The term translational medicine was coined in the 1990s, but it was not used more widely until the early 2000s. Originally, translational medical research grew out of the concept of “from the laboratory to the patient’s bed,” as a type of medical research that sought to remove the barriers between the laboratory and clinical research.
Germán Quintana, Doctor in Veterinary Medicine, Master in Behavioral Medicine and Animal Welfare and Master in Genetic and Genomic Medicine, and biologist Beatriz Aguiar, Master in Clinical Genetics and Assisted Reproduction, have published an article for GRETCA (Clinical Ethology Specialty Group of AVEPA) in which they explain the applications of this approach in the veterinary clinic.
The authors define translational medicine as a rapidly advancing discipline in biomedical research that aims to accelerate the discovery of new diagnostic tools and new treatments using a highly collaborative multidisciplinary approach.
Thus, translational medicine translates the latest discoveries at the laboratory level into clinical studies, and attempts to answer questions through the use of various laboratory techniques. “Its purpose is to improve the prediction, prevention, diagnosis and treatment of diseases. In other words, translational medicine transforms the basic achievements of research into practical theory, technology and methods that reconcile the laboratory and clinical practice ”, they point out.
Translational medicine is a concept that flows in two directions and thus, it will promote the flow of information from the laboratory to the clinic and, in the same way, it should be promoted from the clinic back to the laboratory.
Experts comment that the ultimate goal of translational medicine is to help patients by allowing the development of new diagnostic methods, prognosis and the acquisition of new knowledge useful in the treatment of diseases. In this way, both people and animals will be able to have access to health care of the highest level at a reasonable cost.
“Knowledge of various fundamental biological aspects that affect health and disease is still insufficient. For this reason, the current findings cannot yet be translated automatically and totally reliably into prevention and new, more effective treatments ”. The goals of translational medicine can be achieved only through continued investment and advancement in basic biomedical and behavioral discoveries combined with effective translational science.
PERSONALIZED PRECISION MEDICINE OR PPM
The risk of suffering from a disease and the way in which the patient responds to pharmacological treatments are conditioned by both the genes and the environment to which the patient is exposed. This environment is the result of the environment and the lifestyle. In the text, they indicate that the integration of genomic data and other sciences with the set of clinical data of the patient and his environment, allows to adapt clinical practice to the individual characteristics of each patient, in what is called PPM.
PPM is an essential tool for the application of population segmentation criteria, making it possible to adapt preventive, diagnostic and therapeutic strategies to the characteristics of the patients. “It is, therefore, a powerful tool to improve the choice of treatment, avoiding unnecessary side effects and rationalizing healthcare costs. This is achieved by segmenting therapeutic measures based on various variables (age, sex, race, other pathologies, genetic markers, etc.) ”, they comment.
BIOMARKERS IN THE DIAGNOSIS OF DISEASES
The continuous and recent discoveries made in recent years in the field of molecular biology and genetics, thanks to the use of massive sequencing platforms, have allowed an unprecedented advance in biomedical research.
The text concludes that, thanks to this, the knowledge of the molecular and genetic bases of various diseases has been greatly expanded and a large number of biomarkers have been identified that allow establishing more precise and patient-adjusted protocols, improving both its diagnosis, prognosis as treatment.
Qu intana and Aguiar state that the introduction of these new analysis techniques, as well as the treatment of associated data, constitutes a paradigm shift both at the research level and in care models, enabling the development of new approaches in multiple diseases. However, the widespread application of approaches that have demonstrated efficacy, effectiveness, safety, and cost-effectiveness, poses significant challenges in clinical practice.
OMIC SCIENCES, THE PRESENT OF VETERINARY MEDICINE
The development of high-throughput omics technologies, such as genome and whole exome sequencing, along with the advancement of other omics technologies, such as proteomics, metabolomics, pharmacogenomics, epigenomics, transcriptomics, or microbiomics, and the possibility of integrating this information with patient clinical data, are accelerating the real incorporation of PPM into clinical practice.
Although there are numerous publications in the field of omics sciences in veterinary medicine, the authors emphasize that these constitute isolated studies without a generalized clinical application at present beyond the research or academic field.
“In the last 20 years, 129 articles have been published that address personalized precision medicine in veterinary medicine and many more in relation to pathologies or diagnostic techniques related to PPM. Of these, 108 have been published in the last 5 years, which shows that PPM is not the future of veterinary medicine but the most immediate present ”.
PSYCHIATRY AND PRECISION CLINICAL ETHOLOGY
PPM in areas of knowledge such as oncology has borne important results in recent years and, “today, it is already much more important to know the genetic lineage of a neoplasm than its location”. In contrast, in psychiatry, diagnoses still respond to subjective criteria and a prescription based on trial and error is still carried out.
“Knowledge of the etiopathogenesis of mental illnesses, despite the remarkable progress achieved, continues to be from ‘top to bottom’, rather than ‘from bottom to top’, which is popularly known as’ starting the house at the bottom. roof””. The authors consider that most of the psychotropic drugs currently available are not the result of the discovery of the pathophysiological bases of psychiatric disorders, but of precise but fortunate clinical observations, “and it is from their mechanism of action that we have deduced that something is wrong in the brain with dopamine, serotonin or glutamate ”.
In the authors’ opinion, precision psychiatry, and by extension precision clinical ethology, are here to stay, although they are still in the embryonic stage; soon the speech will be intelligible and clear, and it will not be possible to work denying the biological substrate of mental illness.
Although the objective is to achieve personalized medicine, initially it will be possible to stratify populations without reaching individual ultra-definition, but it will allow defining subgroups within the diagnostic categories. “It has occurred in oncology, it is occurring in neurology (just 10 years ago the diagnosis of multiple sclerosis was exclusively clinical) and it will occur in the field of mental illnesses.”
DEVELOPMENT OF DRUGS BASED ON BIOMARKERS
In psychiatry and clinical ethology there are a series of ideological and economic barriers that condition the evolution of these specialties. The stigma of mental illnesses will still endure for a long time, but the evidence on the biological basis of mental illnesses and the reduction in the costs of biomarkers and mass sequencing techniques will open the door to PPM in both specialties as well as neuroimaging techniques. (CT and MRI) made their way in the last decade in veterinary medicine, to be techniques of routine use today.
On the other hand, as a transversal advance in all medical disciplines, pharmacogenetics makes it possible to have tests to refine the prediction of tolerability and response to different treatments. “The use of treatments that focus on the control of symptoms will be a thing of the past and the industry already accepts that to discover new molecules with real added value it will be necessary to rely on PPM, so many drugs already have information about their efficacy and tolerability in patients with specific biomarkers ”. Although today, it is true that the sensitivity and specificity of the available biomarkers (genetic, biochemical, electrophysiological, imaging or simply clinical) is insufficient, more and more information is available.
In conclusion, at present, “we are witnessing an authentic emergence of small companies of entrepreneurs (start-ups) that are investigating ways to validate the diagnosis and predict the best treatment for the mentally ill, also in veterinary medicine”, they conclude.