The Future of Allergy and Clinical Immunology Prof. G. Walter Canonica - Congreso Slaai 2015
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Prof.G.Walter Canonica Allergy and Respiratory Diseases Clinic DIMI-‐University of Genoa Italy Presidente Congreso SLaai 2015: Dr. Alfonso Cepeda Sarabia
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The Future of Allergy and Clinical Immunology Prof. G. Walter Canonica - Congreso Slaai 2015
- 2. Prof. Giorgio Walter Canonica Allergy and Respiratory Diseases Clinic DIMI-‐University of Genoa IRCCS AOU San Mar:no-‐Genova Italy President President SLAAI, March 15, 2015 The Future of Allergy and Clinical Immunology
- 4. “If it were not for the great variability among individuals, medicine might have well been a science and not an art.” Sir William Osler (1849–1919)
- 10. Collins & Varmus NEJM 2015
- 11. Yanez et al. WAO J.2014
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- 13. Gustaffson et al Gen.Med. 2015
- 14. Gustaffson et al Gen.Med. 2015
- 15. Gustaffson et al Gen.Med. 2015
- 16. The Past/Present
- 17. one disease = one drug The Blockbuster Model ONE SIZE FITS ALL
- 20. The past treatment approach ReacGve Medicine or Medicine by AKempts
- 21. RENNARD et al., ANNALSATS 2015
- 22. Arostegui et al., PLOSone 2014
- 23. Arostegui et al., PLOSone 2014
- 24. Arostegui et al., PLOSone 2014
- 25. BIOMARKER KATZ et al. AnnalsATS 2014
- 26. Taylor RD et al., JACI 2011
- 27. PubMed 8 Marzo 2015
- 28. BIOMARKERS of asthma phenotyping
- 29. Leung et al. Ther.Adv.Resp.Med.2014
- 30. Leung et al. Ther.Adv.Resp.Med.2014
- 31. Chung et al ERJ 2014 Phenotyping……….
- 32. Braido, Holgate & Canonica 2012
- 33. Braido, Holgate & Canonica 2012
- 34. 5 DRAZEN J.M. NEJM September 29, 2011
- 35. 6 DRAZEN J.M. NEJM September 29, 2011
- 36. Braido, Holgate, Canonica. Pulm.Pharm.Ther. 2012 Future scenario in Allergy & Asthma treatment GENERALISTs
- 37. Braido, Holgate, Canonica. Pulm.Pharm.Ther. 2012 Future scenario in Allergy & Asthma treatment 66% pa@ents accordingly to Drazen NEJM 2011
- 38. Braido, Holgate, Canonica. Pulm.Pharm.Ther. 2012 Future scenario in Allergy & Asthma treatment SPECIALISTS
- 39. The promise of personalized medicine • More effective medicines • Safer medicines • Cheaper medicines • Better healthcare • Cheaper healthcare • Less (rather than more) healthcare disparity
- 40. 11 Hamburg & Collins 2010
- 41. 12 Hamburg & Collins 2010
- 42. G551D is the third most common muta:on, affec@ng ~4% of pa@ents. For pa:ents homozygous for Δ508, Vertex has another drug, VX-‐809, which acts by increasing the transport of CFTR protein to the cell surface. A phase 2 clinical trial of combined VX-‐809 and VX-‐770 treatment in Δ508 pa:ents is in progress. Vx-‐770 poten:ates CFTR func:on by promo:ng decoupling between the ga:ng cycle and ATP hydrolysis cycle. Jih KY. et al. PNAS. 2013; 110: 4404-‐9 Vx-‐770; Ivaca[or A CFTR potentiator in patients with cystic fibrosis and the G551D mutation (most prevalent ga:ng muta:on) Ramsey BW, et al. N Engl J Med. 2011; 3658: 1663-72 Complex disease will be stratified into a series of pathway specific disorders creating opportunities for both companion diagnostics and targeted prevention and treatments. But also a new Taxonomy of disease based upon causative pathways rather than signs and symptoms.
- 43. Crea:on of a New Taxonomy first requires an “Informa:on Commons” in which data on large popula:ons of pa:ents become broadly available for research use and a “Knowledge Network” that adds value to these data by highligh:ng their inter-‐ connectedness and integra:ng them with evolving knowledge of fundamental biological processes Toward Precision Medicine. US Nat Acad Sci 2011 Reclassification of human disease by identifiable causal pathways
- 44. AGUSTI A., Thorax 2014
- 45. AGUSTI A., Thorax 2014
- 46. AGUSTI A., Thorax 2014 biomarkers SYSTEMIC INFLAMMOME
- 47. AGUSTI A., Thorax 2014
- 48. AGUSTI A., Thorax 2014
- 50. ASTHMA HORIZON PLANNING in the next 5 years tralokinumab (an@ IL 13, MedImmune) ligelizumab (an@ IgE, Novar@s) dupilumab (an@ IL 4 rec,Sanofi Regeron)
- 51. Pelaia et al.Nature Medicine 2012
- 53. Kupckyk et al. Allergy 2014
- 54. Kupckyk et al. Allergy 2014
- 55. JACI 2013 ISSN 0091-6749 V O L U M E 1 2 9 N O. 4 A P R I L 2 0 1 2 www.jacionline.org THE JOURNAL OF AllergyAND Clinical Immunology CURRENT PERSPECTIVES ICON: Food allergy The role of dendritic cells in food allergy ROSTRUM Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence Health literacy and asthma WORKSHOP SUMMARY Understanding the complexity of IgE-related phenotypes from childhood to young adulthood: A Mechanisms of the Development of Allergy (MeDALL) Seminar CLINICAL REVIEWS An update on the role of human dendritic cells in patients with atopic dermatitis MECHANISMS OF ALLERGIC DISEASES The role of dendritic cells in asthma EDITORIALS We call for iCAALL: International Collaboration in Asthma, Allergy and Immunology The airway epithelium in childhood asthma TH 9 cells: In front and beyond TH 2 Nonimmediate drug allergy: Diagnostic benefit of skin testing and practical approach OFFICIAL JOURNAL OF
- 56. Kim et al. COAI, 2014
- 57. Parulekar, AEk & Hanania COAI 2014
- 58. Corren et al NEJM, August 3, 2011
- 59. Corren et al NEJM August 3, 2011 HIGH Perios.n Total LOW perios.n
- 60. Hanania et al. AJRCCM 2013
- 61. Hanania et al. AJRCCM 2013
- 62. 2014
- 63. et al. AJRCCM 2014
- 64. COSTY TREATMENT REQUIREMENTS Predic.ve Biomarkers of Response Defini.on of Eligibility to Treatment Pay by Results Reimbursement SUSTAINABILITY
- 66. Wenzel S., Nature Med.2012
- 67. Auffray et al. Genome Med 2009;1:2 PaEent reported Clinical FuncEonal Cellular Molecular Future of phenotyping: ‘Systems Medicine’
- 68. Prof. Giorgio Walter Canonica Allergy and Respiratory Diseases Clinic DIMI-‐University of Genoa IRCCS AOU San Mar:no-‐Genova Italy President President SLAAI, March 15, 2015 The Future of Allergy and Clinical Immunology (Part IV - final)
- 69. Mirnezami et al.NEJM 2012
- 73. Chung et al ERJ 2014 Phenotyping……….
- 74. Rossi et al Proteomics Clin Appl. 2014
- 75. ASTHMA Rossi et al Proteomics Clin Appl. 2014
- 76. Rossi et al Proteomics Clin Appl. 2014 ASTHMA 2
- 77. Redhu et al AACI 2013
- 78. Pascual R.M. & Peters S.P. J.A.C.I. 2005
- 79. Airway Remodeling in Severe Asthma: ASM Pepe C et al. JACI 2005;116:554-9. Moderate Asthma Severe Asthma Severe AsthmaFEV1 SMOOTH MUSCLE AREA
- 80. Int.J.Immunopathol. & Pharmacol. 2012
- 81. 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 t=p/4 x arithme2c mean of orthogonal intercepts PRE POST RESULTS Riccio, Dal Negro et al.,Int.J.Immunopathol. & Pharmacol.2012
- 82. 3.00 5.50 8.00 10.50 13.00 BEFORE AFTER TREATMENT t=p/4 x arithme2c mean of ortogonal intercept 12 month Xolair treatment RESULTS Riccio, Dal Negro et al.,Int.J.Immunopathol. & Pharmacol.2012 RESPONDER NON RESPONDER 6.25 µ Severe Asthma Cut off
- 83. Mauri et al. Immunol.LeCers 2014
- 84. Gal 3-‐GALACTIN 3 Responder Non Responder
- 85. Galactin 3 in biopsies of Xolair treated patients Responder Non Responder
- 86. Gao et al. Resp Res. 2015
- 87. IgE/Eosinophilic Neutrophilic GalecKn 3 ASTHMA InflammaKon
- 88. 3 years since Xolair suspension Nopp et al. Allergy 2010;65:56-60 FEV1 RESPONDER NON RESPONDER Gal 3
- 89. Galactin 3 as Biomarker of SUPERESPONDER to Omalizumab POSSIBLE CLINICAL MEANING
- 90. System Biology Nature Biotechnology September ,8 2014,
- 91. Nature Biotechnology September 8, 2014 System Biology
- 93. Lu et al NEJM 2014
- 94. Lu et al NEJM 2014
- 95. FINAL MESSAGE Bioinforma2cs, E-‐health records, Bio-‐banks and data protec2on Although ‘omics’ datasets have provided remarkable insights, it is by analysing, linking and comparing different large datasets (genomic, clinical outcomes, imaging etc.) that the greatest insights have been gained – so-‐ called ‘big data’.
- 96. XVIII Congreso Latinoamericano de Alergia, Asma e Inmunología 2015 Presidente: Alfonso Mario Cepeda Sarabia Comité Organizador Local: Edgardo Jares, Anahí Yañez, Estrella Asayag Presidentes Sociedad Latinoamericana de Alergia, Asma e Inmunología, Slaai: 2013-2015: Alfonso Mario Cepeda Sarabia - 2015-2017: Juan Carlos Sisul Alvariza Buenos Aires, marzo 14-16, 2015 http://www.slaai2015.com/comites-del-congreso/ Información Slaai: www.slaai.org Programa Congreso Para Todos Conferencias XVIII Congreso Latinoamericano de Alergia, Asma e Inmunología Sociedad Latinoamericana de Alergia, Asma e Inmunología, SLaai