The Future of Medicine

We know there are about thirty thousand diseases known to human beings and of those about three-quarters have no treatment whatsoever You have an ageing population worldwide, there are a lot more chronic disorders coming through and these patients need new treatments which are offered on a continuous basis

We see a very big change in therapeutics coming up and we're on the cusp of that change now where you're getting multiple disciplines in brand new technologies and much more understanding the biological science behind it and the net result of all of that is it should introduce new therapeutic modes into the general public So there's a revolution going on in medicine that we want personalized health care, we want to understand our own bodies, the individual nature of those and for that we need sensors but not just on the outside we need sensors on the inside And we've not been very good at making those so nanoscience and nanotechnology is driving towards making new sorts of devices that will really revolutionise medicine This is the idea of personalised medicine as a whole: how do we actually know how we're working as a human? When you go to a doctor they always ask you how are you feeling and part of the reason is they have no machine which can measure how you're feeling So it's about how do we create technologies that actually can read that out and do something much more profound, actually watch how you're living and then start to warn when maybe something is going wrong

Now on the very, very future scale what we actually really want to do is to put nano machines inside our bodies We want them to go and scavenge away and repair parts which are broken, remove clots and all at the moment this is rather large scale interventions that surgeons have to push something in your body What we'd really like to do is to use what the body does and so nanotechnology's learning how to build these sort of nano machines Humans are living longer and longer and of course we've dramatically changed life expectancy over just the last hundred years or so with the introduction of antibiotics and so our tissues, the quality of our tissues decreases with time and that means as we live older and older we're gonna need more and more replacement parts not necessarily just to stay alive but for our quality of life as well So we study natural materials because if we want to make artificial materials that are similar to the natural materials we have to understand the natural materials themselves first

Scaffolds are used for tissue engineering when we make an artificial tissue Tissues have two components – they have cells and the material, the extracellular matrix So our scaffolds mimic the material parts and then if you add cells to that then you can engineer a new tissue Other organisms have enormous powers to regenerate They can regenerate limbs that are lost or hearts that are damaged

Humans – we don't have that ability When somebody has a heart attack part of their heart muscle dies They can lose a billion cardiomyocytes and the heart never repairs that, it's just replaced by scar What we'd like to do is develop a tissue engineered cardiac patch made out of stem cells that can replace and restore normal function to the heart What we're using is embryonic stem cells that can form heart muscle and all the other structures of the heart and what we want to do is to improve the heart function not just by a couple of percent but completely back to normal

I mean the future is actually very bright for regenerative medicine as a whole because other people are working on other organs So kidneys, livers, repairing damaged brain – even spinal cords So there's a huge area of promise here I think that that's what the future holds looking far ahead Immunotherapy is really revolutionising the way in which cancers can be treated My lab is interested in understanding what makes a really good killer cell

These are the cells that recognize and destroy both the cancer and virally infected cells in your body So as effective and revolutionary as immunotherapy has been, it doesn't cure all patients and so it becomes incredibly important to understand in detail what tells a killer cell to kill and how it does so So what my research is aimed at is understanding what makes a really good killer and what are the mechanisms that control that killing One of the approaches we use is to study cells in patients with genetic diseases where the killer cells don't work to try and understand why things don't work when one components missing Another approach that we use is to look at the genes that need to be expressed to train a cell to be a really good killer and finally we use a lot of high resolution imaging on live cells to see what happens to make the killing effective

What we really need is a big enough bag of tricks to understand in detail the mechanisms that control the killer T cells so that every time a cancer cell comes up with its new strategy to try and avoid the immune system, that we have a trick up our sleeve to deal with that I head up a team that's a new team really working and focusing on a new type of technology really on a new breakthrough called CRISPR or genome editing This is a new technology that allows us to essentially rewrite the DNA that's within all of our cells, correcting mistakes in that DNA So the field has really exploded over the last few years and we're really able to do more now than we've ever been able to do in the entirety of history Now CRISPR is essentially the exploitation of an antiviral defense system that exists in all sorts of different species of bacteria and scientists have taken that and taken components of that to be able to rewrite DNA in all manner of cells and all manner of organisms

Gene editing is really essentially a two-part system there is a GPS location and there is a pair of molecular scissors The GPS locator directs the molecular scissors to a specific part of the DNA to be able to make its cut and at that point there, the cut, the removal and the replacement of the DNA can occur What we hope to be able to do is once we've corrected the cells in the petri dish, is to be able to put them back into the patient Now what that will do is, it will not be a therapeutic against a particular disease or it will alleviate the disease – that could potentially be a complete cure for that disease, for that individual What this technology also does is that it allows us to look down within a cell and to tinker and really understand what's going on, how cells work at the most fundamental of levels and that allows us to do all sorts of things

That allows us to turn a cell into a computer for example, to record information into a cell, to program cells to do specific things Very soon in the near future we'll see some diseases being completely cured, simple diseases being cured by CRISPR technology or genome editing technology with more and more complex diseases being tackled over the next few years So we're working with regulators and with clinicians to ensure patient safety is paramount Clearly the field of therapeutics offers many exciting new treatments, the prospects of all sorts of amazing discoveries but it's important to remember that these benefits are not free from risk or controversy Topping most people's lists of issues to be concerned with is the prospect of designing some sort of post human race

So to avoid the metaphorical shipwreck it is really important that we bring together people who are expert in all aspects of technology and society including law and ethics to identify and evaluate the various risks, benefits, themes and trends So I think in 50 years that we really will be able to manipulate these cells with exquisite specificity and I think being able to control what is a fabulous and effective little cell within our body to help the immune system when it needs to be helped or when it begins to go rogue, we'll be able to do that in 50 years Gene editing itself is so versatile it feels a bit like sometimes the sky is the limit I could see a situation where in twenty, twenty five years in the future, that people could be engineering synthetic cells that go inside people and survey around their body looking for disease and dealing with disease as it arises Right now if something goes wrong you might need a donor in order to get a replacement part but in 50 years we might just be able to walk into a room and have there be shelves full of donor parts for all different tissues in the body because of tissue engineering

What my vision is, is that people who have heart attacks, who have damaged hearts, we'll be able to provide a patch through a cardiac surgeon as you go for a bypass now you'd go from bypass and maybe a heart patch as well and we'll be able to restore those hearts back to normal which means that people who currently aren't able to do simple things like walking up stairs or having a normal life can get back to doing just normal things that you and I take for granted and having a normal lifespan as well In terms of the future and I'm aiming the longer term future now, I see a very large change in the way the healthcare delivered so you have new therapeutic regimes which may be done for example in the home environment and maybe the diagnostics will be done there and even eventually the treatments in the home and very much angled against the individual, so it's personalized in the home environment or if it's a more serious disorder, a longer term disorder, that may be that will be conducted in a hospital environment but because of the therapeutics can be delivered by the patient with the patient's own materials it's probably going to change the way hospitals are established, the way the companies interact because they'll have a product which actually comes to the patient side or the bedside and very different geometry from the way it's done right now And if you can get to that stage you can of course save masses of money in the final healthcare treatment regime I think the most exciting thing from my point of view is the fact that you're bringing into into therapeutics and treatments of patients a whole range of technologies It's called convergence in the technical jargon but you're bringing them all together to create a totally new treatment regime and that's right the way from how you handle the patient to actually delivering the final therapeutic product and that's the exciting thing I think

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