James Huang & Stephen Huang on the groundbreaking technologies that could change precision medicine in the near future

For an industry known for its glacial pace and caution, 2018 has seen remarkable breakthroughs in a wide range of emerging technologies. From 3-D printing and genome sequencing to nanotechnology and artificial intelligence, novel technologies have reached new heights and pushed pharmaceuticals one step closer to the ‘holy grail’ in therapeutics. With so many of these promising developments proceeding simultaneously, combining these different technologies will help bring personalised medicine closer to reality.

Currently, when a patient visits their doctor, finding the right treatment is often a process of trial and error. This is because patients are given treatments which have been shown to work for a majority of people, i.e. treatments approved under strict clinical trial settings. For those who do not respond to standard treatments, they have to try several other treatments before finding the right one, a costly and
time-consuming process.

Within two decades, by the time a patient visits their doctor, they will probably have had their genome sequenced. Genome sequencing is the process by which an individual has the DNA sequence of their entire genome mapped out. Using genetic kits like those designed by Futura Genetics, individuals can order a DNA collection kit online, provide a sample (their saliva), send if off to Futura’s labs and receive their results in four weeks. The doctor can then review the results, assess whether the individual risks developing any condition in the future and decide how to treat it based on their own unique characteristics. This will allow doctors to make recommendations regarding lifestyle changes and medications to reduce the risk of developing diseases in the future.
Once a patient’s risk of developing a future disease is known, new treatment approaches like 3-D printing, nanotechnology and gene therapy can help to address it with a higher chance of success.

If the patient’s treatment does require medications, they may be given a 3-D printed tablet, like those produced by Aprecia Pharmaceuticals. 3-D printing of medications is where the pill is ‘printed’ by fusing different materials together layer-by-layer. Due to 3-D printing’s ability to customise the shape, size and colour of the pill into almost limitless combinations, it will be easier for children and the elderly to swallow. Multiple medicines with different dosages and different absorption rates can be fused together into a single tablet. So, when patients need to take their medications, rather than taking numerous tablets several times a day, they would only have to take a single tablet, which contains all their medicines, once daily.

Additionally, patients may be able to purchase their own 3-D printers, at affordable prices as the cost of production decreases. They would be able to print their own medicines at home, after collecting the prescription instructions and base ingredients from their doctor and pharmacist respectively and print these as required; no more stockpiling and wastage of medicines.

Nanorobots are another exciting new technology in the works. Injected into a patient’s body, the nanorobots carry out specific pre-programmed treatments. For example, if a patient has an infection, billions of nanorobots made to mimic white blood cells could be injected into the body, seeking out and ingesting the infectious microbes, thus destroying them in the process. Upon completion of their task, an ultrasound signal will be transmitted to the nanorobots, commanding them to be expelled via the urinary system. Rather than taking days or even weeks, the nanorobots could eradicate an infection within hours.

Even conditions affected by genetic abnormalities are within the sights of these technological breakthroughs. Through gene therapy, which modifies DNA to treat genetic abnormalities, mutated genes which are dysfunctional are removed, subsequently replaced with functioning copies and then reintroduced into the body. For example, at Necker’s Children’s Hospital in Paris, a 13-year-old child with sickle cell disease initially had his stem cells removed from the bone marrow. Using a viral vector, a copy of the ‘correct’ gene was inserted into the stem cells, leading to the production of normal red blood cells, which were then injected into his body. Within two years, his condition was pronounced ‘cured’ by the medical team. While gene therapy is still in its infancy, it is possible that within two decades this could become a standard treatment for patients with certain genetic abnormalities.

To enable more personalised clinical trial participation, patients will be further integrated into the research process than previously possible. For example, through AstraZeneca’s software system called PROACT, patients can send video and audio recordings of their experiences during the studies, including possible side effects or quality of life measures. Pharma companies can then address any issues in real time and adjust their study protocols accordingly to increase the chances of success.

Of course, there are many potential issues with these emerging technologies. A key issue is that personalised medicine relies on patients willing to share highly sensitive and private data with many different stakeholders, including healthcare providers, pharmaceutical and technology companies. How this data is used, who owns it and how it will be protected are all issues that need to be addressed before society will be willing to adopt these technologies widely. Similarly, since gene therapy can alter the fundamental characteristics of human DNA, it is possible that it could be used to alter phenotypic characteristics that many will consider a taboo.

So, while the future will unlock many technological advancements, incrementalism is the necessary approach here. It is crucial that debates are held on diverse issues like cybersecurity, data handling and standards of morality and ethics. The question is no longer whether these technologies will become a reality, but rather how we utilise them to make precision and personalised medicine achievable in our lifetime.

James Huang is a policy researcher and Stephen Huang is a pharmaceutical medicine consultant, both at SCP Medical