The Genes Have It

Care Tailored to the Individual

A woman of the future wakes up feeling not quite right.  It’s far enough into the future that most people in the U.S. have had their genetic makeup analyzed and catalogued, but not so far ahead in the future that infections have been eliminated. So, she gets out of bed and engages the “Do I have a fever?” app on her i-Phone.

The results are “yes,” and the information, along with her medical profile, is automatically relayed to her physician, who after studying the “genetic bio-signature” of the bacteria and the patient, e-prescribes the antibiotic that has the best chance of working for her individual circumstance. GPS systems also track the location of the woman, so physicians can follow any possible spread of that particular bug.

This scenario, as painted by Geoffrey Ginsberg, director of the Duke’s Center for Genetic Medicine, may be a lot closer than we might imagine. He described a world where genetic screening early in life can give clinicians a better idea of what diseases their patients may be susceptible to in the future so they can intervene before the disease even manifests itself.

“The future of medicine is personalization,” Ginsburg said. “We will be able to predict potential risks and make a prognosis on an individual basis.”

In the session of the Raleigh Grand Challenge Summit devoted to engineering better medicines, speakers predicted an era when diagnoses are guided more by an individual’s genetic makeup than educated guesses.

While engineers are not usually thought of in discussions about patients and their ailments, it is becoming increasingly apparent that they will become more intimately involved in the development of next-generation therapies, whether it be the production of replacement body parts from a patient’s own cells to tiny devices that can screen a patient’s genetic makeup from a drop of blood.

Timothy Deming, chair of the Department of Bioengineering at UCLA’s Henry Samueli School of Engineering and Applied Science, is a telling example of how many advances in medicine will of necessity require a diverse background. He trained as chemist, then focused on material sciences, and is now combining chemistry techniques and materials science to hopefully provide relief for those suffering from central nervous system damage. From test tubes to spinal cords.

Deming’s lab is developing biological Jellos  known as hydrogels that can provide ascaffolding on and through which regenerating nerve cells can grow. Because this scaffold is derived from a patient’s own stem cells – what he terms “nature’s biological repair kit” – a patient’s immune system would not attack it as foreign.

“These scaffolds could be safe, biodegradable and versatile, and most importantly, tailored to the individual,” Deming said. “As we advance in tissue engineering, we must always remember that the end product is something a physician can use, so the engineer and physician need to work together.”

Watch Demming's keynote address.

Another engineering approach that shows promise makes use of fabrication techniques used to produce semiconductors. Joseph DeSimone, chemistry professor at UNC and chemical engineering professor at NCSU, has fashioned nano “ice cube trays” that can produce a vast array of custom sized and shaped nanoparticles to ferry drugs into the body.

At Duke, Pratt engineers, working with Ginsberg under a Defense Advanced Research Projects Agency grant, have developed a prototype device that that can detect from a tiny drop of blood markers of infections before they are even apparent. Five small clinical studies have been conducted at Duke isolating these early warning signals of infection, including the H1N1 virus.

Despite all these advances, and the thousands of others being made in labs around the country, the U.S. must keep looking over its shoulder at the rest the world, which is catching up on innovating new treatments, according to Fred Hassan, former chairman of the board and CEO of the pharmaceutical company Schering-Plough.

In his more than 30 years in the health care business, Hassan said that 95 percent of all new drugs in this country come from the U.S. pharmaceutical industry. Unfortunately, he said, the U.S. will not remain pre-eminent by resting on its laurels. He stressed the need for collaborations between industry and government agencies.

“Investment capital is starting to dry up – the return on investment over the past ten years has not been good,” he said. “The U.S. is still pre-eminent in the science – the NIH and our universities are good examples. But K-12 education needs to be better to maintain this position. The FDA is a jewel, but it needs to be better funded and modernized.”

Hassan also advocated for intellectual property (IP) policies that reflect 21st century realities and those that keep pace with foreign competitors. On the social side, he said that scorecards are needed to evaluate the performance of health care providers and that a much greater emphasis must be placed on instilling health literacy in patients early in life.

Ginsberg kept in perspective the discussion of all the imaginative and innovative technologies being brought to bear on human health by concluding that “in the Third World, clean water and food issues are more pressing that personalized medicine.”

It appears there are many opportunities for engineers of all stripes to make a difference in the world.

Watch discussion.