A tablet for you personally
How to choose a "blood pressure drug" in the era of personalized medicine
The idea that different people should be treated differently has a thousand-year history. Nowadays, it has found its expression in the so-called personalized medicine, which should take into account the individual characteristics of a person and the nature of his disease.
Novosibirsk specialists from the Siberian Branch of the Russian Academy of Sciences have developed a unique computer program that allows you to choose individual treatment for patients with arterial hypertension, and in the future – with other cardiovascular diseases and diabetes mellitus.
Even the famous ancient physician Hippocrates believed that it was necessary to "give different medicines to different patients, and what is good for one may not be useful for another." However, this principle did not immediately take root in the classical medicine familiar to us, unlike traditional medicine.
The term "personalized medicine" it began to appear in the literature only since the end of the last century – this is how the formation of a new model of organization of medical care began, focused on the treatment of not "individual symptoms" in an average patient, but a specific person with all his genetic, physiological and biochemical characteristics that must be taken into account when choosing diagnostic, therapeutic and preventive procedures.
At all times there have been doctors "from God", with rich experience and intuition. But modern adherents of personalized medicine are far from the image of such a "family doctor" and primarily rely on diagnostic and prognostic medical technologies based on the latest achievements of molecular biology and digital technologies. True, so far this popular medical trend is more common in the literature and on the websites of private clinics, but, nevertheless, the process is underway.
An example is the program developed by Novosibirsk specialists from the Laboratory of Personalized Medicine of the Institute of Chemical Biology and Fundamental Medicine and the Bioinformatics Laboratory of the Institute of Computational Technologies SB RAS. It is intended for patients with arterial hypertension – this pathology, related to multifactorial diseases, today occurs in about 40% of the adult population and serves as the most common cause of myocardial infarction, stroke, heart failure, chronic kidney disease.
Currently, many pharmacological drugs are used for the treatment of hypertension: diuretics, alpha-blockers, calcium channel blockers, etc. All of them can be attributed to five main classes, each of which contains about twenty basic medicines. They differ in the mechanism of action, effectiveness and side effects, not to mention the cost.
Thus, in the arsenal of the doctor to whom you come with your problem, there are about a hundred (!) drugs that reduce blood pressure. The selection of an effective and sufficiently safe complex of drugs for a particular patient is a difficult task even for an experienced specialist, and it takes a lot of time and money to solve it, not to mention possible complications. According to some data, good control of blood pressure from the first time can be achieved only in a third of patients.
Can a personalized approach help in this situation? Judge for yourself: for example, in 2001 it was shown that the effectiveness of the drug fosinopril– an angiotensin converting enzyme (ACE) inhibitor, is associated with the polymorphism of the gene encoding this enzyme. And the American company began to produce a test to identify patients who should be treated with drugs of this group in the first place.
An example of a personalized approach in the selection of a drug. Warfarin is an indirect anticoagulant that reduces blood clotting, which is used for cardiac arrhythmias, venous thrombosis and thromboembolism, as well as after cardiac surgery. The drug is prescribed for a long time, while taking the medicine is fraught with the development of various complications, primarily bleeding. Individual sensitivity to warfarin is determined by the genotype, in particular by the polymorphism of the VKORC1 gene, which encodes the liver protein responsible for reactivation of vitamin K. Therefore, the therapeutically effective dose of warfarin will be different for patients with different structural variants of this gene. According to the Pharmacogenomics Knowledge Database.
The program for the selection of antihypertensive drugs was developed in Novosibirsk on the basis of a mathematical model of the human cardiovascular system. Today it has no analogues either in Russia or abroad. To get a recommendation for a specific person, personal data (age, height, weight), as well as clinical examination data, such as a general blood test, biochemical parameters and ultrasound of the heart, must be entered into the program. Based on this information, a portrait of a "virtual patient" is calculated, and then the program selects the optimal drugs to reduce blood pressure. Already, the accuracy of the recommendation reaches 90%, and researchers are working on including some genetic characteristics of the patient in the program, which will increase the "targeting" of the program.
Currently, the program is being tested on patients with cardiovascular diseases. It is assumed that in the near future, all medical institutions interested in using it will have access to it. In the future, we plan to modify the program, which will allow us to select personalized treatment for patients with diabetes mellitus.
The publication uses the materials of the press release of the IHBFM SB RAS (Novosibirsk).
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