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Medicine in the next decades
                 By: Mahmoud Ihab Mahmoud, MD, PhD

Professor of Clinical Research and Pharmacology, AUHS, CA USA
 &Professor of Clinical Pharmacology, Jazan Faculty of Medicine,
                               KSA
A revolution and changing of concepts are expected very soon in medicine,
likewise any other area of life. The float of knowledge integrated from different
sources will make our life more precise and sophisticated. It will influence
medicine and people toward personalization of medicine.

Personalized medicine can deliver better information to help patients make an
individual choice about the risks and rewards of a particular course of treatment:
which medicines will work for him or her, which drugs may pose a danger and
whether doses may need to be adjusted. Personalized medicine can also help
profile someone's potential risk for contracting a disease like cancer or diabetes. It
becomes like tailoring medical treatment to individual characteristics of each
patient. It is like buying a custom-made suit versus one off the rack.

The personalized medicine will allow diagnosis and treatment based on genetic
heterogeneity, this mandates to understand the human genome and consequently a
Human Genome Project (HGP) had been developed. HGP is an international
project aimed at determining the sequence of chemical base pairs of DNA and
mapping the approximately 20,000–25,000 genes of human genomes. This project
started in October 1990 and completed in April of 2003. This scientific research
project comes into reality by scientific coloration of scientists from USA, United
Kingdom, Japan, France, Germany and Spain.

Researchers continue to identify protein-coding genes and their functions; the
objective is to find disease-causing genes and possibly use the information to
develop more specific treatments. It also may be possible to locate patterns in gene
expression, which could help physicians glean insight into the body's emergent
properties. Using genetherapy, we may be able to close a gene or restore the
normal genetic pattern of normal physiological life. Implementation of
personalized medicine required a general practitioner with strong genetic
information.
                                           1
In addition to gene therapy, Shrokhov and Zewailsucceeded to develop a 4D
ultrafast electron microscopy and diffraction for atomic-scale visualization in space
and time which characterizes the structural dynamics in chemistry and biology.
Additionally, spectroscopy and large-scale computations will provide information
to understand the complexity of the disease state regarding the nature of chemical
and biological transformations. This approach will be targeting the patient
personally in order to better understand the development of the disease.Zewail
laboratory in Cal Tech institute in California is exploring the 4D microscopy to
understand the molecular pathogenesis of disease. Understanding this mechanism
will change the strategy of treatment.
As know, the current therapy of diabetes is based on replacement therapy, either
directly by insulin injections or indirectly using insulin secretagauges e.g.
sulfonylureas. Under 4D microscopy,they may find that this patient has a normal
synthesis of insulin but lacking magnesium ions which facilitate exocytosis of the
vesicle carrying the insulin. Hence, the treatment of the patient will depend on
providing magnesium ions not the replacement therapy. If Zewail succeeds in this
project, he will be a winner for a next Noble price soon.
Regenerative medicine is also another era which will provide hope for diseases
representing by loss of cells, e.g. Parkinsonism, Alzheimer, diabetes….. etc.
Gluing the stem cells (pre-differentiated or differentiated) into lesions will replace
the damaged cells. This technique could be easy and straight forwards, yet it has to
pass by a lot of legislations and ethical approvals. In my opinion it may be too
early to predict its therapeutic efficiency. As the new growing cells may be losing
the differentiation overtime and retain the proliferation criteria. This shift of the
balance will lead to uncontrolled proliferation and eventually development of
cancer.
As you can see, role of surgery is shrinking and medicine is dominating. This
phenomena started in 1960th, when cancer management becomes an internal
medicine category and not a surgical one. Every year a great emphasis on role of
medical treatments for better improvement.
We need to ask ourselves 2 questions; first question: when do we expect to have
this revolution? The answer is very soon and all research institutes are working
very hard to change the layout of medicine. Here is the second question “Are we
ready for this era, worldwide? We need medical doctors capable to coup with the
new information and applying it. We need a physician who is genetic specialist,
physicist, molecular biologist and a human being with a caring heart.


                                          2
3

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Medicine in the future by mahmoud ihab

  • 1. Medicine in the next decades By: Mahmoud Ihab Mahmoud, MD, PhD Professor of Clinical Research and Pharmacology, AUHS, CA USA &Professor of Clinical Pharmacology, Jazan Faculty of Medicine, KSA A revolution and changing of concepts are expected very soon in medicine, likewise any other area of life. The float of knowledge integrated from different sources will make our life more precise and sophisticated. It will influence medicine and people toward personalization of medicine. Personalized medicine can deliver better information to help patients make an individual choice about the risks and rewards of a particular course of treatment: which medicines will work for him or her, which drugs may pose a danger and whether doses may need to be adjusted. Personalized medicine can also help profile someone's potential risk for contracting a disease like cancer or diabetes. It becomes like tailoring medical treatment to individual characteristics of each patient. It is like buying a custom-made suit versus one off the rack. The personalized medicine will allow diagnosis and treatment based on genetic heterogeneity, this mandates to understand the human genome and consequently a Human Genome Project (HGP) had been developed. HGP is an international project aimed at determining the sequence of chemical base pairs of DNA and mapping the approximately 20,000–25,000 genes of human genomes. This project started in October 1990 and completed in April of 2003. This scientific research project comes into reality by scientific coloration of scientists from USA, United Kingdom, Japan, France, Germany and Spain. Researchers continue to identify protein-coding genes and their functions; the objective is to find disease-causing genes and possibly use the information to develop more specific treatments. It also may be possible to locate patterns in gene expression, which could help physicians glean insight into the body's emergent properties. Using genetherapy, we may be able to close a gene or restore the normal genetic pattern of normal physiological life. Implementation of personalized medicine required a general practitioner with strong genetic information. 1
  • 2. In addition to gene therapy, Shrokhov and Zewailsucceeded to develop a 4D ultrafast electron microscopy and diffraction for atomic-scale visualization in space and time which characterizes the structural dynamics in chemistry and biology. Additionally, spectroscopy and large-scale computations will provide information to understand the complexity of the disease state regarding the nature of chemical and biological transformations. This approach will be targeting the patient personally in order to better understand the development of the disease.Zewail laboratory in Cal Tech institute in California is exploring the 4D microscopy to understand the molecular pathogenesis of disease. Understanding this mechanism will change the strategy of treatment. As know, the current therapy of diabetes is based on replacement therapy, either directly by insulin injections or indirectly using insulin secretagauges e.g. sulfonylureas. Under 4D microscopy,they may find that this patient has a normal synthesis of insulin but lacking magnesium ions which facilitate exocytosis of the vesicle carrying the insulin. Hence, the treatment of the patient will depend on providing magnesium ions not the replacement therapy. If Zewail succeeds in this project, he will be a winner for a next Noble price soon. Regenerative medicine is also another era which will provide hope for diseases representing by loss of cells, e.g. Parkinsonism, Alzheimer, diabetes….. etc. Gluing the stem cells (pre-differentiated or differentiated) into lesions will replace the damaged cells. This technique could be easy and straight forwards, yet it has to pass by a lot of legislations and ethical approvals. In my opinion it may be too early to predict its therapeutic efficiency. As the new growing cells may be losing the differentiation overtime and retain the proliferation criteria. This shift of the balance will lead to uncontrolled proliferation and eventually development of cancer. As you can see, role of surgery is shrinking and medicine is dominating. This phenomena started in 1960th, when cancer management becomes an internal medicine category and not a surgical one. Every year a great emphasis on role of medical treatments for better improvement. We need to ask ourselves 2 questions; first question: when do we expect to have this revolution? The answer is very soon and all research institutes are working very hard to change the layout of medicine. Here is the second question “Are we ready for this era, worldwide? We need medical doctors capable to coup with the new information and applying it. We need a physician who is genetic specialist, physicist, molecular biologist and a human being with a caring heart. 2
  • 3. 3