Mendelspod Podcast

• What Next for LDTs? A Conversation with Sarah Overton of Velsera

  Just weeks before the FDA’s sweeping rule to regulate laboratory-developed tests (LDTs) was set to take effect, a federal court struck it down. What does this mean for the field of precision medicine and for labs themselves? There are have been those on the side of regulation arguing its importance for reimbursement. Yet many, such as the plaintiffs in this case, the ACLA and AMP, have argued that FDA regulation could stifle innovation in a new field and even force labs to shut down. Today we talk with Sarah Overton, Senior Director of Revenue Cycle Management at Velsera, whose team helps clinical labs with everything from validation to reimbursement strategy. She walks us through the practical implications of the ruling. “It came just in time. Even meeting stage one was going to be incredibly burdensome,” she says in today’s interview. (Link to a webinar with Sarah on this topic here.)* 0:00 Impact of recent court decision on LDTs * 5:15 Supports an in-between regulation * 15:15 How are your clients choosing between LDT and IVD?* 20:00 Topic goes hand-in-hand with reimbursement * 25:20 Every test is differentInstead of scrapping oversight altogether, Overton argues for a middle ground — more robust than the current CLIA framework, but less rigid than the FDA’s approach. “We need something in between,” she says. “There are already mechanisms in place — like MolDX’s technical assessment — that address analytic validity, clinical validity, and clinical utility. That could be a model to build on.”We explore how Velsera’s clients are choosing between launching LDTs or IVDs, and what factors drive that decision. Overton emphasizes that reimbursement strategy must be integrated from the beginning — not bolted on at the end. “The test might be clinically excellent, but if it’s not reimbursable, it won’t sustain a lab,” she warns.“We need standards that ensure quality without crushing innovation,” she says. “There are ways to do that now. Let’s build on what’s working.” This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.mendelspod.com/subscribe

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• AI’s Quiet Revolution in the Pharma Supply Chain with Chris Petersen, Scientist.com

  In today’s show, Theral is joined by Chris Petersen, Chief Technology Officer at Scientist.com, a company sometimes called the "Amazon for science"—though with a great deal more complexity. Chris pulls back the curtain on how AI is transforming the research services marketplace and offers a rare look into how AI is already reshaping the infrastructure of pharma and biotech.Calling this the "tinkering phase" of AI, Chris likens the current moment to the early days of the web—when best practices were still forming and every developer had to invent their own solutions. “It’s one of the most exciting times to be a software developer,” he says, describing how AI has enabled a leap forward in productivity across the board—from writing code to streamlining negotiations and customer service. One internal tool, Elisa, functions like a fine-tuned ChatGPT within Slack, answering employee and customer queries on the fly.AI, he says, is speeding up nearly every part of the business. "There are all of these problems that were impossible to solve a year and a half ago. And now you can solve them. One of the hardest things… is your old preconceptions of what you're capable of? You have to let some of that go because you're capable of so much more now."Petersen also talks risk: while AI promises a democratizing effect, making outsourcing more accessible to small players, he warns of the dangers of consolidation—where just a few massive models hold everyone’s data. To avoid that future, Scientist.com is building its own internal LLMs, training and fine-tuning models like Mistral and DeepSeek on proprietary data, all under an evolving platform they call Benchmate.Scientist is betting that AI will not only enhance their marketplace but change how science itself is organized and conducted. Stay tuned for more in this new series on AI. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.mendelspod.com/subscribe

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• We've Been Misclassifying Childhood AML for Years: Jeffery Klco, St. Jude's

  In today’s program, we continue our series on disease subtyping with Dr. Jeffery Klco, a pediatric pathologist and researcher at St. Jude Children’s Research Hospital. Dr. Klco joins us to discuss groundbreaking work recently published in Nature Genetics, which redefines the genomic landscape of childhood acute myeloid leukemia (AML).Klco and his team have identified twelve novel molecular subtypes of pediatric AML—some driven by genetic alterations that had long gone undetected by standard computational tools. Chief among these is the UBTF tandem duplication, a complex mutation previously overlooked but now shown to be a distinct disease subtype that accounts for up to 10% of pediatric AML cases and is associated with relapse and poor outcomes.“We’ve been misclassifying childhood AML for years,” says Klco. “It’s the same disease as in adults—but it behaves very differently. And we’ve been using an adult framework to treat kids.”* 0:00 We’ve been misclassifying childhood AML* 7:25 Challenges with current treatment paradigm* 11:05 Doing clinical whole genome and RNA sequencing* 17:25 How might this new approach work for other pediatric cancers?The conversation delves into how St. Jude’s use of whole genome and RNA sequencing, paired with advanced analytics, has enabled more precise subtyping. In response, Klco’s team is already developing targeted therapies, including the use of menin inhibitors, which have shown early promise.But discovery is just one side of the coin. Implementation is another. Klco discusses the development of a new 357-gene panel—specifically designed for pediatric cancers and incorporating structural variants—that is now in clinical use at St. Jude. It fills key gaps in diagnosis, risk stratification, and minimal residual disease monitoring, especially in complex cases such as post-transplant patients or those whose tissue samples are incompatible with full genome sequencing.Asked about future potential, Klco notes that while most pediatric cancers may now be genomically defined, new methods such as long-read sequencing and methylation profiling still hold promise for sharpening diagnostic tools and stratifying risk.“Pediatric cancers are driven by different genomic forces than adult cancers,” he explains. “Even within the first 18 years of life, we see distinct subtypes emerge at different ages. If a child under three comes in with AML, I already have a good idea what subtype it might be.”It’s a compelling example of how detailed genomic subtyping is not only advancing our understanding of pediatric disease—but directly shaping the next generation of therapies. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.mendelspod.com/subscribe

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• Aaron Viny: A 21-Year Leukemia Survivor on the Frontlines of Epigenetic Cancer Research

  Dr. Aaron Viny, oncologist and researcher at Columbia University, begins today’s conversation with a personal milestone—he’s now been leukemia-free for 21 years. This experience gives his work on cancer a powerful human dimension that comes through in his interview with Theral today—not only in his dedication to patient care, but in his boundary-pushing research on the epigenetic roots of cancer.Dr. Viny’s research focuses on the epigenetic architecture of hematologic malignancies, exploring how errors in chromatin structure—not just mutations in DNA—can lead to cancer. “Cancer, at its root, is often a disease of dysregulated identity,” he says. “Cells that have lost their ability to regulate their own gene expression are primed for malignant transformation.” This breakdown in regulation becomes a doorway to cancer—a perspective that reshapes how we think about both origin and treatment.* Chapters:* 0:00 Leukemia free for 21 years* 5:25 Life as a researcher at Columbia University today* 8:30 Epigenetics and cancer etiology* 17:03 Impact of new spatial and single cell tech* 25:00 What is hypomethylating treatment?* 28:40 Using type and proximity of cell surface proteins to understand immune regulation* 34:15 What next?Dr. Viny discusses how emerging spatial and single-cell technologies are giving researchers a new kind of lens into these processes. The tools allow him and others to study not just what genes are expressed, but where in the tissue and in what context—something that’s proving crucial for understanding the complexity of the tumor microenvironment. He highlights the use of Pixelgen's platform for analyzing cell surface proteins, which offers fine-grained insights into how immune cells interact with cancer cells. “The type and proximity of cell surface proteins,” he notes, “tell us an entirely new story about immune regulation.”He also speaks candidly about the realities of doing science today, especially within a strained academic system. Despite recent threats to research funding at Columbia, Dr. Viny remains resolute: “If we’re not investing in understanding cancer, what are we doing?” This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.mendelspod.com/subscribe

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• Toward Disease Sub-typing with Ben Busby, DNAnexus

  We’re happy to welcome back Ben Busby, Principal Scientist at DNAnexus, to dive deeper into the evolving world of disease subtyping and multi-omic data sets. Building on our previous conversation with Busby about the genomic data ecosystem, we explore the shift from single-cause disease models to multifaceted approaches that incorporate genomics, proteomics, imaging, and more."We’re no longer in a world where we’re doing genomics or imaging or proteomics," he explains. "These things are all coming together, and it’s important that they do. The UK Biobank will soon have 80 million images."Busby highlights the UK Biobank’s leading role in this transformation, with its extensive genomic, imaging, and clinical data available to researchers worldwide. He emphasizes the importance of enabling scientists to access and analyze vast datasets collaboratively while ensuring participant privacy, and points to the role of DNAnexus in providing a trusted research environment where multiple stakeholders, from pharma to academia, can work with data efficiently and securely.The episode also explores the impact of AI in bioinformatics, particularly in hypothesis generation. "AI is helping us think beyond single-cause events," Busby notes, referencing its ability to generate novel insights from complex biological data. He underscores the need for proper alignment between AI systems and scientific goals, stressing that human intuition remains essential in guiding these technologies toward meaningful discoveries.As the field moves forward, Busby calls for more equitable data sharing practices, ensuring credit for data generators and benefits for study participants. "We need to figure out how to incentivize data generation in a way that’s fair and equitable," he says. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.mendelspod.com/subscribe

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