Personalisierte Hepatologie − Gegenwärtige Konzepte, Entwicklungen und Erwartungen im Postgenomzeitalter

Zusammenfassung

Mit der Entschlüsselung des menschlichen Genoms im Rahmen des Humanen Genomprojekts sind individualisierte Ansätze eine realistische Perspektive für effektivere, nebenwirkungsärmere und ökonomisch sinnvollere Therapien. Eine entsprechende Erweiterung des Wissens zu grundlegenden Krankheitsprozesse und Therapieoptionen sowie Biomarkerindentifikation und -charakterisierung ist auch für chronische Lebererkrankungen mit der Hoffnung auf medizinischen Fortschritt verbunden. Vor diesem Hintergrund wird die Erstellung genetischer Fingerabdrücke für eine individualisierte Diagnose, Prognose und Behandlung von Patienten von zunehmender Bedeutung für die translationale Hepatologie. Für einzelne Lebererkrankungen existieren bereits personalisierte Therapieansätze. Beispiele sind die Bestimmung der Genotypen des HCV-Virus, Viruskinetik und die Genotypisierung des IL28B-Polymorphismus zur Optimierung der Behandlung der chronischen Hepatitis C. Die Herausforderungen der nächsten Jahre liegen in der Erarbeitung eines möglichst breiten Wissens, der Etablierung verlässlicher und standardisierter Technologien sowie der Entwicklung intelligenter bioinformatischer Strategien zur Datenanalyse und Datenintegration. Die folgende Übersicht fasst den derzeitigen Stand des Fortschritts der personalisierter Ansätze in der Hepatologie zusammen, erläutert aber auch technische Hintergründe der Limitationen, die eine konsequente klinische Umsetzung derzeit noch erschweren.

Abstract

Promoted by the decoding of the human genome as part of the human genome project, individualised therapy approaches have become a realistic perspective for therapies that are more effective, less prone to side effects and economically reasonable. This also applies to chronic liver disease. With the aim not only to expand the current knowledge base through basic research on the underlying disease processes and treatment options but also to identify and characterise biomarkers, the creation of genetic fingerprints for individualised diagnosis, prognosis and treatment of patients takes its place in the centre of translational hepatology. For certain liver diseases personalised therapy approaches are already existent. Examples are the determination of viral genotypes, viral kinetics and genotyping of the IL28B polymorphism to optimise the treatment of chronic hepatitis C. The challenges of the next few years relate to the broadening of the knowledge base, the establishment of reliable and standardised technologies, and the development of intelligent bioinformatics strategies for data analysis and data integration. The following review not only summarises the current state of progress and possibilities of personalised medicine in hepatological diseases, but also explains the technical background of the limitations that currently hinder a consistent clinical implementation.

Schlüsselwörter

Leber - Hepatitis C - Hepatitis B - HCC - PSC - Bioinformatik

Key words

liver - hepatitis C - hepatitis B - HCC - PSC - bioinformatics

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