Apollo Hospitals' exosome technology detects brain cancer without biopsy

Its two research arms have achieved path-breaking outcomes in non-invasive, cost-effective cancer bio-markers

A burgeoning population and the advent of a range of new pathogenic and lifestyle diseases has made healthcare in India extremely complex. The medical fraternity has risen to the occasion at every step to meet the challenges in maintaining and improving public health, delivering several new molecules and therapeutic procedures to improve the overall wellbeing of the populace. In a new series, Business Standard brings you five institutions that stand out in the field of medical research in India. 

When it was set up in 1983, Apollo Hospitals not only paved the way for corporate, for-profit hospitals but almost 35 years on, it is also leading the way in multiple business opportunities through research.

Clinical and Research innovation at Apollo is delivered under the helm of two research wings -- Apollo Hospitals Education & Research Foundation (AHERF) and Apollo Research and Innovations (ARI). While ARI focuses on clinical research, education and innovation, AHERF focuses on basic research, translational research, public health and epidemiological studies. 

Apollo Hospitals Education & Research Foundation (AHERF)

AHERF is a not-for-profit organisation recognised by the Department of Scientific and Industrial Research (DSIR). With its registered office in Chennai, AHERF has a wet lab for research, the  Cell and Molecular Biology Research Centre (CMBRC) at Hyderabad, with offices at Delhi that operate under Dr N K Ganguly (Former DG, ICMR). CMBRC enables execution of basic and translational research projects in cutting-edge areas such as liquid biopsies, molecular diagnostics, pharmacogenomics and exosome-based technologies. Dr. Sasidhar Venkata Manda, PhD, Chief Scientific Officer heads the CMBRC laboratory at AHERF, Hyderabad and is currently involved in the establishment and validation of various novel exosomal platform technologies leading to development and/or validation of biomarkers for various translational research projects involving cancers, pathological conditions, glioblastoma, among others. 

Apollo Research and Innovations

This division of Apollo Hospitals focuses on clinical trials in drugs, devices, OTC products, new technology validation, healthcare software and consumer healthcare products of clinical relevance. Mandated in 2000, ARI is the first and currently the largest site solutions organisation in the country, with 17 established site offices at eight Apollo Hospital locations -- Ahmedabad, Bengaluru, Bhuvaneshwar, Bilaspur, Chennai, Hyderabad, Madurai and New Delhi. 

"ARI has undertaken more than 900 clinical studies over 10 major therapeutic areas, conducted by a dedicated team of 80 clinical research professionals across 17 different Apollo Hospitals. Thirteen of the Apollo Hospital centres are AAHRPP (Association for Accreditation of Human Research Protection Program)-accredited, a gold seal for clinical research, “ says Ishita Shively, Vice-President,  Innovations. 

Significant advances have been made in using biomarkers for diagnostics. Exosomes are small vesicles and consist of RNA /DNA/protein/metabolite molecules that are secreted by all living cells into body fluids such as blood, saliva, urine and breast milk. They are the molecular internet of the cell that help in cellular communication. They have applications in enhancing the efficacy and potential of diagnostic biomarkers, drug delivery systems and therapy.

Using exosome platform technology, brain tumours can be detected without having to drill into the organ to extract a biopsy. This was the first preliminary non-invasive blood-based diagnostic biomarker system for early detection and monitoring of Glioblastoma Multiforme (GBM) in India. AHERF has established an in-house “circulatory biomarker platform” technology that has paved the way for launching liquid biopsies into the Apollo Hospital system, using exosome technology.

Apollo is extending the test format to almost all biological fluids and various deep-rooted cancers, and is in the process of establishing the detection in  Diabetic nephropathy,  renal transplant rejection, and pseudo progression as well.

The major advantage of these test formats is their non-invasive nature. They are easier to perform, cost less, cause less pain to patients, and facilitate real-time monitoring of the disease and therapy.

Drug Delivery vehicles:  Chemotherapeutic drugs delivered through liposomes and nanosomes have low bioavailability and bring undesirable side effects, including toxicity. Using exosome technology, effective oncological drugs can be made form exosomes found in various natural sources such as fruits, milk and curcumin. Therapies loaded exosomes could serve as a next generational drug delivery mechanism.

Read how Hyderabad-based Asian Institute of Gastroenterology is not only pioneering breakthroughs in the treatment of the digestive system, but is raising the bar in nephrology and diabetology too

Partners in healthcare

AHERF has collaborated with national and international research organisations as well as industry.

Apollo has completed a pilot study to evaluate the benefits of integrating Mobile ODT’s EVA system for digital cervicography into their primary screening for cervical cancer. The study, which has been partly funded by IFC, enrolled 550 patients across five Apollo Hospital centres. The results are indicative of a promising screening tool for cervical cancer, especially in remote rural areas. 

Apollo Hospitals' collaboration with a global start-up successfully evaluated the efficacy of a PoC diagnostic device on parameters such as sensitivity and specificity for diagnosis of malaria in comparison with gold standard microscopy and PCR testing. This novel platform provides malaria detection that is as sensitive and specific as current testing technology.

Drug delivery vehicles: Lipid-based nano materials and liposomes are the most common current drug delivery agents used for targeted delivery of oncology drugs, as explained above. 

Therapeutic agents:  Stem cell-based therapeutics have great potential, but carry significant side effects and must be delivered under a regime of stringent regulations. Besides, they are fraught with issues such as logistics, stability, storage and efficacy. AHERF is currently conducting research on cell-free exosome therapeutics from various cell culture supernatants of stem cells in collaboration with various research organisations. 

Sapien Biosciences, incubated by AHERF in 2012, is today India's largest bio bank with over 100,000 biological samples and counting. The samples along with the clinical information leverage to undertake research for drug discovery and diagnostics. This platform facilitates long-term biomarker development, apart from bridging the gap between the healthcare & life sciences industry and pharma companies, enabling the drug-discovery and development process, and triggering Big Data. 

The new addition to Apollo Hospitals' ecosystem is Urvogelbio -- developing innovative diagnostic and therapeutic solutions in the Central Nervous System space. 

Encouraging research and innovation

Apollo has evolved a Grab-Your-Grant initiative designed to help physicians interested in contributing to research. It focuses on sharing knowledge of upcoming grants from government bodies, with the aim of connecting doctors and scientists who seek such funding. It also helps them write grant applications. ARI provides continuous assistance by identifying grants, mapping research topics to relevant grants, literature search, proposal writing, to facilitating the entire application process. 

The Investigator Initiated Study (IIS) programme is designed to enable more clinicians to participate in research. IIS focuses on clinician-driven research studies with support from pharma companies to enhance current technology . 

At AHERF, non-profit research is being funded through Apollo Hospital's CSR fund. Government support comes from the Department of Science and Technology, Department of Biotechnology and Indian Council of Medical Research (ICMR) in the form of government grants.

Watch this space for the next article in this series, on how Narayana Health has developed liquid biopsy as an alternative to surgical process