Seeing a way forward

4 October 2017

Opening up the human genome presents unimagined treatment possibilities for understanding and treating a huge range of conditions. For one pioneering researcher, it offers the possibility of restoring sight.

Dr Robyn Jamieson

In her lab, Dr Jamieson is working at the forefront of what's happening in genomics.

Dr Robyn Jamieson (PhD(Medicine) ’98) first became interested in the possibilities of medical advances in genetics early in her career, long before the human genome was fully sequenced.

“A lot of the diseases back then, you couldn’t get to the fundamental answer,” she remembers. “We were just treating symptoms – we didn’t really understand what was causing them.”

Now, of course, the science of genomics is rocketing ahead at an astounding speed. Jamieson’s work has been concentrated on the eye and it has led to significant advances in the treatment of certain debilitating genetic eye conditions.

One focus of Jamieson’s work is the White family from Sydney’s north-west. Beth White and her three children all have an extremely rare genetic eye condition – so rare, it doesn’t yet have a name, which has left Beth blind, and her children – Kathryn 15, Samuel 13, and Matthew 10 – with progressively deteriorating vision. They share a defective gene that Jamieson and her team managed to isolate from billions of possibles.

“What’s been really amazing has been the whole next generation sequencing revolution,” she says. “A lot of the patients we were seeing had many, many possible underlying disease genes. It was impossible with the previous technology to get answers. It wasn’t fast enough, and it was too costly.”

The White family, Samuel, David, Beth, Kathryn and Matthew

The White family (from left): Samuel, David, Beth, Kathryn and Matthew, with their dog.

Identifying the gene is only a first step. Now a treatment must be designed. But the Whites themselves are very aware of what a big first step this is. “They had said ‘don’t get excited, they may never find it’. It’s that hard,” Beth White said. “They found it in five months. That’s huge.”

David White – Beth’s husband – adds: “There are some groups that have spent five years, 10 years and mega-millions and never got anywhere near the traction that’s been built up, which is really only over a few years.”

Genetic diagnosis via sequencing has opened the door to a whole new realm. At the same time the advent of gene-editing technologies such as CRISPR, which can add, remove, or alter DNA within a cell, has expanded that realm even further. Yet finding a way to harness gene therapy to cure these rare diseases requires yet more scientific advances – to find both a suitable therapy and method of delivery.

With her team, Jamieson, who is Professor of Genomic Medicine and the Head of the Discipline of Genetic Medicine at the University of Sydney Medical School, has recorded significant breakthroughs, providing some hope for families dealing with congenital diseases.

To me this sort of work and being at this point is just amazing. But it’s such a delicate balance in giving people hope. When you’re a patient, or when you have a child with the condition, while the hope is great, you want treatment now.
Dr Robyn Jamieson

Originally from western Queensland, Jamieson studied widely, including postdoctoral research work in Britain on genomics and disease gene analysis. She returned to Australia to set up her own research group that would do clinical work with patients and, simultaneously, undertake lab work to accelerate the genetic research. Her ideas were in advance of their time and some scientists then were actually doubtful of the benefits of combining genetic research with clinical studies.

Bursting with energy and sheer intellect, Jamieson is also extremely compassionate; concerned about her patients and their relatives, and always worried that scientific advances won’t live up to their hopes and expectations. Still, she knows her work has tremendous potential.

Dr Robyn Jamieson

Dr Robyn Jamieson

The condition affecting the Whites has now been recreated as a laboratory model at the Children’s Medical Research Institute, giving the possibility of developing a treatment.

“We have used whole genome sequencing to identify novel disease genes in several families – genes not previously known to be associated with these types of conditions,” Jamieson explains. “So we’ve made model systems for some of those conditions and we used the CRISPR technology to model the exact mutation. This technology can also be used to determine if we can provide a cure in the model systems. And then that’s proof of principle to go on to the human.”

She adds that the discovery of the novel disease gene serves to help the Whites understand their condition, and later down the track it will give the children information about the exact gene change, something their parents never had. But the Holy Grail is treatment for the existing condition – either to fix it, or stop it progressing.

Meanwhile, work is also underway to determine the best way these sorts of potential treatments can be delivered. A stem cell treatment perhaps, or a type of CRISPR fix could be injected into the eyeball as part of an attenuated virus.

“At the start of my clinical career, I was seeing people and being able to give them basically no information,” she says. “We just had nothing. So much has changed. For families like the Whites, with genetic disorders, hopes are high that any number of new treatments are appearing just over the horizon.”

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