Genes That Fit

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Should doctors insist on a genetic test for each patient before prescribing a new drug? They don’t today, but if a new generation of low-cost, easy-to-use gene testing systems comes to market, such tests could become standard fare.

There are already a number of companies in the Puget Sound region selling products that combine laboratories and information technology to offer the potential for improved health care, including Bothell-based Iverson Genetics, Seattle-based Genelex, and Natural Molecular Testing Corp. of Renton. Meanwhile, Stratos Genomics of Seattle is focusing on ways to sequence genes more cheaply while Seattle-based Spiral Genetics is offering a service to improve the way in which genetic information is stored and processed.

Iverson Genetics shows both the promise and the gamble involved in this market. It is a genetic sequencing and information technology company that sells a program to help doctors or hospitals interpret the results of those tests. CEO Dean Sproles says Iverson’s products and services will vastly expand the use of genetic testing by making results easier to read and interpret.

“What we are providing with Physicians Logic [proprietary software] is an easier operating system—the Windows of genetic medicine,” says Sproles.

One of Iverson’s genetic tests can be used by doctors before they prescribe a blood thinner to a patient. It is well-documented that patients differ in their responses to Warfarin, which is among the most commonly prescribed drugs in the United States. Adverse reactions to drugs are listed as one of the top 10 causes of death in the country, and genetic testing can identify some patients who would respond atypically to Warfarin. The hope is that doctors can prevent adverse reactions by filtering patients based on genetic information.

Genelex and Natural Molecular Testing also sell a variety of gene-testing products. Genelex has its own version of a Warfarin test and sells software to create a better user experience for health care professionals.

Whether the market will embrace these products and services is still unclear. While there are 1.9 million hospitalizations annually due to medication side effects or errors, many are not because of genetic differences but because patients don’t follow directions or there are dosing errors. The Center for Medicare and Medicaid Services (CMMS) has a nationwide clinical trial under way using the Iverson test to try to determine its clinical effectiveness. Seattle’s Group Health Research Institute will soon begin a study of the effectiveness of such tests. Meanwhile, the institute’s director, Eric Larson, remains skeptical.

“So far, the gain [in health] from genetic information has not been as dramatic as we would all like it to be,” he notes. While he recognizes that, over time, genetic tests may make a significant difference, developing such tests and proving their effectiveness could take a long time.

The Seattle area has a long history of innovation in sequencing and genomics. Leroy Hood, who helped design the first machines that sequenced DNA while he was at California Institute of Technology, moved to the University of Washington and later created the Institute for Systems Biology in Seattle, where Sproles once worked. Sproles started Iverson in 2007, and Hood is on Iverson’s advisory board. Hood believes that a greater understanding of the genetic makeup of individuals will result in huge improvements in health care.

But the health care system has been slow to adopt “personalized medicine,” as the approach is often called. One challenge is that it’s often unclear whether health care providers will be reimbursed for such tests. And many physicians remain doubtful about the tests’ effectiveness.

Another Seattle spinoff from the Institute for Systems Biology is NanoString Technologies, which announced in September that it would seek European approval to sell a testing system for breast cancer that shows what is known as a “gene expression analysis.” According to a recent story in the online magazine Xconomy, CEO Brad Gray predicted NanoString would also seek approval from the U.S. Food and Drug Administration in 2013.

An additional challenge to adoption of personalized medicine is the high cost. New technology could quickly drive down some of those costs. Stratos Genomics, which has about 15 employees and is housed inside of Seattle-based Stratos Product Development, believes it has developed a machine for reading an individual’s genetic makeup more quickly and less expensively.

Allan Stephan, founder and CEO of Stratos Genomics, says the system, called Sequencing by Expansion, first expands the DNA molecule (made up of about 3 million base pairs) and then threads it through what is called a nanopore that reads the sequence. Two of Stratos’ competitors in this space are Oxford Nanopore Technologies in England and Ion Torrent of Guilford, Connecticut, and San Francisco.

Spiral Genetics, by contrast, has developed a service that makes it easier to store, access and analyze genomic information. CEO Adina Mangubat admits that the field of genetic sequencing is littered with bold claims that have not panned out, but she thinks she can help the prospects of the entire industry by allowing researchers to analyze more genetic data and understand its impact faster.

For all the skepticism about the promise of genetics research, few doubt the sector will have a huge impact over the longer term. But at this early stage, it’s far from certain what companies will survive and thrive. Makers of genetic tests and equipment think they are in the right part of the business. As Allan Stephan of Stratos says: “During a gold rush, you want to be selling tools.”

[Virtual] Reality Check

[Virtual] Reality Check

Seattle companies will cash in on the coming VR explosion. How it plays out beyond gaming is the next big question.
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After years of hype about virtual reality, it stands ready to move from The Matrix and Avatar into real life, with applications ranging from gaming to e-sales, from collaborative product design to remote surgery. What’s more, many companies in the Seattle region will reap the benefits.
 
“It is a paradigm shift,” says Bob Berry, CEO of Envelop VR, a virtual reality startup in Bellevue. “It’s a new form of computing that is just as transformative as mobile was. We are entering the age of immersive computing.”  
 
Those heralding the arrival of market-ready VR aren’t merely the ones developing the technologies. Investors have become true believers, too. Matt McIlwain, managing director of the tech-oriented Madrona Venture Group, says he was a VR skeptic until recently. “Eighteen months ago, I started meeting with a group of companies that had very early developer kits,” says McIlwain, who noticed two things had changed from earlier efforts. First, the VR experience was “pretty darn good.” Second, he adds, “I didn’t feel woozy coming out of the experience.”
 
Forest Key, CEO of Pixvana, a Seattle startup developing cloud-based tools for VR, couldn’t agree more. “VR in the 1990s made me vomit,” Key relates. But thanks to rapid advances in the underlying technologies, such as faster processing, better graphics and new methods for tracking movements, says Key, virtual reality systems that will hit the consumer market this year are more immersive and much less likely to induce “simulator sickness.”
 
“For hundreds of dollars, or certainly in the low thousands, you can build a rig that is superb in its capabilities and fully capable of tricking your brain into the effect that virtual reality strives for,” Key says. “Once done correctly, it’s like time travel, teleportation and science fiction all in one. It magically transports you to different places and profoundly allows you to have a psycho-perceptual experience that is different than watching a rectangle on a web browser.”
 
The launch this spring of three much-anticipated VR headsets — Facebook’s Oculus Rift, the HTC Vive and Microsoft’s HoloLens — spurs the optimistic frenzy. The Oculus Rift costs $600 and the HTC Vive goes for $799; both are aimed at the consumer market. Microsoft is selling 
HoloLens as part of a developer’s kit for $3,000. It’s aimed at game makers as well as those developing practical applications. 
Of the three companies that have introduced new headsets, only Microsoft calls the Seattle region home. But HTC, which developed its Vive headset in partnership with Bellevue’s game colossus, Valve Corporation, headquarters its United States operations in Bellevue, and its VR offices are in Pioneer Square, about a mile from the SoDo site where Oculus VR recently opened an R&D office.  
 
Los angeles, Silicon Valley and Seattle constitute the three major hubs for VR development, but Seattle may be ideally positioned to benefit most favorably from the coming VR explosion. While Los Angeles has a large pool of entertainment talent to draw from and Silicon Valley has an edge in hardware development, Key says Seattle has two major advantages: companies with long experience in game development and a vast knowledge of cloud services. While single-person VR experiences can run on isolated computers, Key notes, running interactive VR applications requires a cloud-based infrastructure.
 
“In three years,” he predicts, “no one will be debating whether the hardware is ready. It’s going to entirely become a question about software, about content.” In fact, Tom Furness, a professor of industrial engineering at the University of Washington and considered by many to be the godfather of VR, says, “The hardware is here. Now it’s about the content and tools to help us develop content easier and better. We don’t have those tools right now.”
 
Furness recently joined Berry’s Envelop VR as its senior scientific adviser. He says he chose to work with Envelop because it is developing what he considers “the most essential component” for the VR industry. “It is the superglue that brings together and integrates all of the hardware, software and experience design components that make VR an empowering tool for mankind,” Furness says.
 
Madrona Venture Group has been a lead investor in many of the burgeoning VR companies in the region, including Envelop and Pixvana. McIlwain believes the concentration of game and cloud application developers makes the Seattle region the natural location for developing VR content and the tools required to create and deliver the content.
 
“The gaming ecosystem in Seattle is really good,” notes McIlwain. “But, then, this is also the cloud capital of the world. I can go down the street and talk to my buddies at Microsoft and Amazon and ask, ‘What kind of use cases are people using you for? What are the next things you’re building? Why do you need to support this kind of video encoding?’”
 
Key says gaming will be the primary driver of consumer VR sales, but investors and developers alike see VR as a much broader game changer — from education to health care to manufacturing. “[For example,] meetings and conferences,” Key observes. “Meeting with your doctor or your trainer. Any kind of one-to-many or one-to-one communication will be very powerful in VR.  It might be education, or therapy.” 
 
Furness matches Key’s excitement at VR’s potential for bridging distances. “It’s basically a transportation system for the senses, where you can meet with other people even though you’re not physically co-located,” Furness notes. “You can bring people together and get bandwidth not only to the brain but between brains.”
It’s not quite the Vulcan mind meld Mr. Spock used to great advantage in Star Trek, but it’s close. “[VR] will let us look through somebody else’s eyes, let us communicate our perspectives and [give us a space] where we work on things together,” Furness told KUOW last year.
 
In the training sphere alone, whether it’s showing surgeons how to remove a gallbladder or giving aircraft technicians a how-to on painting a helicopter — without wasting any paint — VR promises to revolutionize how teachers teach. 
 
Even Seattle companies you wouldn’t immediately associate with VR are getting into the act. Boeing, which has long used augmented reality for flight training, used VR in the aforementioned example on painting helicopters. Amazon and Vulcan are hiring software engineers with VR expertise, Amazon apparently with an eye on its growing position in film and television production and Vulcan expressing a vague interest in “developing cutting edge solutions in augmented and virtual reality technologies.” 
 
“There are a lot of exciting applications that are in the commercial realm in addition to the consumer realm,” adds McIlwain. He envisions a group of architects “walking around” inside a building in VR, discussing design changes. “Or I can Skype into an interactive session to help a doctor figure out a diagnosis, or help someone repair something in a manufacturing facility. I don’t have to be physically present.”
 
Microsoft designed HoloLens primarily for such nongaming markets. At its Redmond campus last fall, the company demonstrated HoloLens by giving users a full-size 3-D view of a new Volvo sedan, with the ability to look under the hood and remove elements to explore the chassis and power train. Volvo is exploring having its engineers use HoloLens in the design process. One Microsoft video shows a designer looking at a motorcycle and simply touching and pulling on the gas tank, for example, to change its shape.    
 
E-commerce constitutes one of the most immediate and massive nongaming markets for VR. Imagine, Berry says, shopping on Amazon.com for a tent that sleeps six. How big is that tent, really? Big enough for six large people?
 
“I have no way to reason about the actual size of that tent other than looking at 2-D images, or maybe a little 3-D model I can spin around,” Berry says. But imagine clicking on a button next to the tent to summon up a VR view. “Suddenly,” he explains, “you’re inside the tent at scale and you can actually get a sense of how big the thing is. VR allows you to sense scale in a way that your brain can actually understand.”
 
As game makers move into the VR space, new startups in Seattle zero in on developing the tools that will simplify developing those games, as well as any other type of VR application.
 
Envelop VR, which launched in July 2014, developed a VR shell that goes around the Windows computer, allowing users wearing an Oculus Rift headset to work in Microsoft Windows in a 3-D environment. A camera on the Rift headset offers the user a view of the keyboard or mouse so he or she can control the immersive experience of Windows.  
 
The company is also building tools that let developers convert 2-D objects created in, say, AutoCAD, into 3-D objects in a virtual app in the environment. Besides allowing users to explore tents in 3-D while shopping online, the technology can be used in other sectors, such as manufacturing. “An engineer on an auto manufacturing line could put a headset on, export a 2-D design into a VR environment and walk around the object, lean their head into it and evaluate in a much more intuitive way,” Berry says.  
 
Pixvana focuses on delivering a cloud-based video-processing and delivery platform for virtual reality applications. After working on the Silverlight team at Microsoft, and before that as a visual effects specialist at Industrial Light & Magic, Key was aware that VR hardware, to be effective, will require new technologies for processing video at required speeds, especially when interactive applications require cloud services.
 
The new VR applications, says Key, “will require new kinds of tools, new kinds of production process, new kinds of experiential viewing processes. That’s what Pixvana’s mission is.”
 
As engineers put the finishing touches on the soon-to-be-released VR headsets and technologists of various specialties prepare the infrastructure the headsets will run on, industry insiders are not entirely specific on how VR will affect the economy and society. But they are convinced the impact will be huge.
 
In the near term, McIlwain predicts VR products will be adopted quickly. “Smart headsets will become pretty ubiquitous in two to four years,” he says. “Based on what I’ve seen, this stuff is pretty high quality and the chances are good that we are going to get some pretty good headsets out there in the second quarter. And then we’re going to have a big uptake cycle for the holiday season.”
 
As for the longer term, Key believes VR will be as disruptive to earlier technologies as cinema was to vaudeville. “The idea of sitting and watching a static rectangle on a screen will be very passé in 10 years,” he predicts, “because virtual reality is so fundamentally compelling. It’s magical.”  
 
Thanks to that magic, VR pioneer Trond Nilsen told a meeting of the Washington Technology Industries Association last November that we’re all going to live at least part of our lives in virtual reality at some point. “[And] the world,” Nilsen promised, “is going to get strange.”