By Ms. Suzanne Ovel (Army Medicine)September 29, 2016
Researchers at Madigan Army Medical Center are on the front edge of the new field of precision medicine, using patients' unique differences in their genes, lifestyles and environments to predict what medical conditions they are susceptible to and what treatments work best for each individual.
While by default most medicine is designed to work for the "average patient," the White House created a Precision Medicine Initiative in 2015 in recognition that people's complex and unique makeups require more tailored medical solutions.
"Part of precision medicine, the central mantra really, is just predicting your health," said Dr. Nicholas Ieronimakis, a clinical research scientist in Madigan's Department of Clinical Investigations. "It's really about predicting whether you're predispositioned to diseases and also tailoring the treatment."
Ieronimakis is part of a team of researchers who specialize in precision medicine here, building upon current research to study patients' genetic makeups to refine the best tests, the best diagnoses, and even the best genes to focus on in studies.
The field is still in its infancy, since the human genome (which provides the underpinnings of precision medicine) was only fully mapped 10 years ago. Since then, the technology needed to conduct mass genetics studies has grown rapidly enough to make precision medicine research viable.
"It's really the technology that is driving this. In the past precision medicine wasn't feasible in a lot of ways because we could not generate enough information," said Ieronimakis.
Technology not only allows for genetic testing but it also allows for more precise information to be gathered on individual patients; for instance, mobile blood pressure devices can monitor patients at home and report electronically to physicians a fuller picture of one's health.
At Madigan, researchers are using precision medicine to dig deeper into conditions that apply to patients both on and off the battlefield. Mary McCarthy, the senior nurse scientist for Madigan's Center for Nursing Science and Clinical Inquiry, is leading a study to discover the optimal amount of Vitamin D to keep servicemembers healthy and less prone to injuries both here and when deployed. In addition to helping to lower blood pressure and boost immune health, Vitamin D can increase bone health and reduce stress fractures.
"Many factors are associated with an individual's vitamin D status including diet, ethnicity, body composition, sun exposure, and genes that regulate vitamin D metabolism. For this reason, it is important to look for genetic variants to understand a person's risk for deficiency and their response to vitamin supplementation, as this will vary for each and every one of us," said McCarthy.
Researchers in maternal medicine, meanwhile, are looking into predictors for maternal health conditions like preeclampsia. Preeclampsia is a pregnancy condition in which a mother's blood pressure spikes right before labor, leading to serious or fatal results. Although about 10 percent of moms develop preeclampsia, researchers don't know what causes it or why it develops. However, a Madigan researcher collected plasma from more than 300 patients and discovered a protein modification in the plasma that can predict the condition.
"That was a major discovery, a significant milestone that happened here at Madigan," said Ieronimakis, who said that once women know they're susceptible to preeclampsia, they can plan for safer deliveries. By collecting hundreds of samples, researchers were able to develop a "biobank" to analyze enough plasma samples to pinpoint a predictor of the condition.
"That effort brought to light the power of precision medicine, the need for biobanking, and the empowerment the patients can give us by simply providing their samples, which we're utterly grateful for because we can't do these studies without them," he said.
Ieronimakis stressed that the ability to analyze medical data from a large number of patients to include their patterns, genetic makeups, metabolism profiles and environmental factors, is crucial to furthering precision medicine.
"If we can harness large data sets that include a lot of these elements, we can start refining treatments and predicting what may happen to patients," he said.
The key to all of the research is finding patients who are willing to participate in the studies, even if that is as simple as donating a blood sample.
"We actually need the patient's help. We can only do as much as they will allow us to," said Ieronimakis, who encourages patients to take part in studies to identify genetic markers. Even if the study may not immediately benefit the patient, the results of it may later benefit a family member or friend.
"Without patients' involvement," he said, "precision medicine won't happen."