Personalized Medicine: unique treatment for unique patient

Personalized medicine is also the current topic of the 16th Science Day of the Campus of Kontinkangas that is organized on February 19th 2019 jointly with the Faculty of Medicine and the Faculty of Biochemistry and Molecular Medicine at the University of Oulu. Four specialists from the University of Oulu and Oulu University hospital tell how they see the personalized medicine in their field of expertise now and in 2030.

Markus Mäkinen, professor, Faculty of Medicine, University of Oulu and Oulu University Hospital:

Personalized medicine is a central part of daily practice of a pathologist, doctor who gives diagnoses based on cells and tissues. We assess whether a patient is eligible to a targeted treatment; examples include RAS gene mutations in intestinal cancers, BRAF gene analysis in malignant melanoma, and PD-L1 gene in lung cancer. This is because only subset of patients benefits of new targeted treatments today.

In 2030, pathologists are still in the picture guaranteeing the quality of personalized medicine that then is available for masses in developed countries. The use of genomic data is integrated to the treatment decisions, thanks to the development of artificial intelligence, and to the expanded understanding of complex cellular and intercellular interactions that are linked to various diseases. There will be an ongoing shift towards real-time mobile preventive medicine: portable or implanted devices connected to AI-assisted platforms monitor patients at risk of developing serious illnesses like chronic colitis, lung fibrosis or hereditary cancer. In 2030, these achievements will allow us to cure patients nowadays deemed incurable, and treatments will produce less side effects because illnesses are detected early. This technical and methodological development will change the way we teach our students.

Professor Seppo Vainio, Biocenter Oulu, Director of Borealis Biobank of Northern Finland, Faculty of Biochemistry and Molecular Medicine, University of Oulu:

Personalized medicine will offer to us medical treatment that suits best to you based on your inheritance since the genome impacts the efficacy of therapies. Adult human primary cells retain their capability of pluripotency and after induction back to this stage, they can be reprogrammed and differentiated to other cell types. These specialized cells can then be utilized for personalized drug screens and cell therapies.

Given this personalized medicine is advanced via so called pharmacogenomic research and therefore genome databases and stem cell biobanks are needed. The Finnish biobank legislation offers the grounds for personalized medicine, but much research is still needed to make personalized medicine a reality. In summary, the concrete way that you can advance personalized medicine in the Finnish health care setting is to support the biobanks and the associated research. This will provide concrete grounds to advance medicine and the health care system to serve you better with your special needs during your life cycle.

Jussi Koivunen, Medical doctor, Faculty of Medicine, University of Oulu and Oulu University Hospital:

Personalized medicine is already standard-of-care approach in oncology today. In many tumor types, numerous genetic alterations/gene expressions are routinely analyzed in tumors to help in selecting the best treatment approach for a patient.

What I predict to happen in next coming 10 years, is that the number of analyzed genetic/gene expression alterations is growing and it is likely that even whole tumor and normal genome is analyzed before treatment choice. Other growing field is the genetic monitoring of disease during treatment course using tumor shed DNA fragments and modifying therapy accordingly. Electronic follow up of patients with e-questionnaires and wearable electronics that can be coupled to AI approaches will increase and enable accurate and timely feedback to patient and care unit. This offers ways to enhance patient follow-up and personalized care.

Kalervo Hiltunen, Professor (emeritus), Faculty of Biochemistry and Molecular Medicine, University of Oulu:

In addition to currently utilized personalized medicine in oncology, common infections and small injuries will be treated case-by-case by medical professionals during the coming years. Automatization, development of analytical methods and tools of bioinformatics will allow faster collection of more information from smaller sample volumes in a customer friendly manner. In addition, due to increased understanding on pathophysiology of diseases, decision making will be based on individual molecular profiles and genetic make-up of patients instead of averaging responses across large cohorts. Combining metabolite profile and life style with genetic background helps disease risk assessment, prevention or counselling to delay development of the disease state. The novel information leads to precise categorizing subgroups of diseases and ultimately to optimal care based on state-of-art. In vitro screening of malignant cell lines for drug sensitivity is already now in practice for tailoring drug therapy in cancers. Pharmacogenomics will give tools to predict which medical treatment will be safe and effective for individual patient and help to define an individual’s risk based on their genetic and life style backgrounds.

Interviews by:

Anne Tuomisto, PhD, University of Oulu & Renata Prunskaite-Hyyryläinen, PhD, University of Oulu