Personalized medicine: diagnostic methods transform intensive care medicine
Every person is different! Patients vary between their lifestyle, gender, and age, but also in their metabolism and body constitution. These differences can be important game-changers in the successful therapy of an illness. The aim of personalized medicine is the identification of those differences and to offer the best-fitting medication for each individual. Moreover, it also allows the identification of predispositions at an early stage and enables targeted prevention.
Relevance of personalized medicine
A uniform therapy for all patients with similar disease symptoms results in a wide spectrum of standard medication efficiency. It ranges from very good efficacy to complete inefficacy to severe side effects. So far, the previous motto was: one drug for all. Today, diagnostic tests can be used to determine in advance which medicine is or is not the right one for the respective patient. With the help of prior diagnostics, patients can now be treated target-oriented without any unnecessary trials and errors. A wish that has always existed.
Importance of diagnostics in personalized medicine
There is fast progress of technical possibilities in recent years. Nowadays, it is possible to analyse a variety of small samples like blood, tissue, and urine within a short period of time. Multiple diagnostic tools can inform about the patient’s condition or the disease itself (e.g., a tumor). Those should prove in advance of a therapy, which one is the most suitable or whether a drug is even applicable. So-called biomarkers will be identified by biochemical, molecular biological, and genetic analyses. Such molecules can confirm a disease onset or predispositions and thus allow a targeted therapy.
The following molecules can be analysed and used as biomarkers:
- entire gene sets (Genomic)
- gene transcripts and transcript intensity (Transcriptomic)
- proteins (Proteomic)
- metabolites (Metabolomic)
Biomarkers are identified by High-Throughput technics making it possible to divide patients into groups (“stratification”). Biomarkers are used to predict the efficacy, tolerability or optimal dosage of a drug.
Areas of application
Individual diagnostics and therapy are the most advanced in the field of oncology. Here, tumor tissue and the patient are successfully analysed to determine the best possible treatment, because often a tumor is not just a tumor. Increasing progress is also being made in infectious disease research (e.g., HIV, hepatitis-C), as well as for cardiovascular and metabolic diseases or auto-immune diseases (1,2,3,4,5).
Future prospects of personalized diagnostics
Already today, the development of diagnostic tests goes in parallel with that of therapeutic. In the USA more than 25% of drug approvals in 2015 were already such tandems (6). In Germany, the research of academia and the pharma industry have a high interest in this field and join their forces more and more together. More than one-third of the projects related to drug development involve studies with a focus on personal applications. Moreover, new insights for already approved medicals are constantly being added (7). Additionally, the “High-tech Strategy 2025 for Germany” includes funding for personalized medicine and the respective diagnostics (8). Technical advances already allow more rapid and precise tests, even out of analytical labs directly on-site. In the future, these developments will have fast progress and will lead to more and more improvements in diagnostics.
(1) Mallal S, Phillips E, Carosi G, Molina JM, Workman C, Tomazic J et al. HLA-B*5701 screening for hypersensitivity to abacavir. N Engl J Med 2008; 358(6): 568-579.
(3) Currie G, Delles C. Precision Medicine and Personalized Medicine in Cardiovascular Disease. Adv Exp Med Biol. 2018;1065:589-605. doi: 10.1007/978-3-319-77932-4_36.
(4) Padberg I, Peter E, González-Maldonado S, Witt H, Mueller M, Weis T, Bethan B, Liebenberg V, Wiemer J, Katus HA et al. (2014) A New Metabolomic Signature in Type‑2 Diabetes Mellitus and Its Pathophysiology. PLoS ONE 9: e85082
(5) Seung-Ah Yoo et al. (2016) MIF allele-dependent regulation of the MIF coreceptor CD44 and role in rheumatoid arthritis. PNAS 113 (49): e7917-7926. doi: 10.1073/pnas.1612717113
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