In the world of medicine, many promises are dashed by not successfully passing clinical trials. It is very common for inventions that have been studied in the laboratory to be disappointing when tested on people. But there are some advancements that are making their way and that could bring a lot of happiness in the near future.
magazine naturopathy has selected 11 clinical trials – that is, interventions that are already being tested in people – that have the potential to change the medical landscape over the next year.
When creating this type of list, attraction towards medicinal and technological innovation is usually used. However, what is interesting about this work is that it combines the great promises of the most modern treatments – base editors or antibody-drug conjugates – and artificial intelligence. Simple and high-impact interventions,
genetically modify the patient
The future is here. After several years of waiting, in 2023 the first therapy based on the genetic cutter CRISPR was approved, the technology that has made most of the headlines over the past decade for its potential to transform medicine.
Approved therapies are based on extracting cells from the patient, modifying them, and reintroducing them. However, Verve-101 seeks to modify them within the patient’s own body.
‘HART-1’, a trial on some patients with heterozygous familial hypercholesterolemia, has already shown promising results: A single intravenous infusion will halve LDL or ‘bad’ cholesterol levels In these patients, due to genetics, blood sugar levels are extremely high, which translates into serious cardiovascular problems.
In this 2024, its results will be validated and Verve-101 will be able to take the next step, as well as open a new field of medicine, which has caused the most rivers of ink to flow in recent years.
brain cell transplant
Another area that has been written about for years and has seen little progress is embryonic stem cells, which have the ability to become anything else in the human body.
‘STEM-PD’ will show its effectiveness in Parkinson’s disease, which has a double difficulty: it is a pathology with few therapeutic possibilities and its origin is in the brain, organs almost impervious to current treatments,
Scientists at Skåne University Hospital in Sweden a few months ago began transplanting dopaminergic stem cells (derived from embryonic stem cells) into the brains of patients aged 50 to 75 with moderate Parkinson’s. By 2024 they plan to have preliminary results of this therapy: if it demonstrates benefit it will have benefits not only in neurology but in all therapies before and after.
The face of cancer treatment is changing
10 years ago, drugs appeared in the world aimed at changing attitudes towards cancer. Their technical name is ‘immune checkpoint inhibitors’ but they are commonly known as immunotherapy.
This was a paradigm shift: The treatment did not attack the cancer cells but activated the immune system so it could recognize and destroy them., Despite this, the treatment system remains classic: step by step from surgery to the latest options.
‘Nadina’ aims to change this by starting immunotherapy before surgery. Spanish doctors have been pioneering this new way of treating lung cancer and now the Netherlands Cancer Institute is going to apply it to melanoma.
The idea behind this new strategy is that activating the immune system benefits patients more at the beginning of treatment than at the end, and ‘Nadina’ will confirm a new way of treating cancer.
double Impact
If multiple drugs exist with different potencies against cancer cells, why not take advantage of them all at the same time? This is the sense of antibody-drug conjugates: Combine the specificity of a monoclonal antibody – it attacks only tumor cells – and the devastating potential of chemotherapy.,
These drugs have just reached patients and now they want to go one step further: reaching brain metastases, where tumor cells spread to an area that is inaccessible to current drugs.
In fact, patients with brain metastases are often excluded from clinical trials. ‘Destiny-Breast12’ seeks to solve this by testing the effectiveness of trastuzumab deruxtecan (a drug already marketed as Enhertu) in breast cancer that has spread to other areas of the body.
Conjugates are biological drugs, which are much larger in size than chemotherapy molecules. In theory, they are less able to cross the blood-brain barrier and eliminate brain metastases. Therefore, if trastuzumab deruxtecan demonstrates its effectiveness, it will open new fields of application for biological therapies against cancer: it will go where no one has gone before.
Artificial intelligence keeps its promises
In the past year, artificial intelligence has become ubiquitous in conversations and certainly, it cannot be missing from the most promising clinical trials of 2024.
Nature However, a ‘conservative’ essay on the possibilities of AI has been chosen: the prioritization of patients to be treated, something that machine learning Has been working for years.
Four Dutch hospitals are testing MARS-ED, based on an index that stratifies patients according to risk of mortality in the next month. An AI that will work as an assistant to doctors in examining patients coming to the emergency room,
The algorithm has taken data from 266,327 patients and has already shown itself superior to internists at stratification, but MARS-ED would like to go a step further and help in environments where speed and accuracy are important. Its results are expected in mid-2024.
children’s mental health
Another hot topic, especially since the pandemic, is concerns about mental health. Instead of innovative treatments against depression – such as psychotropics – Nature Prefers to focus on interventions with less impact but proven effectiveness.
is one of the mental health needs of children. The New Orleans Intervention Model provides assessment and support to orphan and vulnerable children aged 0 to 5 years.
The ‘Best Services Trial’ seeks to evaluate this intervention in centers in London and Glasgow and will follow children for two and a half years. Its promoters believe that, if its effectiveness is demonstrated, “Could radically change the way these children are looked after, not just in the UK but globally,
An app for depression in pregnant women
Continuing with mental health, the journal proposes a more innovative approach, aimed mainly at low- and middle-income countries, Where access to cognitive therapy is not widespread,
It is an app that allows a woman to receive training in caring for people who are in the second or third trimester of pregnancy (and even after giving birth), are from the same community, and who are Suffering from depression.
The trial aims to demonstrate the potential of digital medicine to reach places where there are no healthcare providers, comparing this type of intervention to face-to-face contact with a professional.
Do malaria vaccines work for a long time?
Continuing the deprived environment, Nature The focus has been on the malaria vaccine, one of the main medical advances of the decade because it is a devastating disease, widespread and for which there was no prevention until less than five years ago.
the problem is that The effectiveness of these vaccines decreases over time: from 55% in the first year to 30% in the fourth.,
2,400 African children between 5 and 36 months are taking part in the trial, with a booster a year after the full three doses. They use the R21 vaccine, which uses a nanoparticle with a higher density of antigen on the surface than the other vaccine, RTS,S, and they will follow up for two years to see how effective it is.
A new attack on HIV
After recent failures of the most advanced HIV vaccines, hope is not lost. The Phase 1 trial (that is, it has been tested for the first time in humans) seeks to vaccinate individuals between the ages of 18 and 55, without HIV and in good health, with VIR-1388, a new vaccine that Induces strong immunogenic responses.
It is based on a previous vaccine, VIR-1111, which is based on cytomegalovirus and demonstrated good safety but low immune response. VIR-1388 is less attenuated, so a stronger response is expected,
People who have antibodies against cytomegalovirus have already been vaccinated to verify that it is safe. Once this phase is over, it will be expanded to the rest of the population for a three-year follow-up.
The bet on this vaccine is strong. The trial, conducted by the HIV Vaccine Trials Network in the US and South Africa, is supported by the North American country’s National Institute of Allergy and Infectious Diseases and the Bill & Melinda Gates Foundation.
Back to lung cancer screening
Lung cancer screening is on the lips of more and more people every day, but it has not yet become a reality. It is yet to be determined whether its utility outweighs the effort required to implement it and the test selected. Nature Will give one of the keys.
The ‘4-In the Lung Run’ is the name of a trial that is being carried out in six European countries and aims to select 26,000 people to establish whether a CT scan every two years will reduce the risk of cancer in those people. Enough to prevent deaths from. The first test showed no abnormalities.
The idea behind the study is to reduce the cost of implementing a national screening programAs well as the potential harms of subjecting a portion of the population to periodic imaging tests.
Screening needs to balance the cost of the intervention with the benefits derived. Performing annual imaging tests on a smoking population is very expensive and may lead to early detection of many cancers, so balancing costs and benefits is necessary to make screening work.
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