Cesil completes strategic plan for personalized medicine

Without haste, but without stopping, Piano, Piano, Castilla y León lays out its strategic plan for personalized therapy with well-woven wicker. It can claim to be one of the autonomous communities with the highest speed of implementation, a revolution with many challenges and a paradigm shift between classical medicine – focused on the disease – and precision medicine, which allows designing ‘tailor-made’ Tries to refine till. Suit’.’ To treat each patient. And it does this from massive amounts of data, data that heals, and where artificial intelligence also makes room to be able to process and interpret such a mix of information that, because of its complexity and volume, no longer Cannot be managed in the traditional way. ,

A study by the Roche Institute, one of the most rigorous in Spain, highlighted five years ago that Castilla y León was in third place among the group of autonomies with the greatest development in personalized and precision medicine. Its methodology was defined as a state reference model with the potential for implementation in other regions, which is constantly growing. Now, the Ministry of Health is completing its roadmap that will serve to integrate, provide a framework and enhance the many initiatives developed over the last decade and which have consolidated it as a reference for many centers and pathologies.

It is not in vain that personalized and precision medicine has been considered a positioning element for large international economies, in which Spain, after taking up the challenge thrown in 2015 by the then President of the United States Barack Obama, began to act in 2019. . Five years ago, he created the Senate’s study report on genomics, which ended with 13 recommendations, where Castilla y León had already started “with a privileged position”.

Maria Isidoro, head of the Clinical and Biochemistry Analysis Service of the Salamanca Healthcare Complex and regional coordinator of the Strategic Plan for Personalized Precision Medicine, explains this to Ikal, whose experience has also helped her to be included in the list of consultants. The Ministry of Health, which works in a transversal portfolio to ensure the inclusion of genomic, personalized and precision medicine in the portfolio of general services of the National Health System in primary and hospital care, as indicated by the findings of the presentation.

“In Castilla y León we start from a privileged position with many previous initiatives. The strategic plan will be the framework to gather all these initiatives and promote them, so it is quite advanced,” says Isidoro, noting that To emphasize that Precision already represents “a revolution in care” with “significant improvements in the quality of care, increased safety, greater accuracy in diagnosis and greater likelihood that treatments will be more effective”. This also includes cost reduction “and not at the expense of the patient’s health, but in favor of their safety.”

rare diseases

Initiatives that are already bearing fruit in Castilla y León, and prioritized by the Strategy on Genomic, Personalized and Precision Medicine for the National Health System, are the approach and genomic sequencing of patients with rare diseases. A year ago, the Community launched the PiERCyL Comprehensive Plan, which has recently been recognized with the MERCOS-ODS National Distinguished Leadership Award, and which has established a model support structure that is helping the design of the regional global plan. This was a big step, since then patients in Castilla y León have been “pioneers” in large-scale whole genome sequencing in a healthcare way, within a portfolio of services, supported by artificial intelligence for the analysis of information.

“The impact of personalized medicine on rare diseases is huge.” “In Castilla y León, a coordinated health care system has been established, from primary to hospital care; between laboratory and clinic, and between different health sectors in the field of pediatrics” which allowed to analyze more than 5,000 patients Thanks to “the Advanced Diagnostic Unit for Rare Diseases of Castilla y León, located in the Hospital of Salamanca, a network structure that now develops the adult sector with the coordination of care nodes and multidisciplinary reference teams.”

pressure characteristics

But the roadmap of Castilla y León goes further, incorporating a comprehensive package of specialties that includes pharmacogenetics, making room for precision psychiatry, cardiology, pathology and precision allergology that have been providing their services for years. Fruit.

In the case of precision cardiology, the Cardiology Service of Salamanca has a Family Cardiology Unit, designated as a CSUR Center – which answers to the centres, services and referrals of the National Health System – and which is now congenitally Desires to achieve this recognition. heart disease.

The community is also a leader in precision pathology, which is one of the pillars of precision oncology, as well as precision medicine, which uses predictive information for precise oncological treatment. Precision pathology also extends to other non-oncological diseases, although it is in this last area where the most progress has been made with drugs specific for specific molecular and genetic alterations. This has been contributed by the Network for the Study of These Diseases, which is supported by a biobank based in the Cancer Research Center, Salamanca, and which coordinates the biobanks of seven hospitals.

“We perform molecular studies on samples from cancer patients. Depending on the type of cancer, we analyze a series of genes whose alteration leads to a specific treatment. We are talking about biomarkers and the development of targeted drugs. With oncological treatment is precise,” the chief summarized. Of cancer service. Maria Dolores Ludeña, Director of Pathological Anatomy of the Salamanca University Care Complex, who recognizes the importance of the arrival in the community a year ago of the first massive next generation sequencers, which allows “with very little DNA”. “The RNA sample studies a large number of genes and the diagnosis is made relatively quickly, within a few days”. This year, they have already studied about 400 patients.

“This gives us very good information about the molecular changes of the tumor that can be treated in a precise, personalized way,” says Ludena, who specifies that Salamanca is a reference center for Zamora and Ávila. In addition, similar molecular studies are being carried out in León and Burgos, and they are being completed in Valladolid. In fact, this year, SACIL will provide large-scale sequencers to the hospitals of León and the Valladolid Clinic to advance in this field. “Four reference centers have been proposed for the entire community,” so that “no one is left out.”

pharmacogenetics

Another thread woven by the regional strategy is its own model, recognized internationally, for rationalizing medical prescriptions ‘Five Step Precision Medicine 5SPM’, promoted by Dr. María Isidoro García, which is now being implemented in a new The system will be strengthened. To systematically apply artificial intelligence, personalized precision medicine, to pharmaceutical prescriptions in chronic patients. To date, this has allowed us to refine the treatment of more than 2,500 patients from multiple services, says Isidoro.

The new artificial intelligence project has funding of approximately 700,000 euros, part of this year’s 2.3 million euro 5P plan of the National Health System for Communities. The tool will work online and in real time, initially in the field of specialized care and later in primary care. The aim is not only to increase the safety of polymedicated patients by reducing the risk of adverse effects; But by focusing prescriptions on the most indicated drug, medicinal effectiveness is also increased by removing those drugs that, due to metabolic interactions, limit the mechanisms of action of the remaining drugs, which implies reduced drug costs associated with unnecessary prescriptions. To reduce and reduce. Health costs associated with the consequences of adverse effects.

The 5SPM model has demonstrated over its 15-year history that, compared to the classic approach, the adaptation of medical treatment to the individual characteristics of the patient results in significant improvements in health and quality of life, as well as saving resources for the system . , “Pharmacogenetics studies the gene variations that determine response to drugs and is a fundamental pillar in personalized precision medicine. Prediction of the response to a certain treatment allows applying preventive or therapeutic interventions and guiding the prescription in a different The benefit represents a more appropriate treatment”, says Isidoro.

artificial intelligence

Artificial intelligence tools play an essential role in the field of precision medicine to help process and interpret such amounts of data. Many hospital services in Castilla y León are beginning to resort to these devices, some pioneering, as is the case of the Allergy Service of the Salamanca University Care Complex, in collaboration with the GIR (Recognized Research Group) Robotics and Society of the University. Salamanca has developed an artificial neural network (ANN) to predict patients who are allergic to beta-lactams, a group of antibiotics where penicillins are most commonly included, so that those at lower risk can be identified. So that beta-lactams can be used safely. In urgent situations, without the need for exhaustive study, explains Esther Moreno Rodilla Ikal.

Currently, and in collaboration with experts from the University of Salamanca, they are developing another project based on Natural Language Processing (NLP) and deep learning techniques. “The main objective of the project is to investigate the usefulness of these techniques in predicting the risk of allergy to beta-lactams. To date, more than 4,000 medical records of the patients studied have been analyzed in our service. Processing and intelligence After obtaining the model, the use of artificial, ‘machine learning’ tools is proposed, which, together with the above model and the decisions taken by allergy doctors, allows us to develop an AI application that can make the predictions necessary for correct risk labeling Is. patients.”

Once the model is obtained, the next approach would be to analyze its usefulness in a multicenter study involving other allergy services from different areas of the national region. “The ultimate aim of the model will be to be able to accurately risk stratify patients with suspected allergy, but without confirming allergy studies, and who require immediate treatment with beta-lactam antibiotics.”

With these well-woven wicker, Castilla y León now carries out its personalized precision medicine planning. Additionally, along with others from various hospitals in the community, where initiatives for early detection of dyslipidemia are being launched; Application of artificial intelligence to new pathological anatomy rings; AI in the field of neurosurgery, as the Rio Hortega University Hospital in Valladolid is doing, or in Burgos to prevent falls in Parkinson’s patients. There are many more teams and projects in the community who are innovators and pioneers who will contribute to advancing this ‘tailored suit’ for the patient, thanks to the past decade of refining disease prevention, diagnosis and treatment. It is a big step. Efforts and actions that outline the medicine of the future already exist.