Predictive, Preventive and Personalised Medicine as the hardcore of 'Horizon 2020': EPMA position paper

Abstract

The European Association for Predictive, Preventive and Personalised Medicine (EPMA) considers acute problems in medical sciences as well as the quality and management of medical services challenging health care systems in Europe and worldwide. This actuality has motivated the representatives of EPMA to comment on the efforts in promoting an integrative approach based on multidisciplinary expertise to advance health care-related research and management. The current paper provides a global overview of the problems related to medical services: pandemic scenario in the progression of common non-communicable diseases, delayed interventional approaches of reactive medicine, poor economy of health care systems, lack of specialised educational programmes, problematic ethical aspects of several treatments as well as inadequate communication among professional groups and policymakers. In the form of individual paragraphs, the article presents a consolidated position of PPPM professionals towards the new European programme 'Horizon 2020' providing the long-lasting instruments for scientific and technological progress in medical services and health care-related programmes. In the author's opinion, Horizon 2020 provides unlimited room for research and implementation in Predictive, Preventive and Personalised Medicine. However, the overall success of the programme strongly depends on the effective communication and consolidation of professionals relevant for PPPM as well as the communication quality with policymakers. Smart political decision is the prerequisite of the effective PPPM implementation in the health care sector. This position is focused on the patients' needs, innovative medical sciences, optimal health and disease management, expert recommendations for the relevant medical fields and optimal solutions which have a potential to advance health care services if the long-term strategies were to be effectively implemented as proposed here.

Figure 1

Book series Advances in Predictive, Preventive and Personalised Medicine. This is the specialised didactic material for Universities, medical centres and specialised international programmes [1].

Figure 2

Founder members of the Directorate. (from right to left) First line: V. Costigliola (President), O. Golubnitschaja (Secretary General). Second line: K. Krapfenbauer (Vice President responsible for European affairs), M. Kapalla (Director responsible for contacts with industry), S. Mandel (Vice President responsible for associated countries and contacts apart from Europe).

Figure 3

Predictive Diagnostics and Personalized Treatment: Dream or Reality. Editor: O. Golubnitschaja, ‘Nova Science Publishers’, New York, June 2009.

Figure 4

EPMA goes global in consensus with United Nations.Left to right: EPMA President, V. Costigliola, UNO Vice Secretary General S. Ordzhonikidze, EPMA Secretary General O. Golubnitschaja.

Figure 5

Global PPPM concepts for stakeholders, The EPMA Journal 2010 , Springer.

Figure 6

A series of the preparatory workshops by the EU-Commission in Brussels in order to create Horizon 2020. (from left to right) *OMICS in Personalised Medicine (workshop to explore the role of *omics in the development of personalised medicine); Clinical trials/regulatory aspects; Biomarkers for patient stratification; Opportunities and challenges for European health care.

Figure 7

European event of high importance, May 2011.

Figure 8

Bonn, Germany, September 2011. Over 40 countries have been represented at the EPMA World Congress in PPPM.

Figure 9

Brussels, September 2013: EPMA Summit in the EU Parliament.

Figure 10

Horizon 2020 as the long-term European programme to support research and the innovation.

Figure 11

Diagram illustrates the budget distribution in Horizon 2020.

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Horizon 2020 is focused on excellence in science, industrial leadership and tackling societal challenges.

Figure 13

Priorities of Horizon 2020 that correspond to those of Europe 2020 and Innovation Union.

Figure 14

Societal challenges prioritised within the Horizon 2020.

Figure 15

Worldwide prognosis of the DM pandemic. *Estimations as published around the year 2000. **Stepwise worsening prognosis as published in 2003–2008. Current prognosis is marked in red colour[10].

Figure 16

Severe complications/comorbidities developed secondary to diabetes. From ‘upstream’ (up) to ‘downstream’ (bottom) in the cascade of pathologic processes [10].

Figure 17

PPPM in pre/diabetes care. 3-Dimensional trans-domain coordinating and networking action by the EPMA responding to the challenges 1, 2 and 3, respectively. CVD cardiovascular disease, NNND neurological, neuropsychiatric and neurodegenerative diseases, DOP dental and oral pathologies, ID infectious diseases. DM affected regions: DM prevalence (million of patients) recorded in 2010 and predicted for 2030 with corresponding percentage of increase.

Figure 18

Potential mechanisms for the increased risk of both degenerative processes and malignancies under stress condition. The first part circled in green colour shows physiologic repair of damaged single cells. The second part circled in red colour demonstrates pathophysiologic processes leading either to degenerative or malignant transformations [12].

Figure 19

Moving from basic research to clinical implementation. Essential steps in creating the evidence-based platform for innovative technologies for early/predictive diagnostics and personalised treatments [13].

Figure 20

Specialised screening programmes and targeted preventive measures. Specialised screening programmes and targeted preventive measures are essential to be performed in newborns for timely protection against severe outcomes of perinatal complications such as birth asphyxia. An example: the correlation of TAU-protein levels (see the diagram) found between brain (mesencephalon, M) and blood samples and asphyxic newborns (A, PA) versus controls (C) allows the performance of minimally invasive blood tests to determine the specific brain damage potentially leading to sever long-term outcomes such as tauopathies (Alzheimer's disease and others) [14].

Figure 21

Metabolic particularities, impairments and individual outcomes by perinatal asphyxia.PPPM predictive, preventive and personalised medicine. Adapted from [14].

Figure 22

Proteomics imaging of blood biomarkers (ex vivo identification in circulating leukocytes) specific for normal-tension glaucoma (NTG). (A)Top: The pathology-specific protein-cluster is completely suppressed in both NTG and vasospasm in contrast to controls. (B)Bottom: The marked protein SSP2602 is highly up-regulated in both NTG and vasospasm; this protein normally does not express by circulating leukocytes of controls—healthy individuals without vasospasm [18].

Figure 23

Health care approaches. Current health care approach (A) versus advanced health care approach (B). The advanced health care approach considers a paradigm change from delayed interventional to predictive, preventive and personalised medicine as the robust platform for optimal medical services; figure is taken from [23].

Figure 24

Recommendations in PPPM. ‘Recommendations in PPPM’ is the collective product of world-leading experts working in the branches of PPPM under coordination of EPMA. The general report has been prepared as the consortial document proposed at the EPMA World Congress 2011 which took place in Bonn, Germany. This forum has analysed overall deficits and trends relevant for the top-science and daily practice in PPPM focused on the patient.

Figure 25

General scheme recommended for the implementation in the trans-disciplinary-action. Main deliverable and health care-relevant impacts are summarised utilising the synthesised PPPM expertise of individual domains relevant for predictive, preventive and personalised medicine in health care.