Research Advocate: Through the Looking Glass to the Future

Translating research into practice requires neither that the clinician read about the research and decide how to implement it clinically, nor that its essentials are viewed in a slide presentation. Rather, the clinician participates in identifying, shaping, and conducting research relevant to clinical practice.

Predicting Vulnerability to Disease

Medical genetics will provide the key to prediction, diagnosis, and early intervention, including computational modeling to predict response to cancer treatment and outcomes, based on disease phenotyping, and knowledge of genotype-phenotype interactions. Considerable work is already in progress using proteomics to identify particular proteins, peptides, and mRNA in saliva and using those as noninvasive biomarkers for oral and salivary gland cancers. This approach may also have implications within the process of anticancer drug discovery. Information from proteomic analysis of saliva may contribute to the target discovery and validation, assessment of efficacy and toxicity of candidate drugs.3 A reliable salivary biomarker would also be an attractive, effective alternative to serum testing, and the possibility of developing home testing kits would further facilitate it as a diagnostic aid, enabling patients to monitor their own health at home.4

Personalizing Treatment Strategies through Advanced Biotechnology

A glimpse into the potential of future treatment strategies is afforded by those already available and in use, such as image-guided surgery, robotic surgery, stereotactic radiosurgery, fMRI, and tissue engineering. With an exploding biomedical technology industry and the creation of a new Institute of Biomedical Imaging and Bioengineering at the NIH, progress in this area is assured; technology will become more sophisticated and its uses expanded. It is not unreasonable to expect that the technology to enable human hair cell and nerve regeneration, subjects of such determined investigation for the past two decades, will be perfected, to the benefit of millions of patients. Other treatment options might include brain-machine interfaces, a broader range of implantable devices, and specialized neurofeedback applications such as those now used in physical medicine and rehabilitation.

Personalizing Prevention and Treatment

Minute differences in a person’s genetic profile determine his or her personal characteristics: eye color, height, facial features, and vulnerability to disease. In the future we can expect to see a person’s genetic profile guide drug dosing, and alert providers to the possibility of adverse reactions. A systems approach to disease and its prevention, diagnosis, and treatment will be driven by the relatively new disciplines of genomics and proteomics. This trend has already begun with the investigation of molecular receptors such as epidermal growth factor receptors and estrogen receptors which, when overexpressed, serve to promote and accelerate malignancies in some of the most commonly involved sites such as the breast, lung, and colon. Such an approach will also facilitate treatment of head and neck cancer guided by analysis of the patient’s genetic profile. Identifying the expression of these receptors enable more precise targeting of chemotherapies and development of effective new tumor-specific drugs.5 An example of a successful clinical application of this research is the development of the drug tamoxifen for treatment of estrogen receptor-positive breast cancer.