Tuesday, November 17, 2009

Molecules of Omaha

I'm off this evening to Omaha, Nebraska to speak on behalf of Centocor as they educate physicians on their new medication Stelara. Stelara is a human monoclonal antibody that binds to two specific cytokines (IL-12, IL-23) to prevent lymphocyte activation and therefore inflammation in psoriasis.

The science behind the new medicines to hit the market these disease is remarkable. When I finished medical school in 1989 most of the pharmaceuticals released were considered toxic products -- that is, they worked primarily by chemically interfering with a biochemical process. Most were "shot gun" type drugs that had minimal specificity for organs or cell types. The result usually meant that in addition to monitoring a patient for improvement or in particular enhancement of a given blood marker (such as cholesterol), you had to also generally and carefully monitor organ function.

Enter the molecular age: today's drugs, if you can even call them that, rely not so much on chemistry, but on manipulating normal human constituents (antibodies, hormones, enzymes) and often perform the task as molecular engineered components of the body. Take Stelara, or ustekinumab as its known in the research world. This drug is a monoclonal antibody that binds to two different small chemicals found in the body in infinitesimally small concentrations (read picograms) and prevents them from binding to cell surface receptors. By blocking this marriage if you will, it prevents these cells from producing bad products that cause psoriasis. Only a small amount of this "drug" creates changes in the micro environment around individual cells that results in better health. No more "toxic" products to think about.

To be completely fair in disclosure, these new medications bring a host of new potential problems. From immunosuppression and the possibility of increased infections and malignancies, to rare bizarre neurological disorders, the jury is still out on the long term safety compared to commonplace medicines like penicillin. Nevertheless, for the first time, many patients are able to lead normal, productive, and satisfying lives with minimal interference of disease and minimal side effects of treatment.

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