A novel way to provide personalized medical care to critical care patients

Dr. Uriel Trahtemberg, M.D., Ph.D.

The Intensive Care Unit (ICU) provides care to patients with severe and life-threatening illnesses and injuries. It is composed of a group of patients who receive advanced treatment options and technology. Unfortunately, due to the enormous heterogeneity of this group of patients and disease states in the ICU, the evaluation of any single specific healthcare intervention becomes difficult and sometimes speculative. In addition, notwithstanding the large body of knowledge of the underlying biological processes of human pathophysiology, there is a large disconnection between the clinical and the basic science aspects of critical care. In fact, this gap is a principal obstacle hindering the translation of novel basic science discoveries into clinical practice for this vulnerable population.

Dr. Trahtemberg has witnessed the gap existing between the basic science related to critical care and the actual clinical experience in the ICU. Dr. Trahtemberg’s aim is to bridge this gap by integrating multiple parameters from different pathways such as, for instance, cytokines obtained experimentally from his patients, as well as their clinical data and outcomes over time. Cytokines are a group of proteins made by the immune system. To communicate, the immune cells use cytokines as chemical messengers. Dr. Trahtemberg’s important research on cytokines is at the forefront of this type of investigation. He is trying to characterize the complex network linking the basic cellular and biochemical processes to the clinical manifestations of these ICU patients using a systems biology approach. This is a collaborative approach (mathematicians, statisticians, computer scientists, experimentalists, clinicians) in biomedical research to understand the larger picture at the level of the organism, tissue or cell. This system will allow diagnostic and prognostic predictions. As such, better decisions are made in a personalized manner.

To illustrate Dr. Trahtemberg’s vision, he has undertaken a preliminary investigation in patients with tracheotomies and measured their cytokine levels over time (once before tracheotomy as a baseline, and 4 times during the next 24 hours). Other researchers studying cytokine patterns used averaged responses, lumping a large number of patients together, obtaining small or insignificant results. By acknowledging the simple yet critical fact that critical care patients are heterogeneous, with different trajectories and etiologies, Dr. Trahtemberg found among these patients different response curves. If those curves were to be lumped together and averaged, the results would be null, as others have found. Yet by studying the patients’ responses at the individual level and clustering them according to their unique responses, subgroups of patients with meaningful differences could be found. This investigation indicates the value of uniting clinical data and clinical insight with basic research on such a complex population - critical care patients. This also highlights the value of personalized medicine, studying patients at the individual level over time, and not as construed, static averages that, in fact, represent no patient. Using the systems biology approach, Dr. Trahtemberg foresees the development of diagnostic and therapeutic interventions that will be personalized for each patient, using prediction models, decision-aiding tools and novel treatments.

Dr. Trahtemberg has a Ph.D. in human immunology, is a specialist in Internal Medicine, and is currently pursuing his subspecialty training in Critical Care Medicine. He represents a new breed of young clinical scientists who think out of the box and he has a relentless passion for science and innovation. He seeks support for this most important research which has all the critical components for a successful outcome that will benefit critical care patients with a personalized touch.