Ciechanovers Traum von der Ära der personalisierten Medizin
Auf der Falling Walls Conference 2011 sollen so manche Mauern eingerissen werden. Heute hat hier Nobelpreisträger Aaron Ciechanover einmal mehr davon berichtet, welchen Durchbruch er erwartet und was er sich davon erhofft. Es ist die personalisierte Medizin, die doch durchaus so einfach offenbar nicht zu realisieren sein wird. Der ethische, rechtliche und gesellschaftliche kritische Bedenken entgegen stehen und die nicht zuletzt nicht auf dem einfachen alten Dogma der Biologie DNA-RNA-Protein aufbauen können wird. Da gibt es die Epigenetik und viele weitere Erkenntnisse mehr, die einen Strich durch diese scheinbar einfache Rechnung machen. Hier folgt nun, was Ciechanover präsentierte – mit ein paar kleinen Kommentaren von mir. Wieder cross-posted auf englisch.
Aaron Ciechanover is an enthusiast and a brilliant scientist and he obviously is one of those scientists who believe in the supporting power of science for a good and healthy future. Here at the Falling Walls Conference in Berlin he said we need to break several walls: walls of knowledge, walls of behavior, walls of environmental misuse, walls of infectious diseases, financial walls, walls of corruption and transparency. And he especially wants to break the walls of diseases with the help of personalized medicine. A vision that he pursues with his research.
In 2004 Ciechanover received the Nobel Prize together with Avram Hershko und Irwin Rose “for the discovery of ubiquitin-mediated protein degradation” – means a discovery of how cells reduce unwanted proteins. Ciechanover did not stop doing science with the Nobel Prize. In contrary he still spends plenty of his time in the lab. At the Israel Institute of Technology in Haifa he and his interdisciplinary team are one of plenty research groups in the world looking for disease-specific molecular markers and drug targets which might lead to novel drugs. They do this not at least because they believe in the future of personalized medicine.
Here at the Falling Walls Conference Nobel Laureate in Chemistry Aaron Ciechanover is talking about a personalized medicine revolution. A revolution moving in three steps. It began in the 1930s with the era of incidental discoveries such as aspirin and penicillin – medicine that helped without researchers knowing how and why they work. The second revolution started in the 1970s with new experimental methods and systematic screenings to finding chemical cures. The last step began in the early 2000s with the end of the human genome project and is now localizing medicine to a personal level.
This revolution, Ciechanover describes, will last until the four P’s are established: Personalized, Predictive, Preventive and Participatory. “Personalized medicine is medicine that determines the cause and severity of each disease on each and every one of us individually”, Ciechanover explains.
Currently we mainly practice a “one-size-fits-all” type of medicine. As there is not one shoe that fits all feet and not one size, that fits us all. We need individual shoes – medicine. This will be the end of patients misdiagnosed because they seemed to be part of a certain group and getting one drug that shoud help all of them, which doesn’t work. Each individual patient responds differently to treatments because their diseases don’t have the same molecular basis. “There is breast cancer A, B, C and D… – not just breast cancer. This is why not all can be treated with the same drug. There are special mutations in different receptors which we have to know and to identify“, Ciechanover says.
Until now individual care is based on medical diagnostics, the study of family history, social circumstances, environment and behaviors. Ciechanover believes, “as the prices for sequencing our genomes will soon be cheaper than 1000 US-Dollar and the genome will be sequenced in one day scientists will know more and more about the genetic profiles of certain diseases in the future .” In the end physicians might become ‘profilers’. “We are going to profile patients initially based on their DNA,” Ciechanover said. “Starting with the DNA, knowing this is not the solution, „we need to go further on to the proteins, which are the machines, that make us who we are.“
Well this sounds pretty good, but there are scientific, ethical, legal and social challenges.
- First of all, the genome isn’t the whole story.
- The genome is the basic script, but the proteome is doing the job and it might be changed by living standards, stress, food and plenty more.
- 11 Years after the human genome has been sequenced we still have a quantity of information but not very much the ability to interpret it.
- Many diseases are multigenic and the causative connection between the gene products is not clear.
- And we have learned a lot about epigenetics in the last ten years, which means, genes are the script, but which genes are active or not changes through your lifetime and is some kind of (re)printed on a second layer above our genes.
- At the end Ciechanover points out bioethical problems. By submitting DNA we are submitting very special informations. This is a question of data security. But there is also another ethical problem. What for example will a women do, if she knows she has a certain condition for getting breast cancer. Will she act differently? Will she talk about it to her daughter?
Lots of questions we should talk about today!
Über und mit Aaron Ciechanover gibt es hier noch mehr in den Blogs zur Lindauer Nobelpreisträgertagung
Am Ende die Hoffnung – Proteinabbau als therapeutisches Ziel – Avram Hershko und Aaron Ciechanover