ESSW – Session 4 – OMICS, OH MY!

ESO European Stroke Science Workshop 2023

Session 4: OMICS, OH MY!

 

The Friday afternoon session with the catchy title “OMICS, OH MY!” presented the first pro and con debate of this year’s ESSW and by this another new feature to the programme of the workshop.

The statement to be debated was: “Genomics will deliver specific stroke treatment in the next 5 years”.

Hugh Markus made the start taking the optimistic view voting for “yes”. He had a difficult task as the pre-debate survey already revealed that the majority of scientists in the audience appeared to be on the sceptic side with regards to the near future promises of genomics for stroke treatment. To support his case, Hugh Markus reminded everybody of the fact that genomics already has led to the identification of new treatment in cardiovascular disease providing the example of PCSK9 inhibitors for treatment of hypercholesterolaemia. In the second part of his talk, he described the prospects of mendelian randomization for the identification of potential therapeutic approaches. Finally, he pointed out that the era of genetic modification to treat stroke has just begun. As an example, he referred to the success in healing sickle cell disease with CRISPR-based gene editing which has been approved in the UK some weeks ago. Other approaches relying on genetic modification are currently being tested for example for cholesterol reduction using base editing of the PCSK9 gene. Against this background, Hugh Markus concluded that the advent of specific novel stroke treatment informed by genomics in the next 5 years is within reach.

Ynte Ruigrok took the role of the opponent. In an enthusiastic talk, she aimed at convincing the audience using five persuasive arguments, ingeniously structured to form the memorable acronym ‘FIASCO’. To start with, given the complexity of the genome and factors involved in stroke, she raised doubts that targeting a single genetic target would work. She also questioned why the next 5 years would bring more progress than the 5 years following the launching of GWAS which also came along with many hopes and promises but failed to deliver. Ynte Ruigrok pointed out that most of the drugs linked to targets identified by genomics had been identified based on other (non-genomic) approaches. Just 1 of 13 identified targets in this milestone analysis had not been known or tested before. This saying she made an excusing remark to the session chairs, Stephanie Debette and Martin Dichgans, who happen to be leading authors of the mentioned paper. Both took it with a smile – no offence taken.

After pros and cons were exchanged the audience was asked again. Obviously Ynte Ruigrok made some good points as the result of the voting was even stronger towards scepticism with 84% voting that genomics will NOT deliver specific stroke treatment in the next 5 years. The talks were followed by a lively discussion acknowledging the huge advances in genomics and also the prospects for future treatments based on genomics while the 5 years perspective might be overoptimistic.