Beyond the buzzword: The promise of precision medicine

With next-generation DNA sequencing and patient-tailored therapeutics entering the market and significantly transforming lives, the era of precision medicine is upon us. What exactly is this bold new approach, and why does it promise to revolutionize how we improve heart health and treat its associated diseases?

Precision medicine. It may be a buzzword, but its fundamental concepts are changing the face of medicine as we know it. By taking into account our individual differences in genetics, lifestyle, and environment, this new and flourishing field of medicine has the potential to completely revolutionize how we diagnose, prevent and treat disease.  

This is an incredibly big deal. Until now, the vast majority of medical treatments, including cardiovascular therapies, have been designed for the “average patient.” The problem with this “one-size-fits-all” approach is  therapies vary in how effective they are. After all, no two people are alike – treatments can be very successful for some patients but not for others. 

One Size Does Not Fit All

Think about it. If you develop an allergy, you go for testing to find out precisely what you are allergic to. If you need a blood transfusion, your blood type must be determined to make a match. 

The promise of precision medicine is to provide a tailored therapeutic treatment to each patient with the same ease and standardization as matching your blood type. 

“We really are on the cusp of doing this,” said Peter Liu, MD, the University of Ottawa Heart Institute’s Chief Scientific Officer and Vice President of Research, speaking at the 6th International Ottawa Heart Conference recently held in Ottawa, entitled Precision Medicine in Cardiovascular Disease.

“By applying science that is catered to an individual’s unique makeup, we are improving healthcare and affecting medicine in ways we’ve never seen.” 

- Peter Liu, MD, Chief Scientific Officer and Vice President of Research, UOHI

“That’s why there’s a pressing need to bring together leading cardiovascular authorities working in the field of precision medicine,” he added. “It’s by sharing our discoveries and perspectives that will allow us to make significant strides in this exciting field.”

While cardiovascular disease (CVD) remains the leading cause of death and disability in the world, the tide is beginning to change. Research in precision medicine is identifying molecular targets associated with the underpinnings of disease and uncovering biomarkers that can assess the effects of cardiovascular medications much earlier in their development. With personalized antiplatelet strategies, antiarrhythmic drug therapies and targeted therapeutics for atherosclerosis all on the horizon, the future is looking more hopeful for patients with cardiovascular disease than ever before.

As Canada’s largest and foremost heart health centre dedicated to understanding, treating, and preventing heart disease, the University of Ottawa Heart Institute (UOHI) annually hosts the International Ottawa Heart Conference to highlight important new advancements and breakthroughs in preventing and treating CVD. Having identified precision medicine as a top research priority, this year’s conference brought together leading minds in cardiovascular science to discuss the latest in gene therapy and biomarkers, disease-in-a-dish modelling, patient-tailored therapeutics, sex and gender effects and personalized health innovations. 

The Future is Now

Gene-editing technologies like Clustered Regularly Interspaced Short Palindromic Repeats, or CRISPR (pronounced “crisper”) for short, have already revolutionized the field of cardiovascular research, as Dr. Kiran Musunuru, an associate professor of cardiovascular medicine and genetics at the University of Pennsylvania’s Perelman School of Medicine, highlighted in a presentation called “Precision Genome Editing in Cardiovascular Diseases.” With the inaugural Dr. Yves Marcel Keynote Lecture to honour the legacy of Dr. Marcel, a world-renowned scientist and leader at the UOHI, Dr. Musunuru’s talk balanced the therapeutic uses of genome editing with its potentially problematic implications.

“We can almost all agree that snipping out and repairing cardiovascular disease-causing genes is of tremendous therapeutic value in helping to prevent heart attacks, sudden cardiac death, and other cardiovascular disorders, but we have to ask ourselves how far we are willing to go,” he cautioned. 

For example, when we start talking about editing our genome at the germline – where changes are permanent and get passed on to future offspring – should we limit such editing to treating severe genetic disorders and reducing their risk, or proceed to “enhancing” unborn babies with desirable but clinically unneeded traits like athletic prowess? 

“This isn’t science fiction,” said Dr. Musunuru. “The future is now, and we need to start thinking and talking about these issues.”

Let’s Talk About It

A similarly probing reflection on the future possibilities of precision medicine was shared by Dr. Victor Dzau, President of the U.S. National Academy of Medicine, Washington, DC in a public talk entitled “Medical Breakthroughs: What are the Possible Game-Changers in the Near Future? How will they Impact Health and Society?” 

“Sequencing the human genome was only the beginning,” said Dr. Dzau. “I think what is new and exciting is the ability to collect so much information with the convergence of biologic, physical, engineering, computer, health and social sciences all acting together to collect patient data.” 

Reflecting the UOHI’s commitment as a leading heart institute to promote an understanding and engagement in cutting-edge cardiovascular science, members of the public were able to discuss the issues raised by Dr. Dzau with a panel of experts in an open question and answer session.

“This kind of dialogue is needed to help inform and engage people,” said Dr. Dzau. “I’m excited and privileged to be able to do these public lectures. After all, as cardiovascular scientists and health leaders, we have an obligation to involve citizens in these important issues affecting our society.”