Technology plays role in decoding disease to target interventions


Amy S. Paller, MD

Amy S. Paller, MD, recognizes that the namesake for the Clarence S. Livingood, MD Memorial Award and Lectureship helped shape the field of dermatology to what it has become today.

“Clarence Livingood was a master clinician and educator. His approach to patients with a careful history, thorough physical examination, and sometimes a biopsy are still the mainstay of our practice today,” said Dr. Paller, the Walter J. Hamlin Professor and Chair of Dermatology and a professor of pediatrics at Northwestern University, Chicago.

Prior to her Sunday presentation, “Bedside to Bench and Back to Bedside,” Dr. Paller said that decoding of the genetic, epigenetic, and transcriptomic features of common and rare skin disease is defining new phenotypic classifications and beginning to shape practice. She said she sees a future in which big data will give physicians more personalized information and, thus, the means to provide more targeted therapies.

“Because technology is rapidly expanding and becoming much less expensive, it’s going to change the way we practice medicine. We’ll be able to diagnose and then treat in ways we cannot imagine,” said Dr. Paller. “We have just started to recognize the potential of technology. Within the next decade or two, the availability of new tests will lead to a very different way of practice.

“We’re lucky in dermatology because we have such amazing access to skin in a way that other specialists for other organs don’t. In the future, we’ll be able to take a very small biopsy, tape strips, or maybe even a noninvasive technology we can’t even imagine right now and rapidly get information that will tell us all about the disease in a particular person and how we can best treat it.”

She noted that high-throughput sequencing of targeted gene regions or even the whole exome is increasingly used to identify gene changes, and not just for rare genetic disorders.

“Targeted high-throughput sequencing is a new way to recognize the clonal populations of early cutaneous T-cell lymphoma and is a sensitive new way to detect recurrence, particularly in the blood,” Dr. Paller said.

Technology also can be used to assess expression patterns of mRNA and protein to understand better how disease impacts function, she said. Using technology to decode the mechanism of disease has led to the development of a range of biologics for psoriasis and is leading to new targeted interventions for other inflammatory skin disorders through suppression of immune activation.

“We’re in a new era with exciting new data, but it’s just the tip of the iceberg of what we’ll learn during the next few years,” Dr. Paller said. “I strongly suspect it will be commonplace another few years from now to add these techniques, done in a commercial laboratory, to our diagnostic evaluation and in deciding therapeutic directions that are best for our patients.

“Think about cost efficiencies in medicine. If these are low-price and if they get us where we need to go quickly, unnecessary visits will be eliminated. We can know to probe for likely comorbidities, and our therapies will be the ones predicted to best lead to responses for our patients.”

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