The Implementation of Personalized Medicine in the Republic of Moldova: Challenges and Opportunities in Cardiology

Abstract

Implementing Personalized Medicine in the operational and functional context of a healthcare system is a complex challenge for most countries. Pharmacogenetics represents the application domain of individual genetic profile testing for drug prescription purposes. Health insurance systems are the mechanism by which drug treatment expenses can be covered. Doctors prescribe treatments based on a patient's clinical evaluation, according to the results of clinical studies that demonstrated the efficacy and low risk of adverse reactions of a particular drug tested on a clearly defined group of patients. Historically, most of these studies missed the assessment of individual capacity to metabolize drugs through xenobiotic transformation pathways. Proteins involved in transforming drug's chemical forms have yet to be well known, and studying their activity mechanisms is complex from a methodological point of view. Structural changes in the genes coding these proteins demonstrated an association with drug metabolism capacity, as revealed by GWAS studies for some populations. Inequality in sample collection and access limited the representativeness of many populations, with statistical significance levels being reached only for some of them. Validation of GWAS associations would allow their application in pharmacogenetic testing services in an evidence-based manner. This study represents a survey of the current opportunities to implement recommended genetic testing for the drugs used in CVD treatment compensated for the population by the National Health Insurance Company in the Republic of Moldova.