ASN President's Column September 2016

By Raymond C. Harris, MD, FASN

Evolving from the previous concept of “personalized medicine,” all aspects of medical practice are demonstrating increasing interest in the implementation of “precision medicine.”  The National Research Council defines precision medicine as referring “… to the tailoring of medical treatment to the individual characteristics of each patient. It does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment. Preventive or therapeutic interventions can then be concentrated on those who will benefit, sparing expense and side effects for those who will not. Although the term ‘Personalized Medicine’ is also used to convey this meaning, that term is sometimes misinterpreted as implying that unique treatments can be designed for each individual. For this reason, the Committee thinks that the term ‘Precision Medicine’ is preferable to ‘Personalized Medicine.’”

Beginning with President Obama’s 2015 State of the Union address, the U.S. has initiated a Precision Medicine Initiative. Its short-term goals have concentrated on utilizing cancer genomics to develop new prevention and treatment modalities, but the long-term goal is to develop a comprehensive scientific knowledge base  compiling genetic, environmental and lifestyle data of a large national cohort at least a million people in order to better understand health and disease.

We in Nephrology can take advantage of scientific advances and lessons learned from precision medicine initiatives in other fields, such as oncology. These include not only new methods for interrogation of tissue and single cell genomes, proteomes and metabolomes, but also the increasing awareness of the importance of direct analysis of human tissue. Experimental models have provided insights into many aspects of kidney function and pathophysiology but have been less effective in identifying viable therapeutic targets.  As Alexander Pope wrote almost 300 years ago, “The proper study of Mankind is Man,” so the NIDDK Kidney Precision Medicine Initiative will focus on collection and interrogation of human biopsy specimens from patients with both acute and chronic kidney diseases in order to begin the identification of pathogenic mechanisms of human kidney diseases.

How can we envision that precision medicine will affect the practice of nephrology?

It may provide better understanding of the pathogenesis of many kidney diseases, may better define gender, race and age differences in responses to kidney diseases, may help to elucidate the interaction of genetic and environmental factors in predisposition and natural history of kidney diseases, may define populations most at risk for progression of CKD in order to design more focused and meaningful clinical trials and most importantly, may lead to development of more effective therapies and identification of both the populations most likely to benefit and those that may be most likely to have side effects from either new or existing therapies. Therefore, precision medicine holds out great promise for medicine in general and Nephrology specifically. 

Category:
Subcategory:
Author:
Raymond C. Harris, MD, FASN
Article Image:
Body:

Evolving from the previous concept of “personalized medicine,” all aspects of medical practice are demonstrating increasing interest in the implementation of “precision medicine.”  The National Research Council defines precision medicine as referring “… to the tailoring of medical treatment to the individual characteristics of each patient. It does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment. Preventive or therapeutic interventions can then be concentrated on those who will benefit, sparing expense and side effects for those who will not. Although the term ‘Personalized Medicine’ is also used to convey this meaning, that term is sometimes misinterpreted as implying that unique treatments can be designed for each individual. For this reason, the Committee thinks that the term ‘Precision Medicine’ is preferable to ‘Personalized Medicine.’”

Beginning with President Obama’s 2015 State of the Union address, the U.S. has initiated a Precision Medicine Initiative. Its short-term goals have concentrated on utilizing cancer genomics to develop new prevention and treatment modalities, but the long-term goal is to develop a comprehensive scientific knowledge base  compiling genetic, environmental and lifestyle data of a large national cohort at least a million people in order to better understand health and disease.

We in Nephrology can take advantage of scientific advances and lessons learned from precision medicine initiatives in other fields, such as oncology. These include not only new methods for interrogation of tissue and single cell genomes, proteomes and metabolomes, but also the increasing awareness of the importance of direct analysis of human tissue. Experimental models have provided insights into many aspects of kidney function and pathophysiology but have been less effective in identifying viable therapeutic targets.  As Alexander Pope wrote almost 300 years ago, “The proper study of Mankind is Man,” so the NIDDK Kidney Precision Medicine Initiative will focus on collection and interrogation of human biopsy specimens from patients with both acute and chronic kidney diseases in order to begin the identification of pathogenic mechanisms of human kidney diseases.

How can we envision that precision medicine will affect the practice of nephrology?

It may provide better understanding of the pathogenesis of many kidney diseases, may better define gender, race and age differences in responses to kidney diseases, may help to elucidate the interaction of genetic and environmental factors in predisposition and natural history of kidney diseases, may define populations most at risk for progression of CKD in order to design more focused and meaningful clinical trials and most importantly, may lead to development of more effective therapies and identification of both the populations most likely to benefit and those that may be most likely to have side effects from either new or existing therapies. Therefore, precision medicine holds out great promise for medicine in general and Nephrology specifically.