Open Multiscale Systems Medicine for a true healthcare system
What if doctors could predict your health risks with incredible accuracy? Did you know that while some risks may still require drug therapy, living a healthy lifestyle can reduce up to 80% of these risks? Why is life expectancy decreasing in Europe, and what is the link between the quality of sleep and Alzheimer’s disease? And is walking 10,000 steps a day really necessary for good health?
These are just some of the questions that multiscale medicine aims to answer. And who better to explain this innovative field than Professor Harald Schmidt from the COST Action Open Multiscale Systems Medicine (OpenMultiMed). Recently, Prof. Schmidt shared his experience with the new generation of COST Action leaders at our recent COST Academy ‘Sustainability of COST Actions’ networking event. Join us as he unveils how systems medicine could revolutionise our lives and enhance our well-being.
COST: Can you explain what multiscale systems medicine is and why it’s important for human health?
Currently, medicine defines diseases mainly by symptoms in organs. There is no understanding of the molecular causes of most diseases. Therefore, no cure is possible, which is why we have so many chronic diseases. Systems medicine overcomes this by integrating clinical data with multiple big data types (hence multiscale) from various disciplines, such as molecular, cellular, genetic, environmental, and social data, to uncover previously hidden relations between our current disease definitions. Thereby we discover their underlying molecular mechanisms. With this knowledge disease even named differently, no longer by a symptom, and, for the first time, curative treatment and even prevention become possible. None of these disciplines alone could have achieved this paradigm shift.
COST: Can Artificial Intelligence (AI) play a role in medical computing?
Eventually, AI will be able to help us, but there are some important steps that need to be taken first. For instance, we need a set of resolved disease cases for the AI to learn from and then another set for the AI to predict molecular mechanisms based on its previous learnings. Once we have verified the accuracy of the AI’s predictions we can start using it to help us resolve the remaining diseases.
Once we have redefined all diseases by discovering their molecular and genetic causes and risks, in the distant future, people will have their genome sequenced as early as possible to accurately predict individual health risks. Some diseases risks may require drug therapy to prevent their manifestation; in 80% of cases, however, these risks can be mitigated by precision prevention, i.e., tailored lifestyle intervention and risk monitoring.
COST: What sort of lifestyle do you recommend?
Often, we give people too many recommendations for healthy living like eating and sleeping well, not to smoke, reducing alcohol, exercising, and reducing stress. But each person may only need to focus on a single personalised recommendation that would already make a big difference for them.
Recently, a study ranked the most important lifestyle measures. Surprisingly, sleep was ranked number one. Getting around seven and a half hours of sleep each night, with enough deep sleep, helps clear the brain and lowers the risk of Alzheimer’s, infections, and cancer. Exercise is the second most important thing, but you don’t need to take 10,000 steps every day. That number came from a marketing misunderstanding. The first mass-produced Japanese pedometer’s name, when written in Japanese characters, resembled a walking man. It also translated as ‘10,000-steps meter’, creating a wrong goal through the decades! Just 15-minutes of speedy walking per day is already good enough. However, many people unfortunately don’t even reach that goal.
Finally, healthy eating can be simplified to three main things: reduce sugar, reduce red meat, and eat lots of fruits and vegetables. The rest of a person’s prevention plan should be tailored to their specific individual risks.
COST: Has multiscale systems medicine already made a difference in people’s lives?
It’s too early to talk about impact but we have obtained substantial preclinical and patient data that are highly promising. Most importantly, we are currently conducting several clinical trials in subtypes of incurable forms of atherosclerosis, stroke, heart failure, and hypertension to test new curative therapies found thanks to multiscale systems medicine. The relevant data should be available by end of 2023. If these clinical trials work out, medicine will need to change completely.
COST: Has multiscale computing in drug repurposing had any impact on the pharmaceutical industry?
The pharmaceutical industry as we know it is declining and there are no more billion-dollar drugs to be found. Smaller companies may benefit from drug repurposing, which is no longer as profitable. Pharmaceutical companies will still exist, but I predict that very soon all necessary drugs will be available and affordable. This will create a more democratic, best practice medicine available globally. The true potential is not in taking drugs, but in preventing disease through tailored lifestyle measures based on understanding individual disease risks.
“The most important of what we are doing is to move from an expensive, imprecise medicine, which repairs symptoms, to a low cost, globally affordable medicine that cures and ideally prevents disease. It will be a new way of defining and identifying health risks and how to handle them. The patient will be in the centre of this wellbeing system, a true healthcare system, rather than the present sick care system.”
Prof. Harald Schmidt
COST: Can you describe the major achievements of OpenMultiMed?
A key outcome was to integrate multiscale patient data into a single resource that can be used also by biomedical scientists without programming skills. By comparing how the same genes and drugs are relevant or work in different diseases, we find previously unrecognised connections between diseases. The multiscale approach is necessary in case we have either no genetic or no drug information and need to extrapolate from other connections e.g., shared symptoms. The end result is that we are able to subtype our current diseases and merge them with other subtypes of other diseases to entirely new, now mechanistically defined diseases with symptoms in more than one organ. These then can be easily and precisely targeted with drugs and/or monitored with biomarkers. The goal is to cure people and to prove that we can do this, not just to generate models or hypotheses.
Biomarkers are all measurable indicators in (glucose, cholesterol, metabolites) or outside the body (blood pressure, walking distance) that can be used to diagnose, monitor, or predict the progression of a disease or the response to a treatment.
COST: What were the challenges of creating a transdisciplinary network?
OpenMultiMed brought together disciplines which never meet each other. Clinicians working in basic science and bioinformaticians making predictions on genes related to diseases spoke different languages. It took a while, but we understood each other and our needs. It was a mutual education.This glued us together and enabled us to apply for major European funding within the Horizon Europe Framework Programme.
COST: What has the OpenMultiMed network been up to since the end of the Action?
Major initiatives of global scale have followed such as the Network Medicine Alliance together with Harvard University, several EU programs such as REPO-TRIAL, FeatureCloud and REPO4EU, patents, licences, etc. all with members of OpenMultiMed.
In conclusion, the OpenMultiMed network is still thriving, with Prof. Schmidt and Jan Baumbach, both members of Action, having secured €50M in funding from the EU to co-coordinate an initiative focused on drug repurposing. Currently, Prof. Schmidt serves as the Coordinator of REPO-TRIAL and REPO4EU.
