Personalised Medicine in New Zealand: A new approach to healthcare delivery
Year: 2011
Type: dissertation
Abstract: Personalised Medicine is expected to improve efficiency of healthcare delivery and reduce costs. Pharmacogenomics fits within this framework and seeks to identify individuals who are most likely to benefit from targeted interventions. The aim of this thesis was to focus on the application of personalised medicine in cardiovascular medicine, particularly as it applies to the use of antiplatelet medications, percutaneous coronary intervention, hereditary cardiac disease and population genomics. A number of clinical trials and observational studies were undertaken. This included studies of drug-drug and drug-herb interactions in Chapters Two and Three, and pharmacogenetic studies of aspirin and clopidogrel in Chapters Four to Seven. Chapter Eight summarises these findings and discusses their relevance to Maori and Pacific Peoples in New Zealand. Biorepositories are discussed in Chapter Nine and their applied clinical use in Chapter Ten. Metabolomics and proteomics were applied in Chapter Eleven to elucidate mechanisms in coronary intervention. Chapters Twelve and Thirteen include a longitudinal study of a 9p21.3 SNP, associated with coronary disease and a simulation of warfarin dose requirement using pharmacogenetics. Chapter Fourteen discusses the barriers to the adoption of genomics and what future policy requirements are needed to overcome these impediments. Results from this thesis are as follows: Concomitant medications, such the nonsteroidal drugs (ibuprofen and indomethacin) block the antiplatelet effect of aspirin. The antiplatelet response to aspirin does not appear to be influenced by genetics. Variants within the CYP2C19 gene (e.g. *2 allele) explain some of the response to clopidogrel Non-response to clopidogrel can be overcome with higher doses of the drug, however this may not be achieved with current maintenance doses (75- 150mg daily). Integrating metabolomics and proteomics has significant value in elucidating novel mechanisms behind disease and identifying biomarkers. DNA in a biorepository, linked to electronic medical records systems, has value in evaluating population genomics and in providing a clinical service The response to antiplatelet drugs is complex and not always influenced by genetics. Clopidogrel treatment, however, can be individualised using pharmacogenomics. Genomic medicine has the potential to bridge population health and individualised clinical practice. The use of genomic medicine may be advantageous in addressing ethnic disparities and may be cost effective when applied on a population basis. Ethical issues and government policy need to be addressed.
Author: Gladding, Patrick
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2795083286