Abstract Detail

Abstract

Policy formation in the field of individual health promotion and protection is one of the priority tasks of national healthcare systems. Canonical health care is becoming increasingly unaffordable in most of the countries, yet it remains ineffective in preventing or effectively treating chronic diseases (including infectious ones). The medicine of the XXI century is Personalized & Precision Medicine (PPM), by protecting and preserving human health throughout the life. In this regard, an upgraded model of healthcare service, which includes the philosophy, principles and armamentarium of PPM and aimed at identifying the disorder at its early (subclinical) stage, is being created and set up.

PPM focuses on predictive and preventive measures that contribute to the development of individualized strategies for managing a healthy lifestyle that stabilize morbidity rates and can help to improve the working capacity of the population. PPM provides procedures for disease prediction and for the prediction of consequences and complications. In this regard, the biomarker-based analysis is intended as a first step towards a more personalized and precision treatment and clinical utility.

Advances in genomics and computing are transforming the capacity for the characterization of biosystems, and practitioners are now poised for a precision-focused transformation in the way they prepare for, and respond to, infectious diseases. In addition, advances in the speed and granularity of pathogen genome generation have improved the capability to track and understand pathogen transmission, leading to potential improvements in the design and implementation of population-level public health interventions.

Meanwhile, despite being a forerunner PPM is not yet routinely applied in infectious patient care. Since, for instance, with the increase in antimicrobial agent resistance and a decreasing antimicrobial pipeline, there is a need for coordinated efforts to promote appropriate use of antimicrobial agents. Such “antimicrobial agent stewardship” measures encourage the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen. PPM can help solve the crisis of antimicrobial resistance (AMR) by changing the way antimicrobial agents are developed and prescribed.

One thing is clear, as we embark into an era of increasing antimicrobial resistance coupled with the routine use of advanced immune modulating agents delivering deep, potent immune suppression, the role of PPM to better understand the clinical outcomes of infectious complications becomes more critical. Efforts to fund and support this nature of clinical and translational research is imperative. Finally, research into personalized medicine will serve as the foundation to develop cellular and immunotherapies specific for infectious pathogens.

For this scope, the next step PPM-oriented and driven education is a crucial step for the successful implementation of PPM in the clinical applications in infectious diseases, and with this part, we would like to encourage learning about PPM in the communicable disease field.

Additionally, new biodesign-driven technologies are supporting the rapid identification of infective agents and targeted approaches based on the genetic resistance of pathogens to antibiotics. This information can lead to revising the data that can be used for personalized predicting diseases, improving the usage of precision biomarkers and personalized treatment, and also personalized prevention strategies specific to infectious pathogens.

Improved patient (or persons-at-risk) outcomes with the application of the above-mentioned biomarker tests must consider not only increased survival or quality of life, but also improved clinical decision support (CDS) & making leading to the avoidance of unnecessary therapy or toxicity captured within the rapid learning system.

Opportunities exist at every stage of disease initiation and progression to develop a Personalized Health Plan (PHP) addressing lifestyle, risk modification and disease management, and later, Personalized Health Management & Wellness Program (PHM&WP). So, a combination of genomic and phenome-related biomarkers is becoming of great significance to be applied in PPM and need to be translated into the daily practice to predict risks of the disease chronification and thus of disabling.

Meanwhile, advances in biomedical informatics and IT technologies brought on and suiting the goal by applying mathematical modeling to secure constructing and maintaining unified biobanks and databanks necessary for personal health monitoring, for instance, by the increasing availability of electronic medical records (EMRs), electronic patient registry (EPR, telemedicine and mHealth tools and cloudy technologies have allowed for the proliferation of data-centric tools and inter-hospital network communications armamentarium, especially in the context of personalized & precision healthcare (PPH). 

Advances in genomics and computing are transforming the capacity for the characterization of biological systems. The set would include the use of genome-based approaches to inform molecular diagnosis and individual-level treatment regimens. In addition, advances in the speed and granularity of pathogen genome generation have improved the capability to track and understand pathogen transmission, leading to potential improvements in the design and implementation of population-level public health interventions. So, we outline several trends that are driving the development of PPM-based epidemiology of infectious disease and their implications for the ability to respond to outbreaks.

Going beyond the detection of the pathogen is crucial to transforming the diagnosis of microbial infections. Consideration of the evolutionary and ecological principles between the host and their microbiome might provide “new strategies for restoring and maintaining human health.” Innovative diagnostics that can identify host, microbiome, environmental and pathogen biomarkers are crucial to PPM-based approach. That Big Data can then be used to design optimal therapeutic strategies for patients that can restore them to health by coordinating agents that can target the pathogen, the host and the microbiome thereby intervening appropriately in the ecological balance in the patient. These strategies bring us a step closer to developing personalized therapies that exclusively remove disease-causing infectious agents. And we would advocate the preservation of our beneficial microbes and provide an overview of promising alternatives to broad-spectrum antimicrobials. Specifically, we emphasize that the newest approaches can not only improve patient care, but preserve antimicrobial agents for the future. We can advance directly to the phase of preclinical validation of disease biomarkers and their underlying mechanisms, and the results can be translated into precision diagnosis enabling patient stratification for individualized therapy. Taken together, the activities proposed will demonstrate the clinical feasibility and advantages of PPM in managing chronic and acute infectious diseases.

As you might see from the above-mentioned, PPM has drastically changed and is keeping on changing the landscape of healthcare. In reality, PPM is the new revolution in medicine which is dramatically modifying the traditional paradigm in medicine with huge consequences for health care systems. And putting PPM-tools in a public health perspective requires an apprehension of the current and future public health challenges.

A symbiotic relationship between infectious diseases, their risks, epidemiological studies, public health and PPM may exist. In this sense, accurate diagnosis of malaria and the resilient capacity that the malaria parasite has in acquiring resistance to anti-malarial drugs (based on the phenotypic variations) form immediate barriers to the control and elimination of this disease. Those variations mentioned could be dependent on geo location or differential transmission setting or even the different ring developmental stage. So, PPM-based and driven OMICS- and IT-armamentarium would secure the advances in spectroscopic-based technologies which is able to reveal unique ‘molecular fingerprint’, and thus providing the much needed rapid phenotyping (rather than genotyping) platform in the field.

Moreover, PPM could help to improve precision diagnosis and individualized treatment of asthma, whilst determining some specific strategies for probing the situation in the tropics with special conditions to be considered for applying this strategy. The clinical impact of the advances in PPM for asthma in the tropics is mainly related to component resolved diagnosis, and would need to be improved via identification of the biomarkers of the next step generation (including interactome- and network-related ones) that allow and accurate definition of phenotypes and endotypes of this heterogeneous disease to secure the proper choice pf personalized treatments.

These examples show how PPM-driven approach to wildlife health has in turn the potential to provide deeper insights into human health and the possibility of stemming and alleviating the impacts of parasite-induced diseases. The integration of the currently emerging PPM-related Initiative with the concepts of EcoHealth and One Health has great potential to deliver a deeper and broader interdisciplinary-based understanding of both wildlife and human parazyte-provoked and infectious diseases.

So, PPM has indeed arrived for the diagnosis of infectious diseases. More than that, it has arrived once and for all in the areas of clinical microbiology, molecular epidemiology and many other areas. Epidemics of the most diverse viruses will continue to occur due to factors that we are not completely able to control. The difference now is that we have powerful PPM-based technologies and tools to win this fight. In this connection, the healthcare providers, public policy sector, and consumer industries will be required to develop new and creative models and products. And, no doubt, next generations will speak about the XXI century as a time, when medicine became preventive and personalized, and its outcomes – predictive and guarantied.

Biography

Sergey Suchkov graduated from Astrakhan State Medical University and awarded with MD, then in 1985 maintained his PhD at the I.M. Sechenov Moscow Medical Academy and in 2001, maintained his Doctorship Degree at the Nat Inst of Immunology, Russia. From 1987 through 1989, he was a senior Researcher, Koltzov Inst of Developmental Biology. From 1989 through 1995, he was a Head of the Lab of Clinical Immunology, Helmholtz Eye Research Institute in Moscow. From 1995 through 2004, a Chair of the Dept for Clinical Immunology, Moscow Clinical Research Institute (MONIKI. Dr Suchkov has been trained at: NIH; Wills Eye Hospital, PA, USA; Univ of Florida in Gainesville; UCSF, S-F, CA, USA; Johns Hopkins University, Baltimore, MD, USA. He was an Exe Secretary-in-Chief of the Editorial Board, Biomedical Science, an international journal published jointly by the USSR Academy of Sciences and the Royal Society of Chemistry, UK. At present, Dr Sergey Suchkov is a Chair, Dept for Personalized Medicine, Precision Nutriciology and Biodesign of the Institute for Global Health and Biotech of MGUPP, and Professor of the Dept for Clinical Allergology & Immunology of A.I. Evdokimov MGMSU, Russia. He is a member of the: New York Academy of Sciences, USA; American Chemical Society (ACS), USA; American Heart Association (AHA), 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); PMC (Personalized Medicine Coalition), Washington, USA.