A Personal Question

Personalized, precision or stratified medicine – we can’t agree on what to call it but we all agree that we desperately need it. With even the most promising modern medicines showing therapeutic activity in only around 30 percent of the population (1), we need to get better at predicting, detecting and targeting diseases across populations.

There is no shortage of international initiatives and funding to fuel innovation in this area. For example, in January 2015, US President Barack Obama launched a Precision Medicine Initiative, while in the UK the 100,000 Genomes Project is already well underway. These programs will lead to a much greater understanding of the diversity of our genomic make up and a plethora of new targets for drug development or diagnostics.

But this is where the current remit of personalized, precision and stratified medicine tails off, and we need to go further. For medicine to be truly personalized, we cannot simply become better at predicting disease. We must be able to routinely and reliably detect, monitor and target disease, and this is where nanotechnology comes to the fore. Nanoparticles or nanocomplexes are already routinely used in diagnostics. From pregnancy testing to malaria diagnosis, they enable precise, accurate and reproducible data. Rather than medical professionals taking blood samples and sending them for analysis off-site, we are starting to see more point of care diagnostics, where nanosensors allow rapid readout from small samples. Nanotechnology is also used in diagnostic imaging. For example, EndoMag has developed a handheld magnetic probe (SentiMag) and magnetic tracer (Sienna+) to localize lymph nodes for cancer detection and staging. The products will be launched in the US in 2015.

The Qualcomm Tricorder X Prize is catalyzing the convergence of PoC diagnostics with digital or e-health. The prize professes to be “turning science fiction into reality” and who would argue with them? It is a global competition to make a portable device that can diagnose 20 different medical conditions and readout continuously to “put healthcare in the palm of your hand”. The top 10 teams, including teams from the US, Canada, India, Taiwan, Slovenia and the UK, all use nanosensors. The biggest issue with delivering precision medicine is exactly that – delivery. Targeting drug molecules to the right organ, tissue or cell is an ever-present problem in pharma and biotech. Nanotechnology from BIND Therapeutics is helping to overcome this challenge. Founded by Professor Robert Langer from Massachusetts Institute of Technology, BIND’s flagship technology, Accurins, deliver targeted and programmable therapeutics. Accurins are functionalized nanocomplexes that target disease-specific cells or tissues and deliver their therapeutic payload directly to the site of disease. Such targeting enhances efficacy and minimizes adverse effects on healthy tissues. BIND has already demonstrated positive Phase II results for non-small cell lung cancer and has inked deals with Amgen, Pfizer, AstraZeneca, Roche and Merck.

The field of theranostics, which combines diagnostic and therapeutic capabilities into a single agent, is another emerging technology, with the potential to diagnose and deliver the right dose to the right tissue at the right time. Personalized medicine doesn’t just relate to genomic subsets of a population – targeting drug delivery to specific age groups can also make a big difference to patients. For instance, VaccineTab has developed a liposome-encapsulated nanotechnology for vaccine delivery. It is a needle- and pain-free delivery system, so is has particular benefits for children’s vaccinations. In addition, the VaccineTab technology is thermally stable, thus reducing the need for cold chain product supply. In the developing world, where the cost of vaccines and lack of cold chain logistics prevent effective vaccination programs, VaccineTab could have a huge impact. With its health market predicted to reach US$1 trillion by 2021, it is abundantly clear that nanotechnology will pick up where genomics ends, driving disease detection and the targeted delivery of personalized medicine. They do say that good things come in small packages...

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