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[ASH2012]获得心血管疾病有用标志物的策略——英国Glasgow大学心血管研究中心Anna F. Dominiczak教授专访

作者:  A.F.Dominiczak   日期:2012/5/28 15:55:46

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《国际循环》:能否跟我们谈下您在本届ASH年会上的演讲“获得心血管疾病有用标志物的策略”?

  <International Circulation>:Can you tell us more about your talk at this ASH Meeting, ‘Strategies to Get Useful Biomarkers for Cardiovascular Disease’?
  Prof. Dominiczak: I think it is a very exciting topic because we already have a number of traditional, so-called “old” biomarkers but we are also developing new biomarkers and the question is what will be useful for patients? Clearly there is curiosity research underway looking at new pathways and biomarkers but not all of them will become clinically applicable and clinically useful. The question is not only how to best select these biomarkers but also how to do new things with the future in mind. My talk is in two parts. I talk about the more traditional biomarkers such as CRP and others of that family that are laboratory biomarkers and are measured in people’s blood. We need to remember that biomarkers are broader than just that. In fact, careful clinical examination, talking to patients and very sophisticated imaging can all be classed as biomarkers. The issue is to select the best. I believe there will be a combination of biomarkers rather than a single biomarker that can answer all of our questions.

  《国际循环》:能否跟我们谈下您在本届ASH年会上的演讲“获得心血管疾病有用标志物的策略”?
  Dominiczak教授:我认为这是一个非常激动人心的话题,因为我们已经有了一系列所谓的“老的”标志物,但是我们也在寻找新的标志物,问题在于怎样的标志物是对患者有用的。显然,当前有一些探索性研究正在进行当中,观察新的信号转导通路和生物标志物,但不是所有标志物都适合在临床应用同时在临床上是有用的。问题不仅仅是如何最合理地选择标志物,还要考虑未来如何做一些新的事情。我的演讲分为两个部分,我谈到了CRP等更为传统的生物标志物,这些都是实验室的生物标志物,通过检测血液来衡量。我们需要记住的是,生物标志物的范围要更广。事实上,详细的临床检查、与患者交谈和非常精细的影像学检查都可以被归入生物标志物。问题在于选择最佳的生物标志物。我认为,要回答我们所有的问题,我们需要依靠生物标志物的组合,而不是单个的生物标志物。

  <International Circulation>:They seem to be an eclectic group of many medical procedures that can lead to a conclusion.
  Prof. Dominiczak: Biomarkers could serve many ends in medicine. They can be predictive which is the way we normally think of biomarkers as risk predictors and can they tell us whether this particular patient or group of patients are at risk of cardiovascular disease in our case. But you can also use biomarkers to discover new disease causation and how completely novel pathways can be uncovered by searching for biomarkers. It is also clinically very useful to have biomarkers that tell us who will respond to which treatment and this is the basis of the now popular personalized approach of stratified medicine which predicts which drug is best for a subgroup of patients and be free of side effects.

  《国际循环》:似乎针对很多医疗检查都有选举委员会,可以对检查应用与否得出结论。
  Dominiczak教授:生物标志物在医学领域的很多方面都可以发挥作用。生物标志物具有预测作用,正如我们通常认为生物标志物是风险预测因素,可以告诉我们某个患者或某一组患者有发生心血管疾病的风险。但是,生物标志物还可被用于发现疾病新的病因,以及通过寻找生物标志物发现全新的信号转导通路。另外,生物标志物的临床用途还包括告诉我们哪些患者会对治疗有反应,这是现在流行的分层医学个体化治疗的基础,生物标志物可以预测对于某一亚组患者来说哪种药物是最好的,是没有不良反应的。

  <International Circulation>: Do you go looking for biomarkers or do biomarkers present themselves and then you decode them?
  Prof. Dominiczak: Both. Traditional biomarkers have of course been with us for decades. Cholesterol is a biomarker; blood pressure is a biomarker; and we use them to put risk equations together in Framingham and others. They found us but we can also use modern biomedical technologies such as genomics, proteomics and metabolomics to search for completely new biomarkers and we have been doing that in Glasgow I think fairly successfully. It has been very exciting.

  《国际循环》:您是在寻找生物标志物还是偶然发现生物标志物后再破译它们?
  Dominiczak教授:两者都有。当然,我们应用传统生物标志物已经好几十年了。胆固醇是生物标志物,血压也是;我们把这些生物标志物的数值填入弗雷明汉风险评分公式或其他公式。有些生物标志物是偶然发现的。不过,我们也可以采用基因组学、蛋白质组学和代谢组学等现代医学技术去发现全新的生物标志物。我们正在格拉斯哥大学做这样的事情,我认为相当成功。真令人激动。
 

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