Pictures of the Future    Spring 2007

Molecular Medicine: Market of the Future

Molecular medicine is—almost by definition—an interdisciplinary area of research. Its goal is to understand the processes that occur on the cellular and molecular levels in healthy and sick people. The knowledge gained here is used to develop procedures to keep people healthy, prevent diseases, and diagnose, treat and cure illnesses. Examples range from DNA-based genetic tests for epidemiological studies to the development of vaccines and genetic therapies.

The molecular medicine market includes the following segments: disease prevention, diagnostics, treatment, and patient care. This report examines the market segments that form the three pillars of diagnostic procedures: in vitro diagnostics, in vivo diagnostics and IT solutions that support the first two pillars.

Laboratory medical applications involve taking samples of blood, urine and saliva and then examining them outside the body "in a glass"—i.e. in vitro. Global market volume for in vitro diagnostics totaled $32.2 billion in 2005, according to the Kalorama market research institute, which also forecasts that this volume will increase to $45.6 billion in 2010—representing annual growth of 7.2 %.

In terms of general regional distribution of sales, the lion’s share of business in molecular diagnostics and in vitro diagnostics is generated in the industrialized countries of North America and Europe, as well as in Japan.

The share of total sales in these fields accounted for by the aforementioned regions was approximately 85 % in 2005, with this proportion expected to decrease only slightly—to 78 %—by 2010. However, if sales in China and India continue to grow at the current high rate, experts estimate that they could surpass the figure for Japan by 2013.

The second pillar of diagnostic procedures in molecular medicine includes a variety of imaging techniques, all of which have a common objective. That objective is to depict biological processes in living organisms (in vivo) on the cellular and molecular level, in high quality and in the most extensive manner possible. Traditional imaging techniques, on the other hand, depict morphological and functional changes that are not visible until the late stages of specific illnesses.

The most widely used techniques for molecular imaging at the moment rely on positron emission tomography (PET), single photon emission computed tomography (SPECT), magnetic resonance tomography (MRT), optical devices such as endoscopes, and high-frequency (more than 20 MHz) ultrasound units.

PET is the most commonly used molecular imaging technique for humans. However, in more than 90 % of cases, it is used in combination with computer tomography (PET/CT) because PET alone does not clearly show the specific location of pathology, whereas CT does. Various approaches are currently utilized with regard to contrast materials. According to Bio-Tech Systems, the biggest market share is still held by the radioactively marked sugar FDG, ¹⁸F-fluordeoxyglucose.

The development of other combined procedures—such as PET/MR—and of more specialized contrast materials (e.g. with hyperpolarized isotopes for MR) can be expected to lead to further progress in this field. The ultimate goal of all activities here will always be to identify diseases in their early and thus most reversible stages with the help of screening examinations, in order to be able to treat them before symptoms occur. All of these imaging techniques are also used in animal studies. It is estimated that several thousand labs worldwide are conducting small animal imaging. Some of these labs are operated by pharmaceutical companies as a means of accelerating the development of new medications.

The third pillar of molecular diagnostics consists of knowledge-based information technology (IT) systems. These bring together information from in vitro diagnostics and molecular imaging techniques and then use extensive databases to form conclusions that assist doctors in deciding which procedures should best be used in individual cases. According to Frost & Sullivan, the market segment for these clinical decision support systems (CDSS) had a volume of approximately $240 million in the European Union alone in 2005—and it’s still in the very early stages of its development. It is therefore not possible at the moment to identify the portion of the CDSS segment that is based solely on information from the field of molecular medicine.

Personalized medicine can be expected to significantly gain in importance in the future. An individualized approach will involve identifying illness and disease at a very early stage, as well as taking into account the patient’s medical and family health history in order to determine the best possible treatment. Molecular medicine will play a key role here, as will scientific results and cost-benefit analyses.

Nevertheless, in spite of steadily growing knowledge in the in vitro area and constantly improving medical imaging technologies, it will most likely be a long time before the ultimate promise of molecular medicine—catching and eliminating diseases before the onset of symptoms—is realized.
                                                                                                            Karsten Hiltawsky