Biotechnology in Healthcare - Essay Example

?  The impact of biotechnology on the prevention, diagnosis and treatment of disease Introduction: Biotechnology as a manufacturing process can be widely defined as the use of biological processes to create some kind of final product (Bruggemeier 2006). These can be pharmaceutical, medicinal, industrial, or consumer food products (Singleton 2004). Biotechnology also includes genetically modified (GM) foods and biological computing (Sager 2001).Relevant to a discussion of disease and medical treatment, biotechnology includes biological processes or studies that have as their result new medical knowledge or interventions. Biotechnology has been around in some form for a very long time, but in the last few decades it has changed drastically to become a modern science that is crucial to the determination of the molecular mechanisms behind disease. Early biotechnology included baking bread and making such fermented food products as beer, wine, cheese, and yoghurt; all of these processes could be considered biotechnology as they require the use of bacterial enzymes to complete. However, this is not what most scientists today consider to be biotechnology, and the first modern use of the term ‘biotechnology’ was in a 1919 publication by Karl Ereky. Ereky was a Hungarian engineer and economist. In his paper on biotechnology, he predicted an “age of biochemistry” which would rival previous technological periods in human history (Bruggemeier 2006). Given the current state of modern medicine and pharmacology, it seems that Ereky's prediction is correct; biochemistry and its brain child, biotechnology, are the way of the future. Modern medicine would be nearly impossible without the many almost miraculous discoveries of biotechnology. Biotechnology has infiltrated medical practice at all levels, from basic preventative care by family doctors and general practitioners all the way to specialized diagnostic techniques and highly individualized and effective treatments. The article seeks to provide basic and applied information on how biotechnology has been useful in the prevention, diagnosis and treatment of disease. Prevention: Preventive medicine is the prospective treatment of disease, an attempt to stop an illness from occurring before it starts and to keep patients in an overall healthy state. Prevention of the disease and/or illness is the objective. This is done through screening patient populations for high-risk groups and providing education and early interventions to those patients, and by providing general prophylactic care such as vaccination or vitamins. Biotechnology in preventative care is best exemplified through the recent advantages of vaccination. A classic example is the vaccination of humans with attenuated bacteria in order to control diseases caused by such bacteria. This type of vaccination with attenuated bacterial vaccines or its modified derivatives to express antigens from the pathogens has the merit of inducing protective immunity to those pathogens (Curtiss, 2002). Furthermore, vaccination with live recombinant attenuated bacterial antigen affords the in vivo production of the antigen in immunized individual long after immunization. This is an effective yet inexpensive vaccination approach. Vaccination is not restricted to the bacteria. Other pathogenic organism, such as viruses, fungi, etc can be use. For instance, a live, oral attenuated vaccine developed from the pentavalent rotavirus vaccine (RV5) has been shown in a trial study conducted in Finland and the United States to prevent 98% of severe rotavirus diarrhea (Patel et al. 2009). As shown in Table 1, an association did exist between the rotavirus vaccine and the rotavirus disease (Patel et al. 2009). Table 1. Association between Rotavirus Vaccination and Rotavirus Disease Requiring Hospital Admission or Intravenous Hydration adapted from Patel et al. 2009. The ability to sequence viral genomes offers another vaccination approach that applied biotechnology fundamentals. Understanding the genome of a virus means researchers also understand the antigenic properties of that virus. Vaccines can be developed using this genetic structure can use only a small portion of the virus, say a viral protein, but cause an immune response to the entire virus. This removes any possibility of an infection by the disease agent such as is possible with live-attenuated vaccination in immuno-compromised patients. Genomic profiling of patients can be used to identify known genetic abnormalities that cause or increase susceptibility to disease. However, this process raises numerous privacy and ethical concerns. For one, it is difficult to have the procedure covered under insurance, as the standards for proving that the test is necessary are often almost as high as the standards of diagnosis without the genetic tests. There are also concerns about such insurance companies using genetic markers to determine insurance rates of patients prior to them developing a disease. Despite all this, when such genetic tests are done successfully, high-risk patients can be preemptively treated or monitored more closely. Diagnosis and treatment decisions are made more quickly when or if the disease to which the patient is susceptible does surface, thus saving lives as well as cutting down the medical bill (Garber & Tunis 2009). Diagnosis: Today, many medical diagnostic tests would be inconceivable without modern biotechnology. For instance, a panmicrobial microarray comprising 29,455 sixty-mer oligonucleotide probes (GreeneChipPm) for detecting vertebrate viruses, bacteria, fungi, and parasites was designed to facilitate rapid, unbiased, differential diagnosis of infectious diseases (Palacios et al., 2007). The probe was shown to exhibit adequate sensitivity that facilitates detection of pathogenic organisms in clinical samples (Table 2). Indeed, the probe was used to detect the presence of viruses and bacteria in nasopharyngeal aspirates, blood, urine, and tissue of persons with various infectious diseases. Table 2. Probe, GreeneChipPm, sensitivity for detection of various infectious agents* , adapted from Palacios et al., 2007. The ability to sequence a microbial genome again comes into play is another fundamental biotechnology tool that has been applied in disease diagnosis. Genetic sequences that are only present in contagious and virulent forms of the microbe can be used as a test for the presence of infection, as there would be no other reason for those sequences to be found in the patient's body. Testing for the relevant sensitized immune cells would allow physicians to know if those sequences were present, and by extension, know of the infection. (Andersen et al. 2000). Of course, one obvious flaw of this method is that it tells the physician if the patient has ever been infected with that agent, not if the agent is currently present in the body. Similarly to testing for the genetic sequences of the infectious disease agent, testing the levels of the patient's own proteins can also inform physicians of the presence of infection, inflammation, or traumatic injury. Specifically, physicians can use what are known as acute phase proteins, as their concentration within the body increases under the previously described conditions. While this procedure is most commonly used in the testing of farm animals for disease, there are no scientific reasons why it would not also work in humans. (Eckersall 2000) Treatment: The impact of biotechnology is most obvious, however, in the treatment of disease. Advances in biotechnology have changed how medications are produced, the quality of those medications, and even what would be considered a medical treatment. Biotechnology has gone so far as to allow us to construct medical treatments that are very carefully aimed at a specific patient's needs, known as personalized medicine. . Ideally, personalized medicine would involve a system of patient evaluation that would tell clinicians the correct drug, dose or intervention for any individual before the start of therapy. A practical approach to this evaluation is the concept of patient stratification in which individuals are biologically sub classified (classically according to some genetic features) and biofeatures modeled in relation to outcome. In principle, such stratification for personalized therapy can be applied to drug safety and efficacy modeling and to more general healthcare paradigms involving optimized nutrition and lifestyle management. Unfortunately, personalized medicine, if they can be developed and applied, will be the luxury of the worlds’ richest citizens and nations. Thus personalized healthcare might appear to be at the opposite end of the medical spectrum to the subject of epidemiology in which disease risk factors and disease incidence are studied in rich and poor populations. By far the most exciting possibility of biotechnology in disease treatment is the advent of personalized medicine. Personalized medicine is defined as the use of targeted therapies that are developed based on the makeup of an individual patient. This can be as simple as determination of the best therapy based on characteristics like age, sex, race, co-morbidities, and personal beliefs (Garber & Tunis 2009). It can also be as complex as basing treatment on the genetic and molecular code of that patient. This type of medicine is in part so exciting because the development and distribution of medications could be based on an individual patient's needs, making them safer and more effective. (Ginsburg & McCarthy 2001) For example, a patient could be given cancer treatment agents that “know” the patient's normal molecular profile and so destroy cancer cells without harming the patient (Mendelsohn & Powis 2008). The use of such medical treatments could change clinical trial selection processes, improving the speed and safety of these trials. Test subjects for clinical trials could be selected based on their genetic code, allowing both drug manufacturers and physicians to more accurately predict which patients would most benefit from a specific therapeutic agent (Ginsburg & McCarthy 2001). For personalized medicine to be achieved, the molecular profile of the particular patient and the particular disease in that patient must be known to a high degree of specificity (Mendelsohn & Powis 2008). However, this difficulty is becoming less and less of an issue as PCR and genomic sequencing technology continues to improve at an exponential rate. Personalized medicine can be as simple as determination of the best therapy based on characteristics like age, sex, race, co-morbidities, and personal beliefs (Garber & Tunis 2009). It can also be as complex as basing treatment on the genetic and molecular code of that patient. This type of medicine is in part so exciting because the development and distribution of medications could be based on an individual patient's needs, making them safer and more effective. (Ginsburg & McCarthy 2001) For example, a patient could be given cancer treatment agents that “know” the patient's normal molecular profile and so destroy cancer cells without harming the patient (Mendelsohn & Powis 2008). The use of such medical treatments could change clinical trial selection processes, improving the speed and safety of these trials. Test subjects for clinical trials could be selected based on their genetic code, allowing both drug manufacturers and physicians to more accurately predict which patients would most benefit from a specific therapeutic agent (Ginsburg & McCarthy 2001). For personalized medicine to be achieved, the molecular profile of the particular patient and the particular disease in that patient must be known to a high degree of specificity (Mendelsohn & Powis 2008). However, this difficulty is becoming less and less of an issue as PCR and genomic sequencing technology continues to improve at an exponential rate. Biotechnology has made possible to production of medications known as biopharmaceuticals. Biopharmaceuticals are medications made using biological processes or from biological organisms. For instance, a wide variety of biopharmaceuticals have been derived from plants (Table 3). Biopharmaceuticals work by targeting the disease based on molecular mechanisms (Bruggemeier 2006). Bacterial enzymes are one example of biopharmaceuticals, and they are used both in the production of medications and as medications themselves (Singleton 2004). However, there are concerns on the possible risks of these biopharmaceuticals, relating to carry-over of DNA, immunological properties, or endotoxins along with the desired product (Dayan 1995). Biotechnology has increased the safety and efficacy of medications in many ways; one specific method is the use of encapsulation technologies. Bio-encapsulation of medications is the process of enclosing a pharmacologically active substance inside a semi-permeable membrane that mimics the natural cell environment. This makes the therapeutic agent more effective, although there have been difficulties in transferring success at the research level to the clinical level (de Vos et al. 2009). For example, the use of bio-encapsulation can reduce the toxicity of a cancer drug without reducing its effectiveness (Green 1984) Table 3. Some biopharmaceuticals derived from plants, adapted from Goldstein & Thomas 2004. AMT, Agrobacterium-mediated transformation; PB, particle bombardment Chemical modification of nucleosides is another method by which pharmaceuticals are created, using enzymes or other organic substances to modify nucleosides in such a way that they affect protein synthesis. This has applications in both infectious disease and non-infectious diseases such as cancer. For example, this method has been used to create the medication forodesine. Forodesine is used in the treatment of T-cell acute lymphatic lymphoma, T-cell non-Hodgkin lymphoma, and chronic lymphocytic lymphoma (Herdewijn 2008). It is a PNP-inhibitor, PNP being the gene coding for the production of the enzyme purine nucleoside phosphorylase. PNP inhibitors work by reducing the protein produced by this gene (Human Genome Organization 2007). An example of the use of biotechnology that has undoubtedly saved countless lives is the synthesis of insulin for diabetics. This is done through the use of pancreatic cells from laboratory animals. It is also possible to create cloned human insulin to be used in place of the animal-derived insulin, suggested in the cases of an allergic response to the animal proteins in the latter type. However, there are few benefits to the use of human cloned insulin, as nearly all cases of immunological response to animal-derived insulin have been resolved by simply changing the animal from which the pancreatic cells are drawn. Biotechnology has also changed what we think of as a medication. An example of this is the recently emerged field of biomedical engineering. Biomedical engineering is primarily used in the surgical repair and rebuilding of damaged cells. Biotechnological processes have allowed scientists to grow cloned skin grafts of the patients own skin, so that they are not rejected. These grafts can help a burn victim heal faster. Other types of biomedical engineering include the growth of neurons to be grafted into patients with peripheral nerve damage, though this is not as yet fully successful at restoring feeling and use of the affected appendages (Pfister et al. 2011). Conclusion: Ekert's “age of biochemistry” is clearly upon us. We deal everyday with amazingly futuristic technologies that have now become commonplace, like the ability to sequence the entire genome of even highly complex organisms such as humans. Biotechnology, as with all science, has come a long way since the advent of wine-making. Separating the use of biotechnology from medicine is rapidly approaching the point of impossibility. Biotechnology has changed the prevention, diagnosis, and treatment of disease in profound ways. The use of these technologies has saved and will continue to save millions of lives, as well as improving the quality of life for tens of millions more. References Andersen, P. et al., 2000. 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