fbpx
 

Innovation in Medical Research and Practice

Biology and Medicine are two fields that contain an immense load of knowledge and approach many diverse issues. Progress in both fields and their crosstalk offer vast opportunities in the academic level but also in clinical and medical practice and in the scientific laboratory.

 

Why is disease so usual and simultaneously so difficult to prevent? There is not a universal answer to this question but there are few basic notions that explain this phenomenon. First of all, pathogenic microbes evolve much faster than humans do, thus making infections unavoidable. As humans evolve much slower than society and cultures do, many diseases arise from the inability of the human body to adapt to the new environment. The notion that certain genes are solely responsible for the birth of diseases has been rendered obsolete by the simple truth that it is the interaction with environmental factors and other genes that can influence the rise of diseases. Lastly, we need to reconsider our view that the human body has been perfectly designed and organized. Natural selection has shaped the human organism in a way that will maximize the chances for reproduction and not health.

 

Another common medical issue that Biology comes to explain is aging. Why must humans age? Aging is not an adaptation to modern environments. It can be better explained as a compromise. A byproduct of natural selection for earlier in life reproductive performance. Evolution has shifted our genes that mediate nutrition, immunity and inflammation, thus prolonging life span. Many people who reach ages of 100 years or even more have strikingly well-preserved telomeres (the ends of chromosomes that become shorter after each cell division).

 

During the last few years, the field of Epigenetics has drawn considerable interest. This field studies heritable changes that do not alter the sequence of DNA. These modifications have shed light into the pathogenesis of many diseases, such as diabetes and its complications. As many diseases are related to these changes, it seems reasonable to look for treatments for these changes. Caution though is required as; epigenetic treatments should be targeted to irregular cells only, since the effect on normal cells could be to transform them into cancer cells. Modern science though, is continuously finding ways to target only problematic cells, thus making epigenetic treatments promising.

 

The above-mentioned information bring forward the observation that modern medicine and its practice need to go along with biology findings. New scientific disciplines have been created by the combination of Biology and Medicine. Continuous education and research are of paramount importance so that physicians can efficiently treat diseases.

 

The Introduction of Peptides in Medical Science

Peptides are short chains of amino-acids, the small “bricks” that make up proteins. The functions of peptides in the human body have been well documented, as they participate in numerous molecular pathways as signaling molecules. The use of peptides in medicine as therapeutic molecules has evolved through time with the most known example being the use of INS in people suffering from diabetes in the 1920s. Another known molecule is the adrenocorticotrophic hormone (ACTH) which was purified from the pituitary glands of livestock, to treat endocrine disorders.

 

Peptide drug discovery has shifted from mimicking human-derived molecules to include peptides present in other organisms (plants, marine organisms e.t.c). The list of approved for therapeutic use peptides is constantly growing. In March 2017, this list contained 68 peptides approved in Europe and USA and many more that are in clinical development.

 

Peptide drugs are characterized by high specificity and efficacy and at the same time remain relatively safe and well-tolerated. Their smaller size enables them to reach deeper into tissues and manifest their therapeutic action. Furthermore, most peptides tend to be less immunogenic than recombinant proteins and antibodies and thus are better tolerated. Nevertheless, peptides have certain disadvantages too. Their low metabolic stability, shorter half-life and reduced action when administered orally are issues that the pharmaceutical sector is facing and striving to solve.

 

Peptide drugs are fast growing and preferred over conventional drugs. New peptide formulations reach the pharmacies’ counters every day and hundreds more are in pre-clinical and clinical development phases. The potential for the therapeutic use of peptides seems boundless and most-promising as long as physicians remain confident and not apprehensive to their use.

 

The shift from Anonymous to Personalized Healthcare

Every human being is a distinct biochemical entity that resembles another human in many aspects but at the same time is unique in many other characteristics. Back in the times of antiquity, Hippocrates was the first to adjust treatments to patients’ needs and profiles. At some point though, medicine became generalized in terms of treatment, ignoring the different needs of the patients. Big pharmaceutical companies produced medicines that were meant to fit any patient regardless of the medical profile. Many physicians got carried away and started prescribing medicine only for a patient’s reported medical issue disregarding any other clinical conditions.

 

Fortunately, over the last years a paradigm shift is reported towards a Personalized Healthcare approach. Being able to examine a patient on an individual basis, enables a more comprehensive diagnosis and a specific therapeutic plan. Novel, innovative diagnostic tests and informatics allow for a deeper understanding of a patient’s condition and provide invaluable information about the proposed treatment. The aim of personalized medicine is to provide patients with treatments that maximize benefits and reducing risks. This notion does not imply that personalized medicine nullifies hitherto medicine. It proposes a different model of diagnosis and treatment, introducing molecular-based therapeutics, through enhanced use and replanning already existing drugs and combination therapies.

 

Personalized medicine focuses on those often complex sub-molecular mechanisms that may hold the key to the optimal therapy and offers a unique chance to upgrade the value of existing drugs by identifying the patients for whom they can have a positive impact. As we pace into the third decade of the 21st century, healthcare is constantly reframed, rethought and redesigned to fit the patients’ needs.

 

Prevent rather than Cure

The famous phrase “Prevention is better than cure” has been attributed to the Dutch philosopher Desiderius Erasmus in around 1500s. As simple as it may sound, it represents the core around which modern healthcare systems have been designed. A noble cause that aims towards no necessity for someone to reach the hospital or clinic.

 

The golden question is: “How can someone prevent an illness?”. Well, there can be many answers to that simple question but the first goal for anyone should be “to remain as healthy as possible”. That phrase can include many aspects of daily life, such as:

  • Abstain from smoking
  • Refrain from drinking too much alcohol
  • Control your weight and follow a healthy diet
  • Exercise daily
  • Live in an area that is not polluted
  • Reduce daily stress
  • Do not neglect regular health checks

 

So why are life expectancy rates seemingly stalling and the percentages of chronic illnesses on the rise? Europeans nowadays almost resemble the USA population in terms of obesity and diabetes. A number of scientists have paraphrased “Prevent rather than cure” to “Prevent rather than cure, except when it comes paying for it”. It may be sad but it is the truth. Almost anyone would choose buying an expensive car, a trip to an exotic place, spend money on clothes and gadgets to engage in daily exercise or go through an annual medical preventive test.

 

The human organism has quite a sophisticated network of homeostatic mechanisms that help us oppose and deal with threats. But it can only take so much. Extended periods of neglecting our health, give rise to serious and often debilitating diseases. So what should we do?

 

We should return to the top phrase of this section. Prevent rather than cure. Modern medicine can now allow for detection of future onset of diseases long before they manifest. Novel, smart diagnostic tests can inform people for their health status and indicate which factors should be closely monitored to prevent the onset of diseases. Molecular and Genetic level tests can reveal the optimal nutrition plan for an individual and assist in fighting obesity. There is utterly no point investing in banks and real-estate if we do no invest in health first.

 

 

References:


  • Cavalli, G., Heard, E. Advances in epigenetics link genetics to the environment and disease. Nature 571, 489–499 (2019). https://doi.org/10.1038/s41586-019-1411-0
  • Childs, B., Durik, M., Baker, D. et al. Cellular senescence in aging and age-related disease: from mechanisms to therapy. Nat Med 21, 1424–1435 (2015). https://doi.org/10.1038/nm.4000
  • Eric M. Pietras; Inflammation: a key regulator of hematopoietic stem cell fate in health and disease. Blood 2017; 130 (15): 1693–1698. doi: https://doi.org/10.1182/blood-2017-06-780882
  • Sofiane Safi-Stibler, Anne Gabory, Epigenetics and the Developmental Origins of Health and Disease: Parental environment signalling to the epigenome, critical time windows and sculpting the adult phenotype, Seminars in Cell & Developmental Biology, Volume 97, 2020, Pages 172-180, https://doi.org/10.1016/j.semcdb.2019.09.008
  • Zhang L., Lu Q., Chang C. (2020) Epigenetics in Health and Disease. In: Chang C., Lu Q. (eds) Epigenetics in Allergy and Autoimmunity. Advances in Experimental Medicine and Biology, vol 1253. Springer, Singapore. https://doi.org/10.1007/978-981-15-3449-2_1
  • Gilbert S. Omenn, Evolution and public health, Proceedings of the National Academy of Sciences Jan 2010, 107 (suppl 1) 1702-1709; DOI: 10.1073/pnas.0906198106
  • J.R. Downie (2004) Evolution in Health and Disease: The Role of Evolutionary Biology in the Medical Curriculum, Bioscience Education, 4:1, 1-18, DOI: 10.3108/beej.2004.04000004
  • Gluckman PD, Low FM, Buklijas T, Hanson MA, Beedle AS. How evolutionary principles improve the understanding of human health and disease. Evol Appl. 2011;4(2):249-263. doi:10.1111/j.1752-4571.2010.00164.x
  • Michael Weinmüller, Florian Rechenmacher, Udaya Kiran Marelli, Florian Reichart, Tobias G. Kapp, Andreas F. B. Räder, Francesco Saverio Di Leva, Luciana Marinelli, Ettore Novellino, José M. Muñoz-Félix, Kairbaan Hodivala-Dilke, Adi Schumacher, Joseph Fanous, Chaim Gilon, Amnon Hoffman, Horst Kessler. Overcoming the Lack of Oral Availability of Cyclic Hexapeptides: Design of a Selective and Orally Available Ligand for the Integrin αvβ3. Angewandte Chemie International Edition, 2017; 56 (51): 16405 DOI: 10.1002/anie.201709709
  • Andreas F.B. Räder, Florian Reichart, Michael Weinmüller, Horst Kessler. Improving oral bioavailability of cyclic peptides by N -methylation. Bioorganic & Medicinal Chemistry, 2017; DOI: 10.1016/j.bmc.2017.08.031
  • Jolene L. Lau, Michael K. Dunn, Therapeutic peptides: Historical perspectives, current development trends, and future directions, Bioorganic & Medicinal Chemistry, Volume 26, Issue 10, 2018, Pages 2700-2707, https://doi.org/10.1016/j.bmc.2017.06.052.
  • Sachdeva, S. Peptides as ‘Drugs’: The Journey so Far. Int J Pept Res Ther 23, 49–60 (2017). https://doi.org/10.1007/s10989-016-9534-8
  • Mathur, S., & Mathur, S. (2017). Personalized medicine could transform healthcare (Review). Biomedical Reports, 7, 3-5. https://doi.org/10.3892/br.2017.922
  • Vogenberg FR, Barash C Isaacson and Pursel M: Personalized medicine: Part 1: Evolution and development into theranostics. P T. 35:560–576. 2010
  • Singh AR. Modern Medicine: Towards Prevention, Cure, Well-being and Longevity. Mens Sana Monogr. 2010;8(1):17-29. doi:10.4103/0973-1229.58817
  • Buck, D. 2018. Prevention is better than cure – except when it comes to paying for it. Available at: https://www.kingsfund.org.uk/blog/2018/11/prevention-better-cure-except-when-it-comes-paying-it