More on Precision Medicine for Chronic Diseases

In my last post, I discussed an article from Dr. Milton Packer describing a new paradigm for treating chronic diseases. There is much more to the story, and it has been building for a while. We have had important pieces of this story available for fifteen years. If you love fast food and processed food and that has led to abdominal weight gain, you have changed gene expression and you are producing hormones in excess that will make you sick. If you are an overweight teenager, the process has already begun and you are not normal. You may feel fine but you have disease. Your bodily function is not normal. You are making hormones that make you unhealthy because of what you eat.

This increase in certain hormones due to obesity (aldosterone, angiotensin II) leads to high blood pressure, type 2 diabetes, artery disease, heart attack, stroke, chronic kidney disease, and congestive heart failure. Investigators in Nanjing in mainland China have given us a much better idea of how that works. These studies were published in an American physiology journal. This is another example of real scientific evidence in China. These important studies from China helped me understand the opportunity for a more effective, more precise approach to chronic diseases like diabetes and arterial disease.

The first study examines how aldosterone activates mTOR and deactivates the survival switch AMPK that we discussed in the last post. If you go to the upper right corner of the diagram, you see that the aldosterone that is increased in obese patients causes increased oxidant production which activates the epidermal growth factor receptor and then stimulates a number of steps that end up deactivating AMPK. Like Jardiance, eplerenone precisely blocks the effect of aldosterone to deactivate AMPK, a master genetic survival switch. That is why eplerenone protects cells and organs just like Jardiance does. Angiotensin II does exactly the same thing and losartan is a drug that precisely blocks that effect.

If you have extra abdominal fat, you are switching off the survival switch AMPK. Jardiance, eplerenone, and losartan are precision medicines that increase AMPK activation. Metformin and statins do the same thing. Losartan, eplerenone, metformin, Jardiance, and statins are all precision medicines that activate AMPK. That is the reason a protocol for type 2 diabetes combining these medication reduces heart attack, stroke, dialysis, blindness, and amputation much more powerfully than the care most people receive.

When I point to excellent medical science coming out of China, you must know that I am no fan of that country. I want us to compete effectively and that means that we must understand our competitor. All we hear is that China is stealing our intellectual property and “we borrow money from Chinese peasants to buy the things those Chinese peasants manufacture”. That sounds like we are underestimating our competition and at the same time we are cutting funding for the National Institutes of Health and scientific research in our great university system. Our success in competing with China depends in great measure on our progress in science and technology. Every Amercian has a stake in these decisions and we are on the wrong path.