A silent revolution in scientific medicine is underway — a revolution that could fundamentally change the way medicines work in the human body.
At a time when media attention is consumed by the debate over the risks and benefits of raw milk, the latest atrocities resulting from the systematic dismantling of science, and the wave of bad medical science promoted on social media, the evidence-based medicine continues to advance.
Public awareness of recent medical advances is limited, while much of people’s attention remains dominated by snake oil salesmen, science deniers and pure pseudoscience.
Furthermore, confidence in medical information from authorized sources has taken a serious hit in recent years, largely due to the veritable epidemic of misinformation we have seen, says neurologist Steven Novella in an article on .
However, the medicines based on monoclonal antibodiess are transforming virtually every area of medicine.
The directorate is revolutionizing cancer treatment. And , along with other genetic technologies, is ushering in an era of treatments for genetic diseases.
Therefore, says Novella, it is important that, at the same time as we expose the dangers and false claims of fraudulent medicine, we also give visibility to the true progress in scientific medicine. The contrast is striking.
This is the case with yet another modern medical technology that is worth knowing: smart drugsnotes the neurologist at Yale University School of Medicine. The idea behind these drugs is increase control over the site where medicines are sent in the body, down to the cellular level.
In classical pharmacology, drugs are distributed throughout different compartments of the body. Some bathes practically all cells of the organism, while others are prevented from entering the central nervous system; some are distributed more in water, others in adipose tissue.
But, essentially, drugs diffuse throughout the body according to its chemistry, even when there is only one specific cell type which constitutes the intended target of its action.
To be “rudimentary” side of drugs contributes decisively to its side effect profile. This will perhaps be particularly evident in the case of chemotherapy: potent drugs, highly toxic to cells.
As we are dealing with potentially deadly cancers, a high profile of side effects continues to be acceptable, and we turn to drugs designed to be more lethal to cancer cells than healthy cells, pushing safe dosing to its limit.
But that was yesterday. Today, we increasingly depend on targeted therapiessuch as immunotherapies that target a patient’s own immune cells against their specific cancer.
There are also smart drugs that use a technology called antibody-drug conjugates (ADC).
These use monoclonal antibodies to recognize a biomarker in a target cell, such as the biomarker for a specific type of cancer. After, deliver a load of medicine to cells that present these biomarkers. This allows the drug to be concentrated in target cells, causing lower concentrations to reach healthy cells.
But ADCs have some limitations. They are large, on a molecular scale, and therefore do not penetrate very deeply into solid tumors. They can also carry just one limited amount of drugand are not as selective as would be desirable, so there continues to be some release of the drug outside the intended target.
Even so, ADCs are smarter than traditional drugs, which simply diffuse through tissues without any guidance.
Now, however, a recently published Nature Biotechnology points the way to a significant advance: the transition from merely intelligent drugs to programmable drugs.
This is a study of proof of conceptso we are not yet ready for clinical practice, but the technology is evolving rapidly. Instead of antibody-drug conjugates, This approach uses DNA-drug conjugates (DDC), which can recognize multiple biomarkers simultaneouslywhich gives them a much higher specificity than ADCs.
There are several advantages over currently existing ADCs, in addition to being more programmable and modular: they are smaller and can penetrate deeper into solid tumors, can transport a greater quantity of drugs and have superior specificity. They can also be used to administer immunotherapiesin addition to other medicines.
Although this technology is ideal for administering chemotherapy, it is not limited to cancer treatment. It can, in theory, be used to target any drug to a specific cell type, which could translate into greater efficacy, fewer side effectsmuch lower total doses and therefore lower toxicity, which also opens the door to truly personalized and targeted pharmacological treatments.
A main limitationat this stage, is that the unmodified DNA used in DDCs is not very stable in plasma, which restricts its usefulness. This is a technical problem that will have to be resolved before DDCs can reach clinical practice, but it appears to be a difficulty with a solution within reach.
This technology could have far-reaching implications for the safety and effectiveness of modern medicine. The idea of simply flooding the entire organism with a drug to act only on a specific cell population may, one day, seem desperately rudimentaryconcludes Novella.
