Trend of the Year 2013:
Genomics out, biochemistry in, for curing diseases?
Genomic variation and complexity are such that the genetic basis of most human diseases is going to require another decade or more to unravel completely, and even then it will be only partially explanatory, due to the profound role of the environment and of developmental history. Even when driver mutations are found and are targeted by a drug, the disease process may not be completely blocked, and alternative biological pathways may be recruited by the disease, as is the case in cancers.
However, diseases have key "vulnerabilities" at a metabolic and biochemical level that can be therapeutically attacked much sooner than that. Such metabolic targets are the result of the combinatoric integration of myriad mutations and environmental effects. For example, in psychiatry, the use of DHA (an omega-3 fatty acid), may correct membrane, signalling and inflammatory abnormalities that are responsible for vulnerability to stress, anxiety, mood and cognitive symptoms.
Genomics will still be important for scientific understanding in the long run, and for risk stratification and diagnostics in the short run.
Alexander B. Niculescu, III, MD, PhD