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Personalized, or precision, medicine is a revolutionary and emerging field of healthcare that aims to provide medication on a completely bespoke and individually tailored level. It considers a range of factors, including a person’s genetic makeup, lifestyle and the environment they find themselves in. This will help to alleviate negative side effects and optimize effectiveness in conquering chronic conditions and diseases. In this article, we look into what defines personalized medicine, how it works and all the benefits that lie within this future of medicinal chemistry.

What defines personalized medicine?

Personalized medicine (also referred to as precision medicine) is the process of tailoring medication to an individual person, rather than treating them as part of a larger group. It gravitates away from a “one size fits all” approach that is used presently in the world of medicine. This helps to give people bespoke health solutions, that work in synergy with them as an individual. Personalized medicine will help to limit the negative side effects of drugs many people experience, plus optimize health outcomes. It is also hoped that more accurate and tailored diagnoses will become possible with the rise of precision medicine, as well as a greater ability to predict potential future illnesses a person might be a risk of, depending on their genetic makeup and environment.

How does personalized medicine work?

Personalized medicine ostensibly aims to optimize the performance of drugs based on a patient’s genetic characteristics, as well as their lifestyle and accounting for environmental factors. These are the following processes for precision medicine.

Genetic tests:

As genetic factors play a huge part in tailoring medicine to a patient's individual needs, the first step in this process is genetic testing. This analyses a person’s DNA to identify any genetic variations that might impact how well their body responds to standard medicine. These tests also reveal knowledge about a person’s genes, involved in drug metabolism, targets and transporters. These tests are vital in identifying the most effective type of medicine to prescribe to a patient, as well as being able to rule out medicines that won’t work with their body.

Pharmacogenomics:

Pharmacogenomics is a field of medicine that studies and examines how a patient’s genetic variations will affect how they respond to drugs. After genetic testing, pharmacogenomics will be used to identify a person’s perfect drug match. It involves identifying specific genetic markers associated with responses to drugs, and the effect this has on a medication's overall safety and effectiveness. Extensive research and trials now mean that scientists have established associations between genetic variations and drug responses for a number of commonly prescribed medications.

Treatment recommendations:

After information has been obtained from genetic testing and then analyzed against pharmacogenomic findings, doctors are in the best position to make personalized medication recommendations. These recommendations may include prescribing a specific type of medication and the correct dosage according to the individual patient’s needs. An example of a personalized medication recommendation would be if a person’s genetic makeup has been identified to react poorly with the typical drug given to their condition, a doctor may look to suggest another drug that will react positively.

Necessary Adjustments:

As with medicine types, instructed dosages of medicines don’t apply to all. Some patients may benefit from more, less, or a different rate of frequency to optimize the positive effects on their bodies. Adjustments may need to be made to the prescribed dosing of a drug so a patient can feel the best effects, as well as limit negative side effects. Genetic variations, for example, can affect how quickly a person metabolizes medication, which influences efficacy and the risk of side effects. Making tailored dosage adjustments can help maximize the benefits of a drug, while also limiting other effects.

Monitoring:

Once a drug has been prescribed for a patient’s use, healthcare professionals may need to monitor how their body responds to the drug. Regular assessments allow doctors to evaluate the effectiveness of a drug over time and also ensure that it remains safe for patient use. This close monitoring means further necessary adjustments can be made to help boost the effectiveness of a treatment, bespoke to a patient’s needs.

The benefits of personalized medicine

Reduces trial and error prescriptions:

One of the main benefits of personalized medicine is that it presents a higher chance of providing a patient with effective medication the first time around. Current healthcare practices often go through a “trial and error” method of offering patients drugs to treat negative health symptoms. This can often put a patient through great stress, not only dealing with side effects but also having to wait longer to receive effective solutions. Personalized medicine aims to align patients with a drug match that will work for their bodies, rather than cycles of trialling different medicines.

Limits negative drug reactions:

While all drug development aims for medication to be as safe as possible, many products still cause adverse reactions. This is typically due to the fact a drug is not suited to a specific person and their genetic makeup. Precision medicine, however, uses genetic testing and pharmacogenomic knowledge to assess how a person might react to a specific medication. This allows for prescriptions to be made that not only work more effectively but also limit negative drug reactions and the experience of the patient as a whole.

Make patients more compliant:

One of the biggest problems that comes with the negative side effects of medications, is that it makes patients far more compliant in taking a full course of their prescribed drugs. This proves even more of an issue when certain medical conditions and diseases are only exasperated when left untreated without the appropriate medication. Personalized medication allows patients to be given drugs that limit negative side effects, therefore making them more engaged with the process. A precision, tailored experience also allows patients to feel an active part of their recovery, allowing them to better understand their genetic risks and their different options.

Allows for earlier disease diagnosis:

The various genetic tests that are carried out as part of the personalized medicine process also allow for diseases to be more easily detected at early stages. For certain diseases, like some cancers, early detection and treatment is vital in helping improve the survival rate of a patient. Precision medicine overall makes it easier to identify medical conditions and diseases, therefore being able to provide accurate and effective treatment plans.

Cost-effective:

While the genetic testing and profiling that must occur initially with precision medicine can be costly, this process has the potential to be more cost-effective long term than standard procedures. This is because personalized medicine can avoid unnecessary treatments and medication trials and the costs that go along with them.

Advancing of medical research:

The growth of precision medicine helps to generate huge amounts of data, which in turn contributes to a growing advancement in medical research. There more commonplace personalized treatments become, the better-placed healthcare professionals will become to develop targeted and innovative treatments.

In conclusion, personalized medicine could prove a revolutionary asset to healthcare globally. It is the process of tailoring a patient's medical experience bespoke to their genetic needs, rather than treating their recovery as a “one size fits all” process.

References:

ACS Cent. Sci. 2015, 1, 1, 11–13 Publication Date:March 23, 2015 https://doi.org/10.1021/acscentsci.5b00088 

Duburs, G., Neibecker, D., & Žarković, N. (2012). Chemistry and personalized medicine - the research and development future of Europe. Croatian medical journal, 53(4), 291–293. https://doi.org/10.3325/cmj.2012.53.29 

 Jack K H, Christopher K. The Influence of Chemistry on Personalized Medicine. Curr Trends Biomedical Eng & Biosci. 2017; 6(3): 555689.DOI:10.19080/CTBEB.2017.06.555689. 

Watkins, J. B., Marsh, A., Taylor, P. C., & Singer, D. R. J. (2010). Personalized medicine: the impact on chemistry. Therapeutic Delivery, 1(5), 651–665. https://doi.org/10.4155/tde.10.64 

Understanding how our bodies process medication and the chemical reactions that take place is vital for providing effective healthcare. An understanding of pharmacokinetics, the study of substances and their effect on the body, can give us a better understanding of human health as a whole. It can also help medicinal chemists develop effective drugs and therapeutic solutions for viruses and diseases. In this article, we look into pharmacokinetics and the 4 stages of processing our bodies go through when administered medicines.

What is pharmacokinetics?

Pharmacokinetics, or PK for short, is the study of how substances like drugs and medication interact with the body. It investigates the chemical reactions that take place and how the body responds throughout the entire exposure to a drug. There are 4 main processes that occur in pharmacokinetics, each of which provides valuable information about how medications target particular areas of the body. This can allow healthcare providers to administer or prescribe medications that expose patients to the lowest risk of side effects and optimized solutions to their health complaints.

How the body processes medication in 4 stages

ABSORPTION

At this stage, a drug (be it in the form of a capsule, or tablet) is brought into the body and systemic circulation. The absorption stage affects not only the speed at which medication enters the body but also the concentration of the drug that will arrive at its desired location. There are multiple ways that medication can be absorbed into the body, most commonly this is either orally or intravenously. Each method of administration has different characteristics, with advantages and disadvantages. Once a drug has successfully moved into the systemic circulation, it can be distributed throughout the body or to a desired area.

DISTRIBUTION

This process refers to how a drug spreads through the body after administration. There are many factors that can affect the distribution of medicines, including the biochemical properties of the drug itself, the physiological makeup of the person taking it blood flow and the permeability of tissues. It is influenced in two main ways: diffusion and convection. Factors such as these can be affected by the binding abilities of a drug, as well as how well a person is hydrated and their protein concentrations.

The main goal of this stage of medication processing is to achieve effective drug concentration. Put simply, this means ensuring the drug reaches its desired site in the body. Medication can only be considered effective if it reaches this location, and not be protein-bound for complete activity. It’s possible for drugs to accumulate in certain organs and tissues in the body, which leads to variations in their concentrations throughout the body.

METABOLISM

The metabolic stage of drug processing is when crucial chemical reactions take place. The main aim of drug metabolism is to convert the medicine into more water-soluble substances. Metabolism primarily occurs in the liver but can also take place in other areas of the body, such as the kidneys and lungs. The liver contains a large amount of enzymes required for the chemical reactions in drug processing. Medical metabolism can be broken down into two parts: phase I and phase II.

Phase I:

In this primary phase of drug metabolism, the molecules of the substance are modified through various chemical reactions. Commonly, this involved reactions like oxidation, reduction, and hydrolysis in phase I. Catalyzed by enzymes, functional groups, such as hydroxyl, amine, or carboxyl groups on the drug molecule are exposed or added to. This all helps to increase the water solubility of a drug, making it easier to expel from the body.

Phase II:

During the second phase of metabolism, the ingested drug is conjugated with endogenous molecules. This means that a large polar molecule is added, which further increases a drug's water solubility. Conjugating molecules include glucuronic acid, sulfate, glycine, or glutathione. This phase of metabolism is catalyzed by enzymes like UDP-glucuronosyltransferases (UGTs), sulfotransferases (SULTs), and glutathione S-transferases (GSTs). This process further assists in helping drugs be excreted from the body.

EXCRETION

This is the final process medications go through within the body. Excretion is when drugs are eliminated from our internal system, and this usually takes place within the kidneys (and then into our urine). With certain drugs, however, the process of excretion may happen in the lungs, skin, or gastrointestinal tract. This can mean other routes of exit from the body including feces, sweat, salvia and exhaled air. The rate of excretion can depend on factors like renal function, hepatic clearance, and drug half-life (the time for serum drug concentrations to decrease by 50%).

To conclude, it’s important to understand pharmacokinetics and the stages of medication processing in our bodies. This allows for better treatment for patients, as well as the development of optimized drugs that work with the chemical reactions in our bodies. With this knowledge, we can improve drug therapy, limit harmful side effects, and ensure the continued safe use of medicines.

The need for sustainable approaches and practices is being felt in all industries, including the field of pharmacology. So-called “green chemistry” is being pushed for more than ever by the modern environmental movement, in which they’re asking for more consideration when developing new drugs and pharmaceutical products. The medicine industry undoubtedly has a role to play in the world’s growing climate crisis, and now is the time to act for a greener future. In this article, we take a deeper dive into what defines green chemistry, its importance and innovative eco measures already being taken for a more sustainable pharmaceutical climate.

What defines green chemistry?

Green chemistry is a growing scientific approach that aims to both reduce the number of hazardous substances used in pharmacology production and limit the environmental effects of chemical and medicinal products throughout the course of their lifecycle. Scientists, and founding fathers of the green chemistry movement, Paul Anastas and John Warner developed 12 key principles in 1998 for a cleaner, greener industry. They are as follows:

1. Prevention - it is better to prevent waste from being caused in the first place than have to treat or clear up when it has formed.

2. Atom economy - synthetic methods of production should aim to maximise the incorporation of materials used for the final product.

3. Less Hazardous Chemical Syntheses - where possible, synthesis should be designed and used to have a limited (or no) toxic effect on humans and the environment.

4. Designing Safer Chemicals - chemical products and medicines should aim to be effective with as minimal toxicity as possible.

5. Safer Solvents and Auxiliaries - auxiliary solvents should only be used when absolutely necessary.

6. Design for Energy Efficiency - the energy required for chemical processing should be monitored and minimized where possible.

7. Use of Renewable Feedstocks - raw materials and feedstocks should be renewable rather than depleting.

8. Reduce Derivatives - unnecessary derivatization should be avoided and minimized to avoid generating more waste.

9. Catalysis - the use of catalytic reagents should take priority and there is no excess waste at the end of the process.

10. Design for Degradation - chemical products should be formulated so they naturally degrade at the end of their lifespan without damage to the environment.

11. Real-time analysis for Pollution Prevention - methods must be developed to allow real-time analysis of environmental harm before hazardous substances are formed.

12. Inherently Safer Chemistry for Accident Prevention - substances within chemical production should be chosen for their safety and minimal potential for hazardous accidents.

Why is eco-friendly medicine important?

Chemical and medicinal practices that are eco-conscious are hugely important not only for the health of our natural world but also for the population as a whole. Find out more about the need for sustainable medicine below.

Limits impact on the environment

The release of harmful chemical waste is just one of the ways that the pharmaceutical industry contributes to global pollution. The entire production and disposal process of medicine has already proved detrimental for the generations ahead of us who will have to rectify our environmental failures. Taking a more sustainable approach helps to recover, limit, and prevent this global damage.

Improves human health

Our worldwide health is also directly impacted by environmental pollution in the pharmaceutical industry. Improper disposal of waste can lead humans to become exposed to hazardous substances and materials, contributing to land and water pollution. Using, for example, more biodegradable materials avoid waste from severely impacting the environment.

Boosts resource efficiency

Pharmacology has historically depleted many raw materials and energy sources in the production of medicines and medical products. Choosing to act in a more resource-efficient way allows for conservation, limits on costs, and leads to less environmental pollution.

Tackles growing health challenges.

With a growing concern for the rise in antibiotic-resistant strains of bacteria and cancers that require targeted treatments, new, sustainable pharmaceuticals may also help to address a wide range of health challenges our population faces globally.

New sustainable approaches in the medical field

While there remains much work to be done to ensure pharmacology is fully sustainable, several eco-initiatives are already being taken. Read about just a few of the new sustainable approaches in the field of medicine below:

Greener drug synthesis

In what is a notoriously energy-consuming process that generates significant waste pollution, new steps are being taken to make drug synthesis greener. Some drug companies are now opting to use flow chemistry for example. This involves the use of small reactors that continuously mix and cause chemical reactions, rather than the traditional batch processing. Flow chemistry is an effective example of how to preserve energy and limit waste output, while at the same time boosting efficiency and the rate of reaction.

Eco-conscious packaging

Huge amounts of packaging is used in modern medicine to appropriately store products, sadly this also means huge amounts of waste that cannot naturally biodegrade. In recent years, changes are being made to make packaging and casings from renewable resources that can then be broken down via composting, for example. Another route would be to use packaging that can be reused, extending the materials’ life cycle, and therefore reducing waste.

Sustainable solvents

Solvents are a common element of medical research, used to dissolve and extract chemicals for drug creation and production. They can, however, be very harmful to the environment and human health when disposed of. To counter this toxicity, scientists are expanding the use of “green” solvents that are made from renewable, non-toxic substances. They are also far more energy efficient and designed to reduce the waste created during manufacturing processes. Alternatively, an approach of solvent-free methods like grinding or melting can be used to extract chemicals without the need for solvents.

Optimizing production processes

Identifying and implementing more efficient and sustainable methods of production (limiting energy consumption) is another step towards greener pharmacology. One of the best ways scientists can optimize their production process is through continuous manufacturing. This involves making a product in continuous flow, rather than in batches. Continuous manufacturing can reduce waste, energy usage and the use of solvents. Another example of an optimized production process would be intensification. This is where advanced technologies are used to streamline and simplify production, which in turn limits excess waste. Microfluidic devices, for example, can be used to automate chemical reactions, improving the efficiency of drug development.

Use of biobased feedstocks

Feedstocks are used in the creation of medical products like drugs, bioplastics, and biofuels. These feedstocks have an environmental impact that is being resolved using renewable, biomass sources. For example, bio-based plastics are now able to be used in medical packaging and disposable devices. Biofuels (like bioethanol and biodiesel) can now be made from plant feedstocks such as sugarcane and corn, which serves as an alternative to fossil fuels. Plant-based compounds are also starting to be used in drug production, with renewable materials creating tissue scaffolds in regenerative medicine.

Use of bioenergy

Bioenergy uses energy that comes from organic, renewable materials. This includes plants and food waste which is then used to power facilities of medical equipment necessary for drug production. The production of biogas from waste materials like manure is a great example of bioenergy. It can be used to generate heat and electricity which is also able to power medical tools and devices. Biomass is an organic material that can be burnt to naturally generate heat or steam, which can in turn be used in medical practices. 

To conclude, a stricter focus on sustainability should be at the forefront of the developing medical field. This is a crucial step that must be taken by the pharmaceutical field to protect both our environment and human health. Through the sourcing of renewable and natural materials, optimization of energy and processing and more eco-conscious packaging and solvents, we can help to combat a growing global crisis.

References:

Agbenyega, J., PhD. (2022, September 23). Green chemistry in the pharma industry: Sustainable pastures for those who innovate. CAS. https://www.cas.org/resources/cas-insights/sustainability/green-chemistry-pharma-industry

Constable, D. J. C. (2021). Green and sustainable chemistry – The case for a systems-based, interdisciplinary approach. iScience, 24(12), 103489. https://doi.org/10.1016/j.isci.2021.103489

Making chemistry greener. (2015, April 15). ScienceDaily. https://www.sciencedaily.com/releases/2015/04/150421163327.htm

Moermond, C., Puhlmann, N., Brown, A. R., Owen, S. F., Ryan, J., Snape, J., Venhuis, B. J., & Kümmerer, K. (2022). GREENER Pharmaceuticals for more sustainable healthcare. Environmental Science and Technology Letters, 9(9), 699–705. https://doi.org/10.1021/acs.estlett.2c00446

Neurodegenerative disorders are those which result in neuron loss in the brain. They can be debilitating and pose severe challenges to patients, with the most common diseases being Alzheimer's, Parkinson's and Huntington’s disease. Highly complex in nature, these conditions often require a multidisciplinary approach and while medicines can assist with associated symptoms, there are yet to be effective drugs that successfully manage them. In this article, we take a look into the different medical approaches available to help support those diagnosed with neurodegenerative diseases.

What is a neurodegenerative disease?

A condition or disease that triggers neurodegeneration involves a pathophysiological change in the brain. These diseases often affect older people and tend to get worse over time until death, often causing a great deal of mental and physical harm to both the person suffering from the disease and the family and support network around them. Neurodegenerative conditions occur when cells in the central nervous system begin to stop working or die, there are currently no cures for these kinds of diseases. While many neurodegenerative diseases can be caused by genetics, they may also occur as the result of a stroke or tumour.

Common neurodegenerative diseases and their impact

Alzheimer's Disease:

Alzheimer’s is a progressive neurodegenerative disease that characteristically involves deteriorating memory loss and cognitive decline. It is considered the most common cause of dementia worldwide and there remain limited effective therapies for patients to help counteract their symptoms and provide a better quality of life. Alongside memory loss, symptoms of Alzheimer's disease include:

●      Difficulty partaking in conversation and finding the right words.

●      Inability to plan or perform regular tasks.

●      Limited ability to make appropriate judgements.

●      A change in personality and behaviour.

●      Withdrawal from social activities.

Parkinson’s Disease:

Parkinson’s is a progressive neurological condition that often leads to muscle stiffness and tremors, as well as balance and coordination issues. While age is considered a triggering factor for Parkinson’s disease, caffeine intake, smoking, and exposure to environmental toxins are also thought to contribute to your likelihood of developing the condition. The symptoms caused by Parkinson’s are due to a gradual loss of dopamine-producing cells in the brain in an area called the substantia nigra. Other symptoms include:

●      Bradykinesia- the slowing down of movement and activities.

●      Sleep disturbances.

●      Cognitive changes and memory challenges.

●      Speech and swallowing complications.

Huntington’s Disease:

Huntington’s is a genetic neurodegenerative disorder that affects the central nervous system. It involves the degeneration of nerve cells in specific parts of the brain. This in turn leads to a wider range of motor, cognitive and psychiatric symptoms. Huntington’s disease is caused by a chromosome mutation that is passed down through families. The most common symptoms of this disease are:

●      Motor issues like involuntary muscle movement, rigidity, stiffness and difficulty with speech.

●      Cognitive issues such as memory loss, inability to plan and problem solve and slowed processing and thinking.

●      Psychiatric issues that include the development of mental health conditions like depression and anxiety, social withdrawal and hallucinations and delusions.

 Medical approaches to neurodegenerative diseases

Alzheimer's Disease

As Alzheimer’s is a neurodegenerative disease with no cure, therapies mainly attempt to limit negative symptoms and slow the progression of the condition. This is commonly achieved through various drugs and medical approaches.

Cholinesterase Inhibitors:

This class of medications is the first-line approach to Alzheimer’s, which work by blocking the activity of an enzyme known as acetylcholinesterase, which breaks down acetylcholine, a neurotransmitter responsible for memory and cognitive function. The three main cholinesterase inhibitors are donepezil, rivastigmine, and galantamine. Studies have shown that taking these drugs helped to reduce cognitive decline, helping to improve communication between nerve cells.

1. Donepezil - used to treat mild to severe forms of Alzheimer’s disease. It’s typically given in tablet form to be taken once a day by patients.

2. Rivastigmine - this drug is used to treat mild to moderate cases of the disease, and is available in both tablet and transdermal patch forms.

3. Galantamine - this cholinesterase inhibitor is also given to treat mild to moderate forms of Alzheimer’s disease. It is given in capsule and extended-release capsule forms.

Glutamate Regulators:

Glutamate is a type of abundant excitatory neurotransmitter associated with various brain functions like memory, learning and synaptic plasticity. Excessive activation of these neurotransmitters (as is linked with Alzheimer’s disease) means that games can incur damage, leading to gradual cognitive decline. This is known as excitotoxicity, referring to the damaging and killing of nerve cells.

There is currently only one type of glutamate regulator that has been approved for use with Alzheimer’s patients. Memantine is used to treat moderate to serve cases of the disease and works as an N-methyl-D-aspartate (NMDA) receptor antagonist. The drug binds to NMDA receptors, which regulate glutamate and contribute to synaptic plasticity. By blocking these receptors, memantine aims to prevent excess neurostimulation and rapid cognitive decline. Studies have found this glutamate regulator to be effective in limiting patient cognitive degradation, especially when used in combination with other drugs. However, while it addresses the symptoms of Alzheimer's disease, it fails to change the pathology.

Parkinson’s Disease:

Despite the fact that Parkinson’s disease is the second most common neurodegenerative condition after Alzheimer's, there remains to be a range of effective therapies that successfully alter the pathology of the disease. In lieu of this, treatments to address the symptoms are offered to provide relief for patients living with motor and non-motor-related difficulties.

Levodopa:

The main approach to managing the symptoms of Parkinson’s disease is by replenishing the lacking dopamine levels, found in the substantia nigra section of the brain. This is typically done by using a combination of two drugs: levodopa and carbidopa. Levodopa immediately initiates the conversion of dopamine in the brain, which in turn assists with rectifying levels of motor function. Carbidopa then works to stop the breakdown of levodopa before it can reach the brain.

As with all neurodegenerative conditions, Parkinson’s disease can also lead to many non-motor symptoms, including mental health conditions like depression, dementia and psychosis. These are also treated symptomatically with appropriate medications, for example, rivastigmine and clozapine.

Huntington’s Disease:

There is no cure for Huntington’s disease, nor are there current drugs available to slow the progression of the condition. However, certain medications are prescribed to patients to help offer relief from negative symptoms.

1. Tetrabenazine and Deutetrabenazine - both of these medications help with managing chorea (a movement disorder that becomes present with Huntington’s disease). They work to limit the excess production of dopamine activity in the brain.

2. Antipsychotics - drugs like haloperidol and risperidone may be prescribed to help alleviate the psychosis symptoms that can come with this condition.

The challenges when delivering brain drugs

The current treatments and therapies for neurodegenerative conditions aim to delay the progression of symptoms, rather than having the ability to eliminate the actual cause. Many drug formulations fail to reach the source of this neurodegeneration: behind the blood-brain barrier. 

Blood-brain barrier:

The blood-brain barrier, or BBB as it is commonly referred to, is a diffusion barrier that stops foreign substances in the blood from entering the brain. This then makes it hard, if not impossible, for many drugs and larger molecules to pass through this passage within the bloodstream. Tight junctions are created between endothelial cells within brain capillaries, this in turn prevents the entry of therapeutic agents. Overcoming the BBB is one of the most significant challenges medicinal chemists face when creating drugs that can enter the brain and limit degeneration.

Pharmacokinetics:

The efficacy of drugs is significantly determined by their pharmacokinetic properties. Depending on their individual characteristics, some medication molecules face issues like becoming bound to proteins in the bloodstream and cell alteration. Typically, small and lipophilic molecules are best suited for brain-drug delivery, as they face less risk of decreased efficacy when travelling through the bloodstream.

Nanoparticles: a promising solution

Due to the limitations and disadvantages of current medical therapies, caused by the blood-brain barrier and pharmacokinetics, new approaches are required to best support patients living with neurodegenerative diseases. Nanotechnology is emerging as a promising solution for targeted drug delivery in the brain and central nervous system.

This technology has the ability to create medical substances and drugs on a nanoscale, typically ranging between 1-1000nm. Materials such as natural polymers, synthetic polymers and inorganic materials have all successfully been employed to create nanoparticles. Nanocarriers have proved highly effective and suitable when used as drug carriers to the brain. Their minute size means they have less trouble getting through the brain-blood barrier and successfully reaching their desired site.

In conclusion, neurodegenerative diseases are highly complex and often require a combination of medical treatments to address all symptoms. While diseases like Alzheimer's, Parkinson’s and Huntington’s as yet remain incurable, there is a range of medicinal and therapeutic approaches to help limit neurodegeneration. There are certain challenges faced when creating brain-delivery drugs, (for example, the inability for large molecules to pass through the BBB) but this will hopefully be rectified with the emergence of nanoparticle technology. 

Medical Approaches to Neurodegenerative Diseases (Youth)

Neurodegenerative disorders affect the structure and function of the nervous system and brain. There are currently no cures for these types of diseases, and medication is given mainly to slow down the process or ease the negative side effects that come with the condition. The three main neurodegenerative diseases are Alzheimer's, Parkinson's and Huntington’s, with each affecting the body and mind slightly differently but all with similar symptoms and effects. These diseases are very complex to treat and therefore may need a combination of different drugs and therapies to address. In this article, we take a look into the most common neurodegenerative diseases, how they affect the body and the medical treatments given to patients.

What is a neurodegenerative disease?

A neurodegenerative disease is a kind of illness that affects both the brain and the body’s nervous system, leading them to stop working properly over time. These conditions are referred to as “neurodegenerative” because the cells in the brain and nerves gradually degenerate and die. Although these diseases often affect older people, conditions like Alzheimer’s disease, Parkinson’s disease and Huntington’s disease can affect people of all ages.

Neurodegenerative diseases worsen over time, causing a great deal of mental and physical harm for both the person living with the condition and their family and support network. There are currently no cures for these types of diseases, and medical attention looks to reduce symptoms and slow the progression of the condition instead. While they can be caused by genetics, neurodegenerative diseases can also be the result of strokes and tumours.

Common neurodegenerative diseases and their impact

Alzheimer's Disease:

Alzheimer’s is a progressive neurodegenerative disease where a person’s brain cells start to experience damage and die. One of the main symptoms of this disease is memory loss, meaning someone with Alzheimer’s is likely to forget things easily or become confused in familiar situations. Someone with this disease may also struggle with:

●      Taking part in conversations or finding the right words.

●      Plan well and complete regular tasks.

●      Making judgements and decisions.

●      Social activities.

Parkinson’s Disease:

Parkinson’s is another progressive neurological condition that affects a person’s ability to move normally. This is caused by cells in the brain becoming damaged or dying, in particular, the ones that control our movements and muscles. People living with Parkinson’s disease experience stiffness of muscles and limbs and struggle with balance and coordination. Even though older age makes you more likely to develop Parkinson’s, caffeine, smoking, and exposure to environmental toxins have also been linked to the disease. Other symptoms include:

●      Bradykinesia- a slowing down of movement and activities.

●      Sleeping problems.

●      Loss of memory.

●      Struggling with speech.

●      Difficulty swallowing.

Huntington’s Disease:

Huntington’s is a genetic neurodegenerative disorder that affects the central nervous system, caused by the passing down of a specific chromosome mutation. This rare genetic disorder affects the brain, causing nerve cells in a specific part of the brain to break down and eventually die. When someone has Huntington’s disease, they typically experience a loss of control in their limbs and movements. Other symptoms include:

●      Stiffness in the muscles.

●      Memory loss.

●      Slowed down processing and thinking.

●      Mental health issues like depression, anxiety and even hallucinations and delusions.

Medical treatments for neurodegenerative diseases

Alzheimer's Disease

As there is no cure for a neurodegenerative disease like Alzheimer’s. Drugs and therapies instead try to slow the progression of the condition and give relief to negative symptoms. Discover more about the treatment of Alzheimer's disease below:

Cholinesterase Inhibitors:

One of the common types of drugs used to treat Alzheimer's disease are known as cholinesterase inhibitors. They work by blocking an enzyme called acetylcholinesterase which breaks down acetylcholine, a neurotransmitter that allows a healthy memory and cognitive function. The three main cholinesterase inhibitors that are used to treat the symptoms of Alzheimer's are donepezil, rivastigmine, and galantamine. Medical studies of patients using these drugs have found that they can reduce mental decline and improve communication between nerve cells.

1. Donepezil - used to treat mild to severe types of Alzheimer’s disease. It’s typically given in the form of a tablet and is taken once a day.

2. Rivastigmine - this drug is used to treat mild to moderate cases of the disease, and is available in both tablet and transdermal patch forms. These are medicine patches that stick to the skin and slowly release the drug into a patient's bloodstream.

3. Galantamine - this cholinesterase inhibitor is also given to treat mild to moderate forms of Alzheimer’s disease. It is given in capsule and extended-release capsule forms. These extended-release capsules also release medication slowly, removing the need for multiple drug doses.

Glutamate Regulators:

These medications assist with regulating a chemical in the brain called glutamate. This chemical is a vital neurotransmitter that helps send signals between nerve cells and the brain. Glutamate assists with various brain functions like memory, learning and synaptic plasticity (the ability of our nerve cells to make connections). If a person has Alzheimer’s, they may have too much glutamate being produced, which causes an overexcitement of the nerve cells which leads to damage and death.

Currently, there is only one kind of glutamate regulator drug that has been approved for use with Alzheimer’s patients called memantine. This medication is sometimes given to those living with moderate to severe cases of Alzheimer's. It works as an N-methyl-D-aspartate (NMDA) receptor antagonist, meaning it blocks or reduces the activity of certain receptors that transmits messages between nerve cells. It does so by binding to NMDA receptors, which help to regulate the production of glutamate. Studies on Alzheimer's have shown that memantine can be effective in limiting the cognitive decline of patients, especially when used in combination with other drugs. However, while it addresses the symptoms of the disease it does not change the pathology (i.e. how the disease affects the body).

Parkinson’s Disease:

Parkinson’s disease is the second most common neurodegenerative disease after Alzheimer’s, however, there are still limited therapies and medical solutions to help support patients in altering how the condition affects their bodies. Instead, drugs are offered to provide pain relief to the physical and mental side effects of Parkinson’s.

Levodopa:

One of the main drugs used to treat Parkinson’s disease is called levodopa. This helps to increase the amount of dopamine created in the substantia nigra section of the brain. Low dopamine levels are a common side effect of Parkinson’s disease, which leads to gradual nerve cell damage and death. In order to raise these levels and limit cognitive decline, levodopa is administered combined with another drug called carbidopa. When taken, levodopa immediately triggers the creation of dopamine in the brain, helping with healthy motor function. Carbidopa helps stop the breakdown of levodopa before it has a chance to reach the brain.

Huntington’s Disease:

There is currently no cure for Huntington’s disease, nor are there drugs that have been developed with the ability to slow the condition. However, certain medications are prescribed to patients to that can offer relief from symptoms.

1. Tetrabenazine and Deutetrabenazine - both of these medications help with managing chorea (a movement disorder that becomes present with Huntington’s disease). They both are linked to decreasing dopamine activity in the brain.

2. Antipsychotics - drugs like haloperidol and risperidone may be prescribed to help alleviate the mental health symptoms that can become present with Huntington’s disease.

The challenges of brain-delivery drugs

The biggest issue when creating drugs to assist with neurodegenerative diseases is that many medications struggle to reach the brain, the site in the body they are needed to be effective. In order for the medication to reach the source of neurodegeneration, it must first break through the blood-brain barrier.

Blood-brain barrier:

The blood-brain barrier (or BBB) is a barrier that stops substances, like medication, in the bloodstream from entering the brain. This makes it very tricky for larger drug molecules to pass through the passage. Tight junctions are created within the cells of the brain capillaries, preventing the entry of foreign substances.

Pharmacokinetics:

How effective a drug is at reducing the symptoms of neurodegenerative diseases depends on how they act with within the body, also known as pharmacokinetics. Different medications have different characteristics and properties that affect how the body processes them. Some, for example, may face issues like becoming bound to proteins in the blood. Small molecule drugs are the best suited for brain delivery, as they are likely to reach the desired site before losing effectiveness.

Nanoparticles: a promising solution

New approaches are now needed to tackle the problems with, and limitations of, current brain-delivery drugs. The most promising solution being looked into is nanoparticles. This innovative technology has the ability to create molecules for drugs on a tiny scale, between 1-1000nm. Typically, the kind of materials used to make these nanoparticles include natural polymers, synthetic polymers and inorganic substances. Known as nanocarriers, they have proved highly effective and suitable to successfully carry drugs to the brain, through the blood-brain barrier. Their tiny size means that nanoparticles have a much better chance of being able to break through this protective barrier.

In conclusion, neurodegenerative diseases are very complex and often need a combination of different drugs and medical therapies to provide relief for patients. While diseases like Alzheimer's, Parkinson’s and Huntington’s have no cure yet, there have been, and continue to be, medications developed to slow down the degeneration process. Some problems are faced with brain-delivery drugs, for example, getting medication to reach the desired site in the brain, but nanoparticles prove a hopeful solution.

References:

Brunton, L., & Knollmann, B. (2022). Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 14th edition. McGraw-Hill Education / Medical.

Davenport, F., Gallacher, J., Kourtzi, Z., Koychev, I., Matthews, P. M., Oxtoby, N. P., Parkes, L. M., Priesemann, V., Rowe, J. B., Smye, S. W., & Zetterberg, H. (2023). Neurodegenerative disease of the brain: a survey of interdisciplinary approaches. Journal of the Royal Society Interface, 20(198). https://doi.org/10.1098/rsif.2022.0406

Hussain, R., Zubair, H., Pursell, S., & Shahab, M. (2018). Neurodegenerative Diseases: Regenerative Mechanisms and Novel Therapeutic Approaches. Brain sciences, 8(9), 177. https://doi.org/10.3390/brainsci8090177

Mortada, I., Farah, R., Nabha, S., Ojcius, D. M., Fares, Y., Almawi, W. Y., & Sadier, N. S. (2021). Immunotherapies for neurodegenerative diseases. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.654739

Pharmaceutics. (n.d.). https://www.mdpi.com/journal/pharmaceutics/special_issues/neuro_treat

Shusharina, N., Yukhnenko, D., Botman, S., Sapunov, V., Savinov, V., Kamyshov, G., Sayapin, D., & Voznyuk, I. (2023). Modern Methods of Diagnostics and Treatment of Neurodegenerative Diseases and Depression. Diagnostics (Basel, Switzerland), 13(3), 573. https://doi.org/10.3390/diagnostics13030573

When wounds, tears or incisions to the skin occur, it’s important to sanitize and disinfect the area with topical antiseptics. This helps prevent the spread of bacteria that could lead to infection. Different types of antiseptics are used for varying purposes, and the chemical process that occurs depends on the active ingredient within the antiseptic. In this article, we look into exactly how topical antiseptics help protect and heal wounds, plus how different types of antiseptics work to disinfect.

What are topical antiseptics?

Topical antiseptics are antimicrobial agents that kill or reduce the number of microorganisms that may become responsible for the infection of a wound. They can help protect open cuts in the skin from bacteria, fungi, viruses, protozoa and prions. Different types of antiseptics work through various chemical mechanisms to inhibit the growth of these harmful microorganisms. Antiseptics should not be confused with antibiotics, which in turn destroy from within the body, rather than on the surface. While antiseptics are known as skin disinfectants, standard disinfectants are reserved for non-living objects (surgical tools, for example).

The role chemistry plays in different types of antiseptic.

Alcohol-based antiseptics:

Antiseptics that have an alcohol base contain one of two water-soluble compounds: ethanol or isopropanol. Both compounds are effective at killing bacteria and even some viruses. The actions of alcohol-based antiseptics used the chemistry of alcohol molecules to be effective against the spread of bacteria. These particular molecules are made up of hydrophilic (water-loving) and hydrophobic (water-fearing) parts. When alcohol antiseptics encounter harmful bacteria, the hydrophobic part of the molecule enters the cell membrane which alters its structure. This causes the cell to then rupture and die. The hydrophilic part dissolves in the water of the surrounding area of a wound, acting as a vacuum to clear away any debris on the surface of the skin. 

One of the main benefits of alcohol-based antiseptics is how quickly they work. Once applied to the skin they effectively can kill a wide range of microorganisms that would otherwise prove harmful to the body. One of the most common examples of alcohol-based antiseptics is hand sanitizers, which help prevent the spread of infectious diseases. Alongside promoting healthy hand hygiene in everyday life, these kinds of antiseptics are also used by healthcare professionals before operations to avoid infecting wounds with harmful bacteria.

Iodine-based antiseptics:

Iodine is a halogen element that is highly effective as a topical antiseptic and in treating clinical wounds. In practice for over 100 years, iodine-based antiseptics are some of the most tried and true ways to kill off bacteria, fungi, and viruses from open wounds. It’s particularly effective due to its natural antiseptic properties as an element, with the ability to disrupt (and ultimately destroy) proteins and cell membranes. As a very small molecule, iodine is able to rapidly penetrate microorganisms and oxidize proteins like nucleotides and amino acids, which leads to the death of the cell. A higher concentration of iodine in an antiseptic is more effective at killing bacteria, however, this can cause skin irritation and damage. Organic matter, such as blood, can also affect iodine’s effectiveness as they bind with iodine ions, which limits its availability to react.

Commonly, iodine-based antiseptics are used prior to surgical procedures to sterilize an area, in wound care and healing and as a general way to effectively cleanse surfaces of harmful bacteria and viruses. While successful at protecting the body against a wide range of bacteria and viruses, one of the downsides of iodine is that it can leave a brown stain on the skin which is difficult to remove. When used in wound healing, this can also discolor wounds, which can make healing difficult to monitor.

Chlorhexidine:

This antiseptic and disinfectant is a cationic bisbiguanide compound which has a broad ability to destroy germs and bacteria. Commonly used to maintain oral hygiene health, chlorhexidine helps with mouth infections, ulcers, and gum disease. The antimicrobial activity of chlorhexidine is possible due to its ability to bind to harmful cells, which disrupts entire membrane structures. Once bound to a cell, it alters the permeability of the membrane which leads to the leaking of intracellular components. This leakage ultimately means the death of a harmful cell.

Chlorhexidine is typically combined with other ingredients and anesthetics to numb pain, for example in throat medication. Commonly, it is present in mouthwashes and in the form of lozenges to help maintain mouth and throat health. It may also be used in hospitals to clean and prep surgical equipment for surgery, to ensure infectious bacteria is not spread to open wounds and incisions.

Hydrogen peroxide:

Hydrogen peroxide is a powerful oxidizing agent, which makes it a particularly effective antiseptic. With the ability to break down into water and oxygen gas, this chemical compound is used worldwide to help treat and protect wounds from infection. When these topical antiseptics are applied to an affected area, they release oxygen and create free radicals. This causes foaming which damages the cell membrane by destroying key proteins and killing the cell in the process.

Alongside being used to treat minor cuts and wounds, hydrogen peroxide is also used in mouthwash to assist with positive oral hygiene. It can also be used to clean medical instruments prior to surgical procedures. Hydrogen peroxide is a popular antiseptic due to the fact it leaves behind no residue or stains, (unlike iodine-based antiseptics) plus it is also less toxic than other alternatives.

Quaternary ammonium compounds:

Quaternary ammonium compounds, also known as QACs, are a class of chemicals that contain a positively charged nitrogen atom that allows them to be antimicrobial against a wide spectrum of bacteria. This positive charge attracts the negative charge of microbial membranes, allowing QACs to penetrate and destabilize the cell. Reduced stability leads to leaking of key proteins and ions which results in complete cell death. Quaternary ammonium compounds can be highly effective when used as a topical antiseptic, most commonly in hand sanitizer. These chemicals can eliminate a range of bacteria, fungi and viruses including SARS-CoV-2, which causes COVID-19. 

In conclusion, the application of topical antiseptics to open wounds is vital in protecting the body from infection. Different types of antiseptics possess various chemical elements and processes that allow them to effectively destroy harmful microbial cells that might infect or cause viral diseases.

Noni is a plant native to Southeast Asia that has been used for centuries for its medicinal properties. Early Polynesians brought noni when they migrated and settled to the Hawaiian Islands because it was said to have medicinal properties that could cure high blood pressure, reduce chances of heart attack and stroke, reduce risk of cancer and type 2 diabetes, and was good for overall health. Since then, native Hawaiians still use noni for its medicinal purposes, and researchers have been keen to investigate whether or not these beliefs are anecdotal or have valid effects on reducing diseases, such as cancer.

A recent study conducted by Kumar et al. (2022) reviewed 22 clinical trials that investigated the efficacy and safety of noni extract as a potential anticancer agent. The trials included a total of 2,129 participants with various types of cancer, including breast cancer, colorectal cancer, lung cancer, and prostate cancer.

The results of the study showed that noni extract may have some anticancer activity (Kuman et al., 2022). However, the evidence was limited and the results of the individual trials were inconsistent. Some trials showed that noni extract was associated with a reduction in tumor size or an improvement in survival, while other trials showed no significant benefit.

The study also found that noni extract was generally safe, with few side effects reported (Kuman et al., 2022). However, some participants experienced mild side effects such as nausea, vomiting, and diarrhea.

The authors of the study concluded that more research is needed to confirm the efficacy and safety of noni extract as a potential anticancer agent (Kuman et al., 2022). They also noted that the quality of the trials included in the study was variable, and that future trials should be better designed and conducted.

So, does noni extract fight cancer? The answer is not clear. More research is needed to confirm the efficacy and safety of noni extract as a potential anticancer agent. If you are considering using noni extract for cancer treatment, it is important to talk to your doctor first. They can help you weigh the potential benefits and risks of this treatment option.

In the meantime, there are many other things you can do to help prevent cancer and improve your chances of survival if you are diagnosed with cancer. These include eating a healthy diet, exercising regularly, and not smoking. You should also get regular cancer screenings, such as mammograms and colonoscopies.

If you are concerned about cancer, talk to your doctor. They can help you develop a personalized plan to reduce your risk of cancer and improve your chances of survival.

Here are some additional things to keep in mind about noni extract:

• Noni extract is not a cure for cancer.

• Noni extract should not be used as a substitute for conventional cancer treatment.

• Noni extract may interact with other medications, so it is important to talk to your doctor before taking it.

• Noni extract is not regulated by the Food and Drug Administration (FDA), so the quality and safety of products can vary.

If you are considering using noni extract, it is important to do your research and talk to your doctor.

Sources:

Chanthira Kumar, H., Lim, X. Y., Mohkiar, F. H., Suhaimi, S. N., Mohammad Shafie, N., & Chin Tan, T. Y. (2022). Efficacy and Safety of Morinda citrifolia L. (Noni) as a Potential Anticancer Agent. Integrative cancer therapies, 21, 15347354221132848. https://doi.org/10.1177/15347354221132848