Cardiac biomarkers and lab services

•

2 likes•1,011 views

Winton Gibbons

Health & Medicine

•  In
the
US,
there
are
about
50
million
troponin,
BNP,

and
other
cardiac
assays
performed
annually.
At
a

price
of
$6
to
25
per
test,
this
equates
to
a
current

market
of
$300
million
to
$1.25
billion.

•  Moreover,
if
beHer
biomarkers
were
available,
market

research
suggests
that
an
addiKonal
6
½
million
acute

and
42
million
chronic
tests
could
be
done
for
heart

failure
discharge
and
monitoring
for
decompensaKon

and
hospital
readmission.
The
resulKng
potenKal

market
would
be
$40
million
to
over
$1
billion.

©
2013
Winton
Gibbons

2

Ischemic
Cluster

Acute

coronary

syndrome

Peripheral

arterial

disease

Deep
vein

thrombosis

Pulmonary

embolism

Ischemic

stroke

©
2013
Winton
Gibbons

3

CHD
S=ll
to
Top
Killer

Death
rate
/
100,000

Heart
disease

179

Cancer

173

Stroke

39

Lower
respiratory

42

Injuries

38

Diabetes

21

Other

255

©
2013
Winton
Gibbons

4

Much
of
the
General
Popula=on
has
CHD
Risk

Factors

Smoker

High
LDL

High
blood

pressure

25%

23%

Some

risk

factor,

47%

No

risk

factor,

53%

12%

©
2013
Winton
Gibbons

5

Many
Firms
are
Involved,
including
the

Burgeoning
Specialty
Heart
Labs

Specialty

Heart
Labs

Novel

biomarker

ﬁrms

Atherotech

Alere

Aviir

Berkeley
Heart
Laboratory

Boston
Heart
Diagnos=cs

BG
Medicine

Cleveland
Heart
Laboratory

Mainframe
diagnos=cs

BRAHMS

Cri=cal
Diagnos=cs

diaDexus

CardioDx

Mainstream

POC
diagnos=cs

FFA
Sciences

LipoSciences

Health
Diagnos=c

Laboratory
(HDL)

MedTest
|
Point
Scien=ﬁc

Singulex

Nexus
Diagnos=cs

©
2013
Winton
Gibbons

Reference
laboratories

6

Typical
Biomarkers
-‐
1

Extra-‐cellular
matrix

remodeling

•  Galec=n-‐3

Myocyte
injury
and

apoptosis

•  Troponin

Oxida=ve
stress

•  MPO

•  oxLDL

Autoan=bodies

•  An=-‐oxLDL

•  An=-‐troponin

Other

•  GlycoMark®

©
2013
Winton
Gibbons

7

Typical
Biomarkers
-‐
2

Extra-‐cardiac

involvement

•  Cysta=n
C

•  NGAL

•  RDW

Myocyte
stress

•  (NTpro)BNP

•  MR-‐proANP

•  GDF-‐15

•  ST2

Neurohormones

•  Copep=n

•  ET-‐1

•  MR-‐proADM

•  UCN-‐1

©
2013
Winton
Gibbons

Inﬂamma=on

•  Adiponec=n

•  CRP

•  IL-‐6

•  LpPLa2

•  PTX3

•  TNF-‐a

•  uFFA

8

Genotyping

Apo
E
genotype

SLCO1B1
genotype

4q25-‐AF
Risk
Genotype

9p21
Genotype

CYP2C19
Genotype

KIF6
Genotype

LPA-‐Aspirin
Genotype

LPA-‐Intron
25
Genotype

©
2013
Winton
Gibbons

9

Mul=-‐marker

Gene

expression

Lipids

(cholesterol)

• Corus®
CAD

• VAP®
Test

• HDL
Map™

• Cholesterol

Balance™

• NMR

LipoProﬁle

• MIRISK®

©
2013
Winton
Gibbons

10

There
are
s=ll
Great
Biomarker
Opportuni=es

in
Heart
Failure

Worst
diagnosis
for
30-‐day
hospital
readmission

6
million
paKents
in
US
have
HF

650
thousand
new
HF
paKents
per
year

6.5
million
hospital
days
annually
due
primarily
to
HF

14
million
oﬃce
visits
per
year
due
to
primarily
to
HF

1.3
million
hospitalizaKons
per
year
have
HF
as
a

primary
diagnosis

•  3
million
hospitalizaKons
per
year
have
HF
as
a
primary

or
secondary
diagnosis

• 
• 
• 
• 
• 
• 

©
2013
Winton
Gibbons

11

Hazard
Ra=o
of
3
or
Greater
Required
by
MDs

to
Use
a
Prognos=c
HF
Assay

Chronic#Hazard#Ra9o#

Es#mated)Required)
Hazard)Ra#o)Range)

35%#
27%#
23%#

8%#
4%#
1.5#

2#

3#

4#

©
2013
Winton
Gibbons

4%#

6#

>6#

12

Need
Objec=ve
Measurement
to
Discharge
HF.

MDs
Willing
to
Move
to
a
Good
Biomarker

Heart Failure 25%
readmission and 11%
death 30-day rates

(22%
death
at
1
year)

©
2013
Winton
Gibbons

13

•  Blog

–  hHp://www.wingibbons.wordpress.com

•  LinkedIn

–  hHp://www.linkedin.com/in/wintongibbons/

•  SlideShare

–  hHp://www.slideshare.net/wingibbons

•  TwiHer

–  @wingibbons

©
2013
Winton
Gibbons

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