Keynote: Precision Delivery of Advanced Therapeutics: Overcoming Surgical and Anesthetic Challenges for Successful Dosing of Next Generation Drugs

The field of medicine has traversed multiple major eras, each typified by major advances in humanity’s ability to diagnose, treat, and prevent disease. At the turn of the 19th century, the scientific method became a cornerstone of the medical field, leading to the development of antibiotics, vaccines, anesthetics, and rapidly expanding surgical capabilities. Currently, we are at the start of the next chapter for the field of medicine, the era of personalized and precision medicine. Medical science has advanced to the point where individual patients with never-before described diseases can be treated with custom-made therapies that vastly improve their quality of life. Gene therapies, cell therapies, and radiopharmaceutical theranostics all rely on highly precise mechanisms of action to treat diseases that until now were untreatable. Many of these therapies require equally precise surgical delivery procedures to be successful. Here, an overview of some of these precision delivery procedures will be presented. These procedures include MRI- and CT- guided infusions; drug delivery to peripheral nervous tissues such as the cochlea, the retina, the semicircular canals, the trigeminal ganglia, and the dorsal root ganglia; high-intensity focused ultrasound enabled opening of the blood-brain barrier for drug delivery; and intranasal delivery of therapeutics for neurologic disease will all be discussed. Advantages of using precision drug delivery procedures such as access to anatomical structures central to disease processes, minimization of off-target toxicity, and management of scalable drug manufacturing processes by reducing the total amount of therapeutic dose will also be highlighted. Development and refinement of these practices in nonclinical settings is a key component of bringing these therapies to the patients and the families that need them.