Understanding Nanomedicine in the Context of Precision Medicine

November 15, 2016 Stephane Cornille

The hereditary 'big is better' doctrine is lost in the fascinating molecular world of nanotechnology.

Nanometre (nm) is derived from the Greek word for dwarf, and is equal to one-billionth of a metre. Nanotechnology is the manipulation and fabrication of the building blocks of the universe and it represents the intrepid opportunity to develop targeted drug delivery mechanisms, novel diagnostic techniques, and nanoscale medical devices.

Honey I shrunk the kids
At the turn of the 20th century, Nobel laureate immunologist Paul Ehrlich conceived, from the far off reaches of science fiction, a theoretical nanoscale 'magic bullet' which could be ingested or injected to deliver a targeted and precise medicinal payload. Current drugs are indiscriminate in their carpet-bombing method of madness, often killing both the diseased and healthy cells on their aimless and chaotic path to their target destination. Today, almost 100 years later, science fiction is no longer fiction, with the regulatory approval of over 247 nanoscale drug delivery vehicles. Miracle miniscule 'magic bullets', over a thousand times smaller than the width of a human hair, are enabling the precise, efficient and targeted delivery of drugs to predesignated sites; reducing the standard dosage typically required to be administered to patients. 

Brain cancer is one of the most arduous and pernicious diseases to treat due to the complexity of traversing the Blood-Brain Barrier, a dynamic and laudable safeguard which separates the circulatory system and prevents the admission of foreign chemicals to the central nervous system in the brain. By binding traditional anti-cancer drugs to nanoscale drug delivery systems, it becomes possible for these drugs to cross that barrier intact and circulate within the brain. With medication non-adherence rates as high as 75%, a nanodrug delivery system could systematically reduce non-adherence, while mitigating the distribution of drugs to non-target sites, all the while maintaining the diffusion of a precise dosage concentration within the predesignated therapeutic window.

Safety in numbers
While nanocarriers are able to deliver precise dosage concentrations to targeted areas, their minute size results in a perverse trade-off between quantity and marksmanship. Taking a page from nature's own cosmic chronicle, swarm intelligence is the collective self-organised, self-directed behaviour of separate decentralised systems – think a school of fish or flock of birds swarming together in an ordered manner. The intelligence and impact of each individual nanobot is negligible when compared to a contrasting collection of colluding nanobots uniting to accomplish an unequivocal common directive. The coordinated behaviour and communication of nanobots through swarm intelligence will enable them to accomplish their task in a methodical and efficient manner. On deployment, nanobots could be individually programmed with different directives, searching and circulating the blood stream. An individual nanobot could then communicate with its friends and co, each with their own unique directive, and request that they all band together to change their coating, charge or size to more effectively monitor the presence of foreign bodies, diagnose, or target diseased tissue.

Sensing the quantified self
Not limited to drug running or observation vehicles, nanomedicine will unlock near limitless sensing capabilities which can be used to monitor and measure the quantified self. Injectable nanoscale particles will soon eliminate the need for diabetes patients to monitor their glucose levels by acting as an artificial pancreas. Using mice with Type 1 diabetes, scientists at MIT discovered that with the injection of biocompatible and biodegradable nanoparticles, mice could maintain normal blood-sugar levels. Nanoparticles can acutely sense when glucose levels are raised and respond by releasing insulin, removing the need for self-observation and self-administration of insulin. Nanoparticles injected into the human bloodstream will also be able to proactively seek out disease by detecting select enzymes that are characteristic with the growth of tumors. Millions of sensors could be created and deployed within the human body to target different diseases at different stages or phases, a truly proactive and individualised approach to healthcare.

From chaos comes order
Sequential to the unstoppable march of nanobots is the rise of distinctively unsettling self-replicating nanobots. Crucial to the success of nanotechnology is the ability to efficiently and economically construct numerous products. Nanobots could soon be capable of autonomous self-replication using just raw materials found in the surrounding environment, representing an astute opportunity to achieve nanotechnology's loftiest goals. Not just limited to the humble confines of patrolling our blood stream, self-replicating nanobots could turn raw material into food or shelter, or restore the ozone layer, all of which could herald an optimistic expectation for the future of humanity. But, unconstrained, self-replicating nanobots (which can use the combined sum of themselves to invoke a higher combined level of intelligence) represent a dangerous new precedent. Moore’s Law presents a 'grey goo' underbelly scenario where just a couple of days of unchecked nanobot self-replication could result in nanobots’ spawn, which would outweigh the entire earth, and perhaps end all humanity.

By inviting an artificial mechanical helping hand into our bodies, we have the opportunity to help each and every individual from the inside-out, the true definition of proactive, preventative and personalized medicine. Employing nanobots to comprehensively and precisely monitor, diagnose, repair and improve the human condition from a molecular level represents an opportunity to alleviate pain and suffering, so much so that once we overcome our initial hesitation and second guessing, it will be viewed as unethical not to open the front door and welcome them in.

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