Into the World of Molecular Medicine. What's That?

 

Earlier I wrote an essay here in this blog of mine to introduce readers to molecular biology. I then promised I shall write another short essay on how molecular biology is applied in specialized medicine even though I have given a few examples earlier.

Let me now briefly explain how we can apply our knowledge in molecular biology into the practice of highly specialized medicine.

Most medical doctors who are basically clinicians know only clinical medicine as practiced in hospitals. They have very little clue what's going on conducted by medical scientists working silently in their research laboratories for the advancement of medicine that finally led these scientists to win the highly prestigious Nobel Prize in Medicine. 

It is very unfortunate there was a dramatic drop of medical doctors winning the Nobel Prize in medicine after 1936 as clinicians themselves moan and sigh here:  

Nobel Prizes in Medicine: are clinicians out of fashion?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164255/

Most of the advances and new discoveries in medicine are done by medical scientists who have a doctorate degree (PhD), not just a basic medical degree (MD). These scientists worked silently in their research laboratories while the clinicians worked mainly in hospitals and clinics. Thus, clinicians have little idea on new discoveries in medicine. In fact, most clinicians hardly even attend clinical sessions or go for CME (continuing medical education), read research papers published in medical journals specially meant for them, let alone conduct medical research. 

Because of this gap, let us then go behind the screen of medicine into the world of Molecular Medicine. 

Molecular medicine is closely related to molecular biology but focuses more specifically on the application of molecular biological techniques and knowledge to understand, diagnose, and treat human diseases. While molecular biology is concerned with understanding the fundamental molecular mechanisms of life, molecular medicine applies this knowledge directly to medical practice.

Relationship Between Molecular Medicine and Molecular Biology

Molecular medicine can be considered a sub-specialty or an application of molecular biology within the medical field. It involves using molecular biology tools to study disease mechanisms at the molecular level and develop new diagnostic methods, treatments, and therapeutic strategies. While molecular biology provides the foundational knowledge, molecular medicine translates that knowledge into practical applications for improving human health.

Applications of Molecular Medicine

Let us first deal with diagnostics. In molecular diagnostics, techniques such as Polymerase Chain Reaction (PCR), next-generation sequencing (NGS), and microarray analysis are used to detect genetic mutations, pathogens, and other molecular markers associated with diseases. For example, PCR is widely used for detecting viral RNA in infections such as HIV and COVID-19.

Next, we use biomarker discovery. By this, I mean identifying specific molecules (biomarkers) in the blood, tissues, or other body fluids that indicate the presence of a disease. For instance, the HER2 protein is a biomarker used to guide the treatment of breast cancer.

Treatment wise, oncologists may use targeted therapies. These therapies target specific molecular pathways involved in disease. For example, Imatinib (Gleevec) targets the BCR-ABL fusion protein in chronic myeloid leukaemia, effectively treating the disease with fewer side effects than traditional chemotherapy.

Then we can think of gene therapy. This involves correcting defective genes responsible for disease development. For example, gene therapy has been used to treat certain types of inherited blindness and is being explored for treating other genetic disorders like cystic fibrosis.

Next, we can also consider RNA-based therapies.  The use of small interfering RNA (siRNA) or antisense oligonucleotides to silence specific genes involved in disease. An example is the drug Onpattro (patisiran), which uses siRNA to treat hereditary transthyretin-mediated amyloidosis.

In research and discoveries where I am more familiar with, we can also offer cancer genomics.  This area of study looks at the genetic mutations that drive cancer development. Molecular medicine has led to the identification of oncogenes and tumour suppressor genes, which are now targets for cancer therapies.

We can also apply our knowledge in molecular biology for stem cell research. Molecular medicine has advanced the understanding of stem cell biology, leading to potential treatments for conditions such as Parkinson's disease, spinal cord injuries, and diabetes through regenerative medicine.

What about its application in pharmacology? This area is what we call pharmacogenomics. We study how genes affect a person’s response to drugs. This research has led to personalized medicine, where treatments are tailored to an individual’s genetic makeup, optimizing efficacy and minimizing side effects.

Drug development requires rational drug design.  Molecular medicine aids in designing drugs that specifically target molecular structures involved in diseases. For example, structure-based drug design was used to develop protease inhibitors for treating HIV/AIDS.

Molecular biology is also applied in biological medicines.  These are drugs derived from living organisms, such as monoclonal antibodies, which can specifically target and neutralize disease-causing agents. For example, monoclonal antibodies like Rituximab are used to treat certain cancers and autoimmune diseases.

We can also apply our knowledge in the development of vaccines. Molecular techniques have been pivotal in developing new vaccines, such as mRNA vaccines for COVID-19, which are based on molecular biology principles and applied through molecular medicine. I have mentioned this in the last article.

In oncology and cancer treatment, we have precision medicine. We can use genomic information to guide the treatment of cancer patients. For instance, patients with non-small cell lung cancer with EGFR mutations can be treated with EGFR inhibitors like Gefitinib or Erlotinib, leading to better outcomes.

Of course, I have not forgotten how we can apply our knowledge on molecular biology in cardiology. First, we apply it in molecular imaging. Almost most clinicians have no clue how this is done?   Techniques such as PET and MRI, enhanced with molecular probes, allow for the visualization of molecular processes in the heart. This can be used to diagnose and monitor diseases like atherosclerosis at an early stage.

Ah! We learn much about infectious diseases. Almost all clinicians have not heard of how molecular medicine comes in. All they can know is how to use antibiotics to treat an infection that finally leads to antibiotics-resistant strains of pathogenic bacteria and nosocomial hospital-acquired infections.   

Let me explain. Let us take the case of HIV management.  Molecular medicine has transformed HIV treatment, from the development of antiretroviral drugs that target specific enzymes of the virus to the use of molecular diagnostics for monitoring viral load and resistance mutations.

In neurodegenerative diseases such as in Alzheimer’s disease research, molecular medicine has provided insights into the pathogenesis of Alzheimer’s, leading to the development of diagnostic biomarkers (like beta-amyloid and tau proteins) and potential therapeutic strategies targeting these proteins.

Molecular medicine is a rapidly growing field that bridges the gap between molecular biology and clinical practice. Its applications are vast, and as our understanding of molecular processes continues to evolve, so too will the potential for new and more effective medical treatments.

I think these few examples will suffice. I shall write another article later on how further areas on molecular medicine are applied in the practice of medicine. 

If readers want more information, below are some references

 

References for Further Reading

1.    Molecular Medicine: Principles and Practice by Jens Kurreck (2020) This book provides an overview of the principles of molecular medicine and its applications in various fields.

2.    The Journal of Molecular Medicine, a leading journal that publishes research articles on the molecular aspects of disease pathogenesis, diagnostics, and treatment.

3.    National Centre for Biotechnology Information (NCBI)Offers a wide range of resources and databases for exploring research articles related to molecular medicine.