[Personalized therapy in cardiology. Biomarkers, pharmacogenetics and therapy of monogenic diseases].
Improved therapy and prophylaxis of cardiovascular diseases have contributed to an increase in life expectancy like no other field of medicine. However, many cardiological diseases remain untreatable and standard therapies often work only in a minority of patients or cause more harm than benefit. Personalized approaches appear to be a promising solution. Monogenic heart diseases are paradigmatic for this approach and can in rare cases be treated mutation specifically. Overall, however, success remains limited. Next generation sequencing will facilitate the identification of mutations causing diseases. Cell culture models based on induced pluripotent stem cells open the perspective of individualized testing of disease severity and pharmacological or genetic therapy. In contrast to monogenic diseases genetic testing plays no practical role yet in the management of multifactorial cardiovascular diseases. Biomarkers can identify individuals with increased cardiovascular risk. Furthermore, biomarker-guided therapy represents an attractive option with troponin-guided therapy of acute coronary syndromes as a successful example. Individual responses to drugs vary and are partly determined by genes. Simple genetic analyses can improve response prediction and minimize side effects in cases such as warfarin and high doses of simvastatin. Taken together personalized approaches will gain importance in the cardiovascular field but this requires the development of better methods and research that quantifies the true value of the new knowledge.
Institut für Experimentelle Pharmakologie und Toxikologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg. t.eschenhagen@uke.de.
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D015415:Biomarkers / Q000032:analysis; D002309:Cardiology / Q000639:trends*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D005819:Genetic Markers / Q000235:genetics*; D005820:Genetic Testing / Q000379:methods*; D015316:Genetic Therapy / Q000639:trends*; D006801:Humans; D058990:Molecular Targeted Therapy / Q000639:trends*; D010597:Pharmacogenetics / Q000639:trends; D057285:Precision Medicine / Q000379:methods*
D015415:Biomarkers; D005819:Genetic Markers