One size fits all? Not in precision medicine


The Estonian Genome Center (EGC) of the University of Tartu has put a lot of effort into promoting personalised medicine on a national scale in Estonia. Lili Milani, Senior Researcher at EGC, explains that her research enables to identify previously unknown genetic variants associated with drug metabolism. We now have sufficient information regarding the human genome to start implementing genetic testing in everyday medical practice. It is finally possible to move away from the “one-size-fits-all” approach and eliminate the trial-and-error method of prescribing owing to considering the functionality of each individual’s genes, and the ways in which this may affect the efficacy of the patient’s current and/or future treatments. Such approaches are commonly termed personalised or precision medicine, in which drugs and their dosing are optimised for each individual’s unique genetic makeup.

But how can this be turned into reality?

The EGC suggests that everyone aged 35 to 65 in Estonia should be offered to get genotyped, i.e., have their personal gene chip. So far, 52,000 Estonians have donated their blood to create the Estonian Biobank.
The data generated in the Biobank enables using individual genomic variation obtained from genetic analysis and computational methods to predict and prevent diseases, and optimise drug treatment.
The data collected at the Biobank has been further improved by incorporating data from the nation-wide health database of the Estonian National Health Information System and other more specific registries. These extensive health records and molecular profiling data of the biobank participants are used to calculate disease risk and likely drug response. Since both databases are continually improving, estimates of the disease risks and probable drug responses must be re-calculated regularly.
Estonia is currently in a position to be one of the first countries in the world to start the implementation of personalised medicine on a national scale. Implementing personal genetic information together with automated decision support systems will help physicians and have a huge impact on disease prediction, prevention and treatment. Personalised medicine should be viewed just as a new, additional instrument available for physicians. Therefore, one-size-fits-all may soon be history in the Estonian health care system.

PhD Lili Milani
Senior Researcher
Estonian Genome Center

Prof. Andres Metspalu
Director of Estonian Genome Center
University of Tartu

This article was supported by the European Regional Development Fund through Estonian Research Council.

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