Clinical Perspectives in Diagnostic-omics and Personalized Medicine Approach to Monitor Effectiveness and Toxicity of Phytocomplexes

Abstract

The advances of systems medicine and network pharmacotoxicology, as well as 'omics diagnostic techniques, or “diagnostic-omics,” nowadays provide formidable new strategies and tools for a guided and assisted use of phytocomplexes. At the same time, personalized medicine might promote a larger and better use of medicinal plants, especially for prevention and wellness. Despite the increasingly information available from systems medicine, research is not yet fully exploited in the clinic, although the introduction of diagnostic-omics in routine medical care is becoming more relevant and meaningful every day, especially in pharmacotoxicology, and clinical pharmaco/toxico-genomics are increasingly performed for a more effective and safer use of drugs and medicinal plants.

In the last 20 years, at least two major scientific advances provided a major contribution to the present situation: the simultaneous detection of entire molecular families in a given biological system, and the ability to collect, classify, network, and visualize an unexpectedly large amount of analytical data through bio-informatics. The genomics area has been at the vanguard of this evolution. Currently, whole genome sequencing allows the identification of clinically actionable genetic information and is included in all major prospective studies that focus on personalized and precision medicine. Other “'omics” techniques, such as proteomics and metabonomics (except for a few meaningful examples such as lipidomics), although developed to high-quality standards and considered to be key operating procedures in systems medicine research, are still in the pipeline to be applied routinely in a clinical setting.

“'Omics” techniques are particularly appropriate for analyzing the biological effects of herbal drugs, which have multiple concomitant effects on several molecular targets. 'Omics techniques can assess simultaneous molecular effects, and bio-informatics allows researchers to look at such effects with a global view of the biological system. This approach is even more relevant when using multi-herbal mixtures, as in traditional medicines where plants are often used as blended herbal preparations − sometimes consisting of mixtures of mixtures − with each herbal component exerting its specific role, either as an effector, an enhancer, or a mitigator.

Systems biology-oriented P4 personalized (and precision) medicine can be envisioned as an ultra-advanced holistic approach to the patients who, based on their individual characteristics, can be monitored for prominent risk factors and treated using targeted therapies. The ability to identify individual health risk factors from the molecular to the environmental level is progressively leading to a shift from medicine to proactive medicine, and preventive and pre-emptive medicine. In this context, traditional herbal medicines, highly personalized in their approach and with the information that they provide on preventative strategies, can be exploited for integrative strategies, aimed at combining the best of deterministic and holistic medical traditions. The increase in the use of herbal medicines, while introducing new therapeutic strategies and potentiating those available, at the same time raises safety concerns that need to be addressed and managed to assure a positive balance between benefits and risks when using herbal products. In a fully personalized context, genetic profiling and a pharmaco-toxicological characterization of the patient should be performed before prescribing or administering any herbal product − especially if other drugs or herbs are being taken − given the potential inter-molecular pharmacokinetic and toxicologic interference.

A step-by-step description of the patient management in a personalized medicine context has finally been suggested, to explain how diagnostic-omics of pharmaco-toxicological interest can be applied when using herbal prescriptions. Key moments are highlighted, from taking a family history, to risk evaluation, to medication reconciliation. An example of how a future systems medicine approach could be introduced is also given, as well as how various diagnostic-omics profiling can be performed longitudinally in the same subject, so as to characterize the pharmaco-toxicological networks of the patient and then use them for personalization of therapy, toxicity prediction, and monitoring when using phytocomplexes.