The Future of Medicine

We know there are about thirty thousand
diseases known to human beings and of those about three-quarters have no
treatment whatsoever. You have an ageing population worldwide, there are a lot more
chronic disorders coming through and these patients need new treatments which
are offered on a continuous basis. We see a very big change in therapeutics
coming up and we’re on the cusp of that change now where you’re getting multiple
disciplines in brand new technologies and much more understanding the
biological science behind it and the net result of all of that is it should introduce new therapeutic modes into the general public. So there’s
a revolution going on in medicine that we want personalized health care, we want
to understand our own bodies, the individual nature of those and for that
we need sensors but not just on the outside we need sensors on the inside.
And we’ve not been very good at making those so nanoscience and
nanotechnology is driving towards making new sorts of devices that will really
revolutionise medicine. This is the idea of personalised
medicine as a whole: how do we actually know how we’re working as a human? When you go to a doctor they always ask you how are you feeling and part of the reason
is they have no machine which can measure how you’re feeling. So it’s about
how do we create technologies that actually can read that out and do
something much more profound, actually watch how you’re living and then start
to warn when maybe something is going wrong. Now on the very, very future
scale what we actually really want to do is to put nano machines inside our
bodies. We want them to go and scavenge away and repair parts which are broken,
remove clots and all at the moment this is rather large scale interventions that
surgeons have to push something in your body. What we’d really like to do is to use
what the body does and so nanotechnology’s learning how to build these
sort of nano machines. Humans are living longer and longer and of course we’ve
dramatically changed life expectancy over just the last hundred years or so
with the introduction of antibiotics and so our tissues, the quality of our
tissues decreases with time and that means as we
live older and older we’re gonna need more and more replacement parts not
necessarily just to stay alive but for our quality of life as well. So we study natural materials because if we want to make
artificial materials that are similar to the natural materials we have to
understand the natural materials themselves first. Scaffolds are used for
tissue engineering when we make an artificial tissue. Tissues have two
components – they have cells and the material, the extracellular matrix.
So our scaffolds mimic the material parts and then if you add cells to that
then you can engineer a new tissue. Other organisms have enormous powers to regenerate. They can regenerate limbs that are lost or hearts that are
damaged. Humans – we don’t have that ability. When somebody has a heart attack
part of their heart muscle dies. They can lose a billion cardiomyocytes and the
heart never repairs that, it’s just replaced by scar. What we’d like to do is
develop a tissue engineered cardiac patch made out of stem cells that can
replace and restore normal function to the heart. What we’re using is embryonic
stem cells that can form heart muscle and all the other structures of the
heart and what we want to do is to improve the heart function not just by a couple of
percent but completely back to normal. I mean the future is actually very bright
for regenerative medicine as a whole because other people are working on
other organs. So kidneys, livers, repairing damaged brain – even spinal cords. So
there’s a huge area of promise here I think that that’s what the future
holds looking far ahead. Immunotherapy is really revolutionising
the way in which cancers can be treated. My lab is interested in
understanding what makes a really good killer cell.These are the cells that recognize
and destroy both the cancer and virally infected cells in your body. So as
effective and revolutionary as immunotherapy has been, it doesn’t cure
all patients and so it becomes incredibly important to understand in
detail what tells a killer cell to kill and how it does so. So what my research
is aimed at is understanding what makes a really good killer and what are the
mechanisms that control that killing. One of the approaches we use is to study
cells in patients with genetic diseases where the killer cells don’t work to try
and understand why things don’t work when one components missing. Another approach
that we use is to look at the genes that need to be expressed to train a cell to
be a really good killer and finally we use a lot of high resolution imaging on
live cells to see what happens to make the killing effective. What we really
need is a big enough bag of tricks to understand in detail the mechanisms that
control the killer T cells so that every time a cancer cell comes up with its new
strategy to try and avoid the immune system, that we have a trick up our
sleeve to deal with that. I head up a team that’s a new team really working
and focusing on a new type of technology really on a new breakthrough called
CRISPR or genome editing. This is a new technology that allows us
to essentially rewrite the DNA that’s within all of our cells, correcting
mistakes in that DNA. So the field has really exploded over the last few years
and we’re really able to do more now than we’ve ever been able to do in the
entirety of history. Now CRISPR is essentially the exploitation of an
antiviral defense system that exists in all sorts of different species of
bacteria and scientists have taken that and taken components of that to be able
to rewrite DNA in all manner of cells and all manner of organisms. Gene editing
is really essentially a two-part system there is a GPS location and there is a
pair of molecular scissors. The GPS locator directs the molecular scissors
to a specific part of the DNA to be able to make its cut and at that point
there, the cut, the removal and the replacement of the DNA can occur. What we hope to be able to do is once we’ve corrected the cells in the petri dish, is
to be able to put them back into the patient. Now what that will do is, it will not be a therapeutic against a particular
disease or it will alleviate the disease – that could potentially be a
complete cure for that disease, for that individual. What this technology also does is that it allows us to look down within a cell and
to tinker and really understand what’s going on, how cells work at the most
fundamental of levels and that allows us to do all sorts of things. That allows us
to turn a cell into a computer for example, to record information into a
cell, to program cells to do specific things. Very soon in the near future
we’ll see some diseases being completely cured, simple diseases being cured by
CRISPR technology or genome editing technology with more and more complex
diseases being tackled over the next few years. So we’re working with
regulators and with clinicians to ensure patient safety is paramount. Clearly the field of therapeutics offers
many exciting new treatments, the prospects of all sorts of amazing
discoveries but it’s important to remember that these benefits are not
free from risk or controversy. Topping most people’s lists of issues to be
concerned with is the prospect of designing some sort of post human race. So to avoid the metaphorical shipwreck it is really important that we bring
together people who are expert in all aspects of technology and society
including law and ethics to identify and evaluate the various risks, benefits,
themes and trends. So I think in 50 years that we really will be able to
manipulate these cells with exquisite specificity
and I think being able to control what is a fabulous and effective little cell
within our body to help the immune system when it needs to be helped or
when it begins to go rogue, we’ll be able to do that in 50 years. Gene editing
itself is so versatile it feels a bit like sometimes the sky is the limit. I could see a situation where in twenty, twenty five years in the future, that people could be
engineering synthetic cells that go inside people and survey around their
body looking for disease and dealing with disease as it arises. Right now if
something goes wrong you might need a donor in order to get a replacement part
but in 50 years we might just be able to walk into a room and have there be
shelves full of donor parts for all different tissues in the body because of
tissue engineering. What my vision is, is that people who have heart attacks, who
have damaged hearts, we’ll be able to provide a patch through a
cardiac surgeon as you go for a bypass now you’d go from bypass and maybe a
heart patch as well and we’ll be able to restore those hearts back to normal
which means that people who currently aren’t able to do simple things like
walking up stairs or having a normal life can get back to doing just normal
things that you and I take for granted and having a normal lifespan as well. In terms of the future and I’m aiming the longer term future now, I see a very
large change in the way the healthcare delivered so you have new therapeutic
regimes which may be done for example in the home environment and maybe
the diagnostics will be done there and even eventually the treatments in
the home and very much angled against the individual, so it’s personalized in
the home environment or if it’s a more serious disorder, a longer term
disorder, that may be that will be conducted in a hospital environment but
because of the therapeutics can be delivered by the patient with the
patient’s own materials it’s probably going to change the way hospitals are
established, the way the companies interact because they’ll have a product which actually comes to the patient side or
the bedside and very different geometry from the way it’s done right now. And if
you can get to that stage you can of course save masses of money in the final
healthcare treatment regime. I think the most exciting thing from my
point of view is the fact that you’re bringing into into therapeutics and
treatments of patients a whole range of technologies. It’s called convergence in
the technical jargon but you’re bringing them all together to create a totally
new treatment regime and that’s right the way from how you handle the patient
to actually delivering the final therapeutic product and that’s the
exciting thing I think.

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