Synthetic biology is already being applied to some areas of medicine and there is considerable potential to expand its use.³² Many medicines are either sourced directly from living organisms or based on chemicals produced in nature. Synthetic biology has the potential to find many new candidate drugs³³ and to produce medicines in cellular factories.³⁴ Notably, the first synthetic vaccines have been made and shown to be effective.³⁵

Future Horizons:

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5-yearhorizon

Human cells and genomes are re-engineered through AI

AI guides the re-engineering of human cells and genomes. The human pangenome is used to predict unwanted side effects of genome edits. Cell-based diagnostic systems can be implanted into the human body, and rational design of binding molecules such as antibodies leads to new and targeted treatments. More effective probiotics and symbiotics are available. Many new cell therapies such as CAR T-cell and cancer therapeutics begin to appear, along with rapid design and production of new RNA-based easily programmable vaccines, including variants for emerging strains.

10-yearhorizon

Synthetic-cell therapies are customisable

Generic and customisable systems can create synthetic-cell therapies. Cellular factories allow high-throughput production of new therapeutics. Improved understanding of microbiome-host relationships enables microbiomes to be used for therapy. Cellular sensors, some integrated with electronic systems, monitor fluctuating body systems such as blood sugar. A new base-editing tool that opens up new therapeutic strategies is discovered. Cell-free biosensors are used to assess water quality.⁵²,⁵³

25-yearhorizon

Organ production is programmable

Programmable organ production from stem cells for human transplants becomes possible, along with inducible tissue regeneration for a limited set of organs. Whole-organ engineering begins to happen. Cellular devices can both diagnose and treat conditions, for instance by synthesising a treatment. Long-lasting microbiome therapeutics that can release a drug steadily eliminate the need to take pills. Engineered phage therapies for antibiotic-resistant bacterial infections become available. Synthetic biology approaches to public health are applied, providing clean water, nutrition and improved air quality.

It is theoretically possible to use genome editing to treat genetic diseases.³⁶ Inherited diseases are a particularly tempting target. A number of technologies exist for precision genome editing of human cells,³⁷ and some in vivo experiments targeting conditions like mucopolysaccharidosis have already been conducted.³⁸ However, genome editing’s potential goes beyond genetic conditions. For instance, CRISPR-Cas may be used to treat viral infections by targeting the virus’s genome within human cells.³⁹ There is also potential for improving cancer treatments,⁴⁰ such as by engineering immune cells to kill tumours.⁴¹ To minimise the risk of off-target effects, improved maps of human genetic diversity are a prerequisite for such therapies.⁴²

Therapies based on synthetic cells⁴³ have shown promise for certain hard-to-treat conditions such as spinal muscular atrophy.⁴⁴ In some cases,⁴⁵ bacteria act as “living drugs”.⁴⁶ Controlling such cells remains a challenge,⁴⁷ but programmable synthetic receptor systems may offer a means of doing so.⁴⁸ There have also been preliminary investigations into the benefits of modifying the skin microbiome.⁴⁹ Going beyond cells, engineered tissues have potential as drug-delivery systems,⁵⁰ while synthetic transplant organs and induced tissue regeneration remain distant but tantalising possibilities.⁵¹

Medicine and health - Anticipation Scores

The Anticipation Potential of a research field is determined by the capacity for impactful action in the present, considering possible future transformative breakthroughs in a field over a 25-year outlook. A field with a high Anticipation Potential, therefore, combines the potential range of future transformative possibilities engendered by a research area with a wide field of opportunities for action in the present. We asked researchers in the field to anticipate:

The uncertainty related to future science breakthroughs in the field
The transformative effect anticipated breakthroughs may have on research and society
The scope for action in the present in relation to anticipated breakthroughs.

This chart represents a summary of their responses to each of these elements, which when combined, provide the Anticipation Potential for the topic. See methodology for more information.