Theranostics: rethinking postgenomic diagnostics

Theranostics: towards postgenomic diagnostics

Theranostics is a portmanteau word created by linguistically blending ‘therapeutics’ and ‘diagnostics’. Theranostics has indeed turned over a new leaf for medical diagnostics in the postgenomics era. The new concept of theranostics is made possible by integrating the application of molecular biomarkers across the continuum of tests and interventions ranging from disease susceptibility testing and the monitoring of clinical outcomes resulting from interventions, such as drugs (e.g., pharmacogenomic tests), nutrition (e.g., nutrigenomic tests) and vaccines (e.g., vaccinomic tests) [1–4]. Being crucial to both human health and diseases, theranostics therefore has inherent orientation towards improving global health and widespread societal issues such as poverty and conflicts that are intimately linked with health [3,4]. Theranostics involves a variety of biotechnological inventions including the data-intensive platforms (genomics, proteomics and metabolomics) nanotechnology and hybrid assay platforms as exemplified by nanoproteomics. Seen in this light, the concept of theranostics is markedly broader than the classic notion of personalized medicine or biomarkers that draw moderately from a singular biotechnology platform such as high-throughput genotyping.

Theranostics is emerging at a time when there is growing interest in ecosystem health – another strand of conceptual extension in postgenomic diagnostics currently being accelerated by theranostics. Indeed, the initial findings of the Human Microbiome Project (HMP) announced in June 2012 have suggested the need for considering theranostics under the holistic rubric of ‘one health’. The HMP data thus far have shown that microbial communities and their genes (the microbiome) inextricably co-exist throughout the human body, with fundamental roles in both human and ecosystem health [5]. In fact, there is emerging evidence that human microbiomes are implicated in conditions such as malnutrition despite adequate access to food and commonly known chronic diseases (e.g., Type 2 diabetes and obesity) [5,6]. Although many of these human diseases appear to run strongly in families, research in genetics has not been able to elucidate the causative genes in a commensurate manner – that is, the so-called ‘missing heritability’. It could be that some of the heritable components of common human diseases may rest in the microbiomes that can be passed on through generations. Hence, viewing human beings as ‘walking ecosystems’ that contain many collaborating and competing species provides clues for another possibility: the new generation of postgenomic theranostics may very well be harnessed, not only from the keen knowledge of the host (human organism), but also from the biological variations in the microbiomes.

Finally, it is noteworthy that such remarkably broad range of postgenomic diagnostics anticipated to emerge from theranostics R&D is also embedded in vast societal expectations, whether by governments, industry or citizens, in the ‘bioeconomy’ and knowledge-based innovations. This trend is happening in North America [101], Europe [102] and developing countries [3].

This special issue features articles that seamlessly illustrate the documented applications and what we may anticipate from the burgeoning field of theranostics. These articles feature original analyses and synthesis by leading experts in the field and touch upon the highly dynamic facets of the theranostics knowledge frontier in the postgenomic era. In keeping with the transdisciplinary nature of theranostics, this special issue is complemented by two interview articles by eminent scholars to address the broader innovation canvas in which theranostics is embedded: anticipated impacts on global health, bioeconomy and direct to consumer theranostics, thus bypassing the traditional delivery models such as physician-centered healthcare.

Madadi et al. have provided an insightful account of the current convergence of maternal health and theranostics [7]. Their article not only offers a unique blend and original synthesis of theranostics in a context of global maternal health, but also highlights the existing and emerging findings that are contributing to the development of novel diagnostics for public health action on the ground. Overall, their article exemplifies an invaluable scholarship for readers with the interest in theranostics applications in both global health and maternal health.

In response to a large gap in theranostics and molecular biomarkers literature, Zgheib et al. have explored applications in primary care as compared with tertiary healthcare settings [8]. Primary care covers a vast patient population and is a crucial entry point of theranostics to routine health services. The authors present a detailed thoughtful overview drawing from examples in pharmacogenomics, which is one of the most established subfields of theranostics. Their article concludes with concrete ways forward in order to accelerate the integration of pharmacogenomics in primary care. As we gaze into the postgenomics future, Zgheib et al. provide invaluable ideas for novel entry points for large-scale theranostic applications.

Fisher et al. have aptly observed that beneficial outcomes of innovations do not simply flow from the generation of scientific knowledge and technological capability in a linear fashion [9]. At the early stage of theranostics, the authors offer a fascinating foresight on the possible future(s) for nanodiagnostics and theranostics intersection, a postgenomics subfield that is likely to experience a volatile innovation trajectory. In all, Fisher et al. examine the novel technology policy approaches and the best ways to ensure robust theranostics innovations through integrating technological, behavioral, social and cultural shifts in postgenomic healthcare.

Hu et al. have drawn out the highly interesting issues of drug and herbal medicine interactions with theranostics that can offer mechanistic insights while guiding clinical care [10]. Other than of purely academic interest, this topic is of great significance to the global health community and the current merger of data-intensive omics sciences (e.g., genomics and proteomics) with traditional Chinese medicine [11]. Herbal medicines and traditional Chinese medicine or similar alternative therapies are widely used both in Western countries as well as in Asia–Pacific, Africa, Europe, the Middle East and many other parts of the world. Hence, this paper is both timely and of global relevance.

In the first of the two interview articles featured in this special issue, Tikki Pang, a global health scholar and the leading writer of the World Health Report 2012, helps to position theranostics in the 21st century bioeconomy, with recent findings from the HMP and what we may anticipate from theranostics in developed and developing countries [12]. He suggests that the sustainability of transdisciplinary innovations (e.g., theranostics) in the 21st century rests in part on our ability to govern the global public goods, such as diagnostics for public health.

In the second interview article, Barbara Prainsack, a political science scholar and the current Chair of the European Science Foundation’s (ESF) Forward Look on Personalized Medicine for the European Citizen, helps us to see beyond what is immediately visible in the theranostics field – as approached through a much needed political science perspective [13]. She revisits and contextualizes the emerging notions of entrepreneurship, collective action for postgenomic science and how best to understand direct-to-consumer theranostics tests. Both interview articles offer us broad vistas that complement the technology-driven papers in this special issue.

In closing, and to be sure, this November special issue gives the readers a sense of the cutting edge accomplishments of the postgenomic science and medicine as exemplified by theranostics concepts and applications. Reading the articles should prove informative and interesting.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.