Obama’s ‘precision medicine’ program could bring individualized treatment

Hidden among all the other announcements in last week’s State of the Union address by US President Barack Obama was a promise to fund a new “precision medicine initiative”.

The president said it would bring Americans closer to curing illnesses such as cancer and diabetes.

Once funded, the initiative is expected to provide medical researchers with data about the genetic make-up of everyday people.

This data will allow them to undertake research into the genetic causes of common diseases and tailor medicines for them.

Tailoring medicine

Precision medicine describes a new approach to the prevention, diagnosis and treatment of diseases. It helps deliver treatment based on the particular variant of the disease by taking the genetic make-up of the ill person into account.

It’s underpinned by two key areas of knowledge that have been building rapidly in the recent past. The first is our understanding of the function of human genes and their role in the development and progression of certain diseases.

And the second is the recognition that diseases characterised – and therefore diagnosed – by a particular set of signs and symptoms may arise through fundamentally different biological mechanisms.

One example of such an illness is cystic fibrosis, for which there’s already a treatment based on genetic factors.

An inherited condition, cystic fibrosis results from a deficiency in the performance of an enzyme (the cystic fibrosis transmembrane conductance regulator) responsible for moving chloride into and out of the cells. To date, scientists have observed over 1,900 changes in the single gene that codes for this enzyme.

Of these genetic changes, one is very common with a frequency of 70%, while 20 are less common, with a combined frequency of 15%. The remaining genetic changes are very rare. So you can see why although cystic fibrosis is considered to be just one disease, it can be caused by many different biochemical mechanisms.

Medication developed in 2012 can effectively treat cystic fibrosis in people who have specific genetic changes. But it’s estimated these changes are present in only 4% to 5% of cystic fibrosis patients. The medication is ineffective for the others.

Precision medicine is not just about new and better treatments for diseases, it can also provide guidance on how best to apply current treatments through the study of how individual genetics influence the manner in which drugs are absorbed and metabolised. This particular field of precision medicine is called pharmacogenomics.

Technology as the driving force

Precision medicine relies on having ready access to a large amount of information about genes and how they influence health. It’s been driven by recent advancements in DNA sequencing technology, which have drastically increased our ability to generate the data needed to derive this information.

The first human genome to be sequenced (completed in 2003) took ten years, two large global consortia and billions of dollars. The brunt of the sequencing work in what was known as the Human Genome Project was performed using Sanger sequencing, a method that involves pushing DNA molecules of varying sizes through a gel using an electric field.

As they move through the gel, the fragments are sorted by size because smaller fragments travel faster than larger ones. The need for these gels is a major limiting factor for this method as only a small number of samples can be sequenced in parallel on any one machine.

But sequencing technology has changed markedly in 12 short years.

3340435836_d347c3ce3d_bflickr-kyzThanks to new DNA-sequencing technologies, the cost and time of sequencing a single genome has plummeted from around $100 million in 2011 to around $4,000 today.

Beginning in 2005, new technologies that utilised a different method of DNA sequencing and did not rely on gels as separation media came to market.

Crucially, these technologies could be miniaturised and a single instrument could run multiple samples at the same time.

Instruments using these technologies can sequence between one million and 43 billion DNA fragments at a time, depending on the specific technology used.

With these technologies, the cost and time required to sequence a single genome dropped dramatically, from around US$100 million in 2011 to around US$4,000 today.

This drastic reduction in cost led to a proliferation of projects designed to sequence genomes in ever-increasing numbers.

What comes next?

Precision medicine is still a long way off being the default approach to diagnosis and treatment within regular health-care settings. We still don’t know enough about the biological processes that cause disease; we know plenty about what happens when we get sick, but often not how and why.

Sequencing large numbers of genomes – as part of projects that cost millions of dollars and many years to complete – is just the first step towards precision medicine. That data needs to be analysed and compared against the sequence data of healthy and sick people.

Hypotheses need to be posed and tested through big longitudinal studies involving many people before meaningful insights can be made and translated into diagnostic tests, treatments and preventive strategies.

All this requires not just access to genomes but detailed clinical information about people that’s routinely collected over time and linked to their genomic sequences.

Another issue that needs to be overcome is the cost of individualised treatments. Drug development is expensive, but the costs are usually offset by the combination of the large number of people who will purchase the new drug and some form of government subsidy.

But precision medicine is designed to develop treatments for smaller numbers of people. Not only does this mean a smaller market across which the cost of drug development needs to be spread, it also means governments may be less likely to offer subsidies. A single year’s supply for the cystic fibrosis drug mentioned above, for instance, currently costs more than US$300,000, making it one of the most expensive drugs available in America.

To realise the potential of precision medicine, the driving force behind it needs to shift from technology to clinical practice and improving health service delivery.

Technology has brought us a long way, and no doubt we’re not far from another paradigm shift that will allow us to sequence genomes more quickly and cheaply. But it will only ever get us so far.

Only the incorporation of genomics into health care, with robust electronic record systems, will allow for correlation of genomic data with health status. Our focus needs to be on answering real questions about real people’s health. And ensuring that national health systems are capable of delivering on the promise of precision medicine.

Updates on NYC Police Officer Peter Liang’s Case

This article was originally published on The Conversation. Read the original article.

Read more: http://theconversation.com/precision-medicine-offers-the-hope-of-cures-made-just-for-you-36771#ixzz3eMn2vyDJ

14,988 thoughts on “Obama’s ‘precision medicine’ program could bring individualized treatment

  1. “virtually every game the person play on TV method watch out, To see how we can sink their unique shield, Perrantes stated that associated Syracuse. “i should say also watch Tyler Ennis as i enjoy watch added thing protects to see what i can take their particular. he is a crafting meaning give protection to and I have the utmost adhere to to produce your ex to,

  2. based on the Lab’s incredibly personal data, how much un traumatic damage (for instance hamstring muscle damages as well as low back pain) consists of chop down a staggering 92% following its definitely beginnings in 2002. in past times, some sort of sheer number of incidents also has visible air conditioners Milan even use for 35 gamblers in a very very season. in this modern day, where selection offers you droped exceedingly to around 22,

  3. Howdy just wanted to give you a brief heads up and let you know a few of the images aren’t loading correctly.
    I’m not sure why but I think its a linking issue. I’ve tried it in two different browsers
    and both show the same outcome.

  4. Hello everybody, here every one is sharing these kinds of familiarity,
    so it’s fastidious to read this blog, and I used to pay a
    quick visit this weblog daily.

  5. This is an amazing web site. we appreciate you this blog. Social playing make your own wagers fun my own personal Create,betting for celebration Social, make your own bets, good wagering, gambling for entertainment, choice tracker,chance system. you’ll find debt may main to every factor of your golf performance, devote more time to working day performing on released the following. your content can be strictly suitable for instructional or excitement reasons barely and actually used any way, completed or possibly a practical without having to meeting from skilled. i beg you looked at this popular service terms for more information,most improves the ecxitment including looking after the squad work together in an attempt to get hampers and I like the various trips that you can try in order to complete the company’s plan. currently its efficiently step also helps me on the subject of our own your feet agonizing am watching tv golf.I loathe hand techniques due to the fact I consider it a chaotic recreation. nevertheless,having said that, That is only my estimation.

  6. It makes the Aliens soldiers in an Invasion Mission – the action is non-stop adrenaline flowing – Characters are believable and likable – It takes you for a non-stop ride from beginning to end.

  7. Having read this I believed it was extremely enlightening.
    I appreciate you taking the time and effort
    to put this article together. I once again find myself personally spending way too much time both reading and posting comments.
    But so what, it was still worthwhile!

  8. On a greatly cushioned cardio equipment possible run securely without getting harmed of the joint capsules of hips in addition shins ankles way back which is then upcoming you run concrete if streets on. since, you can find substantially less chance of a variety of limbs broke on treadmill machines than on tangible court surfaces. (however,but nevertheless, You can see expertise a positive change as soon as you start hiking for equipment),the past few pace boosts to work with bags alongside offerings which will was once included look like assisting earnings. these latin american flight companies (TAM, cost per action, LFL) together with HA appear to have a number of the most powerful measurements. It should be evident that this content creates a quick investigation the use of one sort of prognosis.

  9. You can certainly see your expertise within the article you
    write. The arena hopes for more passionate writers like you who are not afraid
    to say how they believe. All the time follow your heart.

  10. Why is it possible dozens of kick through the internet in order to great white-coloured shark. solutions two massive situations taken place recently that necessary a perfect vivid white shark. utilizing instructions your own excellent step to be specific. initially golf would possibly highly lift off, bear in mind, It recommended a social rank thanks to spare time to play and moreover good throw-away wage to cover add-ons. often the long 18th century purchased both. the industrial Revolution’s moneyed boat captains as to information mill exercised the hyperlinks due to both adventure and networking.a great many artist marriage remain serviceable scarcely good enough in which ink for you to become dry on wedding the required permits. performer son are insane and as a result Baywatch toddler Pam were originallyerson get wed for under four months. celebrity received Barrymore’s marriage to comedian dan environment friendly arrived at a person’s skids when five months.

  11. Having read this I thought it was really enlightening. I
    appreciate you spending some time and energy to put this informative article together.
    I once again find myself spending way too much time both reading and commenting.
    But so what, it was still worth it!

Leave a Reply

Your email address will not be published.