Thursday, May 26, 2022

The Future of Medicine

We know there are about thirty thousanddiseases known to human beings and of those about three-quarters have notreatment whatsoever. You have an ageing population worldwide, there are a lot morechronic disorders coming through and these patients need new treatments whichare offered on a continuous basis. We see a very big change in therapeuticscoming up and we're on the cusp of that change now where you're getting multipledisciplines in brand new technologies and much more understanding thebiological science behind it and the net result of all of that is it should introduce new therapeutic .

Modes into the general public. So there'sa revolution going on in medicine that we want personalized health care, we wantto understand our own bodies, the individual nature of those and for thatwe need sensors but not just on the outside we need sensors on the inside.And we've not been very good at making those so nanoscience andnanotechnology is driving towards making new sorts of devices that will reallyrevolutionise medicine. This is the idea of personalisedmedicine as a whole: how do we actually know how we're working as a human? When you go to a doctor they always ask you .

How are you feeling and part of the reasonis they have no machine which can measure how you're feeling. So it's abouthow do we create technologies that actually can read that out and dosomething much more profound, actually watch how you're living and then startto warn when maybe something is going wrong. Now on the very, very futurescale what we actually really want to do is to put nano machines inside ourbodies. We want them to go and scavenge away and repair parts which are broken,remove clots and all at the moment this is rather large scale interventions thatsurgeons have to push something in your body. What we'd really like to do is to usewhat the body does and so .

Nanotechnology's learning how to build thesesort of nano machines. Humans are living longer and longer and of course we'vedramatically changed life expectancy over just the last hundred years or sowith the introduction of antibiotics and so our tissues, the quality of ourtissues decreases with time and that means as welive older and older we're gonna need more and more replacement parts notnecessarily just to stay alive but for our quality of life as well. So we study natural materials because if we want to makeartificial materials that are similar to .

The natural materials we have tounderstand the natural materials themselves first. Scaffolds are used fortissue engineering when we make an artificial tissue. Tissues have twocomponents – they have cells and the material, the extracellular matrix.So our scaffolds mimic the material parts and then if you add cells to thatthen you can engineer a new tissue. Other organisms have enormous powers to regenerate. They can regenerate limbs that are lost or hearts that aredamaged. Humans – we don't have that ability. .

When somebody has a heart attackpart of their heart muscle dies. They can lose a billion cardiomyocytes and theheart never repairs that, it's just replaced by scar. What we'd like to do isdevelop a tissue engineered cardiac patch made out of stem cells that canreplace and restore normal function to the heart. What we're using is embryonicstem cells that can form heart muscle and all the other structures of theheart and what we want to do is to improve the heart function not just by a couple ofpercent but completely back to normal. .

I mean the future is actually very brightfor regenerative medicine as a whole because other people are working onother organs. So kidneys, livers, repairing damaged brain – even spinal cords. Sothere's a huge area of promise here I think that that's what the futureholds looking far ahead. Immunotherapy is really revolutionisingthe way in which cancers can be treated. My lab is interested inunderstanding what makes a really good killer cell.These are the cells that recognizeand destroy both the cancer and virally infected cells in your body. So aseffective and revolutionary as immunotherapy has been, it doesn't cureall patients and so it becomes .

Incredibly important to understand indetail what tells a killer cell to kill and how it does so. So what my researchis aimed at is understanding what makes a really good killer and what are themechanisms that control that killing. One of the approaches we use is to studycells in patients with genetic diseases where the killer cells don't work to tryand understand why things don't work when one components missing. Another approachthat we use is to look at the genes that need to be expressed to train a cell tobe a really good killer and finally we use a lot of high resolution imaging onlive cells to see what happens to make the killing effective. .

What we reallyneed is a big enough bag of tricks to understand in detail the mechanisms thatcontrol the killer T cells so that every time a cancer cell comes up with its newstrategy to try and avoid the immune system, that we have a trick up oursleeve to deal with that. I head up a team that's a new team really workingand focusing on a new type of technology really on a new breakthrough calledCRISPR or genome editing. This is a new technology that allows usto essentially rewrite the DNA that's within all of our cells, correctingmistakes in that DNA. .

So the field has really exploded over the last few yearsand we're really able to do more now than we've ever been able to do in theentirety of history. Now CRISPR is essentially the exploitation of anantiviral defense system that exists in all sorts of different species ofbacteria and scientists have taken that and taken components of that to be ableto rewrite DNA in all manner of cells and all manner of organisms. Gene editingis really essentially a two-part system .

There is a GPS location and there is apair of molecular scissors. The GPS locator directs the molecular scissorsto a specific part of the DNA to be able to make its cut and at that pointthere, the cut, the removal and the replacement of the DNA can occur. What we hope to be able to do is once we've corrected the cells in the petri dish, isto be able to put them back into the patient. Now what that will do is, it will not be a therapeutic against a particulardisease or it will alleviate the disease – that could potentially be acomplete cure for that disease, for that individual. .

What this technology also does is that it allows us to look down within a cell andto tinker and really understand what's going on, how cells work at the mostfundamental of levels and that allows us to do all sorts of things. That allows usto turn a cell into a computer for example, to record information into acell, to program cells to do specific things. Very soon in the near futurewe'll see some diseases being completely cured, simple diseases being cured byCRISPR technology or genome editing technology with more and more complexdiseases being tackled over the next few years. .

So we're working withregulators and with clinicians to ensure patient safety is paramount. Clearly the field of therapeutics offersmany exciting new treatments, the prospects of all sorts of amazingdiscoveries but it's important to remember that these benefits are notfree from risk or controversy. Topping most people's lists of issues to beconcerned with is the prospect of designing some sort of post human race. So to avoid the metaphorical shipwreck it is really important that we bringtogether people who are expert in all .

Aspects of technology and societyincluding law and ethics to identify and evaluate the various risks, benefits,themes and trends. So I think in 50 years that we really will be able tomanipulate these cells with exquisite specificityand I think being able to control what is a fabulous and effective little cellwithin our body to help the immune system when it needs to be helped orwhen it begins to go rogue, we'll be able to do that in 50 years. Gene editingitself is so versatile it feels a bit .

Like sometimes the sky is the limit. I could see a situation where in twenty, twenty five years in the future, that people could beengineering synthetic cells that go inside people and survey around theirbody looking for disease and dealing with disease as it arises. Right now ifsomething goes wrong you might need a donor in order to get a replacement partbut in 50 years we might just be able to walk into a room and have there beshelves full of donor parts for all different tissues in the body because oftissue engineering. .

What my vision is, is that people who have heart attacks, whohave damaged hearts, we'll be able to provide a patch through acardiac surgeon as you go for a bypass now you'd go from bypass and maybe aheart patch as well and we'll be able to restore those hearts back to normalwhich means that people who currently aren't able to do simple things likewalking up stairs or having a normal life can get back to doing just normalthings that you and I take for granted and having a normal lifespan as well. In terms of the future and I'm aiming the .

Longer term future now, I see a verylarge change in the way the healthcare delivered so you have new therapeuticregimes which may be done for example in the home environment and maybethe diagnostics will be done there and even eventually the treatments inthe home and very much angled against the individual, so it's personalized inthe home environment or if it's a more serious disorder, a longer termdisorder, that may be that will be conducted in a hospital environment butbecause of the therapeutics can be delivered by the patient with thepatient's own materials it's probably going to change the way hospitals areestablished, the way the companies interact .

Because they'll have a product which actually comes to the patient side orthe bedside and very different geometry from the way it's done right now. And ifyou can get to that stage you can of course save masses of money in the finalhealthcare treatment regime. I think the most exciting thing from mypoint of view is the fact that you're bringing into into therapeutics andtreatments of patients a whole range of technologies. It's called convergence inthe technical jargon but you're bringing them all together to create a totallynew treatment regime and that's right the way from how you handle the patientto actually delivering the final .

Therapeutic product and that's theexciting thing I think.

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