The Precision Medicine World Conference (PMWC) is always an energizing meeting, full of exciting updates on the latest technologies, diagnostics, and targeted therapies. While the topics covered were vast and varied, one common theme that popped up frequently this year was the increasing importance of multiomics in precision medicine diagnostics.

PMWC’s Liquid Biopsy track on Day 2 started off with a panel discussion on the use of liquid biopsies in early cancer detection, an application that we believe will be pivotal to win the war on cancer, as patient prognosis depends primarily on stage at diagnosis. Panel members from Freenome, Delfi Diagnostics, Guardant Health, and Adela leverage different approaches, but they all agreed on one thing: multiomics will prove pivotal to achieve the sensitivity, specificity, and clinical utility necessary for maximum patient benefit. 

Blood is an ideal sample for diagnostics. It’s easily accessible, decreasing the sampling burden on patients and thus increasing the likelihood of clinical adoption (it’s been accurately said that a test is only useful if it’s used). It also carries signals from throughout the body, enabling a single draw to be used for a number of tests interrogating multiple systems. However, the wealth of biological signals in the blood is a double-edged sword: there may be a lot of valuable information, but it means filtering through more noise to get to it. This is where multiomics come in: layering complementary analytes is a way to get a more complete picture of the complex biology underlying disease. A multiomics signature of 10 circulating proteins and 10 circulating free DNA (cfDNA) fragments may provide a depth of information that 100 proteins or 100 cfDNA may not. 

The big players in liquid biopsy are already putting this into practice. When Freenome’s Jimmy Lin asked the panel which technology has the most potential to advance liquid biopsy diagnostics, the answer was overwhelmingly multiomic analyses. AmirAli Talasaz of Guardant reported the upcoming addition of proteomics to their ctDNA-based diagnostics, which already utilize methylomics and fragmentomics in addition to analysis of genetic alterations. Anne-Renee Hartman said that while Adela’s platform can extract deep insight from ctDNA methylation patterns, it’s planning to increase utilization of its fragmentomics capabilities. 

The exhibition hall similarly reflected the importance of multiomics. From service providers to diagnostics companies and data analytics firms, at least 40 of the 100 exhibitors either use or provide a multiomic platform as part of their main offering. ExosomeDx’s brochures cite internal research showing that the addition of exosomal RNA to cfDNA results in synergistic insights greater than either analyte can provide alone. 

Finally, the value of multiomics extends beyond biological samples to patient data: there was a strong parallel focus on collecting, structuring, and analyzing patient and real-world data to facilitate their incorporation into diagnostic algorithms. Gundolf Schenk presented UCSF’s Information Commons, an integrative multifactor database of patient data that includes structured electronic health records, clinical notes and reports, and radiology images. Amir Bahmani shared Stanford’s Data Ocean, an open-source multi-omic dataset with a range of biological and digital biomarkers, the latter of which was impressively used to develop an algorithm that could detect pre-symptomatic COVID in patients using data from wearable devices that monitored several physiological systems. 

Precision medicine technologies traced the central dogma of biology: the revolution was kickstarted by genomics, extended by transcriptomics, and followed by proteomics. With the acceleration of research technology development all the other omics are following suit, each extending our insight into biology further than ever before.