personalised medicine: the new frontiers of human health

and personalised medicine: the new frontiers of human health

of treatments, precision of surgical gestures or even the screening of molecules with biological activity: these are the outlines of a cutting-edge medicine for which each patient is unique.

With 2.1% of global research in 2019, France ranks 12th in artificial intelligence and 6th in the EPO with 3.7% of patent applications. Presented on 21 March 2017, the French AI strategy focuses on health through a sectoral theme of “health and medical applications”. It remains to encourage the transfer of research work to industry by continuing to open up health data, by training in new professions involving the implementation of digital technology and AI, by supporting the development of digital health start-ups and by encouraging the development of telemedicine.

The Health Data Hub (HDH) is part of this dynamic. Created by the law of 24 July 2019 on the organisation and transformation of the healthcare system, the HDH brings together 56 stakeholders and guarantees easy, unified, transparent and secure access to health data to improve the quality of care and support for patients. The HDH’s service offer is based on four main themes: enhancing data assets, facilitating data use, protecting citizens’ data and innovating with all stakeholders. For example, the Rexetris project, selected by the HDH in 2019 and led by the Limoges University Hospital, aims to produce concrete recommendations on long-term treatment following a kidney transplant. To date, the HDH has more than 1,600 projects submitted, 173 affiliated researchers and 1,262 members of the open-source community.

Automatic analysis of mammograms and digital twins

For its part, public research in AI is steered by Inria through the four 3IAs (Interdisciplinary Institutes for Artificial Intelligence), labelled by the State in April 2019. At Inria, research projects in digital health and biology are numerous and interdisciplinary, allowing the genesis of world-class startups such as Therapixel, whose automatic mammography analysis tool reduces the false positive rate by 5%, Anatoscope, which has created digital duplicates of patients’ anatomy, or Vidium, which is developing digital twins in cell biology. focus on biomedical imaging, clinical decision support, genomics and cognition with a view to creating advanced computer-assisted decision and diagnostic systems for personalised medicine (evaluation, equity, transparency, explicability). For its part, the MIAI Grenoble Alpes mobilises the Grenoble Alpes University Hospital as well as numerous doctors, mathematicians, computer scientists, chemists and industrial players around 3 research programmes: 4P “real-life” medicine, multiomics and computer-assisted medical intelligence. A third 3IA is making health an emerging theme in its activity: ANITI. This is evidenced by three chairs in neuroscience, robotics and AI: “Deep Learning with semantic, cognitive and biological constraints”, “Motion Generation for Complex Robots” and “Neuroadaptive technology”. Synergies in prospect.

© Setzner1337

X-ray of a hand, with automatic calculation of bone age by computer software / Rayon X d’une main, avec calcul automatique de l’âge osseux par un logiciel informatique

E-health: multiple applications for patients

Teleconsultation, tele-expertise, remote monitoring, remote assistance (including assisted surgical procedures) and medical regulation: through these five acts, telemedicine aims to meet challenges such as the ageing of the population, the increase in chronic diseases, the unequal distribution of health professionals and budget constraints. Its development prospects are considerable if we consider its potential beneficiaries: people suffering from heart, kidney or respiratory failure, patients in prison, the elderly, people with reduced mobility, etc.

For example, Bouygues Telecom has designed a 5G-connected telemedicine booth to offer the expertise of a doctor or a specialty to medical deserts. The same objective has been set by MaQuestionMedicale.fr, the only telemedicine platform that is independent of any mutual insurance company or insurance company: created by Dr Jean Tafazzoli in 2018, it has already put 2,500 doctors and 70,000 patients in contact with each other across the country. The platform stands out for the innovation of the services it offers: telemedicine, “connected” and “augmented” medicine, generalised third-party payment, securing health data, digitalisation of health, medical deserts, the government’s “Ma santé 2022” (My health 2022) plan...

These approaches are supported by the Agence du Numérique en Santé (Digital Health Agency, ANS), which accompanies the digital transformation of the French healthcare system through its three main missions: to regulate e-health by setting out frameworks and good practices, to conduct projects of national interest under the aegis of the public authorities and to support the national and territorial deployment of digital health tools and projects in order to develop uses and encourage innovation. At the request of the Ministry of Health in March 2018, the ANS conducted a national study to support the deployment of telemedicine. This approach, which included an inventory of regional telemedicine platforms, the formalisation of a functional reference framework and a reflection on the security issues of teleconsultations, was integrated into the digital component of the Ségur de la santé: within this framework, 2 billion euros were granted to support the massive and coherent development of digital health in order to accelerate the modernisation, interoperability, reversibility, convergence and security of health information systems. Only software solutions referenced by the ANS will be eligible for Ségur funding. A rigorous framework to support the expansion of post-Covid-19 telemedicine.

Care adapted to the specific genetic characteristics of patients

Personalised medicine has entered the field of medical practice with full force: the examination of the genetic characteristics of a person or a pathology is now indispensable in prenatal diagnosis, oncology, the rarest genetic diseases as well as the most frequent chronic diseases. Several factors have contributed to its emergence: the progress of knowledge, the development of genetic and computer analysis capacities and the emergence of targeted therapies. France has a significant lead in this field thanks to the impetus of the Gustave-Roussy Institute (IGR, Villejuif), the Curie Institute and the National Cancer Institute, which has set up genetic testing platforms that have benefited more than 200,000 patients over the last 10 years. However, the added value of genetic tests varies greatly depending on the situation and depends on three parameters: the frequency of the risk, its seriousness and the possibility of medical action. It is to measure the real medical benefit that a learned society dedicated to personalised medicine was founded: the French Society of Predictive and Personalised Medicine (SFMPP).

For its part, the French National Research Agency (ANR) continues to support the promotion and coordination of research activities on personalised medicine, in France and internationally. The Agency is a partner in the international ICPerMed consortium, a member of the ICPerMed Secretariat and chairs the ERA-PerMed consortium: this ERA-net dedicated to personalised medicine in the framework of the European Horizon 2020 programme brings together 32 partners. With a national budget of €8.45M, the ANR is funding 38 French teams through 31 projects. A fourth transnational call with a budget of €24M was launched on 14 December 2020 to promote innovative interdisciplinary collaboration and encourage translational research proposals. A public initiative that finds powerful relays in the private sector: witness the research projects in oncology, immunology and neurosciences of the Roche Personalized Medicine Research Fund and the personalized medicine and healthcare technologies developed by Microsoft (genomics, clinical analysis, care coordination, safety and compliance). Tailor- made treatments thanks to big data and 5G are already beyond the realm of science fiction!

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