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Molecular Medicine

An Introduction

Jens Kurreck and Cy Aaron Stein

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Dedication

Dedicated to Ferdinand Hucho and John J. Rossi for their contributions to the life sciences, and most importantly, for being extraordinarily well-respected, decent, honorable human beings.

Preface

Molecular medicine is one of the hottest, most dynamic areas in all the life sciences and combines the disciplines of biology, biochemistry, human biology, and pharmacology, in addition to basic and clinical medicine. Knowledge of the molecular sources of disease has and will continue to pave the way for the development of novel diagnostic procedures and therapeutic strategies to treat inherited or acquired diseases. The expanding repertory of therapeutic approaches finally makes it possible to address diseases that hitherto have been untreatable. Molecular medicine will without doubt change our disease treatment paradigms; rather than employing standard therapies for every individual and adjusting treatment based on observed efficacy and side effects, personalized approaches based on specific constitutional features of the distressed individual will become possible.

In recent years, many universities worldwide have established bachelors and masters degree programs to study molecular medicine. In addition, molecular medicine has become an indispensible component of well-established curriculums. Courses of study in medicine, (molecular) biology, biochemistry, human biology, and biotechnology have frequently been offered. We thus had the sense that it was time to assemble an up-to-date introduction to the entire spectrum of molecular medicine, one written in a clear and uniform style. Numerous color figures and expositions of clinical relevance will, we hope, also ensure a systematic introduction to the topic.

This textbook primarily addresses undergraduates and lecturers. It is based on our experience in teaching courses in molecular medicine for many years, in laboratory research, and in medical practice. We assume that students who use this textbook have at least some basic knowledge of molecular and cell biology. If not, we recommend that students first consult appropriate introductory textbooks such as Principles of Biochemistry by Voet et al. or Molecular Biology of the Cell by Alberts et al. Although this textbook is primarily written for undergraduates, we also hope that medical and graduate students and researchers in the field of molecular medicine will also benefit from it.

For many reasons, writing a book on molecular medicine is a challenging task. First, there is no common consent on just what molecular medicine actually is. We view molecular medicine as a discipline that investigates normal and pathological cellular processes at the molecular level. Such in-depth analysis will help us to better understand the causes of disease, improve diagnosis, and develop novel therapeutic strategies. This understanding of molecular medicine has led us to the selection of the topics that are covered in this book.

The broad range of topics poses a second challenge, as no two-author team can possibly be experts in all areas of molecular medicine. However, we chose not to edit a book composed of individual specific articles, each written by an expert in a particular field in his or her own style. Instead, we have attempted to present a homogeneous textbook in a uniform and consistent style.

Numerous cross-references will help the reader to understand the complex interdependencies between the different fields of molecular medicine. For example, the monoclonal antibody Herceptin not only provides a comparatively new treatment option for aggressive breast cancer but is also a recombinant protein drug that is challenging to produce. Its successful therapeutic use represents one of the paradigmatic applications of pharmacogenetic testing.

Finally, the dynamics of the field of molecular medicine required us to assemble a textbook with the most up-to-date information possible. An accompanying Web site – http://www.wileyvch.de/home/molecular_medicine – will contain figures and figure legends from the book, in addition to regular updates on the latest developments in the field.

This textbook is divided into chapters, each of which can be viewed as one lecture of a one semester course on molecular medicine. The sections are structured in a logical order. However, each chapter can also stand alone as an introduction to a single topic, for example, gene therapy or stem cell technology. Cross-references will help the reader to find sections in the book that should be consulted for an in-depth understanding of the topic.

The textbook commences with a short general introduction to molecular and cellular biology and then describes some selected methods widely used in modern life science research. Several chapters deal with the molecular causes of disease, and established as well as new diagnostic approaches are also described. Viral, bacterial, or eukaryotic pathogen infections are also covered, as these are a major cause of suffering and death worldwide, and require continuous improvements in therapeutics for the management of emerging pathogens and drug resistance. The outline of novel therapeutic approaches for the treatment of cancer and genetic disorders developed in the era of molecular medicine will certainly leave the reader impressed by the dynamism of this field: Drugs based on recombinant proteins, particularly monoclonal antibodies, have already become an important element in clinical practice. Timely topics such as the newest advances in gene therapy, stem cell research, and RNA technologies will be introduced with numerous helpful figures. The book will conclude with a chapter on the ethical dimensions of molecular medicine.

Every chapter is accompanied by recommendations for further reading. Rather than providing an exhaustive list of bibliographical references that would be of limited use for most students, we selected educationally valuable review articles for each topic. While we initially intended to choose current articles, we also found older reviews that can provide excellent introductions to various subjects. In addition, the reference lists are intended to help students to begin navigating through the jungle known as the modern scientific literature.

We hope that the readers will enjoy our journey through the field of molecular medicine and share our enthusiasm for this fascinating subject. We would be very pleased if our textbook helps prepare you for working in this exciting field.

Acknowledgments

This book would not have been possible without the help of many people. We are particularly thankful to Erik Wade for reading all the chapters and providing valuable suggestions. We also thank Anke Wagner for her comments on several chapters. We also want to thank our (JK) student Derya Günes for her chapter revisions. Additional thanks goes to Mary Houlemarde and Tonya Nickens for their support, and to Daniela Castanotto for her unfailing good humor, common sense, and help in probing some of the more complex issues of this narrative. A big thanks goes to Harry Kurreck for proofreading all the chapters and giving valuable comments.

We want to thank the team at Wiley, Waltraud Wüst, Anne Chassin du Guerny, Gregor Cicchetti, and Andreas Sendtko, for their advice and assistance. A special thank goes to our graphic designer Anke Wagner for converting our quirky sketches into illustrative figures.

It is impossible for two scientists to cover the whole field of molecular medicine in depth. We are, therefore, thankful to our expert colleagues for their valuable comments on specific topics: Thomas Bock, Toni Cathomen, Henry Fechner, Anja Pöhlein, Roland Lauster, and Daniela Castanotto. In addition, we want to thank Tatjana Schütze for support with the graphical representation of protein structures. We also want to thank our research groups for their enthusiasm about molecular medicine.

Last but not least, we express our most heartfelt appreciation and thanks to our families for their patience when we spent far too much time writing this book. Therefore, this book is for Harry, Marianne, Malte, Paul, and Anke; for Myra, Allison and Warren; Lauren and Brian; and Lily Leigh and Margot Nicole.

May 2015

Jens Kurreck, Berlin

Cy Aaron Stein, Duarte