a particular disease; in this case on their apolipoprotein levels in the context of cardiovascular disease. Therefore, he believes that the information made possible by Nightingale Health can also encourage patients to better look after their own health, which is of course a crucial aspect of preventing the occurrence of chronic diseases.

“At Nightingale we can actually follow-up on a molecular level how the lifestyle intervention is affecting your personal risk of getting a chronic disease. Based on our experience, people are very motivated when you provide the right tools and the right kind of feedback,” he added.

Partnership with UK Biobank

The recent announcement that the company will be analysing the blood biomarkers of 500,000 blood samples from UK Biobank opens new opportunities for understanding how chronic diseases develop. The analyses will be performed at Nightingale’s laboratory in Finland and will be made available to the scientific community after a 9-month exclusivity period for the company. This ability to openly access this type of information is a very important factor for Mr Suna.

He outlined the impact that having such a huge sample to work from could have in predicting the onset of chronic disease in the future. Conditions such as cardiovascular disease and diabetes often have a complex set of biomarkers that can vary a great deal between different people. Therefore, individual testing of biomarkers is often an inaccurate way of predicting the onset of disease; instead, a lot more data are required to build a detailed picture of the many different categories there are to comprehend how these conditions develop at a personalised level.

Mr Suna explained: “In the big picture, this is very much connected to precision medicine, because it will allow us to understand the individual risks better. In the current situation this is not the case; for example, if you take diabetes and glucose, diabetes is defined as being if your glucose level is above a certain threshold. So, what the healthcare system is essentially doing is splitting people into two categories: the ones who have the disease and the ones who don’t. Biology is not like that, it’s a lot more complex how disease is developed at an individual level.”

He continued: “To gain better understanding, to create more individual categories you need two things: first of all, you need more biological data, more biomarker data to capture the individual differences. For example, for some individuals it may be that glucose value is a red flag, but then another metabolic profile signals something else.”

New information will be revealed following a major statistical analysis; this will measure and compare the blood samples of the individuals involved against their broad biological data, enabling patterns to be found and new categories of risk factors to be created.

Future Potential

With the technical pilot of this huge blood analysis underway, the EMG will be keeping a close eye on updates from this project going forward, particularly the new insights into the development of chronic diseases that are likely to emerge. Nightingale Health’s vision and technology could significantly help reduce the prevalence of these conditions in the future, particularly diabetes and cardiovascular disease.

EMJ Cardiology and EMJ Diabetes

The EMG team are currently working hard on the next editions of the EMJ Cardiology and EMJ Diabetes eJournals, both of which will be available as open access publications on our website in October and November, respectively. In addition to abstract reviews, symposium reviews, interviews, and peer-reviewed papers, these journals will include reviews of the upcoming annual European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) congresses, which members of our team will attend. You can subscribe to our cardiology and diabetes content here for free to ensure you receive instant news of these publications straight to your inbox!

 

REFERENCES

 

  1. Nightingale Health. Nightingale to analyse half a million blood samples from UK Biobank. 2018. Available at: https://nightingalehealth.com/news/nightingale-to-analyse-half-a-million-blood-samples-from-uk-biobank. Last accessed: 24 July 2018.
  2. OECD. Europe paying a heavy price for chronic diseases, finds new OECD-EC report. 2016. Available at: http://www.oecd.org/health/europe-paying-a-heavy-price-for-chronic-diseases-finds-new-oecd-ec-report.htm. Last accessed: 24 July 2018.
  3. UCLA. Most heart attack patients’ cholesterol levels did not indicate cardiac risk. 2009. Available at: http://newsroom.ucla.edu/releases/majority-of-hospitalized-heart-75668. Last accessed: 24 July 2018.
  4. Welsh P et al. Circulating amino acids and the risk of macrovascular, microvascular and mortality outcomes in individuals with type 2 diabetes: results from the ADVANCE trial. Diabetologia. 2018;61(7):1581-91.
  5. Nightingale Health. The value of measuring apolipoproteins in the risk assessment of cardiovascular disease. 2018. Available at: https://nightingalehealth.com/news/the-value-of-measuring-apolipoproteins-in-the-risk-assessment-of-cardiovascular-disease. Last accessed: 24 July 2018.

 

Photo credit: Adam Schultz, Solve MIT