Introduction
The people of many developing countries are still living in dire poverty with dysfunctional health care systems and extremely limited access to basic medical care. The balance between the basic biological sciences and innovative aptitude towards the health of our societies are the major player in planning the development of health care services for the future. With the revolution in innovation the trend in biological sciences is scaling a new height in diagnostics and therapeutics. There are several key drivers; pushing research institutions/ organizations to explore creatively and devise newer tools way to manage and capture value from existing knowledge. The shift towards knowledge-driven, evidence based innovation in medicine is the new horizon in health care. It is going to lead for the development of platform technologies/standards as globalization accelerates and what is especially new is the ease of communication amongst a very broad scope of distributed, virtual and diverse knowledge resources. Sophisticated use of information technologies enables users flexibly to interconnect these resources and to deliver research efficiencies. But the explosion of promising new fields of research and technological opportunities will not translate into broad based improvements in health care without some sound policy work and a high level of consensus amongst the scientific communities involving institutes/practitioners and industry/manufacturers.
The biological research system is under enormous pressure as it has become far more diverse, has accommodated many new players globally, has distributed its knowledge intensive resources widely, is awash in information, and has become increasingly costly to maintain. Biological research institutions are looking for new ways of working. The organization of research is changing driven by informatics and the relatively new notion that collaboration and sharing of knowledge is the need for sustenance. Particularly there is a need of convergence of knowledge and technologies from the fields of biology, engineering, information technology, nanotechnology etc.
Priorities in Biological Sciences
In the setting of priorities for biological research, the central objective is to restore the balance of research between industrial and developing countries so that a far greater proportion is directed at the needs of the latter. It has been estimated that even though 85 percent of the global burden of disability and premature mortality occurs in the developing world, less than 4 percent of global research funding is devoted to communicable, maternal, perinatal, and nutritional disorders that constitute the major burden of disease in developing countries. The second priority is to analyze in much more detail methods of delivery of those aspects of health care that have already been shown to be both clinically effective and cost-effective. It is vital that the delivery of health care be based on well designed, evidence-based pilot studies rather than on current fashion or political guesswork. It is essential to understand why there are such wide discrepancies in morbidity and mortality between different socioeconomic groups in many industrial countries and to define the most effective approaches to educating the public about the whole concept of risk and what is meant by risk factors. In addition, a great deal more work is required on mechanisms for assessing overall performance of health care systems. The third priority must be to focus research on the important diseases that the biological sciences have yet to control, including common communicable diseases such as malaria, AIDS, and tuberculosis; cardiovascular disease; many forms of cancer; all varieties of diabetes; musculoskeletal disease; the major psychoses; and the dementias. The current pandemic outbreak witnessed as COVID-19 has challenged the technological advancements in hand as the situation is still not under control.
Emerging Technologies
- Genomics
The human genome project lead to claims that knowledge gained from this field would revolutionize medical practice in the coming time. However, some doubts have been raised about this claim, nevertheless, considerable reason for optimism still exists. Although the majority of common diseases clearly do not result from the dysfunction of a single gene, most diseases can ultimately be defined at the biochemical level; because genes regulate an organism’s biochemical pathways, their study must ultimately tell us a great deal about pathological mechanisms. The genome project is not restricted to the human genome but encompasses many infectious agents, animals that are extremely valuable models of human disease, disease vectors, and a wide variety of plants. However, obtaining a complete nucleotide sequence is one thing; working out the regulation and function of all the genes that it contains and how they interact with each other at the level of cells and complete organism presents a much greater challenge. The human genome, for example, requires the identification and determination of the function of the protein products of 25,000 genes (proteomics) and the mechanisms whereby genes are maintained in active or inactive states during development. All this information will have to be integrated by developments in information technology and systems biology. In the process, however, valuable fallout from this field is likely to occur for a wide variety of medical applications. The first applications of DNA technology in clinical practice were for isolating the genes for monogenic diseases. Either by using the candidate gene approach or by using DNA markers for linkage studies, researchers have defined the genes for many monogenic diseases. This information is being used in clinical practice for carrier detection, for prenatal diagnosis, and for defining of the mechanisms of phenotypic variability. It has been particularly successful in the case of the commonest monogenic diseases, the inherited disorders of hemoglobin, which affect hundreds of thousands of children in developing countries. Gene therapy, that is, the specific correction of monogenic diseases, has been fraught with difficulties, but these are slowly being overcome and this approach seems likely to be successful for at least some genetic diseases in the future.
From the global perspective, one of the most exciting prospects for the medical applications of DNA technology is in the field of communicable disease. Remarkable progress has been made in sequencing the genomes of bacteria, viruses, and other infective agents, and it will not be long before the genome sequence of most of the major infectious agents is available. Information obtained in this way should provide opportunities for the development of new forms of chemotherapy and will be a major aid to vaccine development. In the latter case, DNA technology will be combined with studies of the basic immune mechanisms involved in individual infections in an attempt to find the most effective and economic approach. Recombinant DNA technology was used years ago to produce pure antigens of hepatitis B in other organisms for the development of safe vaccines. More recently, and with knowledge obtained from the various genome projects, interest has centered on the utility of DNA itself as a vaccine antigen. This interest is based on the chance observation that the direct injection of DNA into mammalian cells could induce them to manufacture—that is, to express—the protein encoded by a particular gene that had been injected. Early experiences have been disappointing, but a variety of techniques are being developed to improve the antigens of potential DNA-based vaccines. Recently launched covi-shield vaccine against COVID-19 is a viral vector based vaccine and contains genetic make-up for spike proteins. The clinical applications of genomics for the control of communicable disease are not restricted to infective agents. In a study the mosquito genome was sequenced, leading to the notion that it may be possible to genetically engineer disease vectors to make them unable to transmit particular organisms. A great deal is also being learned about genetic resistance to particular infections in human beings; information that will become increasingly important when potential vaccines go to trial in populations with a high frequency of genetically resistant individuals. The other extremely important application of DNA technology for the control of communicable disease—one of particular importance to developing countries—is its increasing place in diagnostics. Rapid diagnostic methods are being developed that are based on the polymerase chain reaction (PCR) technique to identify pathogen sequences in blood or tissues. The remarkable speed with which a new corona virus and its different subtypes were identified as the causative agent of SARS and the way this information could be applied to tracing the putative origins of the infection are an example of the power of this technology.
The role of DNA array technology for the analysis of gene expression in tumors has already been mentioned. Advances in bioengineering, with the development of bio-micro-electromechanical systems, microlevel pumping, and reaction circuit systems, will revolutionize chip technology and enable routine analysis of thousands of molecules simultaneously from a single sample, with application in many other fields of research. Although somatic cell gene therapy—that is, the correction of genetic diseases by direct attack on the defective gene—has gone through long periods of slow progress and many setbacks, the signs are that it will be successful for at least a limited number of monogenic diseases in the long term. It is also likely to play a role for shorter-term objectives—in the management of coronary artery disease and some forms of cancer. DNA technology has already revolutionized forensic medicine and will play an increasingly important role in this field. Although it is too early to assess to what extent the application of DNA technology to the studies of the biology of aging will produce information of clinical value, considering the massive problem of our aging populations and the contribution of the aging process to their illnesses, expanding work in this field is vital. Current work in the field of evolution using DNA technology seems a long way from clinical practice; however, it has considerable possibilities.
- Stem Cell Therapy
Stem cell therapy is an area of research in cellular biology that is raising great expectations and bitter controversies. Transplant surgery has its limitations, and the possibility of a ready supply of cells to replace diseased tissues, even parts of the brain, is particularly exciting. Stem cells can be obtained from early embryos, from some adult and fetal tissues, and (at least theoretically) from other adult cells. Embryonic stem cells, which retain the greatest plasticity, are present at an early stage of the developing embryo, from about the fourth to seventh day after fertilization. Although some progress has been made in persuading them to produce specific cell types, much of the potential for this field so far has come from similar studies of mouse embryonic stem cells. For example, mouse stem cells have been transplanted into mice with a similar condition to human Parkinson’s disease with some therapeutic success, and they have also been used to try to restore neural function after spinal cord injuries. Many adult tissues retain stem cell populations. Bone marrow transplantation has been applied to the treatment of a wide range of blood diseases, and human marrow clearly contains stem cells capable of differentiating into the full complement of cell types found in the blood. Preliminary evidence indicates that they can also differentiate into other cell types if given the appropriate environment; they may, for example, be a source of heart muscle or blood vessel cell populations. Although stem cells have also been found in brain, muscle, skin, and other organs in the mouse, research into characterizing similar cell populations from humans is still at a very early stage. One of the major obstacles to stem cell therapy with cells derived from embryos or adult sources is that, unless they come from a compatible donor, they may be treated as “foreign” and rejected by a patient’s immune system. Thus, much research is directed at trying to transfer cell nuclei from adult sources into an egg from which the nucleus has been removed, after which the newly created “embryo” would be used as a source of embryonic stem cells for regenerative therapy for the particular donor of the adult cells. Because this technique, called somatic cell nuclear transfer, follows similar lines to those that would be required for human reproductive cloning, this field has raised a number of controversies. Major ethical issues have also been raised because, to learn more about the regulation of differentiation of cells of this type, a great deal of work needs to be carried out on human embryonic stem cells. If some of the formidable technical problems of this field can be overcome and, even more important, if society is able to come to terms with the ethical issues involved, this field holds considerable promise for correction of a number of different intractable human diseases, particularly those involving the nervous system.
- Information Technology
The explosion in information technology has important implications for all forms of biological research, clinical practice, and teaching. The admirable desire on the part of publicly funded groups in the genomics field to make their data available to the scientific community at large is of enormous value for the medical application of genomic research. This goal has been achieved by the trio of public databases established in Europe, the United States, and Japan (European Bioinformatics Institute, GenBank, and DNA Data Bank of Japan, respectively). The entire data set is securely held in triplicate on three continents. The continued development and expansion of accessible databases will be of inestimable value to scientists, in both industrial and developing countries. Electronic publishing of high-quality journals and related projects and the further development of tele-pathology will help link scientists in industrial and developing countries. The increasing availability of telemedicine education packages will help disseminate good practices. Realizing even these few examples of the huge potential of this field will require a major drive to train and recruit young information technology scientists, particularly in developing countries, and the financial support to obtain the basic equipment required.
- Non/Minimally Invasive Techniques
Given the increasing costs of hospital care in industrial countries and the likelihood of similar problems for developing countries in the future, reviewing aspects of diagnostics and treatment that may help reduce these costs in the future is important. In several advanced countries, the number of hospital beds occupied daily reduced drastically even though the throughput of the service increased. A major development with this potential is the application of minimally invasive and robotic surgery. Advances in imaging, endoscopic technology, and instrumentation have made it possible to convert many surgical procedures from an open to an endoscopic route. These procedures are now used routinely for gall bladder surgery, treatment of adhesions, removal of fibroids, nephrectomy, and many minor pediatric urological procedures. The recent announcement of successful hip replacement surgery using an endoscopic approach offers an outstanding example of its future potential. Although progress has been slower, a number of promising approaches exist for the use of these techniques in cardiac surgery. Transplant surgery will also become more efficient by advances in the development of selective immune tolerance. These trends, and those in many other branches of medicine, will be greatly augmented by advances in biological imaging. Major progress has already been made in the development of noninvasive diagnostic methods by the use of MRI, computer tomography, positron imaging tomography, and improved ultrasonography. Image guided therapy and related noninvasive treatment methods are showing considerable promise.
- Neuropsychiatry
Neuropsychiatry will be of increasing importance in the future as depression and related psychiatric conditions are predicted to be a major cause of ill health and because of the increasing problem of dementia in the elderly. Developments in the basic biological sciences will play a major role in the better diagnosis and management of these disorders. Furthermore, the application of new technologies promises to lead to increasing cooperation between neurology and psychiatry, especially for the treatment of illnesses such as mental retardation and cognitive disorders associated with Alzheimer’s and Parkinson’s diseases that overlap the two disciplines. The increasing application of functional imaging, together with a better understanding of biochemical function in the brain, is likely to lead to major advances in our understanding of many neuropsychiatric disorders and, hence, provide opportunities for their better management. Early experience with fetally derived dopaminergic neurons to treat parkinsonism has already proved to be successful in some patients and has raised the possibility that genetically manipulated stem cell treatment for this and other chronic neurological disorders may become a reality. Promising methods are being developed for limiting brain damage after stroke, and there is increasing optimism in the field of neuronal repair based on the identification of brain-derived neuronotrophic growth factors. Similarly, a combination of molecular genetic and immunological approaches is aiding progress toward an understanding of common demyelinating diseases—notably multiple sclerosis. Strong evidence exists for a major genetic component to the common psychotic illnesses—notably bipolar depression and schizophrenia. Total genome searches should identify some of the genes involved. Although progress has been slow, there are reasonable expectations for success. If some of these genes can be identified, they should provide targets for completely new approaches to the management of these diseases by the pharmaceutical industry. Recent successes in discovering the genes involved in such critical functions as speech indicate the extraordinary potential of this field. Similarly, lessons learned from the identification of the several genes involved in familial forms of early-onset Alzheimer’s disease have provided invaluable information about some of the pathophysiological mechanisms involved, work that is having a major effect on studies directed at the pathophysiology and management of the much commoner forms of the disease that occur with increasing frequency in aged populations.
- Sophisticated Cell Cultures and Organs On A-Chip
Organs-on-chips are generated using micro-scale engineering techniques that, when combined with cultured, living human cells, recreate the physiological, mechanical and biochemical microenvironment of the living organs in a reductionist yet complex, highly precise and controllable manner. This technology enables the study of complex human physiology and pathology in an organ-specific context and offers a unique platform for developing specialized in vitro human disease models. Each organ-on-a-chip is approximately the size of an AA battery and is often composed of a transparent, flexible, biocompatible and gas-permeable material. Cells are cultured within continuously perfused microchannels that run through the chip, and the chip can be stretched or other-wise stimulated to recreate the physiological forces that cells experience in the body. Organs-on-chips have been designed to re-produce the complex, dynamic state in which living cells function in a real human organ, which includes substrate (extracellular matrix), tissue–tissue interface, mechanical forces, immune cells and blood components, and bio-chemical surroundings. One key benefit of the technology is that it allows scientists to gain mechanistic insight into human biology and human response to drugs; and it has the potential to be used in many fields, including drug discovery, food and chemical research, as well as precision and regenerative medicine. However, the technology is still new and not yet fully mature – the added value of organs-on-chips compared with more-traditional 2D and 3D tissue culture models has yet to be confirmed empirically, and scientists currently believe that, although organs-on-chips definitely have the potential to bridge the translational gap that exists in preclinical testing, the technology is not yet capable of the absolute replacement of animals and should remain complementary to studies on animals for the near future.
- Artificial Intelligence
Artificial intelligence (AI) refers to a computer mimicking “intellectual processes characteristic of humans, such as the ability to reason, discover meaning, generalize, or learn from past experience” to achieve goals without being explicitly programmed for specific action. There is no consensus on what constitutes AI. Different criteria for intelligence proposed have not satisfied everyone leading to the famous aphorism, “AI is whatever hasn’t been done yet.” For example, optical character recognition and translation has now been relegated from “artificial intelligence” because of the routine nature of their use. AI applications have become common, e.g. Siri, Alexa, and Cortana. In medicine, IBM Watson-Oncology has picked up drugs for treatment of cancer patients with equal or better efficiency than human experts. Microsoft’s Hanover Project at Oregan has analyzed medical research to tailor personalized cancer treatment option. United Kingdom’s National Health Service (NHS) used Google’s Deep Mind platform for detecting health risks by analyzing mobile app data and medical images collected from NHS patients. Stanford’s radiology algorithm picked up pneumonia better than human radiologists, while in diabetic retinopathy challenge, the computer was as good as expert ophthalmologists in making a referral decision. In 2018, scientists trained an automated algorithm for diabetic retinopathy (DR) grading while working on quantifying errors in DR grading based on individual graders and the majority decision using adjudication. They retrospectively analyzed Health Insurance Portability and Accountability Act Safe Harbor deidentified images labeled by American board-certified ophthalmologists and retinal specialists in addition to the “developed and tuned” algorithm.
- Smart Wearable Sensors
Smart wearable home sensor technologies contribute to the empowerment of patients. These technologies, such as the popular Fitbit, give users more insight and control over their health and can help prevent illness by giving real-time feedback on health status by monitoring vital signs, allowing the user to adjust and target their activities to reach optimal fitness or health results. Real-time health feedback is extremely suitable for gamification, as behavioral change and motivation regarding exercise can be influenced by adding points and badges and leader-boards to the data stored in the cloud and on the device. These wearable sensors are becoming smaller, less obtrusive and more integrated with the human body. For instance, Google’s digital contact lens will allow diabetes patients to monitor and manage their glucose levels from tears in real time. Additional integration can be expected from digestible sensors, sensors placed in teeth and organs of the body and thin e-skin sensors or biometric tattoos and radio frequency identification chips (RFID) implanted under the skin, which store vital health information and act as control devices for purposes such as automatically calling for assistance if vital signs signify that health problems are imminent. Early adopters of these new technologies are already using implants to give themselves superpowers; for instance, the use of recreational cyborgs to improve their eye sight or hearing.
- Genetically Modified (GM) Crops
There is going to be a gigantic increase in world’s population, with much of the projected growth occurring in developing countries. As a consequence, there would be huge demand in food requirements. However, the annual rate of increase in cereal production has declined; the present yield is well below the rate of population increase. About 40 percent of potential productivity in parts of Asia and Africa and about 20 percent in the industrial world are estimated to be lost to pathogens. Given these considerations, the genetic modification (GM) of plants has considerable potential for improving the world’s food supplies and, hence, the health of its communities. The main aims of GM plant technologies are to enhance the nutritional value of crop species and to confer resistance to pathogens. GM technology has already recorded several successes in both these objectives. Controversy surrounds the relative effectiveness of GM crops as compared with those produced by conventional means, particularly with respect to economic issues of farming in the developing world. Concerns are also expressed about the safety of GM crops, and a great deal more research is required in this field. The results of biosafety trials in Europe raise some issues about the effects of GM on biodiversity. Plant genetics also has more direct potential for the control of disease in humans. By genetically modifying plants, researchers hope it will be possible to produce molecules toxic to disease-carrying insects and to produce edible vaccines that are cheaper than conventional vaccines and that can be grown or freeze dried and shipped anywhere in the world. A promising example is the production of hepatitis B surface antigen in transgenic plants for oral immunization.
Conclusion
Technology has extensive use in biomedicine, including disease diagnostics and prediction, living assistance, biological information processing, and biological research. It has interesting applications in many biological areas as has an increasingly important role due to innate complex nature of biological problems. Emerging technologies like AI, biosensor, genomics etc provide novel solutions for the biological challenges, and the development of newer techniques provide greater approach to the enhanced medical infrastructure. This match of solution and problem and coupled with developments will enable to advance significantly in the foreseeable future, which will ultimately benefit the quality of life of people in need.
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