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Precision medicine is an emerging approach for complex diseases

Researchers at Lund University Diabetes Centre are studying whether different subgroups of diabetes need different treatment. Photo: Kennet Ruona
Researchers at Lund University Diabetes Centre are studying whether different subgroups of diabetes need different treatment. Photo: Kennet Ruona

Newborn babies are already being screened for mutations and genetic tests help families with hereditary breast cancer. Genomic-driven precision medicine (GDPM) is an emerging approach for disease treatment. Around 30 Swedish researchers suggest a direction forward in a review article in Journal of Internal Medicine (JIM).

"At the moment newborns are screened for a small number of mutations. In the future we may have a scenario where we screen for a much larger number of mutations, which may allow us to detect genetic diseases earlier and better optimize prevention and treatment," says Paul Franks, professor in genetic epidemiology at Lund University and lead author of the article in Journal of Internal Medicine (JIM).

In Sweden, the PKU-test has been given to newborns since the 1960:s to be able to detect rare disorders. The PKU-test is only one example of how we can make use of genetics to give the right treatment at the right time. A more recent example of genomic-driven medicine is genetic testing for inherited breast cancer.

Technological readiness

The researchers behind the article in JIM are part of Genomic Medicine Sweden (GMS), a national venture for the implementation and development of precision medicine in Sweden. The review summarises the conditions for precision medicine within different disease areas and highlights a few fields with a high degree of technological readiness – cardiology, endocrinology, obstetrics, gynecology and psychiatry. Researchers at Lund University and Karolinska Institutet have led the work with the review article. 

"We all come from different disease areas, which I think is a great strength. I have a background in diabetes research, whereas the three other lead authors at Karolinska Institutet are experienced in fields such as clinical and psychiatric genetics, cancer and allergic diseases," says Paul Franks, researcher at Lund University Diabetes Centre (LUDC) and scientific director at Novo Nordisk fonden in Denmark.

Treatment of diabetes

Precision medicine is often defined as providing the patient with the right treatment at the right time. New genetic techniques, image diagnostics and big data create new opportunities to treat complex diseases. The review article in JIM discuss how more powerful data and analytical approaches could improve diagnostics and treatment of different complex diseases, such as diabetes.   

In a clinical context, precision medicine may aid diagnostics by identifying subgroups within a complex disease where the patient can benefit from a targeted treatment. An example of this is a study from researchers at Lund University Diabetes Centre (LUDC) that divided diabetes into five different types instead of the current classification into two main forms. The researchers are now studying if different groups of patients with type 2 diabetes need different kinds of treatments. 

"Currently we are studying how different groups of patients are responding to different treatments. We hope that our work with the sub-classification can lead to better treatment of diabetes," says Maria Gomez, professor and coordinator of Lund University Diabetes Centre (LUDC) and one of the authors of the article in JIM.

Priority to other ethnic groups

Precision medicine raises questions around ethics and equality. GDPM involves the collection of genetic data, which needs to be stored in a secure manner. The vast majority of human genetics has been undertaken in people of European ancestry. Studies of other ethnic groups should be prioritised in the future, according to the authors.

"Genetics has a lot to offer, but we need to make sure that we now give priority to research in non-European ancestries, so that we don’t miss out on rare variants of interest. We also need to ensure that precision medicine helps decrease health disparities rather than increase them," says Paul Franks. 

Read the news item on Karolinska Institutet's website: https://news.ki.se/precision-medicine-new-opportunity-for-complex-disea…

 

The review article in JIM

Technological readiness and implementation of genomic-driven precision medicine for complex diseases is published in Journal of Internal Medicine (JIM). The article summarises the views of clinicians and scientists who specialise in GDPM of complex diseases within the framework of Genomic Medicine Sweden (GMS) and considers benefits and risks.
Precision medicine includes diagnostics, treatment and follow-up to provide patients with individual treatments. GDPM uses a wide range of large-scale technologies, such as gene sequencing.
Cardiology, endocrinology, obstetrics, gynecology and psychiatry have a high degree of technological readiness regarding diagnostics, prevention, therapeutics or prognostics, according to the authors.
Link to the article in JIM: https://onlinelibrary.wiley.com/doi/10.1111/joim.13330

Genomic Medicine Sweden (GMS)

Genomic Medicine Sweden (GMS) is a national initiative that brings together clinicians, researchers, industry and patient organisations with the aim of implementing precision medicine in healthcare across Sweden. 
GMS receives national funding from the Swedish Innovation Agency, Vinnova, as well as co-funding from the participating regions and universities.

Lead authors of the article in JIM

Paul Franks, professor at the Department of Clinical Sciences, Lund University
Richard Rosenquist Brandell, professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet
Patrick Sullivan, professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
Erik Melén, professor at the department of Clinical Sciences and Education Södersjukhuset, Karolinska Institutet 

Contact

Maria Gomez, professor of physiology at the Department of Clinical Sciences, Lund University, and coordinator for Lund University Diabetes Centre (LUDC)
+46 702 226 216
+46 40 391 058

Paul Franks, professor of genetic and molecular epidemiology at the Department of Clinical Sciences, Lund University, and scientific director of Novo Nordisk fonden
+45 20 632 350