Medicine, individualized

An individual s blood samples can be collected and analyzed. Through the study of single nucleotide polymorphisms and pharmacogenomics, the genes that cause diseases can be pinpointed. The results will show the individual s disease condition or predisposition to some diseases. In this way, treatment or preventive measures can be prescribed. 

Exhibit 11.5 shows an example of how differences in genetic make-up affect the effectiveness of a drug on individuals. 

Currently, there is stUl a gap for the potential of gene therapy to be fulfilled. Gene therapy clinical trials have been conducted for diseases such as severe combined immunodeficiency disease (SCID, bubble baby syndrome), sickle cell anemia, cystic fibrosis, familial hypercholesterolemia, and Gaucher disease. 

Exhibit 11.5 shows the strategy drawn up by the World Health Organization for TM. 

Policy Integrate TM/CAM with national health care systems, as appropriate, by developing and implementing national TM/CAM policies and programs. 

Safety, efficacy and quality Promote the safety, efficacy and quality of TM/CAM by expanding the knowledge base on TM/CAM, and by providing guidance on regulatory and quality assurance standards. 

Access Increase the availability and affordability of TM/CAM, as appropriate, with an emphasis on access for poor populations. 

An individual s blood samples can be collected and analyzed. Through 

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Many of these unwanted functionalities have been collected based on chemists feedback from hit identification and lead optimization projects, and by looking at compounds not considered good starting points for optimization by medicinal chemistry or difficult to synthesize [35]. However, one could say that beauty is in the eye of the beholder and selecting attractive chemical starting points depends upon the experience and prejudice of individual chemists. An interesting study at Pharmacia in which 13 chemists reviewed about 22000 compounds in a compound acquisition program showed that medicinal chemists were inconsistent in the compounds they reject [36]. Furthermore, it was found that individual medicinal chemists do not consistently reject the same compound. 

Kirchheiner, J., Bertilsson, L., Bruus, H. etal. (2003). Individualized medicine - implementation ofpharmacogenetic diagnostics in antidepressant drug treatment of major depressive disorders. Pharmacopsychiatry, 36, 235-43. 

Paul, N. W. Fangerau, H. (2006). Why should we bother Ethical and social issues in individualized medicine. Curr. Drug Targets, 7, 1721-7. 

Evans, W.E. and Relling, M.V. (2004) Moving towards individualized medicine with pharmacogenomics. Nature, 429 (6990), 464-468. 

Although the problems of medical practice lie outside the field with which this book is concerned, it seems worthwhile to say that one potential argument for individualized medicine, and against any... 

Another application of bioinformatics is the use of pharmacogenomics. There are some diseases, such as sickle cell anemia (Exhibit 2.3), in which the difference of one amino acid group can have drastic consequences. These differences in nucleotides are termed single nucleotide polymorphisms (SNPs). SNPs, whether due to genetic origins or environmental factors, translate to individual differences. By understanding these SNPs using bioinformatics, more individualized medicines with better efficacy and less adverse effects can be prescribed. 

There are near-term prospects for sequencing the genomes of individuals rapidly and at reasonable cost. This ability would have profound implications for the future of individualized medicine. 

In a recent study at Pharmacia it was found that medicinal chemists were inconsistent in the compounds they reject (2). In addition, it was also observed that individual medicinal chemists don t consistently reject the same compounds ... 

Evans, W., and M. V. Relling. Moving Towards Individualized Medicine with Pharmacogenomics. Nature 429 no. 6990 (2004) 464-468. 

The ancient Chinese wrote extensively on medical subjects. The Pen Tsao, for instance, was written about 2700 B.c. and contained classifications of individual medicinal plants as well as compilations of plant mixtures to be used for medical purposes. The Chinese doctrine of signatures (like used to treat like) enables us to understand why medicines of animal origin were of such great importance in the Chinese pharmacopoeia. 

Combinatorial chemistry has moved from specially centralized laboratories, often equipped with multimillion-dollar robots, onto the bench of individual medicinal chemists. This change in direction requires the availability of personal chemistry tools that are simple to operate, easy to arrange in the laboratory, and reasonably priced. Such instruments are now available for the effective synthesis of combinatorial libraries. The Encore synthesizer represents a simple and efficient personal chemistry tool that allows the execution of directed split-and-pool combinatorial synthesis. The current version of the Encore synthesizer is designed for solid-phase synthesis on SynPhase Lanterns however, it can be modified for synthesis on alternative solid supports such as resin plugs from Polymer Laboratories (e.g., StratoSpheres Plugs). 

Srivastava P. Drug metabolism and individualized medicine. Curr Drug Metab. 2003 4 33—44. 

Industry response to the pressures described above—particularly the pressures for individualized medicine and for a new and more complex medical model—will be a diversification of product lines. As NDA and ANDA reviewers require more extensive testing and offer more restricted labels, industry will be forced to offer a brand extension of products. For example, look for a manufacturer of an allergy medication to introduce a variant for men, for women, for children, for older individuals, etc., much as vitamins are currently marketed. 

As the FDA indirectly encourages a diversification of drug options, resulting in both the brand extensions described above and in the variety of individualized medicine choices to be experimented with, consumers and their health-care providers will need to broaden both their information sources and the extent of that knowledge. 

Evans WE, Relling MV. Moving towards individualized medicine with phar-macogenomics. Nature 2004 429 464-468. 

Variability in drug response is a major barrier to successful drug development. As Sir William Osier said in 1892 about the practice of medicine, if it were not for the great variability among individuals, medicine might as well be a science and not an art. PGx can provide the scientific tools that enable us to explore the pathophysiological mechanisms for these differences in drug response at... 

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