Theranostics-enabling high-tech centers: the value of centralizing resources in countries in development

1.1 The evolution of personalized medicine

Throughout history, the approach to medicine has been typically generalized. However, with the advent of theranostics, healthcare has ventured into an era of personalized medicine that caters to the unique needs of every individual. This shift in medical philosophy and practice has been gradual and guided by several key developments (Table 1).

The shift towards personalized medicine, powered by theranostics, is not just an evolution in healthcare but a revolution. It is a paradigm shift that promises to transform the way we diagnose and treat diseases, ultimately leading to better patient outcomes and a healthier world.

1.2 Understanding theranostics

With its traditional meaning, the term theranostics pairs diagnostic biomarkers with therapeutic agents to diagnose and treat cancer. The most common use of the term covers only the application of radiopharmaceuticals in diagnosing and treating cancer patients. However, in the modern era of cancer treatment, this definition could encompass much more than this traditional definition. Especially in the era of targeted therapy for cancer, the personalized approach has gained significant importance about improving both the clinical efficacy and cost-effectiveness of the treatments and decreasing the side effects. Therefore, the combination of diagnostic approaches providing predictive and prognostic value with therapeutic strategies could be included within the scope of theranostics. Accordingly, theranostics could be further expanded to include developing diagnostic tools and treatment strategies under the same production roof. The term theranostics can be defined as the development and use of therapeutic agents based on diagnostic tools (Choudhury & Gupta, 2018; Herrmann et al., 2022; Seifert et al., 2021; Yin et al., 2022; Zahiri et al., 2021).

At its core, theranostics is guided by the fundamental idea that each patient’s disease profile is distinct, demanding a targeted and customized approach. The primary components of theranostics include (Figure 1):

Figure 1. Theranostics framework.

The figure illustrates the main components of theranostics, including: 1) diagnostic, which focuses on the identification of biomarkers, molecular signatures and other indicators using advanced tools that provide crucial insights into the patient’s disease; 2) patient stratification and personalized medicine through the previous diagnostics, allowing interventions tailored to the patient’s genetic makeup, disease progression and treatment response; and 3) specific therapeutics for individual patients or groups drawn from diagnostics information, which includes selecting suitable agents and delivery methods, and designing specific treatment regimes, minimizing side effects.

Theranostics has yielded remarkable advances in various medical domains, including oncology, cardiovascular diseases, neurology, and infectious diseases. In oncology, for instance, theranostics enables the identification of specific tumor markers that guide the selection of targeted therapies and monitor treatment response (Altena et al., 2023; Buck et al., 2022; Lecocq et al., 2019). Similarly, in cardiovascular diseases, molecular imaging techniques assist in detecting early-stage arterial plaques, enabling timely intervention and treatment (Zan et al., 2023).

Notably, both medical practitioners and patients are experiencing remarkable outcomes with the application of theranostics in the context of prostate cancer (O’Dwyer et al., 2021; Plichta et al., 2021). This form of cancer poses significant challenges when diagnosed at an advanced stage, contributing to an annual toll of over 1.4 million lives, according to the World Health Organisation. Furthermore, theranostics extends its benefits to various clinical scenarios, encompassing the management of bone metastases originating from prostate cancer, neuroendocrine tumors, non-Hodgkin lymphoma, and adrenergic tumors (Ballinger, 2018). Moreover, its well-established role in addressing hyperthyroidism and thyroid cancer (Gomes Marin et al., 2020) underscores its versatility. Besides the above-mentioned traditional examples of theranostics, genomics, and molecular-based diagnostics, they have also fueled targeted drugs such as tyrosine kinase inhibitors and immunotherapeutic agents (Smidova et al., 2021; Xu et al., 2022). While the potential for theranostics to expand into novel realms of care is substantial in the near future, the extent of this expansion will inevitably hinge on the pace of drug development and the necessary regulatory clearances (Perera & Morris, 2022).

Integrating theranostics into infectious disease management, especially in the context of viral infections, is an evolving area of research and practice. There are indications that theranostics could offer valuable insights into managing viral infections (Gholami et al., 2023), with a notable emphasis on viral outbreaks (Itani et al., 2020).

One of the most prominent examples lies in the realm of antiviral therapies. Consider the case of Hepatitis C, a viral infection that affects millions globally, according to the World Health Organisation. Theranostics has been explored to guide treatment decisions by identifying specific genetic markers within the virus. This information helps tailoring antiviral therapies to the patient’s viral strain, thereby increasing treatment efficacy while minimizing side effects (Coppola et al., 2015).

In addition, the application of systems medicine within theranostics offers a unique avenue for understanding the complex interactions between viruses and their host organisms. In the face of viral outbreaks, such as the Zika virus, systems medicine takes a holistic approach, considering not only the virus itself but also the individual’s immune response, genetic factors, and environmental influences (Ferraris et al., 2021; Fuller et al., 2017; Giraldo et al., 2023). By integrating vast amounts of data, this approach can predict disease progression, identify potential treatment targets, and ultimately contribute to more effective interventions (Abrams et al., 2017; Alam et al., 2021).

However, it is essential to acknowledge the challenges and uncertainties of applying theranostics to viral infections. Viruses are notorious for their rapid mutation rates, which can impact the accuracy of diagnostic markers and the effectiveness of targeted therapies (Pawlotsky, 2014; Thompson & McHutchison, 2009). As such, the use of theranostics in this context requires ongoing research and adaptation to keep up with evolving viral strains.

Furthermore, regulatory considerations and the pace of drug development play a crucial role in determining the extent to which theranostics can be integrated into viral infection management. Regulatory agencies need to evaluate the safety and efficacy of theranostics-based approaches before they can be widely adopted (Herrmann et al., 2022; Perera & Morris, 2022).

In conclusion, while there are instances where theranostics has shown promise in managing viral infections, its full integration into this field is a complex and evolving process. The success of such endeavors requires a multidisciplinary approach, collaboration between researchers and healthcare practitioners, and a continuous effort to adapt to the dynamic nature of viral infections.

Overall, theranostics represents a paradigm shift in medicine, departing from generalized treatment approaches toward personalized care. It capitalizes on the synergy between diagnostics and therapeutics, providing medical professionals with a comprehensive toolkit to combat diseases more effectively while minimizing adverse effects. As technologies continue to evolve, theranostics holds the promise of transforming healthcare by offering patients treatments tailored to their individual needs, fostering better patient outcomes, and enhancing the quality of life.

3.1 Johns Hopkins Medicine (USA)

Situated within the renowned Johns Hopkins University, the Theranostics Center is a prime example of resource centralization that offers personalized cancer diagnostics and therapies. This center boasts state-of-the-art imaging facilities, molecular analysis laboratories, and a comprehensive clinical setup. By centralizing these resources, it facilitates seamless interaction between researchers, clinicians, and engineers. The center’s multidisciplinary approach fosters collaboration, allowing experts from various fields to collectively develop and refine theranostics-based solutions. This center has propelled groundbreaking research in precision medicine, with teams of experts collaborating to develop targeted therapies based on individual patients’ molecular profiles. By utilizing state-of-the-art imaging technologies and advanced treatment modalities, they have achieved remarkable outcomes in cancer treatment - especially prostate cancer - and neurodegenerative disorders (Beik et al., 2021; Solnes et al., 2020; Zhang et al., 2005).

3.2 Karolinska Institute (Sweden)

Sweden’s Karolinska Institute, known for awarding the Nobel Prize in Physiology or Medicine, has established the Karolinska Theranostics Center as a beacon of innovation. Within the Karolinska Institute, collaboration between clinicians, researchers, and industry partners is paramount. While the center centralizes advanced imaging technologies, it also thrives on collaborations with neighboring research institutions and hospitals. This approach capitalizes on each entity’s strengths, enabling the center to tackle complex challenges through shared expertise and resources. This center focuses on leveraging nanotechnology and molecular imaging to enable early disease detection and personalized treatment plans. Their successful endeavors include developing nanoparticle-based drug delivery systems for cancer therapy and non-invasive imaging techniques for neurological disorders (Altena et al., 2023; Porsch et al., 2013).

3.3 Gustave Roussy Cancer Campus (France)

Gustave Roussy Cancer Campus exemplifies a collaborative theranostics ecosystem centered around patient care. As Europe’s largest cancer center, it unites diverse medical disciplines, researchers, and technology experts. By centralizing expertise and integrating patient data, the campus creates a collaborative environment that tailors theranostics solutions to individual needs. This approach showcases how resource centralization and interdisciplinary collaboration can synergize for better patient outcomes, specifically in cancer treatment (Petranović Ovčariček et al., 2023; Seban et al., 2019).

3.4 Seoul National University Theranostics Center (South Korea)

Seoul National University Theranostics Center underscores the pivotal role that international collaboration plays in advancing healthcare. This center brings together experts from diverse fields, including medicine, engineering, and material science, to develop innovative theranostics solutions. While it centralizes facilities, its strength lies in global partnerships. Collaborations with research institutions, industries, and academic entities worldwide foster a dynamic ecosystem where knowledge exchange and shared resources drive theranostics breakthroughs. Their achievements range from early cancer detection using molecular imaging to the creation of smart nanoparticles for precision drug delivery (Jung et al., 2022; Oh et al., 2023).

These examples underscore the global momentum behind theranostics-enabling high-tech technological centers. By fostering interdisciplinary collaboration, investing in cutting-edge technologies, and prioritizing personalized approaches to healthcare, these centers are paving the way for a future where diseases are detected earlier, treatments are more effective, and patient outcomes are improved. As they continue to push the boundaries of innovation, their collective efforts promise to reshape the landscape of modern medicine and offer new hope to patients worldwide.

4.1 Current challenges in the healthcare sector and their mitigation through resources centralization

As one navigates the complex landscape of development in many parts of the world, it is imperative to recognize the numerous challenges these countries face. The spectrum of issues is vast, encompassing economic, social, and technological dimensions, according to United Nations (United Nations, 2018). In particular, developing countries face a plethora of challenges when it comes to accessing quality health care. These issues revolve around infrastructure, quality of health services, expertise availability, affordability, and geographical reach. Let’s explore these challenges and how the centralization of resources can significantly mitigate them.

Infrastructure

Lack of adequate infrastructure in these countries often inhibits efficient healthcare delivery concerning personalized medicine. Essential facilities like well-equipped hospitals are often lacking, and the existing ones need to be improved to handle the needs of the population.

Quality of health services

The quality of health services often suffers in developing countries given the constraints such as the lack of appropriate equipment, the lack of standardization in services, and the reduced availability of specialized care.

Expertise availability

A significant impediment to healthcare in developing countries is the shortage of skilled healthcare professionals and experts in various medical disciplines.

Affordability

High costs related to health services are a major deterrent for many individuals in developing countries.

Geographical reach

In many developing countries, healthcare facilities are often concentrated in urban areas, rendering it inaccessible to a significant portion of the population residing in remote and rural areas.

In summary, centralizing resources into high-tech centers addresses several key challenges in healthcare delivery in developing countries, making advanced and quality care more accessible and affordable for their population. The benefits of centralizing resources at the national level range from enhancing healthcare delivery to fostering research and development. Here are some of the many benefits:

Figure 2 provides a visual representation of the impact of implementing resource centralization for the availability of theranostics in developing countries.

Figure 2. Impact of implementing resources centralization for the availability of theranostics in developing countries.

In this graphical abstract, a sequence of consecutive steps is presented on the left, with their immediate short and long-term impact depicted on the right. These steps encompass: 1) identify resources for the creation of a resource allocation plan in the short-term and for the improvement of resource management in the long-term; 2) invest in high-tech centers, which in the short-term leads to job creation and economy stimulation, and in the long-term provides a sustainable economic growth; 3) foster research and development drive innovation in theranostics products in the short-term and improves the healthcare delivery in the long-term; and 4) establish international collaborators results in gaining global recognition in the short-term and increasing the international investments in the long-term.

4.2 Risks of centralizing resources

While the centralization of resources in countries in development can indeed pose certain challenges, it is important to understand that these potential risks are far outweighed by the numerous benefits. A major concern often voiced revolves around the potential for unequal distribution of resources. However, these risks can be mitigated through thoughtful planning and effective management.

In the context of centralizing resources, it is crucial to ensure that the benefits are evenly distributed and accessible to all regions within the given country. Without careful oversight, there is a risk that certain areas may be left underserved. This could potentially exacerbate existing inequalities, with more affluent or urban regions having better access to these high-tech centers than rural or impoverished areas.

While centralizing resources does have its advantages, it is also vital for policymakers and decision-makers to address the potential pitfalls to effectively streamline the development of theranostics technologies. Here, we share several strategies that can be implemented to mitigate the associated risks.

In conclusion, centralizing resources in developing countries for theranostics development can bring significant economic and health advantages. Over and above these points, centralization also presents an opportunity for capacity building within developing countries. High-tech centers can serve as hubs of innovation and learning, fostering the growth of local talent and driving economic development. It is an opportunity that developing nations should seize to foster growth and improve the quality of life for their citizens.

4.3 Key value propositions of high-tech theranostics centers

The establishment of high-tech centers aimed at enabling theranostics in developing nations offers crucial benefits that extend beyond the realm of technological advancement. The potential of theranostics is vast, promising not only significant healthcare enhancements but also substantial societal and economic gains. Below are ten reasons why these centers warrant serious consideration:

In sum, the establishment of high-tech technological centers for SMEs to develop theranostics products in developing countries can catalyze economic growth, healthcare advancement, and innovation. These efforts align with broader goals of enhancing healthcare access, boosting local economies, and positioning the country as a frontrunner in scientific and medical innovation leader.

As decision-makers, it is crucial to understand the immense potential that centralizing resources in developing countries brings. This strategy can not only boost the economy but also enhance the infrastructure for the development of diagnostic and therapeutic products, known as Theranostics.

4.4 Case studies: Success stories from high-tech centers

The Theranostics Revolution in India

India stands as a shining example of how resource centralization has magnified their capabilities in the theranostics sector. In the past decade, India has made remarkable strides in the field of theranostics, courtesy of their concerted efforts towards centralizing resources.

India’s Biotech Consortium India Limited (BCIL) is a prime example of this model. BCIL was established by the government as an entity to aid in the centralization of resources and to foster collaboration among various stakeholders. This initiative has enabled the development and production of diagnostic and therapeutic products at a fraction of the time and cost.

The Chilean model of centralized innovation

Chile has been at the forefront of technological innovation in South America, thanks to its robust policy of pooling resources.

The government’s establishment of The Chilean Economic Development Agency (CORFO) has played a pivotal role in this success story. CORFO has been aiding in the consolidation and distribution of resources to high-tech centers, paving the way for cutting-edge theranostics solutions.

As a result, Chile has seen a surge in its innovation and technological prowess, significantly improving its healthcare system and making strides in achieving sustainable development goals.

South Africa’s Leap into theranostics

South Africa sets a precedent with its successful implementation of centralized resources in the theranostics sector. The country’s Department of Science and Innovation (DSI) has been instrumental in this regard.

DSI, through its National System of Innovation (NSI), has fostered the centralization of resources, enabling the development and implementation of theranostics solutions. This move has not only led to significant advancements in healthcare but has also created numerous job opportunities, bolstering the country’s economy.

These three examples serve to underline the fact that resource centralization is no longer a luxury but a necessity for developing countries aiming to make significant strides in the theranostics sector. It’s a blueprint for success that can empower nations to transform their healthcare systems and significantly enhance their global standing in the high-tech industry.