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Precision medicine (PM) is a medical model that proposes the customization of healthcare, with medical decisions, treatments, practices, or products being tailored to the individual patient. In this model, diagnostic testing is often employed for selecting appropriate and optimal therapies based on the context of a patient’s genetic content[1] or other molecular or cellular analysis. Tools employed in precision medicine can include molecular diagnostics, imaging, and analytics.[2]

Contents

Relationship to personalized medicineEdit

In explaining the distinction from a similar common term of personalized medicine, the National Research Council explains:

Precision Medicine refers to the tailoring of medical treatment to the individual characteristics of each patient. It does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology or prognosis of those diseases they may develop, or in their response to a specific treatment. Preventive or therapeutic interventions can then be concentrated on those who will benefit, sparing expense and side effects for those who will not. Although the term 'personalized medicine' is also used to convey this meaning, that term is sometimes misinterpreted as implying that unique treatments can be designed for each individual.[2]

On the other hand, use of the term "precision medicine" as well can extend beyond treatment selection to also cover creating unique medical products for particular individuals—for example, "...patient-specific tissue or organs to tailor treatments for different people."[3] Hence, the term in practice has so much overlap with "personalized medicine" that they are often used interchangeably.[4]

Scientific basisEdit

Precision medicine often involves the application of panomic analysis and systems biology to analyze the cause of an individual patient's disease at the molecular level and then to utilize targeted treatments (possibly in combination) to address that individual patient's disease process. The patient's response is then tracked as closely as possible, often using surrogate measures such as tumor load (v. true outcomes, such as 5 year survival rate), and the treatment finely adapted to the patient's response.[5] The branch of precision medicine that addresses cancer is referred to as "precision oncology".[6][7]

Inter-personal difference of molecular pathology is diverse, so as inter-personal difference in the exposome, which influence disease processes through the interactome within the tissue microenvironment, differentially from person to person. As the theoretical basis of precision medicine, the "unique disease principle"[8] emerged to embrace the ubiquitous phenomenon of heterogeneity of disease etiology and pathogenesis. The unique disease principle was first described in neoplastic diseases as the unique tumor principle.[9] As the exposome is a common concept of epidemiology, precision medicine is intertwined with molecular pathological epidemiology, which is capable of identifying potential biomarkers for precision medicine.[10]

PracticeEdit

The ability to provide precision medicine to patients in routine clinical settings depends on the availability of molecular profiling tests, e.g. individual germline DNA sequencing. While precision medicine currently individualizes treatment mainly on the basis of genomic tests (e.g. Oncotype DX[11]), several promising technology modalities are being developed, from techniques combining spectrometry and computational power to real-time imaging of drug effects in the body.[12] Many different aspects of precision medicine are tested in research settings (e.g., proteome, microbiome), but in routine practice not all available inputs are used. The ability to practice precision medicine is also dependent on the knowledge bases available to assist clinicians in taking action based on test results.[13][14]

On the treatment side, PM can involve the use of customized medical products such drug cocktails produced by pharmacy compounding[15] or customized devices.[16] It can also prevent harmful drug interactions, increase overall efficiency when prescribing medications, and reduce costs associated with healthcare.[17]

Artificial intelligence in Precision MedicineEdit

Artificial intelligence is providing paradigm shift toward precision medicine.[18] Machine learning algorithms are used for genomic sequence and to analyze and draw inferences from the vast amounts of data patients and healthcare institutions recorded in every moment.[19] AI techniques are used in precision cardiovascular medicine to understand genotypes and phenotypes in existing diseases, improve the quality of patient care, enable cost-effectiveness, and reduce readmission and mortality rates.[20]

Precision Medicine InitiativeEdit

In his 2015 State of the Union address, U.S. President Barack Obama stated his intention to fund an amount of $215 million[21] to the "Precision Medicine Initiative" of United States national.[22] A short-term goal of the Precision Medicine Initiative was to expand cancer genomics to develop better prevention and treatment methods.[23] In the long-term, the Precision Medicine Initiative aimed to build a comprehensive scientific knowledge base by creating a national network of scientists and embarking on a national cohort study of one million Americans to expand our understanding of health and disease.[24] The Mission Statement of the Precision Medicine Initiative read: "To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized treatments".[25] In 2016 this initiative was renamed "All of Us" and an initial pilot project had enrolled about 10,000 people by January 2018.[26]

See alsoEdit

External linksEdit

ReferencesEdit

  1. ^ Lu, Y.-F.; Goldstein, D. B.; Angrist, M.; Cavalleri, G. (24 July 2014). "Personalized Medicine and Human Genetic Diversity". Cold Spring Harbor Perspectives in Medicine. 4 (9): a008581–a008581. doi:10.1101/cshperspect.a008581. PMC 4143101. PMID 25059740.
  2. ^ a b Timmerman, Luke (4 February 2013). "What's in a Name? A Lot, When It Comes to 'Precision Medicine'". Xconomy.
  3. ^ LAT Brand Publishing (23 February 2015). "Changing medicine with 3-D bioprinting, where organs can be synthesized by technology". LATimes.com.
  4. ^ "N-of-One: Tailored Clinical Molecular Test Interpretation". n-of-one.com.
  5. ^ Blau, CA, Liakopoulou, E (2013). "Can we deconstruct cancer, one patient at a time?". Trends in Genetics. 29 (1): 6–10. doi:10.1016/j.tig.2012.09.004. PMC 4221262. PMID 23102584.
  6. ^ Garraway, Levi A.; Verweij, Jaap; Ballman, Karla V. (2013). "Precision Oncology: An Overview". Journal of Clinical Oncology. 31 (15): 1803–1805. doi:10.1200/jco.2013.49.4799.
  7. ^ Shrager, Jeff; Tenenbaum, Marty (2014). "Rapid Learning for Precision Oncology". Nat Rev Clin Oncol. 11 (2): 109–118. doi:10.1038/nrclinonc.2013.244.
  8. ^ Ogino S, Lochhead P, Chan AT, Nishihara R, Cho E, Wolpin BM, Meyerhardt AJ, Meissner A, Schernhammer ES, Fuchs CS, Giovannucci E. Molecular pathological epidemiology of epigenetics: emerging integrative science to analyze environment, host, and disease. Mod Pathol 2013;26:465-484.
  9. ^ Ogino S, Fuchs CS, Giovannucci E. How many molecular subtypes? Implications of the unique tumor principle in personalized medicine. Expert Rev Mol Diagn 2012; 12: 621-628.
  10. ^ Ogino S, Lochhead P, Giovannucci E, Meyerhardt JA, Fuchs CS, Chan AT. Discovery of colorectal cancer PIK3CA mutation as potential predictive biomarker: power and promise of molecular pathological epidemiology. Oncogene advance online publication 24 June 2013; doi:10.1038/onc.2013.244
  11. ^ "Oncotype DX: Genomic Test to Inform Breast Cancer Treatment".
  12. ^ Precision Medicine: Harnessing the Extraordinary Growth in Medical Data for Personalized Diagnosis and Treatment http://claudiacopeland.com/uploads/3/6/1/4/3614974/hjno_novdec_2016_precision_medicine.pdf
  13. ^ Huser, V.; Sincan, M.; Cimino, J. J. (2014). "Developing genomic knowledge bases and databases to support clinical management: Current perspectives". Pharmacogenomics and Personalized Medicine. 7: 275–83. doi:10.2147/PGPM.S49904. PMC 4175027. PMID 25276091.
  14. ^ Ashley, E. A. (2015). "The precision medicine initiative: A new national effort". JAMA. 313 (21): 2119–20. doi:10.1001/jama.2015.3595. PMID 25928209.
  15. ^ "Divining your future in healthcare". pmlive.com.
  16. ^ "3D-Printed Medical Devices Spark FDA Evaluation". LiveScience.com.
  17. ^ "Personalized Medicine Benefits - The Jackson Laboratory". jax.org.
  18. ^ Mesko, Bertalan (2017). "Expert Review of Precision Medicine and Drug Development". Journal Expert Review of Precision Medicine and Drug Development. 2 (5). doi:10.1080/23808993.2017.1380516. Retrieved 21 May 2018.
  19. ^ Ray, Amit. "Artificial Intelligence and Blockchain for Precision Medicine". Inner Light Publishers. Retrieved 21 May 2018.
  20. ^ Krittanawong, Chayakrit (30 May 2017). "Artificial Intelligence in Precision Cardiovascular Medicine". Journal of the American College of Cardiology. 69 (21): 2657-2664. doi:10.1016/j.jacc.2017.03.571. Retrieved 21 May 2018.
  21. ^ "The Impact of Precision Medicine on Cancer". weillcornell.org.
  22. ^ Neergard, Lauran (30 January 2015). "Obama Proposes 'Precision Medicine' to End One-Size-Fits-All". Drug Discovery & Development. Associated Press.
  23. ^ "Near-term Goals". nih.gov.
  24. ^ "Longer-term Goals". nih.gov.
  25. ^ "The White House Precision Medicine Initiative".
  26. ^ Cunningham, Paige Winfield (2018-01-16). "The Health 202: NIH wants 1 million Americans to contribute to new pool of gene data". Washington Post. ISSN 0190-8286. Retrieved 2018-01-20.