South Florida Hospital News
Friday October 23, 2020
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May 2006 - Volume 2 - Issue 11
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Exploring the Technological Frontiers in Heart Disease

One of the most gratifying aspects of clinical practice is the opportunity to help people in demonstrable and sometimes readily apparent ways. The researcher, on the other hand, may never witness the true fruits of his labor, but is constantly bolstered by the knowledge that the future belongs to his efforts. There are many areas of exploration which open entire new potential areas for exploration in medicine. Nanotechnology incorporates the knowledge of certain size-related physical properties that differ at sizes one billionth of a meter, to yield information which may some day permit us to "listen to cells" (based on frequency differences), as well as to visualize their internal behavior directly. The potential applications in diagnostics and therapeutics are mind-boggling.

Artificial intelligence involves layers upon layers of interactive computer programming that may ultimately assist in off-site (or off-planet) surgery, implantable therapeutic devices and advanced diagnostic capabilities.

The list of such potential technologies is long and growing. At the Florida Heart Research Institute we are at the leading edge of applying these new technologies to scientific advancementóproteonomics, imaging, myocardial regeneration. One such exciting area is genetic exploration. The Human Genome Project has provided a wealth of information about human genetic composition. The application of this information, however, remains a serious challenge. With several billion base pairs of genetic data stored in human DNA, the researcher needs a coherent strategy for identifying productive areas to look for a given clinical outcome. First of all, the majority of this information appears to be regulatory rather than expressive in nature; that means that more of the DNA is involved with regulation of expression (or other activities the role of which still remains to be defined) than is involved in the actual code for protein synthesis. Moreover, the activation and regulation of this information is subject to many different aspects of cellular activity. Therefore, two different individuals could have the exact same group of nucleotide base pairs coding for exactly the same proteins, yet express that "potential" at different times and under different circumstances (or potentially not at all). Secondly, even without such complex regulatory issues, how does the researcher avoid the "needle in the haystack" problem of finding those specific genes whose expression (or mutational expression) accounts for a given clinical observation?

Advancing technologies rely on the remarkable degree of DNA homogeneity across different individuals to identify certain "marker" genes. These markers can be used to generate "haplotypes" (based on the concept that if markers are similar, other information is similar as well.) To put it very simply, if I know that itís a car I am looking for, then it is reasonable to assume that there will be four wheels, even if I havenít yet seen them. If it has a Ford engine, chances are good that it is a Ford, etc. At the same time, computer chip technology has been applied to the production of "gene chips" which can be implanted with large volumes of genetic information to yield a rapid "screen" to suggest which areas of the genome might be associated with which clinical syndromes. Combine all this with advanced programming capacity and improved sequencing techniques and you can begin to see the "needles" coming out of the "haystack".

Sudden cardiac death takes over one quarter of a million American lives every year. As irregular heart rhythms are either the cause or the mechanism of demise in most of these people, researchers at the Florida Heart Research Institute are investigating genetic predisposition to sudden cardiac death. Given the complex of circumstances (associated disease states, environmental, metabolic and chemical factors, etc.) which interact to produce a clinical event it is not readily apparent which genetic factors may be playing a role, and under what circumstances they do and do not result in a clinical event.

In collaboration with researchers at the University of Miami and elsewhere, FHRI is developing novel approaches to identify those genetic expressions which predispose to sudden death, and how they interact with environmental, metabolic and other factors to produce actual clinical events. This is a graphic and gratifying example of how multiple advancing technologies can be brought to bear on solving pressing and compelling clinical problems.

Dr. Paul Kurlansky, board certified cardiothoracic surgeon, Director of Research at the Florida Heart Research Institute, can be reached at (305) 674-3154 or DoctorWu18@aol.com.
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