Textbook of Personalized Medicine - Second Edition [2015]

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When combinatorial protein or small-molecule libraries are studied, large numbers
of binding events can be analyzed simultaneously. Such libraries may be used in a
sequential phage escape format, where cycles of phage binding and release of
mutants are driven by antibodies or small molecules and the diffi culty of escape
increases at each cycle. When viral systems are studied, a checkmate analysis allows
experimental evaluation of the evolutionary contest between viruses and the
immune system and may predict which antibodies and small-molecule ligands
should be generated in anticipation of viral mutations before these mutations create
viral epidemics. The result is a detailed chemical map of the trajectories of viral
escape and antibody response. This enables scientists to explore all the possible
routes that a virus might take to escape an immune response or small molecule
therapeutics. Because this approach is both simple and inexpensive, it is within
reach of almost any biomedical laboratory in the world.
Although immune mechanisms are involved in virus infection, there are no sig-
nifi cant immune modulators available. Understanding how the viruses manipulate
the host immune system may provide some clues to better therapies, both vaccines
and antiviral therapeutics. MAbs are in development for some viral diseases and are
promising but there are only a couple of signifi cant products, one of which is in
market and the other in late stage clinical trials. Among the novel technologies such
as gene therapy, antisense and RNAi, the main problems have been delivery and
although there are some clinical trials, there is no prospect of a curative viral therapy
in the next few years. Personalized therapy approaches are being applied to improve
antiviral therapeutics. HIV was the fi rst viral diseases where molecular diagnostic
was used to guide treatment.

Personalized Approach to Management of HIV

HIV belongs to a large family of RNA lentiviruses. The result of HIV infection is
destruction of the immune system leading to onset of the acquired immunodefi ciency
syndrome (AIDS). The AIDS epidemic has already resulted in the deaths of over half

Molecular diagnosis

Personalized approach

to viral diseases

Novel antivirals Vaccines

Gene therapy

RNAi

Prevention

Novel delivery technologies Nanobiotechnology

© Jain PharmaBiotech

Fig. 11.1 An integrated approach to viral diseases

11 Personalized Management of Infectious Diseases