Metabolomics: The Next Step in Personalized Cannabis Medicine

Why is cannabis effective for some people or ailments and not others? What methods of delivery, formulation, and frequency work best? Metabolomics, or the direct measure of disease or a response to a therapy in individuals, may hold the answer to most of these questions and more as scientists work towards a more personalized approach to medicine. We recently spoke with Dr. Tim Garrett, the Chief Scientific Officer and cofounder at Juno Metabolomics, about the work his company is doing related to medical cannabis and metabolomics. Here, Dr. Garrett offers some education on metabolomics and the capabilities it holds for the future of medical cannabis.

Can you explain metabolomics for our readers?
Dr. Tim Garrett: Precision medicine aims to redesign treatment away from methods focused on the average response to methods tailored to the individual. Precision medicine is possible because techniques can measure the unique makeup of individuals down to molecular species. One example of this is genomics in which the genetic makeup of an individual can be used to understand how that individual would respond to a specific drug (pharmacogenomics) or how a specific gene can identify susceptibility to a disease such as the BRCA1 gene in breast cancer. While genes represent the exact code of an individual, the manifestation of that code in a person can have a varied application and having a specific gene does not indicate when or if an individual will get a disease or disorder. The direct measure of disease or a response to a therapy in individuals is called metabolomics. The metabolome describes the set of small molecules present in a person that immediately indicate the response to a stimulus, treatment, or active disease and is considered the closest representation of an individual phenotype. It consists of many small molecules such as amino acids, organic acids, sugars, lipids, hormones, and even exogenous metabolites (termed the exposome) derived from food, the environment, or microbes in our gut that affect health. Metabolomics is the measurement of these metabolites in a reproducible and unbiased manner typically using mass spectrometry coupled with chromatography for separation. The resulting pattern measured represents a digital readout of current health status that can be used for personalized diagnostics.

How did you first get involved with metabolomics?
Dr. Garrett: I got involved with metabolomics at the University of Florida through the development of a center for metabolomic research over 5 years ago. This center explored the techniques for studying metabolites, primarily mass spectrometry based, as well as the bioinformatic tools to identify biomarkers in disease. Stephan Kang and I teamed up to develop Juno Metabolomics a little more than a year ago.  Juno Metabolomics is a cutting-edge startup company tackling the challenge of transforming metabolomic profiling to enable faster and highly reproducible platforms through the development of chip-based integration of analysis and informatics. 

What role do you foresee metabolomics playing in the cannabis industry?
Dr. Garrett: Using metabolomics and metabolism-based analyses we can begin to provide evidence for several key areas in the cannabis industry. We can measure the body’s response to cannabis use and treatment, we can measure the individual efficacy based on treatments and we can characterize the differential biochemical response associated with the different varieties of cannabis as well as the many different delivery approaches. By measuring individual metabolites we can decipher how the body is changing before and after use in relation to many different uses such as how neurotransmitters or endogenous endocannabinoids may be altered, providing necessary evidence for use.
 
What was the most challenging aspect of reverse-engineering the standardization process by measuring and defining metabolic response because of cannabis use or treatment?
Dr. Garrett: There are two key challenges, one of which is the implementation of bioinformatics to characterize the hundreds to thousands of metabolites measured in every sample. With the high number of measured metabolites, we have to develop a robust informatics approach to evaluate reproducibility in all of them to ensure the response we observe is based on a true biochemical change. The second challenge is carefully navigating the varied legal landscape to ensure the necessary tests are performed to describe efficacy and success.  

What benefits does metabolism-based analysis offer to medical cannabis patients and doctors?
Dr. Garrett: Metabolism-based analysis offers a direct measure of response to treatment.  Analyzing patient samples before they begin treatment will provide a critical baseline assessment that can be compared to samples taken 1-day, 1-week, and even 1-month after treatment that give biochemical evidence of how the body is responding to treatment.  If changes are not observed, a new formulation could be tested that could improve response. 

What are the next steps in your research?
Dr. Garrett: With our fully integrated medical cannabis platform (JUNOKANA) launch, we are quickly taking next steps to expand and accelerate our medical cannabis efficacy measurement technology adoption within clinical uses and cannabis-based consumer product developments. So we can bring true benefits of medical cannabis for consumers based on an innovative and science-based approach.