n
Total cost of treatment (labour,
infrastructure, goods): €200;
n
Days of work lost due to illness: 1.5 days;
n
Duration of therapy effect: lifespan
of patient.
The doctor’s day is full, in addition to the 77-
year-old man who had iPS developed from
his placenta at birth in 2013. Using similar
approaches but with different combinations,
she has an 85-year-old road cleaner whose
diabetes has flared up again, a five-year-old
infant who fell off their bike and whose Achilles
tendon has torn completely through, and a 30-
year-old postman who has the early onset of
Parkinson’s disease; she can successfully treat
and send home all of these patients today.
In the department next door, her prescription
nurse is spending the day eradicating cancer
from his patients using the inter-body equivalent
of a calamine lotion; he is basically providing
anti-cancer patches, which contain targeted
delivery vehicles which pass through the skin,
scour the body and destroy all relevant cancer
cells within three hours before passing out
through the urine.
A snapshot of future medicine
The ‘snapshot’ indicated above is achievable but
has to be placed in the context of the real world,
in that all patient-focused therapies must be:
n
Cost-effective
(resolve direct and indirect
costs);
n
Reimbursable
(it is affordable for
customers; governments and HMOs);
n
Reproducible
(so it is worth reimbursing);
n
Broadly applicable
(a platform to be
tailored and expanded);
n
Exportable
(it works for everyone,
everywhere);
n
Generating a return on investment
greater than 3%
(so it is worth it).
2090…or 2020?
DR DAVID SASSOON, PROFESSOR JÖNS HILBORN,
AND
DR JONATHAN DANDO
INDICATE WHAT NEEDS TO BE DONE IN THE FIELD OF REGENERATIVE MEDICINE
AND HOW THESE GOALS CAN BE ACHIEVED
T
he doctor holds the vial up to the window and lightly shakes it by
the lid. A fine cloud of desiccated dust fills the chamber; perfect.
She has selected this vial as the material inside, based on a PEG-
hyaluronic conjugate, provides a better environment for the tissue to
be repaired. Other materials exist in her cabinet: fibrins in various
formulations, silica, carbon nanoparticles, calcium and zinc based materials,
all specifically designed for different tissues and effects and all very
affordable (at only €5). The treatment in her hand is the most expensive.
After an injection of 1ml of saline containing epigenetic modifiers,
myostatin inhibitors and antifibrotics into the vial to dissolve the material
and a quick spin in the centrifuge, it is ready.
The 77-year-old patient outside – a builder with at least 15 years of
working life left – had come in two weeks ago with mild chest pain, and
immediate imaging at the clinical centre had revealed early onset
acquired genetic cardiac muscle disease; detailed analysis indicated that
it would be better to be safe than sorry and a combination approach
would be more effective. The doctor could have opted for just the
materials and factors, but the patient needed to have total functionality
restored within 48 hours due to professional requirements.
This is why she submitted an online request to the patient’s hospital
that same day for them to pull his iPS (induced stem) cells, created 78
years earlier, out of the freezer, expand them and send them across for
today’s treatment.
Combining the liquid with the cells, the doctor walks into the next room,
where one of her colleagues has prepped the patient with a local
anesthetic ready for the key-hole application; the imaging agent used
two weeks previously is still in the patient and functional, and is used by
the doctor to guide the cell-material-factor combination direct to the
location of damage. A little pressure on the plunger and the mix is
delivered directly to the area to be repaired; pulling out the macroscopic
device, the imaging agent is changing colour on the screen, indicating
that the combination therapy is already starting its action. Two hours later,
and following another check on the scan, she lets the patient know he
has the all clear; he can go home.
The damaged tissue is repaired, and while it will take another day to be
fully functional, she can see that the resident cells have been recruited
into the material and are correctly integrating and aligning with the injected
cells in the damaged space. There has been limited fibrotic infiltrate, clear
blood vessel growth and innervation, while the inflammatory cells are busy
cross-talking with the stem cells to figure out what is best to repair the
tissue and restore function.
Pan European Networks: Science & Technology
06
156
NEURODEGENERATIVE RESEARCH
1...,146,147,148,149,150,151,152,153,154,155 157,158,159,160,161,162,163,164,165,166,...300