Introduction
Imagine your own body turning against you. The same force that protects you from pathogens every day, becomes the same force that leaves you in pain, suffering, and hurt. That is the reality of over 8,551,845 people in the United States alone who suffer from autoimmune diseases. These autoimmune diseases encompass a wide array of manifestations; different symptoms, severities, and triggers, make autoimmune diseases some of the most difficult conditions to diagnose and treat. Currently, most approaches involve managing symptoms rather than curing conditions. However, personalized medicine is emerging as a treatment option. Personalized medicines include biological drugs tailored to specific immune pathways, pharmacogenetic medicine, and cell-based therapies. These treatments offer a more targeted and individualized approach to managing autoimmune diseases.
What are examples of personalized medicines?
Rituximab and tocilizumab are examples of biological drugs that have been tailored to target specific immune pathways. Rituximab is a monoclonal antibody that targets CD20, a protein found on the surface of B cells, which plays a role in the immune response. This helps reduce autoimmune activity, making it effective for conditions like rheumatoid arthritis and certain types of vasculitis. On the other hand, tocilizumab inhibits the interleukin-6 (IL-6) receptor. By blocking this pathway, tocilizumab reduces inflammation and symptoms, thereby improving joint function and preventing further joint damage. These two treatments highlight the potential of therapies that target specific immune pathways.
Unlike biological drugs that target specific immune pathways, Pharmacogenetic medicines are specifically designed to be compatible with the unique genome of individual patients. For example, certain genetic markers can indicate whether a patient is likely to metabolize a drug quickly or slowly, impacting the drug's dosage and potential side effects. Examples include Azathioprine and TPMT Testing. Azathioprine is an immunosuppressant often used to treat autoimmune diseases. Testing for Thiopurine Methyltransferase (TPMT) enzyme activity helps determine the proper dosage for patients.
Finally, cell-based therapies are another emerging treatment option. These therapies involve engineering patient’s cells to better regulate the immune system. For example, although mostly used in oncology, CAR-T Cell Therapy has applications in treating autoimmune diseases. This treatment makes T cells express chimeric antigen receptors (CARs) that target specific immune cells contributing to autoimmune pathology. Early research has suggested that CAR-T cell therapy could benefit severe cases of autoimmune diseases. When a patient has not responded to conventional treatments, CAR-T Cell Therapy may be an effective option. This approach not only promises effective treatment of autoimmune disease but also represents a shift toward therapies that could potentially provide lasting curative outcomes.
Current Limitations
Despite the promise of personalized treatments, some limitations do persist. Advanced genetic testing for personalized biologics can be expensive. Not all insurance covers such new and experimental treatments, making cost a significant barrier to those who can benefit from personalized medicine. Limited accessibility to these treatments can also hinder widespread use. Finally, the complexity of autoimmune diseases themselves make it difficult to develop personalized treatments. Multiple genetic and environmental factors can play roles in the pathology of autoimmune diseases. This makes it difficult to pinpoint and target all contributing elements effectively.
Conclusion
Despite the promise of personalized treatments, some obstacles must be overcome in order to make these treatments as widespread as possible. Nevertheless, therapies such as targeted biologics, pharmacogenetic approaches, and cell-based approaches represent significant strides toward individualized care. These treatments have the potential to revolutionize how autoimmune diseases are managed. Future research will continue to refine these treatments by improving their safety, affordability, and accessibility. Eventually, personalized medicine may be the key to creating a world where autoimmune disease is better controlled, if not cured.
References Jacobson, D. L., Gange, S. J., Rose, N. R., & Graham, N. M. H. (1997). Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clinical Immunology and Immunopathology, 84(3), 223–243. https://doi.org/10.1006/clin.1997.4412
DrugBank. (n.d.). Rituximab. DrugBank Online. https://go.drugbank.com/drugs/DB00073
Yoshio-Hoshino, N., Adachi, Y., Aoki, C., Pereboev, A., Curiel, D. T., & Nishimoto, N. (2007). Establishment of a new interleukin-6 (IL-6) receptor. Cancer Research, 67(3), 871–875. https://aacrjournals.org/cancerres/article/67/3/871/534012/Establishment-of-a-New-Interleukin-6-IL-6-Receptor
Tavakolpour, S., Darvishi, M., & Ghasemiadl, M. (2017). Pharmacogenetics of autoimmune disease treatments. Clinical Genetics, 88(5), 481-497.
Ledford, H. (2023). CAR-T cell therapy for autoimmune diseases: A promising approach. Nature Medicine. https://www.nature.com/articles/d41586-023-03968-6 Image:
https://acgtfoundation.org/news/important-parts-of-immune-system/ Assessed and Endorsed by the MedReport Medical Review Board