Emilie Balk-Møller: Interdisciplinarity of Systems Biology Will Play A Crucial Part in The Future Paradigm Shift in Healthcare

Quite a few efforts by the Health Team of Copenhagen Institute for Futures Studies focus on something we refer to as new biology. Today we talk with Emilie Balk-Møller our lead in the area. Emilie is the CIFS Health Team scientific advisor, she holds a PhD in Biomedical Science, she applies her extensive research experience to health innovations.

Q: You focus on the area known as ‘new biology’. What does this area include, and why? 

A: New Biology is known as New Systems Biology. It is a strategy or way of thinking about how to research organisms and complex natural systems such as cells. It aims to understand the full picture of biological systems composed of dynamic and interrelated genetic, protein, metabolic, and cellular components by the combining different sciences including biology, mathematics, and computer science. Systems biology emerged with the Human Genome Project and is driven by complexity and transfer of information between biological systems such as cells and organisms as well as the technological advances than enables investigations of these systems, processes and complexities.

Biology have moved from a century of reductionism where biological systems has been dissected into its constituents’ parts and that has been great for understanding how the systems are build and of which components. But these methods don’t capture the dynamics and fluctuation within and between the systems. Many of the most critical aspects of how e.g., a cell works comes from collective behaviour of many molecular parts, all acting together. Understanding the individual parts is not enough to understand or predict how the systems work, especially under fluctuating conditions. This is where the interdisciplinarity of systems biology come to play and plays a crucial part in this paradigm shift where we’re moving from a reductionist approach in biology to a more holistic one with the rise of new systems biology. 

Q: Futurists talk about megatrends. Which megatrends do you see in new biology? 

A: Interdisciplinarity, which is a key component of “new biology”. If we want to understand the complexity and dynamics we must work across fields and disciplines, which is exactly what is being done. Data. As in all other fields, data is produced in gargantuan volumes and proportions, hence data scientists and new analytical tools will gain further importance. Another megatrend is omics. It has been around for a few decades with the birth of genomics, but newer omics or subcategories are still emerging. Omics is a suffix combined with a lot of biological terms such as “protein” to form “proteomics” etc. and implies a comprehensive, or global, assessment of the respective components in a biological setting. In other words, if you are investigating a cell or a sample, you will then be studying all the many thousands different proteins of that cell or sample. It’s a holistic approach and falls under the category of new systems biology. In essence, combining the different omics is like putting together the many pieces of a puzzle to get the full picture. 

Talking about holism, another megatrend is One Health based on a holistic approach to include the environment. The concept of One Health is based on the interconnectedness between humans/animals and conservation of their environments. Several schools of thought, or scientific disciplines support One Health: environmental studies, food & nutrition studies, climate research, social and behavioral sciences.

The last two is driven by advances in biotechnology. Genetic engineering and synthetic biology. Genetic engineering has been around for decades but the advance within the field is accelerating fast now with the emergence of gene editing tools such as CRISPR. The progress is driven by increasing genetic understanding and improvements in biotechnological technologies. When I talk about genetic engineering and its possibilities, I don’t want anybody to think about designer babies – a horrible thought- it is solely about the opportunities to treat or reverse certain genetic diseases or design drugs or vaccines that can e.g., manipulate the immune system to eradicate infections or cancers. 

Synthetic biology is a little similar to genome editing. In synthetic biology, scientists typically stitch together long stretches of DNA and insert them into an organism’s genome altering the organism of even create completely new ones. Its is not only useful in biomedicine but also in environmental setting where microorganisms can be modified to remove harmful substances from ecosystems or the food industry to create meat-like products such as the incredible bleeding burger.

Q: Journalists love to ask about the most important development, while there is almost never one priority. Hence, the question, in your view, what are the most important recent developments in your focus area that will affect healthcare in the near future?

A: It is the understanding of our genes and which role they play in health and disease. With the development of genetics and genomics which investigates either single genes or the whole genomes, respectively, we’ve gotten a magnifying glass into the deepest of our cells, the DNA. This has increased our understanding of both health and disease and led to the development of tools such as gene therapy and genetic engineering.

Healthcare is moving from a one-size-fits-all approach to personalized medicine where therapy and treatment to a much larger degree is directed to individuals based on their genetic profiles. That will lead to individually tailored therapies with better outcomes for patients. 

Genetics and genomics have given us a better disease understanding while at the same time revealed that not so many diseases as we though are imprinted in the genome or that many gene are often involved. This fact significantly increases the complexity and making disease predictions and treatments much more difficult. This led to the rise of the other omics. Another crucial development within the field. Using these omics and combining them, gives scientist a better picture of what happens at the molecular level during both health and disease states and eventually what happens at the molecular level when going from one state to the other, e.g., healthy towards disease. With that knowledge we can measure some of these molecular elements, knowing which rises or decreases in case of disease development and set in with actions and treatment and a much earlier state which in many cases can lead to better health outcomes. 

Q: What will it mean to patients and healthy individuals? What do you think they will be able to do, of what they cannot do today? 

Much of this research is still basic science and translational science, meaning we’re still “just” understanding how the human body works and what happens when we get sick. We have a lot of knowledge, tools and treatment options, but we’re still far from having the complete picture and we’re constantly improving with treatments and drugs. The knowledge we get from the genome and other omics is extremely important for better clinical use such as in screening, early diagnosis, real time monitoring and better treatments. Take screening for example, an important tool in prevention and early diagnosis. These are already carried out today in many areas such a measurements of cholesterol, important in cardiovascular diseases, and blood sugar levels for diabetes. Omics adds to the list of possible measurable molecular markers which is increasing as our molecular knowledge expands with the further development of omics and systems biology. 

For cancers, which is one of the leading causes of deaths in high- and middle-income countries, few screening tools are available such as for cervical, breast and colorectal cancers. All procedures which are uncomfortable and needs to be carried out in a clinic. But soon we will be able to screen many types of cancers with just a blood sample. Today we’re developing Liquid biopsies for cancer detection and monitoring. A liquid biopsy is a non-invasive biopsy technique, which is mainly used as a diagnostic and monitoring tool for diseases such as cancer. It is a test done on a sample of blood or urine to look for cancer cells or for pieces of DNA (or RNA) from a tumor that are circulating in the blood. It allows real time monitoring of cancer development, its response to treatment or monitor if the cancer is back, and completely new tool that will benefit both doctors and patients.

Q: What do you consider to be strong sides of the European health related science? What are its weak points?  

A: Collaboration. There are many great European collaborative initiatives that supports research and collaboration between countries, institutions, universities, and industries such as Horizon Europe, Interreg, IMI, Digital Europe, EIT health and so many others. Europe has many excellent research programmes that has been a powerful force and driven collaborative efforts both between the members states and beyond. Furthermore, Europe has some great research infrastructures that also enables collaborations through offering facilities, expertise, resources to conduct research. In a world where the science becomes more sophisticated and complex, collaboration and interdisciplinarity is key. 

The weak point might be a growing inequality in Europe where not all countries have the financial capacity for research spending. An inequality that might be further highlighted in the light of the covid crisis.

Q: How do you envisage the European research to change in the near- and longer-term future, and why? 

A: Hopefully there is a momentum for even more and stronger collaboration than before. There is already focus on collaboration, open science, and data sharing, but I believe that with the geopolitical tension we see today we will further be strengthening in all these areas. Especially data sharing. There is intense competition in R&D both form the west with US and the east. Especially  China which is investing heavily in research and has lifted their scientific output, acumen, and reputation significantly. If Europe want to be a part of this race, they will have to collaborate and stay united. 

Q: I would love to but cannot avoid a couple of covid related questions. What have healthcare systems learnt? How different will be our responses to future stresses? 

A: Well healthcare systems have learnt a lot and is still learning. It became clear to all healthcare system around the globe that they were not prepared for this pandemic. And while they are still grappling with the ongoing pandemic -now under much more control- the effects that it has had is not yet completely revealed. For the next many years, we will see the reverberation on the healthcare system.

Some of these include cancer screening that didn’t take place in most of 2020, people with heart problems or other signs of illnesses that did not show up at the hospitals as they normally would etc. I fear that many early signs of disease and early diagnosis for many patients, was lost in that year. I think we have learned a lot about the acute phase. How to handle a crisis, what to do and not to do but for sure we have learnt a lot, but we have a lot more to learn and, in many instances, a new and better healthcare system to build.  

We – the citizens – also learnt a lot about how we use the healthcare system, how we take care of one another and how it is possible to use telemedicine in our everyday life -what to many seemed impossible not so long ago.  

Q: In your view, how did covid change the research community?  

A: What I found more interesting, is what happened during the first year of the pandemic in the research community as a whole, not just in my research. I know I just talked a lot about collaboration within the scientific society, and although it is great with collaboration, note that research is a highly competitive field where everything you do is being measured on the novelty of your research. If you want to stay in the field you must publish to receive funding, publish good and publish novel findings, a trend that luckily seems to change a bit now.

In the beginning of the pandemic, in the spring of 2020 where all countries closed their borders and protected themselves, the scientific community shatters theirs, shared data like ever before, collaborated and managed to produce not just one but several highly effective vaccines in a timeframe that NO ONE would have ever believed possible.