I.M.Sechenov First Moscow State Medical University Russia
Dr Suchkov is an author of more than 500 publications including 10 patents and more than 10 monographs, handbooks and textbooks published in Russia and USA. Dr Suchkov is a Supervisor for 18 dissertations maintained including 14 Candidates and 4 Doctors of Science. At present, 10 dissertaions are being supervised by Dr Suchkov. Dr Suchkov is a member of the: ● New York Academy of Sciences, USA ● EPMA (European Association for Predictive, Preventive and Personalized Medicine), Brussels, EU; ● ARVO (American Association for Research in Vision and Ophthalmology); ● ISER (International Society for Eye Research); ● All-Union (from 1992 - Russian) Biochemical Society; ● All-Union (from 1992 - Russian) Immunological Society.
Any innovations in healthcare services are an important driver to move medicine and thus biopharma forward. In this sense, a new systems approach to disease would result in a new trend in the healthcare services, namely, predictive, preventive and personalized medicine (PPPM). The latter is defined as: “…the capacity to predict disease development and influence decisions about lifestyle choices or to tailor medical practice to an individual.” All chronic disorders develop gradually over a period of time to take years for a process to reach a level where it could be diagnosed definitively and treatment initiated properly and in time before changes are irreversible! But a majority of medical interventions occur late in the pathological process, when treatment outcome can be less predictable and effective. Moreover, those interventions used led to so-called ‘‘chronification’’ of complex, previously fatal diseases. And despite the benefits of being able to offer such treatments to patients (but not to persons-at-risk), the intervention and maintenance of treatment at this level of disease progression was and still is inefficient and expensive. With healthcare costs amounting to US$2.6 trillion in 2010, and three out of four treatment dollars being spent on the management of chronic conditions (e.g., Parkinson’s costs society $27 billion per year in medical bills and lost wages; worldwide, projected cases of Parkinson’s will more than double by 2030!), the need for new approaches to address these issues has never been more pressing. The above-mentioned would highlight the need for new precise and preventive (PPPM-based) therapeutic development strategies. To achieve the implementation of PPPM concept, it is necessary to create a fundamentally new strategy based upon the subclinical recognition of biomarkers and biopredictors of hidden abnormalities long before the disease clinically manifests itself. This strategy would give a real opportunity to secure preventive measures whose personalization could have a significant influence on demographics! Two key objectives of PPPM are: (i) detection of subclinical abnormalities with a selection of suitable targets for the next step of PPPM protocol, i.e., drug-based prevention; (ii) drug-based correction of the abnormalities detected under the heading of preventive measures. PPPM is thus a medical model being tailored to the individual and dictates a construction of PPPM algorithms to diagnose, to predict, and to prevent in time whilst following a concept of biomarkers impact into the daily practice! The key benefits of PPPM include new abilities: I. to detect disease at a subclinical stage, when it is easier and less expensive to treat effectively; II. to stratify patients into groups that enable the selection of optimal preventive treatment; III. to reduce adverse drug effects by more effective early assessment of individual drug responses; IV. to improve the selection of new molecular targets for drug discovery; V. to shift the emphasis from illness to wellness. Despite an increasing ability to compare and contrast different disease entities at a range of biological levels of organization, an important challenge lies in translating this into clinical decision making tools. And translational armamentarium and thus its tools are appearing to become well-positioned to contribute to the many challenges inherent in bridging this gap between our current reactive methods of healthcare delivery and the intent of PPPM. The first discriminatory step illustrating the PPPM-oriented survey and positive outcome of translational efforts is estimating of the correlation strength between genetic polymorphism and risks of the disease, and subsequent construction of the groups at risks. Those goals can be solved by using of BioChip methodology (each disease has specific genomic biomarkers and thus the individual fingerprints). As a result, a patient becomes a data carrier (i.e., he/she knows about possible risks of a disease), and the physician whilst managing the Biobank services can reasonably select of preventive and/or prophylactic protocol, proceeding from the assays made. Individuals, selected at the first stage, undergo the second phase of the survey, which uses a panel of phenotypic biomarkers and biopredictors to get a stage of subclinical & predictive diagnostics finalized. In many pathologies, subclinical (pre-disease) conditions can now be identified (e.g., pre-hypertension, pre-T1D etc.), states which imply increased for a patient, and in some cases, with an accompanying opportunity to engage in pre-early preventive and/or prophylactic strategies (e.g., exercise prescriptions, dietary changes, medications) which can reduce the risk of progression. Some of pre-disease states which represent significantly increased risk of future adverse health outcomes, identifying reliable biomarkers of these pre-disease states, and developing the key challenges in this paradigm of disease screening are in identifying useful therapeutic strategies to offer individuals should they receive a pre-disease diagnosis. The aforementioned is can enable the identification of the ‘‘key drivers’’ of pathology, which may represent novel therapeutic targets or biomarker candidates that play a more direct role in the etiology of disease. Meanwhile, while some methods (e.g., the use of disease biomarkers to drive treatment choices) already reflect a standard of care within certain areas of medicine, other areas (e.g., the modeling of causal disease networks) which do not yet routinely impact clinical care, are expected to add insight to the identification of high quality drug targets to inform drug development, as well as guiding the interpretation of individual genetic variation in creating tailored therapeutic strategies. The development of safe and effective targeted medicine is obviously needed. The latter would include methods for datadriven disease classification, drug repositioning, identification of disease biomarkers, and the creation of disease network models, each with significant impacts on drug development approaches. However, the current biopharma development pipeline is not presently well poised to meet this need. An important bottleneck in the application of updated technologies in translational research is the lack of educated investigators who are versed in both biomedical domains and informatics. For instance, it would be extremely useful to integrate data harvesting from different data- and biobanks for applications such as prediction and personalization of further treatment. Medical practitioners will be able to thus provide more tailored prevention and treatment programs for their patients resulting in improved patient outcomes, reduced adverse events, and more cost effective use of health care resources. Use of PPPM is categorized into predictive and preventive medicine and personalized treatment optimization. The latter refers to pharmacogenomics which aims to match the best available drug or dose to an individual’s genomic profile. So PPPM whilst utilizing a highly promising concept of biomarkers and biopredictors to be translated into the daily practice, would offer great and real challenge for the future, and next generations will speak about the XXI century as a time, when healthcare services became predictive and preventive whilst utilizing translational armamentarium, and its outcomes – secured and guaranteed!