Introduction
Over the years, the field of medicine has withstood several changes. Different types of diagnostic and therapeutic procedures have been employed for better treatment results. Recently researchers have been able to identify different biomolecules associated with pathological conditions. Accurate identification of such molecules and treating them could be beneficial in disease management. Such a type of practice is known as precision medicine.
What Is Precision Medicine?
Precision medicine is a branch of medicine that deals with genes, proteins, and various molecules of the body and uses these substances for treatment purposes. These molecules help in the process of diagnosis, prevention, and treatment purposes. Modern science has identified different biomarkers responsible for various pathological conditions. Also, genetic sequencing can identify genes involved in diseases like cancer. Precision medicine aims to identify all these factors for disease identification. Different therapeutic agents, which are part of the precision medicine practice, target particular molecules associated with a particular disease condition. This enhances the therapeutic potential of the drugs and reduces the side effect caused by medicines.
In gastroenterology, precision medicine can be used in different fields like liquid biopsy, gene panel sequencing for gastrointestinal cancer, cancer biomarker identification, and precision surgery.
What Is Liquid Biopsy?
The biopsy is a standard procedure in medicine. In a traditional biopsy technique, tissue samples are taken from the affected site for histopathological analysis. But this procedure is difficult due to the gastrointestinal organs' anatomical complexities. Also, collecting samples from the perfect location, chances of metastasis, and pain and adverse effects associated with such a procedure make it more complex and difficult.
Liquid biopsy is a novel method in which certain biomarkers present in the blood are analyzed to detect the presence of cancer. Apart from blood, various other body fluids like cerebrospinal fluid, urine, pleural fluid, and ascites can be used for cancer identification. In this procedure, proteomic assessment of a wide variety of tumor-derived molecules such as circulating tumor cells, circulating tumor deoxyribonucleic acid (ctDNA), and tumor-derived extracellular vesicles (EVs) is done. This procedure helps to eliminate potential complexities of biopsy and radiological techniques. Molecular assessment helps to pinpoint the exact cancer disorder and its progression.
1. Circulating Tumor Cells (CTCs) Analysis: In advanced cases of cancer, the circulating cancer cells reach different parts of the body through the circulatory system. Blood is one of the key pathways for the cancer cells for metastasis. Identification of such cells can be beneficial in identifying the type of cancer, and it's essential for clinical staging. Though the chances of finding circulating tumor cells are very less in the case of gastrointestinal cancers, a certain amount of circulating tumor cells can be colorectal cancers.
2. Circulating tumor DNA (ctDNA): Analysis of circulating tumor DNA (ct-DNA) has proved to be more valuable in diagnosing gastrointestinal cancers. Both qualitative and quantitative assessments of the ct-DNA can be used for the identification of cancer cells. For example, the amount of circulating ct-DNA is very high in cases of colorectal cancers. Also genetic mutations like KRAS and NRAS can also be identified in this method.
3. MicroRNAs (miRNAs): MicroRNA or miRNA is involved in various cellular processes and genetic expressions. These markers are very useful in blood-based tumor cell identification as these biomarkers are stable in blood and plasma. In colorectal cancers, miRNA-21 can be used as a biomarker.
4. Circulating Exosomes: Exosomes are known as extracellular vessels. The function of the exosomes is to carry out substances from one place to another. Exosomes are composed of substances like proteins and nucleic acids. Cancer-specific exosomes can be identified by unique cell surface proteins. Glypican-1 (GPC1) is a type of protein that can be found in pancreatic cancer cases.
What Is Cancer Biomarker Identification?
Identification of Proper biomarkers is important for the identification of cancer. Clinical relevant biomarkers are suggestive of genetic, epigenetic, proteinic, or cellular alterations. For example, genetic mutations ALK, ROS1, and NTRK genes are suggestive of poor prognosis in colorectal cancer cases. On the other hand, the assessment of MMR is related to the prognosis of gastric cancers.
What Is Precision Surgery?
Precision medicine is a branch of medicine that deals with the use of specific technology that targets specific portions of the body for therapeutic purposes. Tumor-infiltrating lymphocytes (TILs) are the major cells that act against gastrointestinal cancer cells. Increasing the number of such cells is part of precision medicine practice. Fluorescence-guided surgery is a real-time guided surgery that helps to identify cancerous parts of the gastrointestinal organs. This helps in the precise removal of cancerous parts and increases the survival rate of the patient. Also, unnecessary damage to healthy tissues can be avoided.
What Are the Benefits of Precision Medicine in Gastroenterology?
1. Disease Identification: Disease identification is one of the essential processes of disease prevention. Biomarkers for several gastrointestinal cancer like liver cancer, bile duct carcinoma, and colorectal carcinoma can be identified using precision medicine. Differentiation between ulcerative colitis and Crohn's disease can be possible by identifying biomarkers. Differentiation between different subtypes of inflammatory bowel disorder can be possible by this method.
2. Prediction of the Disease: Identification of the molecular and genetic factors responsible for gastrointestinal diseases can be identified. This helps to identify the exact cause of the disease and helps to predict disease outcome and prognosis. For example, the assessment of several subtypes of consensus molecular subtypes can be useful in the identification of the subtype of colorectal cancers.
3. Better Treatment Option: Precision medicine is responsible for the improved efficiency of the drug. This increases overall survival and reduces the drug-related adverse effect.
Precision medicine opens the pathways to more clinical trials. Prognosis and treatment outcomes can be predicted much more easily.
Conclusion
The field of medicine is an ever-evolving field. Continuous implementation of various innovations has made the process of diagnosis much easier. Gastrointestinal disorders are one of the most complex and most prevalent pathological conditions. The introduction of precision medicine in the field of gastroenterology helps to identify the causative factors responsible for diseases. Also, the understanding of therapeutic progress and prognosis of the disease can be possible through this process.
