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Special Article |

Genomes, Transcriptomes, and Proteomes:  Molecular Medicine and Its Impact on Medical Practice

Ivan C. Gerling, PhD; Solomon S. Solomon, MD; Michael Bryer-Ash, MD
Arch Intern Med. 2003;163(2):190-198. doi:10.1001/archinte.163.2.190.
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The human genome project and the technological breakthroughs it has produced have moved the field of molecular medicine forward with breathtaking speed. This will impact not only the advance of scientific discoveries and the way science is conducted but also the clinical practice of medicine. In this review we explain the basic principles of these new technologies. Their potential use and impact are demonstrated by using diabetes mellitus as an example of a common and serious medical disorder. Finally, several potentially adverse consequences of "excessive" knowledge are discussed.

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Figure 1.

Comparative analysis of gene expression levels on a "gene chip." The messenger RNA (mRNA) is isolated from each sample and converted to complementary DNA (cDNA) and labeled with different fluorescent dyes: sample A with Cy3 (*) and sample B with Cy5 (°). Their relative signal at the 2 different wavelengths is then determined for each gene spot.

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Figure 2.

Comparative proteome analysis of levels of each protein in 2 biological samples. Proteins in the samples are separated by 2-dimensional gel electrophoresis and visualized by a quantitative stain. Image analysis software identifies differentially expressed spots and the proteins in those spots are identified by mass spectrometry. Mr indicates molecular weight; pI, isoelectric point.

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Figure 3.

Potential therapeutic impact points in molecular medicine approach to type 1 diabetes mellitus. At the stages denoted by the shaded boxes, increasing potential for ultimate clinical disease is predicted by screening at the genome, transcriptome, and proteome levels. Boxes at bottom denote current conventional stages of late preclinical and clinical detection.

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Figure 4.

Potential therapeutic impact points in molecular medicine approach to type 2 diabetes mellitus. IGT indicates impaired glucose tolerance; IFG, impaired fasting glucose. Legend otherwise corresponds to that of Figure 3.

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Figure 5.

Evolution of medical diagnostic methods and likely impact of molecular medicine on disease detection. Black boxes denote the presence or suspected presence of overt disease. Shaded box denotes a late preclinical stage in the evolution to overt disease. The gray arrow denotes that the opportunity exists for intervention prior to overt clinical disease. Black arrows represent opportunities for targeted intervention at an early preclinical stage, such as gene therapy, individualized treatment, or environmental manipulation.

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