The Future of Medicine Danny Belkin. “ Our generation may be the last to have to accept death and taxes as inevitable." - Commander Shaun Jones,US Navy,

The Future of MedicineThe Future of Medicine

Danny BelkinDanny Belkin

““OurOur generation generation may be the may be the last to have to accept death last to have to accept death and taxes as inevitable."and taxes as inevitable."

- Commander Shaun Jones - Commander Shaun Jones ,,US NavyUS Navy,, D DARPAARPA

Contents

• Challenges to “traditional” big pharma, their

future

•Pharmacogenomics

• Current and Future Biotechnology

•Stem Cell Therapy

• Microtechnology and nanotechnology

Challenges to Pharmaceutical Companies

• Aging and informed population

• Increased focus on preventive care / wellness

• Demand for safety and efficacy

• Serious drug side effects (Vioxx, Hormone Serious drug side effects (Vioxx, Hormone

replacement therapy)replacement therapy)

•Prescription drugs that don’t always work

• Progress in science and technology providing other

therapeutic paradigms

• Keeping up with advances in information technology

• Lack of R&D productivity increase despite sustained Lack of R&D productivity increase despite sustained

investmentsinvestments

• Increased regulatory demandsIncreased regulatory demands

• Unacceptable failure rates of R&D projects Unacceptable failure rates of R&D projects

…challenges which lead to changes in healthcare• Better understanding of nutrition and its effects

•Initially specified for diseases/population groups(problems with clinical trials for unpatentable nutrition compounds)

•Later - per individual genetic makeup

• Pharmacogenomics and Proteomics

• Many major diseases understood at molecular

level – advanced drug design

• Smart Drugs for Cancer and Autoimmune

Diseases (arthritis, psoriasis, diabetes).

• Development of diagnostics combined with

targeted therapeutics

• in silico simulations of biological systems

The “5 P’s” of Future Medicine

•Predictive - Pharmacogenomics and Pharmacoproteomics

•Preventive - Acting proactively with preventive medicine

•Point of care - Mobile communications & ubiquitous computing

•Parametric - Multiple parameters, over time, referenced to patient’s own baseline and genetic profile, compared to standard model

•Personalized - Individual treatment for each patient

Pharmacogenomics - Personalized Medicine

Both preventative and therapeutic Single nucleotide polymorphisms (SNPs) - Only a fraction

of these, probably 300,000, determine everything from hair colour to disease susceptibility and drug response.

100,000 people die each year in the US from adverse reactions to prescription drugs, stemming from specific gene loci. Millions more suffer painful side effects from drugs.

Knowledge of patients’ genetic profile will allow significantly improved preventative measures as well as improved drug safety and effectiveness (“tailor made”).

• Begin colonoscopy at age 40

• Avoid high fat in diet

•Gene-based drug therapy for cancer

•Gene & Cell therapy for heart disease

• Drug dose of antidepressant determined by drug metabolism genetic profile

Risk prediction Pharmacogenomics New Therapies

Pharmacogenomics - Personalized Medicine

• RNAi (RNA Interference) and micro RNA to disable/weaken expression of genes

•Ageing-promoting•Pathogens •Cancer •Autoimmune

• Gene Chips• Cell Therapy• Gene Therapy• Combined Cell and Gene Therapy• Human Cellular Engineering and Tissue

Engineering

Current and Future BiotechnologyCurrent and Future Biotechnology

Stem Cells Therapy - Regenerative Medicine Multipotent Cells that can develop into any organ or tissueMultipotent Cells that can develop into any organ or tissue

Embryonic stem cells – controversial and technically difficult Embryonic stem cells – controversial and technically difficult

to manipulateto manipulate

Ideally - patient’s own stem cells, rejuvenated and then Ideally - patient’s own stem cells, rejuvenated and then

delivered into desired tissuedelivered into desired tissue

Stem cell transplants have been effective in treating cancersStem cell transplants have been effective in treating cancers

Stem cell therapy now being used for degenerative diseasesStem cell therapy now being used for degenerative diseases

Future of Stem Cell TherapyFuture of Stem Cell TherapyMultipotent Blood-derived cells are available now

• Developing further depth: additional cell types• Developing further width: treatment of additional diseases

treatable by a certain cell type• Automation of manufacturing processes for:

•Faster, more efficient production (e.g. improved, closed-system culture systems)

•R&D – Rapid improvement of manufacturing process; manufacturing of more effective products

• Improved transplantation techniques: microcapsules; targeted systemic infustion; slow release; in vivo growth by mimicry of BM

• Integration of gene therapy to form a synergetic product exhibiting the benefits of both technologies

Microtechnology and Nanotechnology

Bring the ability to detect, preventBring the ability to detect, prevent and treat disease down to the and treat disease down to the molecular levelmolecular level

First Microtechnology Pioneers

• BioMEMs – Microelectronic Mechanical Systems : microsensors, drug delivery, disposable chips for diagnostics

• Dendrimers – synthetic polymer for disease detection and drug delivery

• Artificial microbes - producing beneficial materials or breaking down harmful ones

First Microtechnology Pioneers

From: WiredFrom: Wired 14.1214.12

•Nanodevices can potentially:

• Be much more therapeutically effective than

current drugs

• Be much more efficient than current diagnostic

tests

•First generation nanoparticles are already in

development:

• Magnetic particles for in vivo diagnostics are in

use in the clinic

• Lipid-based nanoparticles capable of delivering

drugs or genes in advanced preclinical testing.

The Potential of Nanotechnology

NanotechnologyNanotechnology: : Information Meets the Physical WorldInformation Meets the Physical World

• A technology ripening 10-20 years from now

• Massive parallel diagnostics

• Paradigm – first augmenting, then replacing

• Highly expensive, moderately efficient, then ultimately cheap and efficient

• Upgrading the cell nucleus with a nanocomputer and nanobots


• The Biological assembler


•Surveillance and monitoring nanobots•Hormone delivering nanobots•Oxygen-extracting nanobots – no need for lungs •Microbivores (artificial phagocytes)•Tumor-destroying nanoparticles•Surgical Nanorobotics – vascular maintenance, gene or

chromosome replacement•Metabolic nanobots – introducing nutrients directly into

bloodstream; no need for digestive system•Augmentation of all that’s left: skeleton, skin, sensory organs,

brain.

http://www.foresight.org/Nanomedicine/Gallery/index.htmhttp://www.foresight.org/Nanomedicine/Gallery/index.htm

Nanobots in the bloodstream


Nanobots

Nanobots in the bloodstream


Clottocytes

Housekeeping Nanobots

Nanobots


Respirocytes (mechanical RBC)

Neural Augmentation/replacement

Nanobots


Surveillance and monitoring nanobots

Nanobots

1990 2000 2010 2020 2030

Gene Therapy I

Cell Therapy II

Advanced Tissue Engineering

Nanomedicine - interventional

Combined Gene & Cell Therapy

Nanomedicine - diagnostics

Advanced drug design – based on proteomics & genomics

TimelineTimeline

Cell Therapy I

Gene Therapy II

Whatever happens, it will be an interesting place to be…Whatever happens, it will be an interesting place to be…

To Whoever is still awake…To Whoever is still awake…

Thank you for your attention.Thank you for your attention.

Documents

The Future of Medicine Danny Belkin. “ Our generation may be the last to have to accept death and taxes as inevitable." - Commander Shaun Jones,US Navy,