Molecular Medicine

Molecular-based (Personalized) Medicine : 

Molecular-based (Personalized) Medicine By I&C President Ryan Witt Witt.rj@gmail.com

Schedule : 

Schedule Bio101 Molecular Medicine

Our Bodies : 

Our Bodies Made up of ~10 to 100 trillion cells Cells make up Tissue Tissues make Organs (i.e., Skin, lungs, brain)

Molecules : 

Molecules So… what and where are “molecules?” What: A group of (two or more) atoms bonded to one another. (Pauling, Linus (1970). General Chemistry. New York: Dover Publications, Inc.. ISBN 0-486-65622-5 ) Where: Everywhere Including inside AND outside of cells Water =)

The Driver : 

The Driver Molecules are the drivers of cells. Forming the structure of DNA, RNA, proteins, enzymes, and EVERYTHING pushing our body to do what it does!

DNA’s Molecular Structure : 

DNA’s Molecular Structure

DNA : 

DNA the “Masterplan” Some will say, “your DNA is your destiny.” Codes for everything – proteins, enzymes, microRNA, RNA, etc.

But, : 

But, DNA isn’t everything! DNA Mutations change our DNA throughout our lifetimes Plus Expression and shape is partially independent of DNA (i.e., methylation / epigenetics) Expression and “end-conformation” of molecules is what matters most -- that is, what action and structural components (i.e., RNA, glycoproteins, proteins) will be active.

Example:Stubbing your Toe : 

Example:Stubbing your Toe + Rubbing

Moreover : 

Moreover Our actions change our molecules, which change our cells, organs, and bodies! “Technology is not only changing our lives, it’s changing our BRAINS.” - Dr Gary Small, Director of the UCLA Center on Aging & Professor of Psychiatry and Behavioral Sciences at UCLA

Lastly : 

Lastly Beware! ALWAYS ask, “What, Why, When and How” http://www.youtube.com/watch?v=R34Sguwxe2o

Recap : 

Recap

Molecules : 

Molecules Two or more atoms bound together! Molecules make up the components of cells, tissue, organs, and us as a whole

How your body works : 

How your body works

Our actions affect our bodies,at the molecular level : 

Our actions affect our bodies,at the molecular level Rubbing

Summary : 

Summary Information about our unique genetic code (DNA) tells us the blueprint of our lives. Expression levels and the sequence of molecules—which constantly are changing—are key to understanding the underlying causal mechanisms of us at any given moment in time. Ask your doc about molecular testing (if you have a disease or want to learn about yourself) DNA Expression levels / sequence of expressed molecules

COOL! : 

COOL! We are done with part 1 (the bio background bit) Any questions?

Medicine(the standard & innovation) : 

Medicine(the standard & innovation)

Things can get very hazy : 

Things can get very hazy Cancer

Medical Diagnostics:currently : 

Medical Diagnostics:currently “Differential diagnosis” What is the most likely cause Physical Examination – checking your signs and symptoms Histopathology – looking under a microscope to distinguish cell / tissue characteristics Imaging Tools (MRIs, CT scans, fMRI, etc)

BUT : 

BUT Wait a minute! …What about these “molecular drivers?”

Molecular Diagnostics : 

Molecular Diagnostics Diagnosing by taking a sample of a person’s diseased or infected cells (and normal cells), examining it at the molecular level -- looking at RNA, protein structure and expression, and genetic makeup (DNA). The methods are there (immunohistochemistry, DNA arrays, RNA microarrays, real-time quantitative PCR)

STOP!! : 

STOP!!

Okay… : 

Okay… “You’re telling me that medicine isn’t doing this now?! Why SHOULD I believe YOU!??” History of medicine Discovery of technological instruments to view @ this level. Discoveries w. this technology

Fine, I believe you… : 

Fine, I believe you… But “If my doc doesn’t know, you’d better be able to prove it to me!” Any questions based on previous few slides? Ask: HOW, WHY, WHAT, WHEN!

OK to continue? : 

OK to continue?

Applying Molecular Diagnostics and Treatment : 

Applying Molecular Diagnostics and Treatment CANCER Xeloda – Thymidine Phosphorylase overexpression EGFR & MET therapy FUS1, MDM2, & P53 therapy

FUS1, MDM2, & P53 therapy : 

FUS1, MDM2, & P53 therapy

Applies to ALL diseases : 

Applies to ALL diseases With every ailment, there are respective proteins, genes, and molecules driving its progression. Bacterial Infections Azithromycin – various strains of bacteria (inhibits 50S ribosomal subunit from acting) ALS Arimoclomol -- SOD1 gene …Alzheimer’s, MS, Parkinson’s, Crohn’s, Lupus

What does this mean for me? : 

What does this mean for me? Many of the same diseases by modern classification have different molecular characteristics. Meaning: NSCLC, squamous type –> What is driver… MDM2 mutation? p53 mutation? And/or EGFR mt? Picture Source: http://www.iftheshoefitz.com/

Hence, without moleculardiagnostics : 

Hence, without moleculardiagnostics You will have -- Different responses to the same treatments, in regards to the safety and effectiveness of that therapy. http://learn.genetics.utah.edu/content/health/pharma/intro/ Life? Death?

Why do we say this? : 

Why do we say this? Well --have you ever wondered why you responded differently than your best friend to the SAME treatment? the Answer: Diff genetic makeup and molecular expression expressions than your friend  Meaning, the “things” that break down the treatment in your body are different as are those “things” that clear them from your body, as are your molecular profiles in the cells you wish to target. Hence, we have effectiveness and safety differences!

W/o molecular testing and treatment : 

W/o molecular testing and treatment Resistance development & your window of opportunity is lost! Personal level Society at large

Result -- different with different diseases : 

Picture of infectious organism killing you or a happy person. Infectious organisms – body may fight off, without molecular medicine, with defense mechanisms inherent to your body. Cancer -- likely will not. Result -- different with different diseases

Slide 35: 

Learning about #lungcancer mgmt trends. EGFR mut'n testing is up from 2-3% to ~10-12% from early to late 2009; should rise more in next yr. The biology of lung cancer differs from one patient to the next, depending on age and sex, according to scientists at Duke University Medical Center. The findings may help explain why certain groups of patients do better than others, even though they appear to have the same disease. - http://www.brightsurf.com/t/52409/

Benefits : 

Benefits More specific detection and classification of existing diseases, leading to more accurate prognoses. Predisposition tests and actionable things you can do with this info Results that show what, molecularly, to target and how to most effectively and efficiently treat a patient with a particular illness or infection. http://learn.genetics.utah.edu/content/health/pharma/intro/

Where to go from here : 

Where to go from here Make sure your physician knows what the underlying molecular cause of the disease is, OR it is well articulated in the journals that decide “standard of care” (what dr’s go off of) Make sure you are treated off of this!! B/c you are the best baby!

What Are We (I&C) Doing? : 

What Are We (I&C) Doing? Bringing innovation to you is our goal. Working with physicians and developers to create the technology to integrate molecular medicine into physicians’ workflow. Building an interface to empower you to make a difference. Grassroots education and resource sharing