Personalized medicine: promises and pitfalls

222 Pages·2016·11.73 MB·English

by  Gronowicz, Gloria

HEALTHCARE
Personalized Medicine: Promises and Pitfalls broadly explores the
tailoring of medical treatment to a patient’s characteristics, needs, and
preferences during all stages of care, including prevention, diagnosis,
treatment, and follow-up.
The book’s goal is to explain the science behind personalized medicine,
what impact it may have on specific diseases, and some of the reper-
cussions of a personalized medical approach on our medical institutions.
Novel personalized therapeutic treatments and their scientific basis are
discussed by covering topics as diverse as genomics, proteomics, epi-
genetics, integrative medicine, stem cells, and the factors that influence
personal health.
A personalized medical system also requires patient involvement in
developing a healthy lifestyle, and so this book touches on topics such
as the individual’s family history, present and past lifestyle, nutrition,
exercise levels, and stress factors.
By explaining these broad topics in personalized medicine and the
science behind them, we discover how personalized medicine can have
a positive impact on an individual’s health.
K25314
ISBN: 978-1-4987-1491-4
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PERSONALIZED
MEDICINE
PROMISES AND PITFALLS
Gloria Gronowicz, PhD
University of Connecticut Health Center
Farmington, CT, USA
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2016 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20160301
International Standard Book Number-13: 978-1-4987-1492-1 (eBook - PDF)
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Contents
Author vi
Cover artist ix
Introduction xi
1 Genomics 1
DNA 1
Chromosomes 2
Genes 2
Transcription and translation 6
The birth of genetics and Mendel 7
Mitosis, meiosis, and recombination 9
Single-nucleotide polymorphism 10
Cystic fbrosis, cancer, and genomics 14
Post-translational modifcations 15
Microarrays and CRISPR/Cas9 16
Chimera 17
References 18
2 Proteomics 21
Amino acids and proteins 22
Post-translational modifcations 25
Biomarkers 27
Proteomics, biomarkers, and prostate cancer 27
Metabolomics 32
Proteomics, biomarkers, and breast cancer 33
Proteomics and atherosclerosis 35
References 37
3 Epigenetics 39
Diabetes and epigenetics 40
Diabetes and DNA methylation 42
Histones and epigenetics 43
Genomics, epigenetics, and environment in mental illnesses 43
miRNAs, siRNAs, and piRNAs 46
iii
iv Contents
miRNAs and cancer 48
miRNAs and hepatitis C 49
References 50
4 Integrative medicine: Nutrition and exercise 53
Healthy diet 54
BMI 54
Vitamins 5
Minerals in our diet 57
Metabolic syndrome, cholesterol, low-density lipoproteins,
high-density lipoproteins, and blood pressure 60
Genetics, obesity, and healthy diets 62
Weight loss 63
Eating healthy 64
Sugar-sweetened sodas 64
Physical activity and exercise 65
Poverty and child nutrition 66
References 67
5 Other integrative medical treatments 71
Acupuncture 72
Stres 75
Stress reduction 81
Mind–body therapies: Meditation, mindfulness,
Dr. John Kabat-Zinn, and guided imagery 82
Yoga 84
References 89
6 The placebo effect 93
Psychological factors and neurobiology 94
Hormone and immune responses 96
Placebo and antidepressants 98
Placebo effect, survival effects, and other questions 99
References 9
7 Stem cells 101
Stem cells in medicine 101
Embryonic stem cells 101
Induced pluripotent stem cells 103
iPSCs and Yamanaka factors 103
Somatic cell nuclear transfer 104
Scientifc problems to be solved for iPSCs 105
Present use of iPSCs for medicine 107
Stem cells and Parkinson’s disease and macular degeneration 108
References 10
8 Scientifc studies and medical trials 113
Case reports 114
RCTs 15
Other types of medical studies and the issues with RCTS 117
Animal studies 120
Contents v
Cell studies 123
Computer-based modeling 126
Peer review of medical and scientifc studies leading to publication 126
References 127
9 Medical training for personalized medicine 131
Genomics and the medical school curriculum 132
National resources for genomics training 134
Collaboration across medical disciplines for personalized medicine 134
References 135
10 Drug, hospital, and medical care costs 137
Healthcare costs 139
Drug costs 140
What ails us 143
Adding personalized and preventative medicine to our healthcare
system 14
Conclusions 148
References 149
11 Ethics 151
Laws protecting patients 153
Privacy of patient records and HIPAA 156
Patient autonomy, well-being, and equity 158
Personalized therapeutics 160
Research ethics 161
Artifcial intelligence 162
References 164
12 Conclusions 165
References 170
Glossary of scientifc terms 171
Author
Dr. Gloria Gronowicz earned her PhD in biology from Columbia University,
New York, and later obtained a postdoctoral fellowship in the Department
of Biochemistry at the University of Chicago. She came to the University
of Connecticut Health in 1983 as a postdoctoral fellow and later joined the
Department of Orthopedics, where she became director of Orthopedic Research
from 1989 to 2007 and developed the basic research curriculum course for
orthopedic residents. She was a tenured professor in 2002. Later, she joined
the Department of Surgery in 2007 and continued as a full professor with a
joint appointment in orthopedics until 2015 when she became professor emeri-
tus. Dr. Gronowicz has published over 100 articles in peer-reviewed journals,
and nine book chapters. She was the director of the Center for Bone Histology
and Histomorphometry, which she developed in 1998. Te Center closed
in 2007 when she joined the Department of Surgery. She has trained over 25
PhD and postdoctoral fellows, and is a member of the Skeletal Biology and
Regeneration graduate program of which she was director from 2012 to 2014.
Dr. Gronowicz also had major teaching commitments in the Medical and
Dental Schools throughout her academic career. She received continuous NIH
(National Institutes of Health) funding for the past 25 years and also been
funded by numerous scientifc and medical foundations. Dr. Gronowicz has
served on NIH and NASA (National Aeronautics and Space Administration)
study sections, and has lectured all over the world. She played major roles in
the American Society of Bone and Mineral Research, and in the Orthopaedic
Research Society where she was elected chairman of the Bone Topic Committee
from 2012 to 2014. Her research encompasses bone biology, aging, response of
bone to implant materials, otosclerosis, and i ntegrative medicine.
vii