Tuesday, November 26, 2013

Reflexions at CRBCM

I like the time I am living in today when it comes to progress in Medicine.  We have more answers to what seemed mysterious, "only God knows" kind of time!
I remember helping  during or  later on performing surgery in Africa as a young doctor in the early 1980s.  Just to lose the patient from "undetermined " complications.  The high Mortality of peritonitis, sepsis and other systemic diseases continue to mark our experience in Medicine because so much of what is happening during the pathophysiology of these conditions, remains unknown, or I say today, unspecified.
The realization today that most of these events are genetically based brings comfort in a way.  Because it brings the challenge to a more human dimension.  It is no longer "only God Knows" but rather  "are we looking at the right gene or cytokine?"  What receptor is at play? where can we interfere to change the course of the process?  New biomarkers should now be defined in these diseases, and I mean genetic biomarkers!

Diseases like "Crohn's and ulcerative Colitis " were just mysterious when first discovered in the late 1970s.  Today all makes sense, failure at an abnormal NOD2 gene, abnormality of the NLRC4 gene and subsequent failure of recruitment and initiatation of the Caspase cascade makes perfect sense to me now!  I can now see it and play with the scenarios.  I can see how MAVS/IRF3/IKK and there TICAM-1 comes to play in this disease. VISA, RIG-1/IPS-1 and other genes.  Hell, I understand the roles of the Retinoic Acid Receptor and induced genes.This is good for unraveling the mystery.

I see the role of OCTN-1 in the absorption at the Intestinal Epithelium and its interaction with PDZK-1, and potential alteration of ion channels and its relation to Uric Acid stone in this disease.   I can also understand why affected individuals can lose their hair (check out FARP2).  The role of Estrogen and its receptor now influenced by Interferon and other cytokines (TNF,TGF etc..) brings down the extra thrombotic risk.  Natalizumab brings in the power of endothelial recruitment of Lymphocytes by stressing the role of Integrins.
It really reminds me of cooling effects given to TBI patients.  Here cooling was effective in TBI through decreasing IL-1.  In all this review I was struck by MAVS, is it a new biomarker of viral involvement or Mitochondrial implication in the immune reaction?

I AM GLAD FOR OUR TIME, A TRANSITION TIME FOR WHAT WILL BE THE MEDICINE OF THE NEXT 50 YEARS. AFTER THAT, HUMANS WILL GO INTO "NANO" IN MEDICINE,  I HOPE!


Post a Comment