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Personizing Medicine

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Personalizing Medicine
By:
Daniel Ostroff
12-09-2009

I believe it is absolutely essential to take steps to further personalize medicine. There are too many generalized treatments that may work for most patients, but still a great many patients with slight irregularities are not eligible because of these slight differences. For example, research is being done at the BIO5 Institute at the University of Arizona by Dr. Jonathan VandeGeest and his laboratory to switch the commonly used generalized metallic stents to treat an aortic aneurysm to custom manufactured Functional (due to the use of dendrimers for drug delivery) Polymeric Endoluminal Paving prototypes. The development of these customized prototypes for aneurysm patients is a massive step forward in personalized medicine. The traditional procedure to correct this condition involved complex open-chest surgery. Depending on the size and growth rate of the aneurysm, surgery can take many hours and may require multiple return visits. During surgery, the two traditional treatments are aortic grafts or metallic stents. The grafts are a wire mesh that is sewn into place to prevent further growth and leaking, which involves an extremely dangerous and invasive procedure. Otherwise, a generalized metallic stent is used, but because this device is pre-formed, it will only fit a select group of patients whose aorta is in a straight and vertical orientation. Any other shape and the treatment couldn’t be applied. Though, because the aorta is almost never perfectly straight, slips of the stent are likely to occur. Once a slip does occur, the probability for a leak is greatly enhanced. If a leak does develop, the graft loses its purpose and if a refitting surgery is not preformed, the consequences can be fatal. Both the stents and grafts may require refitting procedures and patients would have to return approximately every four years. Dr. VandeGeest has proposed a new revolutionary type of personalized Functional Polymeric Endoluminal Paving created from biodegradable materials that are able to accommodate any patient, regardless of the shape of their aorta. The design is based on manufacturing a unique paving for each individual patient, based on scans and computer modeling, to provide a precise custom fit. This change in treatment eliminates any discrimination among patients based on their physiology. To ensure an exact aortic fit, a computerized tomography or CT scan is taken of the abdomen. This is done using an X-ray unit that rotates around the patient’s body and a powerful computer. The result of the scan is a series of cross-sectional images detailing the entire abdomen. The series spans the length of the aorta providing sufficient data to accurately determine its shape. The information is then collected by a computer to generate a three-dimensional model of the aneurysm. Using this model, the paving is manufactured using a patent pending technique involving three dimensional printing. Three-dimensional printing is a faster and more economical method of creating a wide variety of high-resolution and highly detailed three-dimensional models. It creates a three-dimensional object by adding successive layers of material to a base frame. This technology is known as additive manufacturing. Three-dimensional printers are able to print parts using a varity of different materials in a single object. Dr.VandeGeest intends on using this unique property to employ the use of dendrimers within the biodegradable material of the paving. A dendrimer is a molecule capable of encapsulating a drug and deliver it to the necessary site where its effect will be most beneficial. Many different drugs are being explored by Dr. VandeGeest’s team, but currently the drug doxycycline seems to be the most promising for the treatment of the aneurysm. Once the Functional Polymeric Endoluminal Paving has been printed according to the patient’s three-dimensional model, the patient then undergoes the installation operation. During this operation, the paving is introduced into the aorta and placed within the aneurysm. The shape of the aorta consists of a main body which splits into two legs at the bottom of the artery. The paving mimics this shape using two separate pieces. These pieces consist of the main piece which covers the main body and includes a leg, and then, the second piece covers the other leg. The two pieces of the paving are then joined together in the artery. Once the Functional Polymeric Endoluminal Paving is securely in place, it is expanded slightly using a heat treatment to ensure an exact fit. Since the fit is made with a high degree of precision, the need for follow-up surgery is practically eliminated. This significantly improves the chances of a full recovery for the patient. The addition of the dendrimers improves the chances and shortens the time of recovery as well. In conclusion, the Functional Polymeric Endoluminal Paving greatly improves the chances of survival for this commonly fatal condition. The combination of using a three- dimensional printer for manufacturing, and including the use of dendrimers for drug delivery, ensures that this will be an affordable and effective substitute for the current treatment. This is a perfect example of further personalizing medicine. There are many other treatments for extremely serious conditions that are too generalized. New options must be researched and developed to improve success rates and reduce invasive surgeries. Lessons must be learned from Dr. VandeGeest and his team to never settle for outdated treatment options and always strive for new ideas to improve the health of humanity as a whole.
References:

"Aortic aneurysm: Treatments and drugs - MayoClinic.com." Mayo Clinic medical information and tools for healthy living - MayoClinic.com. Web. 08 Dec. 2009. .

"Objet Geometries – Company Overview." 3D Printing by Objet Geometries Ltd. Web. 08 Dec. 2009. .

Vande Geest, Jonathan P. "Functional Polymeric Endoluminal Paving Production Details." Telephone interview. 09 Dec. 2009.

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