BACKGROUND: The majority of diseases originate in a particular cell or cell type, proliferate in the body until patient symptoms are noticeable and, subsequently, diagnosed by a physician. At this stage, the physician has a choice of how to handle the cell / cell type in question (depending on the disease and availability of therapies):

• Kill it (e.g.: chemotherapy)
• Replace it (e.g.: stem cells)
• Regulate it (majority of current pharmaceutical options e.g.: antihypertensives, antidiabetics)

THE ISSUE: The common problem for all these approaches is the lack of specificity when engaging with their target, this often leads to side-effects collateral cell damage or inadequate patient response. THE SOLUTION: Two potential new models have emerged as a solution to the targeting problem:

• Programmable cells (e.g.: CAR-T)
• Programmable nanorobots (e.g.: DNA-origami technology)

Both have the potential to deliver targeted killing and regulation of cells, and at least contribute to cell replacement. They are, however at different stages of development, with CAR-T therapies having passed human clinical trials, received FDA licenses and undergoing licensing with EMA, while DNA-origami has only been tested in animal models.

IMPACT: Since the lack of specificity continues to be an issue for most current therapies, the authors believe that improved targeting of therapies could have a dramatic impact on the future of healthcare, including:

• The patient benefitting from longer survival and better quality of life
• The pharma industry undergoing a transformation, focusing on these new models and optimizing existing models through price competition
• The healthcare systems and governments adapting to new market paradigms, as well as potentially adjusting policy to account for the longer life expectancy

These effects must be investigated further to understand their full potential.