The long-held practice of listening to, examining and treating individual patients is converging with genomic, bioinformatic and artificial intelligence technologies to create ‘precision’ medicine, which will transform the way we practise medicine. Learn about how these concepts are defined and what they mean for the future of clinical practice.
Using the example of organ transplantation, P. Marquet describes how translational research may help to optimize therapeutic success, focusing on the genetic determinants of pharmacokinetics and the role of therapeutic drug monitoring.
Geriatric care will become increasingly important over coming decades as life expectancy increases. F. Nourhashemi describes how the standardized geriatric evaluation is changing to incorporate new understanding of the evolution and impact of frailty and trajectories of disability among elderly people.
Mapping of the human genome and the development of next generation sequencing (NGS) have led to advances in screening, pharmacogenetics and targeted therapies. Dr Galibert describes the impact of these advances on precision medicine, and the technological, regulatory, ethical and financial issues they have raised.
Advances in bioinformatics have led to sophisticated clinical decision-making tools that can integrate data on a drug’s competitive inhibition, affinity, and metabolic pathways, and on a patient’s environmental and genetic factors. J. Turgeon shows us how these tools help to ensure patients receive individualised therapy with the greatest potential for benefit and the least potential for harm.
Type 2 diabetes and hypercholesterolemia both arise from a combination of genetic predisposition and environmental/lifestyle factors, but treatment practices for these conditions have taken a purely phenotypic approach. Learn how personalised medicine is being applied to treatment decisions in these two conditions, in order to individualise therapy and reduce the risk of cardiovascular morbidity and mortality.
Have we reached the stage where each cancer patient should have their tumour sequenced? C. Le Tourneau looks at whether cancer treatment can truly be individualised based on the patient’s tumoral genetic map, or whether we still have some way to go before universal tumour sequencing makes clinical sense.
More and more people are undergoing kidney transplant each year, but the success of these procedures is determined by a range of factors related to the donor, the host and the grafted organ. Although there are several scoring systems available to predict long-term graft outcomes, T. Hauet demonstrates how the application of precision medicine to graft evaluation has the potential to significantly improve transplant outcomes.
S. Hacein-Bey describes the history of gene therapy, the triumphs and failures of ex vivo gene transfer technology in hereditary diseases, the development of chimeric antigen receptor (CAR) T cell therapy for cancer, and the exciting opportunities that are emerging with new gene editing technologies such as CRISPR.
JP. Michel asks what precision medicine means for clinicians and patients: what is its scope? What are the potential benefits and for whom? But also what are the potential challenges and risks for prescribers, patients, healthcare systems and regulators, and are we ready for the implications of this fundamental shift in medical practice?