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Clinical Perspectives in Diagnostic-omics and Personalized Medicine Approach to Monitor Effectiveness and Toxicity of Phytocomplexes

  • Alessandro BurianiEmail author
  • Stefano Fortinguerra
  • Maria Carrara
Chapter

Abstract

The advances of systems medicine and network pharmacotoxicology, as well as 'omics diagnostic techniques, or “diagnostic-omics,” nowadays provide formidable new strategies and tools for a guided and assisted use of phytocomplexes. At the same time, personalized medicine might promote a larger and better use of medicinal plants, especially for prevention and wellness. Despite the increasingly information available from systems medicine, research is not yet fully exploited in the clinic, although the introduction of diagnostic-omics in routine medical care is becoming more relevant and meaningful every day, especially in pharmacotoxicology, and clinical pharmaco/toxico-genomics are increasingly performed for a more effective and safer use of drugs and medicinal plants.

In the last 20 years, at least two major scientific advances provided a major contribution to the present situation: the simultaneous detection of entire molecular families in a given biological system, and the ability to collect, classify, network, and visualize an unexpectedly large amount of analytical data through bio-informatics. The genomics area has been at the vanguard of this evolution. Currently, whole genome sequencing allows the identification of clinically actionable genetic information and is included in all major prospective studies that focus on personalized and precision medicine. Other “'omics” techniques, such as proteomics and metabonomics (except for a few meaningful examples such as lipidomics), although developed to high-quality standards and considered to be key operating procedures in systems medicine research, are still in the pipeline to be applied routinely in a clinical setting.

“'Omics” techniques are particularly appropriate for analyzing the biological effects of herbal drugs, which have multiple concomitant effects on several molecular targets. 'Omics techniques can assess simultaneous molecular effects, and bio-informatics allows researchers to look at such effects with a global view of the biological system. This approach is even more relevant when using multi-herbal mixtures, as in traditional medicines where plants are often used as blended herbal preparations − sometimes consisting of mixtures of mixtures − with each herbal component exerting its specific role, either as an effector, an enhancer, or a mitigator.

Systems biology-oriented P4 personalized (and precision) medicine can be envisioned as an ultra-advanced holistic approach to the patients who, based on their individual characteristics, can be monitored for prominent risk factors and treated using targeted therapies. The ability to identify individual health risk factors from the molecular to the environmental level is progressively leading to a shift from medicine to proactive medicine, and preventive and pre-emptive medicine. In this context, traditional herbal medicines, highly personalized in their approach and with the information that they provide on preventative strategies, can be exploited for integrative strategies, aimed at combining the best of deterministic and holistic medical traditions. The increase in the use of herbal medicines, while introducing new therapeutic strategies and potentiating those available, at the same time raises safety concerns that need to be addressed and managed to assure a positive balance between benefits and risks when using herbal products. In a fully personalized context, genetic profiling and a pharmaco-toxicological characterization of the patient should be performed before prescribing or administering any herbal product − especially if other drugs or herbs are being taken − given the potential inter-molecular pharmacokinetic and toxicologic interference.

A step-by-step description of the patient management in a personalized medicine context has finally been suggested, to explain how diagnostic-omics of pharmaco-toxicological interest can be applied when using herbal prescriptions. Key moments are highlighted, from taking a family history, to risk evaluation, to medication reconciliation. An example of how a future systems medicine approach could be introduced is also given, as well as how various diagnostic-omics profiling can be performed longitudinally in the same subject, so as to characterize the pharmaco-toxicological networks of the patient and then use them for personalization of therapy, toxicity prediction, and monitoring when using phytocomplexes.

Keywords

'Omics Companion diagnostics Personalized medicine Pharmacogenomics Genomics Whole genome sequencing Natural drugs Personalized medicine Proteomics Metabonomics Metabolomics Microbiome Systems biology Network pharmacology Network toxicology Herbal medicines Phytocomplex Precision medicine P4 medicine Holistic Proactive Prevention Traditional Chinese medicine Health risk assessment Family health history Genetic profiling Medication reconciliation 

Abbreviations

BD2K

Big data to knowledge initiative

BMH

Best medication history

CDSS

Clinical decision support systems

CGD

Clinical genomic database

DILI

Drug-induced liver injury

DSHEA

Dietary Supplement Health and Education Act

EBM =

Evidence-based medicine

ESF

European Science Foundation

FDA

Food and Drug Administration

HER

Electronic health records

HPWP

Hundred person wellness project

HRA

Health risk assessment

iHMP

Integrative Human Microbiome Project =

iPOP

Integrative personal omics profile

KEGG

Kyoto Encyclopedia of Genes and Genomes

NHS

UK National Health System

NIH

US National Institutes of Health

NMR

Nuclear magnetic resonance

N-of-1 RCTs

Single case randomized controlled trials

P4 medicine

Predictive, preventive, personalized, participatory medicine

PMC

Personalized medicine coalition

SNPs

Single nucleotide polymorphisms

TCM

Traditional Chinese medicine

TCMSP

Traditional Chinese medicine systems pharmacology database

WES

Whole exome sequencing

WGS

Whole genome sequencing

WHO

World Health Organization

Notes

Acknowledgements

We would like to thank Roberta Sato at the Library of the Department of Pharmaceutical and Pharmacological Sciences of the University of Padova for her technical assistance with database search and bibliography, and Mariagnese Barbera for text revision.

Conflict of Interest

Alessandro Buriani and Stefano Fortinguerra are in charge of the Personalized Medicine Service of the Gruppo Data Medica Padova.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Alessandro Buriani
    • 1
    • 2
    Email author
  • Stefano Fortinguerra
    • 1
    • 2
  • Maria Carrara
    • 2
  1. 1.Center Maria Paola Belloni Regazzo for Pharmacogenomics and Personalized MedicineGruppo Data MedicaPadovaItaly
  2. 2.Department of Pharmacological and Pharmaceutical SciencesUniversity of PadovaPadovaItaly

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