MEDICINE
approach on its head. It recognises that, rather than considering complex diseases as a single entity, it should be recognised that one disease may have many different forms, or ‘subtypes’, resulting from the complex interaction of not only a person’s biological make-up, but also of the diverse pathological and physiological processes within their body. These will not only vary between patients, who have the same disease, but also within an individual patient as they get older and their body changes.
Put simply, personalised medicine offers the opportunity to move away from ‘trial-and-error’ prescribing to optimal therapy first time round.
Clinicians are already beginning to see the development of simple point- of-care tests, based on genomic knowledge, which enable clinicians in a wide variety of settings to identify the best therapy. This marks the beginning of an end to the frustrating and costly practice of ‘trial-and-error’ prescribing: a fact alluded to by Professor Tony Bjourson at the recent launch of the new Centre for Personalised medicine, Clinical Decision making and Patient Safety at Ulster University.
‘Currently 30 per cent to 50 per cent of patients don’t respond to the treatment they are prescribed,’ Professor Bjourson said, ‘and this number is much higher for some diseases. Through this new Centre, we will aim to improve the health of tens of thousands of people and at the same time develop more cost- effective healthcare not just here in Northern Ireland, but around the world. In addition, we will be creating innovative products and new optimised care pathway tools and we‘re confident that this will attract investment that will contribute to economic growth.
‘Translating the promises of personalised or stratified medicine discoveries from the lab to the clinic, where the rubber meets the road, is recognised as a major global challenge. The key strength of this project is that it is driving personalised medicine discoveries to the front line to help clinicians make better clinical decisions and improved treatment outcomes for us as patients.’
The new centre, which has been made possible by �8.6 million of funding from the European Union’s INTERREg VA programme, aims to dramatically improve clinical decision making and tailored patient care in five priority disease areas. The research project, which will be a cross-border collaboration between the academic, clinical and commercial sectors, will focus on heart disease, emergency surgery, acute kidney injury, diabetes and dementia. It is anticipated that the centre’s research will improve the health of tens of thousands of patients and help cut healthcare costs dramatically in Northern Ireland, Republic of Ireland and internationally.
Professor Tony Bjourson, who is Professor of genomics at Ulster University, will lead the project.
‘Ulster University has a longstanding history of world-leading medical and health-related teaching and research,’ he said. ‘This new Centre for Personalised medicine, Clinical Decision making and Patient Safety will add yet another dimension to the University’s work and standing in this important area. Ulster invests £42m in research and innovation programmes each year. That research is often undertaken in partnership with commercial organisations ensuring it is relevant and applicable to real world problems. with the healthcare sector under immense pressure globally and the need for effective, tailored treatment options coupled with excellence of care, this INTERREg VA funded project will place Ulster University at the heart of the solution.
The new centre’s research objectives include developing tools which will allow earlier diagnosis of dementia and therefore earlier clinical intervention and support, and also learning how to recognise acute kidney injury earlier to reduce mortality and hospital stay. It will also seek to improve the triage of patients with chest pain to allow more appropriate and rapid emergency referral, and look at how to help people better manage their diabetes.
Although this centre is new to the province, both of NI’s universities have been heavily involved in personalised medicine for some time.
As far back as 2014, scientists from queen’s University in Belfast, led by
Professor Tony Bjourson
Professor mark lawler, Chair in Translational Cancer genomics at queen’s Centre of Cancer Research and Cell Biology (CCCB), travelled to Belgium to help launch a ‘Roadmap for Personalised medicine in Europe’ – a collaboration involving patients, doctors, scientists, pharmaceutical and biotech companies, which aimed to make personalised medicine available to all European patients.
‘Understanding the genetics of a disease, say bowel cancer,’ Professor lawler said at the time, ‘has made us realise that all bowel cancers are not the same and therefore a ‘one size fits all’ approach cannot work for all patients. New technologies allow us to understand the type of disease based on the genetic make-up and therefore this information lets us personalise the treatment for each of these bowel cancer patients.’
Since then, Professor lawler and his team have taken great strides in their research. Recently, the team has discovered how a genomic approach to understanding bowel (colorectal) cancer could improve the prognosis and quality of life for patients.
‘for clinicians, treating patients with bowel cancer can be particularly challenging,’ Professor lawler said recently. ‘Currently, patients with colorectal cancer are offered chemotherapy treatment. while this treatment may be successful for some patients, for others it will have no effect on fighting the cancer, though the patients may suffer debilitating side effects such as nerve damage that can result in a loss of sensation or movement in a part of the body.’
The researchers at queen’s - in collaboration with the University of Oxford and the University of leeds -
have made a significant advance in the treatment of bowel cancer. In a recent study, which was published in the high impact journal Nature Communications, the researchers showed how defining precise gene signatures within bowel cancer cells can allow clinicians to develop novel prognostic and predictive markers for bowel cancer and help to drive personalised medicine approaches.
‘Through analysing the molecular and genetic data generated from patient tissue samples,’ said Dr Philip Dunne, Senior Research fellow at queen’s, ‘we have discovered that there are different subtypes of bowel cancer. This research unequivocally identifies robust gene signatures that can be used to inform patient management. It will allow us to identify particular gene signatures that indicate sensitivity or resistance to specific therapies. Thus, we can tailor treatment to the individual patient, maximising its effectiveness while minimising potential side effects.’
In addition to the work being carried out by NI’s universities, the NhS has also taken up the ‘personalised medicine’ baton and is running with it - at some speed! In 2013, thanks to an investment package worth more than £300 million, a four-year pioneering initiative entitled the ‘100,000 genomes Project’ was launched. The aim of the project was to decode 100,000 human genomes in people with rare diseases and cancer. Clinical teams in thirteen NhS genomic medicine Centres across the Uk enabled the NhS to become the first health service to collect and use whole genome sequencing alongside routine collection of clinical and diagnostic data on a large scale.
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