Lichtgedanken 05

Rubrik 34 »When the hammer does not hit the nail« One diagnosis—one drug. In reality, it is normally not this simple. The effect of medication depends on many factors: in addition to age and body type, gender also plays a significant role. Personalized medicine takes these factors into account. In this interview, pharmacologist Prof. Dr Oliver Werz discusses its promises and limitations. INTERVIEW: STEPHAN LAUDIEN AND TILL BAYER What does personalized medicine mean? Personalized—or, better, stratified me- dicine—takes the biological constituti- on of patients into account during treat- ment. Factors such as the patient’s age, weight, gender and body fat potential all influence the effect of medication and how it is broken down in the body. An example: if a small, slim woman and a heavy man take the same dose of a drug, they will each experience diffe- rent results. I work in the field of gen- der-specific medicine. Where is stratified medicine used? The main areas of treatment are in can- cer therapy and the treatment of viral diseases. The patient’s genetic make-up is of crucial importance. If, for example, a cancer patient does not have the speci- fic mutated gene that the medicine com- bats, targeted therapy doesn’t make any sense. You can’t hit the nail on the head if there is no nail to hit. The medicine only takes effect if the gene is functio- ning in a specific way. It is now man- datory to perform certain tests before respective medication is prescribed. What kind of research is being under- taken in Jena in the field of personali- zed medicine? As far as I am aware, we are the only Institute of Pharmacy in Germany that is researching the effect of medication in regard to gender. We have discover- ed that the efficacy of drugs, especially those used to combat autoimmune di- seases such as rheumatoid arthritis, dif- fers between men and women. Women are significantly more prone to autoim- mune diseases than men. One reason for this is that women have two X chro- mosomes and certain alleles are present twice over. Furthermore, sex hormones have a major influence. The problem is that the drugs are still developed based on the male organism. One first step would be to adjust the dosage, so it is gender-specific. Why is the dosage so important? The body’s ability tometabolize the acti- ve substances in medication has a huge impact on how effective they are. Some patients have slow metabolisms, some have normal and some have fast. Also, because the active substances are often stored in fatty tissue, body fat percenta- ge also plays a role. The »King of Pop« Michael Jackson, a very slim man, pro- bably died as a result of an excessive dose of a relatively harmless drug. This drug (propofol) is broken down more quickly in women and is redistributed from the blood into the fatty tissue. Is the third gender taken into account in the research? There are only very few studies about the third gender. There have been stu- dies into the effect of sex hormones fol- lowing sex changes, for example. The problem is that there is too little biologi- cal test material, such as blood samples, available. Overall, I am sorry to say that intersex people have thus far been neglected from the research. What about children? The dosage is generally adjusted for children. A well-known medicine such as paracetamol or certain antibiotics are prescribed depending on age and body weight. Children are not allowed to take some medication in any form, as it would affect growth processes. But there is a need for further improvement in this field too. In addition, puberty— which means the period of transition from childhood to adulthood—is lar- gely disregarded. In other words, there is a need for an approach that is more tailored to indi- vidual characteristics? We can see a very clear need for ac- tion where the parameters are soft. Nevertheless, classic personalized medicine, which focuses on individu- al circumstances, is an important field of research. But you have to keep an eye on the practicalities too. Lab-ba- sed genetic testing is not cheap and also prompts ethical questions. Many patients do not want their genes to be investigated. Often, they don’t under- stand that these tests will only concern specific genes.  Prof. Dr Oliver Werz.