Chemistry for Better Health

A White Paper from the Chemical Sciences and Society Summit (CS3) 2011www.rsc.org

About the Chemical Sciences and Society Summit (CS3)
The annual Chemical Sciences and Society Summit (CS3) brings together the best minds in chemical science
research from around the world and challenges them to propose innovative solutions for society’s most pressing
needs in the areas of health, food, energy, and the environment. This unique event boasts an innovative format,
aiming to set the course of international science, and rotates each year among the participating nations.
Chemistry for Better Health summarises the outcomes of the third annual CS3, which focused on advances inchemistry for modern medicine. Thirty top chemical scientists from the five participating countries assembled
in Beijing to identify the scientific research required to address key global challenges, and to provide
recommendations to policymakers. The full white paper presents an international view on how chemistry cancontribute positively to human health.
The CS3 initiative is a collaboration between the Chinese Chemical Society (CCS), the German Chemical Society(GDCh), the Chemical Society of Japan (CSJ), the Royal Society of Chemistry (RSC) and the American Chemical
Society (ACS). The symposia are supported by the National Science Foundation of China (NSFC), the German
Research Foundation (DFG), the Japan Society for the Promotion of Science (JSPS), the UK Engineering andPhysical Sciences Research Council (EPSRC), and the USA National Science Foundation (NSF).
This white paper was compiled and written by Jon Evans and James Hutchinson.

i | Chemistry for Better HealthTable of contents
About the Chemical Sciences and Society Summit (CS3)i

Executive summary

2

Recommendations for policymakers
Summary of recommendations
A new global model for drug discovery
Sharing of data, knowledge and resources

4
4
5
6

1. Challenges to human health
1.1 Disease
1.2 Diagnosis
1.3 Pharmaceuticals

8
8
9
9

2. Chemistry and disease
2.1 Understanding disease onset and progression: chemical medicine
2.2 Genes and non-infectious disease
2.3 Oxygen and disease
2.4 The brain and disease
2.5 Analysing biological processes

11
11
12
12
13
13

3. Novel chemistry for diagnosis
3.1 Biomarkers
3.2 Probes
3.3 Molecular imaging and diagnostics

14
14
14
15

4. C
 hemistry and drugs
4.1 Target validation
4.2 Designing more effective drugs
4.3 New synthetic methods
4.4 Process automation
4.5 Drug delivery
4.6 New approaches to treating disease
4.7 Sustainable manufacturing

16
16
17
18
18
19
20
21

5. Opportunities for the chemical sciences
5.1 Chemistry and disease
5.2 Novel chemistry for diagnosis
5.3 Chemistry and drugs

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25
26

References

29

Appendix
Chemical Sciences and Society Summit (CS3) 2011 participants

32
32

Chemistry for Better Health | 1

Executive summary
All of modern medicine is dependent on advances inchemistry. To ensure the development of healthcare
keeps pace with the increasing health challenges oursociety faces, investment in the underlying chemical
science research is absolutely vital.
The healthcare goalposts have moved as the century
has turned. We all face problems with the spreading of
infectious disease on an unprecedented scale. Poor
nations are unable to afford or distribute expensive
modern drugs, while in all nations drug resistance is
growing. The exponentially increasing prevalence of
non-infectious disease in an ageing population brings
unforeseen and expensive challenges to healthcare.
Chemistry will offer solutions.
When governments allocate funding to healthcare andlife science research the chemical sciences shouldn’t beoverlooked. It is vitally important that we support thebasic science that enables healthcare research tobloom. If we do, vital opportunities will be created inunderstanding the molecular processes underlying cellbiology and genetics, the identification of chemicalprobes for biomedicinal research, advanced chemistry
for the preparation of efficient chemical reagents andpharmaceuticals, and the innovation of new screening
and diagnostic methods.
Often the challenges to developing better healthcare
lie in a lack of basic molecular-level understanding of
biological processes and of the chemistry of diseaseprogression, or a lack of sufficiently advanced tools
and methods to detect and treat disease and tovalidate drug targets. These are all challenges thatwell-funded chemical science research can overcome.
By developing new chemistry tools to detect diseaseearlier, and more sensitive detection methods tomonitor disease more closely, chemical scientists will
enable quicker diagnosis and more effective, lessinvasive monitoring of disease.

2 | Chemistry for Better Health

The deep well of innovative new drugs that society
has become accustomed to is on the verge of runningdry. With a lack of understanding of the biologicalprocesses and potential drug targets that underpin
disease, rising manufacturing costs and tighter
legislation, the pharmaceutical industry now faces
threats to its current business model, which it isstruggling to overcome.
The discovery and development of new medicinesrequires a number of technologies, to identify themolecular structure of the biological target:• searching for lead compounds that bind to thetarget,• developing a candidate by optimisation of the leadcompound,• identifying appropriate patient groups andbiomarkers and to access efficacy at an early stageof development.
A suite of next generation drug therapies will becomplemented by a range of new therapeutic
approaches, including medical devices, synthetic
biologics and personalised medicine. All of theseadvances will be crucially underpinned by cuttingedge chemistry and a thorough understanding of theunderpinning molecular processes.
To avert the worst of this crisis, and to secure asustainable source of more effective drugs, we mustencourage and support innovation throughout theprocess: from the molecular medicine that will
elucidate and intervene with disease pathways andsystems, to the advanced synthetic chemistry that
adds to the drug designers’ molecular toolkit.
Cutting-edge materials science deliver drugs moresafely, painlessly and efficiently. In the future,
automated machinery will streamline screening
and manufacturing.

This crisis brings opportunity for evolution and change
in the healthcare industry. A more open approach totrial and research data would lead to global
collaborations for the benefit of society. More efficientuse of high-tech equipment and skills could be
introduced through centralised facilities and networks.
National and international strategies for supplying ahealthcare skills pipeline would lead to linked,
coherent and driven workforces working towards
common goals.
Chemistry for Better Health explores these themes, andsets out not only the immense value the chemical
sciences have in healthcare, but the critical importanceof supporting future healthcare with a well-funded
bedrock of talented chemical scientists developing
tools, techniques and treatments to defeat new
challenges to global health.
Opportunities for the chemical sciences to improveglobal health include:• Delivering a better molecular understanding of
biological pathways, and how malfunctions in themolecular machinery of biological systems leads todisease onset and progression.
• Developing a better understanding how our genes
and environmental factors contribute towards noninfectious and age-related diseases.
Genetics andepigenetics

Metabolism• Developing improved methods for diseasediagnosis, including revolutionary point-of-carediagnostic and molecular imaging technologies.
• Improving the efficiency and probability of successfor the drug discovery process by improving the
choice and selection of biological targets andadopting a more rational approach to drug design.
• Bringing medicines research and development into
the modern age through cutting-edge synthetic
chemistry.
• Developing innovative modes of drug delivery
and new approaches to treating disease, including
personalised medicines, regenerative medicine andimproved biological therapeutics• Embedding innovative and sustainable newchemistry throughout the entire medicines researchand development process, to reduce environmental
impacts, lower the overall price of healthcare andincrease global access to medicines.
Chemists and the chemical sciences have played acritical role in the development of modern medicine,and they will need to play a similarly central role inushering in the next generation of medical treatments
and diagnostic technologies (Figure 1).

Cellular processes
and functions

Age andenvironmental factors

Infectious
agents

Disease onset
and progression
Therapeutics• Identification and validation of drug targets• Effective drug design• Development of new synthetic methods
to aid drug design• Process automation• Improved drug delivery• Exploring new treatment approaches• Enabling sustainable drug manufacture

Diagnosis• Improved and more reliable biomarkers• New molecular probes• Improved and more accessible
imaging techniques

Effective
treatment

Figure 1: The chemical sciences can help to improve global healthcare from basic research that helps to understand themechanisms underlying disease, through the development of improved means of diagnosis and through optimising thedevelopment of effective drugs.

Chemistry for Better Health | 3

Recommendations for policymakers

Collaboration

Chemically-trained scientists have the skills and insightto overcome the challenges outlined in this report.
Many of the opportunities will need sustained,collaborative and interdisciplinary research. The
solutions presented here will not be implemented in
our lifetime without the commitment fromgovernments worldwide to a realistic strategy for
improving global healthcare. Financial support for theunderpinning scientific research will be of paramountimportance.

• Improved collaboration between the pharmaceuticalindustry and publicly-funded academia should be
encouraged at the pre-competitive level.

The implementation of the recommendations below forpolicymakers and other stakeholders would significantly
advance our abilities to diagnose and treat disease, andwould give excellent return on investment for society.
The implementation of many of these recommendations
could be achieved with modest amounts of financial
support.

Summary of recommendations
Data sharing• Infrastructure and initiatives should be put in placeat the early stages of drug discovery to enable thepharmaceutical industry and academia to share
more scientific data in a manner that is free ofintellectual property constraints.
• The way that data exclusivity and intellectual
property influence drug discovery and development
should be examined.
• Universally accepted standards for reportingchemical data should be established and integrated
into regulation.
• Governments should make sharing data a conditionof receiving any research-related tax breaks.

4 | Chemistry for Better Health• Further joint appointments across university
departments and non-academic governmental
research facilities should be promoted, including
providing access to industry facilities.
• Greater multidisciplinary collaboration between
scientists across disciplines, particularly chemists,
physicists, biologists, clinicians, and engineers
should be enabled by bespoke funding sources.

Core facilities• Establish 10 linked international public-private
centres of excellence for drug discovery, to focus
on clinical needs currently being neglected by thepharmaceutical industry.
• Establish complementary networks of national
screening centers to combine biological targets,with international access.
• Establish centralised, freely-accessible compound
libraries to deposit compounds and screens andto provide informatics and compound logistics
to enable wider access to existing compound
collections and screening capabilities.
• Establish global centres to train national drug
regulatory agencies to regulatory authority status.

Education

A new global model for drug discovery• Ensure chemists, biologists and pharmacologists
have sufficient training in both biology and chemical
synthesis.

Policymakers, scientists and other stakeholders
must work together to deliver a new global systemof healthcare innovation that can tackle the healthchallenges of the 21st century. It can no longer beleft only to the free market.

• Offer more interdisciplinary training withinfundamental degree courses to empower chemical
scientists to collaborate with other scientists andengineers.
• Provide a more comprehensive graduate experiencethat continues to provide in-depth chemistrytraining while developing skills in multidisciplinary
research, business, communicating with the public
and teaching to better equip students to address
societal health problems.
• Better international co-ordination on
chemistry education.
• Encourage coordinated syllabus discussions
between secondary and tertiary level courses.

We need a global strategy for drug discovery that
capitalises on world-class talent with pump-priming
investment from governments, research funders,charities and the private sector. The fundamental
challenges are to balance drug prices, R&D
expenditure and risk with a fair return on investment
to fund continued innovation. A more open
intellectual property landscape will be required tomeet these challenges.
Key stakeholders should work together to develop asustainable funding model with enhanced public
sector participation that will support world class scientists
in the discovery and development of innovative new
medicines to meet the medical needs of the 21st
century and to contribute to economic growth.
Clinicians and policymakers urgently need to workwith chemists and other scientists across academia
and industry to prioritise therapeutic areas ofsignificant medical need and to generate innovative
new medicines that will improve quality of life andprovide global economic benefits.
Governments should prioritise the establishment of
non-profit public-private centres for drug discovery
that are jointly funded by the pharmaceutical industry
and academia. Lacking the commercial pressures of apurely private company, such centres would havemore scope to discover new anti-infectives and drugs
for treating rare or neglected diseases.
New drug discovery centres could increase theproductivity of academic research worldwide byproviding ‘Centres of Excellence’ where screening tools
and expertise could be combined to explore newmeans of drug discovery. Academic drug discovery
centres have already been established by someuniversities, particularly in the areas of cancer andtropical diseases where an innovative drug discovery
environment has been fostered, with participation fromacademia and industry. An example of this is the Dundee
Drug Discovery Unit (DDU).1

Chemistry for Better Health | 5

Sharing of data, knowledge and resources
Our ability to globally deliver new treatments could
be drastically improved by fostering domestic
and international sharing of data, knowledge andresources. Early stage sharing will facilitate public
and private drug discovery.

Pre-competitive sharing and collaboration
Pre-competitive drug discovery data (including
bioinformatics and information on a drug’s mechanismof action) should be made public with an ethos of‘reduce, reuse and recycle’. Even opening access todata already in existence would dramatically increase
our collective understanding of disease processes,
drug mechanism of action and drug failure. This
understanding would be highly beneficial for the
discovery and development of new medicines acrossthe entire drug discovery sector. Governments should
encourage sharing of pharmaceutical industry data bymaking data-sharing a condition of receiving any
research-related tax breaks.
Initiatives to improve sharing of dormant andredundant compound libraries are needed. Large
quantities of chemical compounds and data that are
dormant in compound libraries and databases aroundthe world and could greatly enhance drug discovery
programmes if disseminated.2 Establishing screening
centres and compound banks could potentiallyachieve this without impacting on commercial
sensitivities. The Innovative Medicine Initiative (IMI) has
made a step towards achieving this through thecreation of a European Lead Factory consisting of two
topics: the European Screening Centre and the Joint
European Compound Collection.3

6 | Chemistry for Better HealthThe pharmaceutical industry generates significant
amounts of data during the drug development
process, much of which is not released into the publicdomain due to concerns over confidentiality andintellectual property.4 This includes data in compound
libraries as well as data on screening, drug candidates
and clinical trials, much of which becomes redundantin private databases when drug discovery
programmes come to a close. There is little perceived
value in a company expending human and financial
resources in an effort to fully elucidate and understand
why a drug candidate fails. Usually failed candidates
are simply abandoned. There is, however, a long-term
benefit to the industry in determining the common
factors involved in the failure of drug candidates, inorder to try to reduce failure rates.
Duplication of drug discovery efforts often occurs
when pharmaceutical researchers focus on biologicaltargets although chemical tools are already available
to support target validation and drug discovery. As aresult, many researchers are often unknowingly
duplicating efforts already made elsewhere.
Academic institutions, many of which often build up
their own unique chemical compound libraries, canalso greatly benefit from data sharing. Sharing ofacademic data and compounds would enable thoseengaged in academic drug discovery to ‘bringsomething to the table’, which in turn would
encourage data sharing from industry.
Shared knowledge of pre-competitive activity would
help to reduce redundancy and duplication of data
across the pharmaceutical sector, and enable
companies to abandon flawed drug discovery
programmes at an earlier stage. Scientists engaged in
drug discovery could take advantage of earlier efforts(such as target validation) instead of duplicating work.

Global data and publishing

Intellectual property and regulation

Publishers of chemical science need to work together
to develop a global strategy towards a universal data
format for compound characterisation. At present,
most scientific publishers have their own ‘houseformat’ which makes it difficult to create shared global
databases. Data sources are, in effect, each in adifferent language.

Current intellectual property laws and practices inhibit
the drug discovery process and produce barriers tocollaboration between academia and industry.5,6 We
need a more innovative global intellectual property
framework that better facilitates scientificcollaboration, provides financial incentives for thosethat develop the drugs needed to combat the diseasesof the 21st century, and that reduces the financial
burden of drug discovery and development. Regulators
must ensure that those investing in the developmentof intellectual property are appropriately incentivised.

A standard format should be expanded to patent
literature and this should include structural annotation,
spectroscopic data, formatting and standardised
software for data sharing. This would facilitate easierdata searching and mining of large repositories. It
should no longer be acceptable for publicly-fundeddata to be re-sold by database companies. As a firststep towards this goal, society publishers should agree
on a common chemical data format. Academic
scientists could consider favouring journals thatadhere to the standard format.
A transition to an open access model across scientificpublishing would assist data dissemination andsharing. Governments and publishers need to work
together to ensure that the move towards a new
publishing model is concerted and sustainable for the
publishing sector.

Encouraging patents to be filed later, and extending
the lifetime of patents associated with key medicines,
would have a positive impact by allowing companies
that deliver drugs to the market to gain longer
market exclusivity.
Political support will be needed to make some of thesechanges. However, the rewards of creating an
intellectual property landscape with greater freedom
are potentially great, if pre-competitive freedoms areencouraged.7

Chemistry for Better Health | 7

1. Challenges to human health
Our ability to better treat infectious disease has resulted
in longer life expectancies in high-income countries.8
This means that non-infectious diseases such as
cardiovascular disease, cancer, diabetes and Alzheimer’s
disease are becoming more prevalent. The United
Nations (UN) has stated that 36 million people worldwide
died from non-infectious diseases in 2008, which
represents 63% of all deaths that year (Figure 2).10

1.1 Disease

Non-infectious diseases are caused by combined genetic
and environmental factors, and cannot be cured, only
controlled, by current drugs. Many are more common
with increasing age and are becoming increasingly
prevalent in countries with ageing populations. It has
been predicted that, by 2030, non-infectious diseases willaccount for 69% of all deaths worldwide and thisrepresents a significant challenge for modern science.11
These diseases require treatment over extended periodsof time and necessitate alternative treatment models.
Treating the growing number of elderly people withchronic diseases is already placing stress on thehealthcare systems in many countries and this stress isonly going to get worse (see case study 1).

Numerous challenges to human health still remain.
Deadly infectious diseases including malaria, cholera
and tuberculosis may have been largely conquered inhigh-income regions of the world, but remain a major
threat in poorer regions such as Africa.8 Even in richer
nations infectious disease remains a constant threat,as the swine flu pandemic in 2009 and the dramaticincrease of antibiotic resistance has made clear.6
Infectious diseases are still the main cause of death inmany developing countries, because of a lack ofreadily available and inexpensive drugs and vaccines
treatments. Poverty and a lack of access to modern
drugs mean that infectious diseases that are rare orunder control in high-income countries (such as
diarrheal illness, TB and human immunology virus/
acquired immunodeficiency syndrome (HIV/AIDS) arestill major causes of death.8
In high-income countries, some infectious diseases
remain a challenge due to the rise of antibiotic
resistance in many bacterial pathogens and theemergence of new strains of viruses.9 Modern healthsystems are struggling to cope with the demand fornovel and more effective antibiotics, as pathogens
develop resistance to existing treatments. There is anurgent need for new drugs to fight multi-resistantinfectious agents as our present antibiotics become
ineffective due to global misuse in medicine and thefood industry.

8 | Chemistry for Better Health

Percentage of all deaths worldwide
from infectious diseases

Chemists and the chemical sciences have been
integral to the development of modern medicine,from diagnostics to drugs and the creation of thepharmaceutical industry. The result has been asteady improvement in our health and life
expectancy over the past century. However, anageing population and the lack of access to modern
healthcare worldwide still pose significant challenges.

100
80
60
40
20
0
2002

2008

2030

Year

Figure 2: The proportion of deaths due to noncommunicabledisease is projected to rise from 59% in 2002 to 69% in 2030.
In 2008 the the proportion was 63%.

Percentage of US Gross Domestic Product(GDP) spent on treating chronic diseases

Case study 1:
Chronic Disease US healthcare expenditure
25
20
15
10
5
0
2002

2008

2017

Improved diagnosis is required in the developed anddeveloping world. Quick and accurate diagnosis
benefits individual patients by improving theirtreatment, in addition to ensuring the efficient use ofresources and limiting the spread of infectious
diseases. New, less invasive, technologies are needed
for the early detection of non-infectious diseases suchas cancer, cardiovascular disease and Alzheimer’s
disease, to enable healthcare professionals tointervene at an earlier stage of disease progression.
This will require an improved molecular understandingof disease onset and progression as well as a new suiteof diagnostic technologies.15
In addition to detection, there is a need to better monitor
the effectiveness and safety of therapies and medication.

By 2030 around 20% of the US population will be over
65 years old and 42% of the population will sufferfrom at least one chronic disease. Chronic diseases
account for 75% of all US healthcare expenditure,
which has grown from 13.7% of US Gross Domestic
Product (GDP) in 1993 to 16.6% in 2008. By 2017, US
expenditure is predicted to rise to 19.5% of GDP.

1.2 Diagnosis
Recognising disease early in its natural development isvital for effective treatment. We need to advance to earlier
diagnosis and improved methods of monitoring disease.
Globally more than 33 million people live with HIV, but
only 10% are aware that they are infected.12 There arealso 8.8 million new cases of tuberculosis (TB) annually(Figure 3), many of which remain undiagnosed. Thesediseases, along with 665,000 deaths from malaria peryear,14 place a huge burden on developing countries.
To overcome this, better systems are required that canbe used in resource-limited settings to detect diseases
as early as possible, to monitor the effectiveness oftreatments, and to direct treatments to where they areneeded.6

Number of people
living with HIV (millions)

Year
45
40
35
30
25
20
15
10
5
0
1990

1998

2000

Year

Figure 3: Globally more than 33 million people live with HIV
and by 2020 HIV/AIDS will cause more deaths than any othersingle infectious disease worldwide.

1.3 Pharmaceuticals
We need new and more effective treatments forboth infectious and non-infectious disease, but thepharmaceutical industry – historically the main sourceof new medical treatments – is finding it increasingly
difficult to develop them.
A new estimate for the average cost of bringing a new
drug to the market is $1.3 billion, up from $1.1 billion
just five years earlier.16 Most novel drug compounds do
not even reach the market, with over 90% of candidate
compounds failing at some point during clinical trials.17

Chemistry for Better Health | 9

Only three out of ten new drugs that do reach themarket will be major successes that generate enoughreturn on investment.18,19
Historically, most pharmaceutical companies have relied
on very few successful drugs to generate the revenue
required not only to pay for their development, but also
to pay for the development of other, less successful
drugs and the thousands of failed drug candidates
that never reach the market. Until 2008, pharmaceuticalcompanies were spending more and more on R&D,
but drug success rates have continued to decline. R&D
expenditure dropped between 2008 and 2010,
reaching a three year low of $68 billion.20
Financial pressures mean that increasing emphasis isplaced on cost/benefit analyses to justify
reimbursement. In the past, this has driven theindustry to search for so-called ‘blockbuster’ drugs
with annual sales of more than $1 billion and as aresult a handful of drugs now generate the majority of apharmaceutical company’s sales.21 For instance justeight products accounted for 58% of Pfizer’s annual
worldwide sales of $44 billion in 2007.22 This has seen ashift towards therapies for chronic diseases that
require treatment over extended periods of time toprovide a longer period for recouping investment.
Companies have seen their sales figures fall by up to
80% when the patent protection on one of theirblockbusters expires.a With fewer blockbusters in thepipeline, pharmaceutical companies have foundthemselves in trouble.
Even finding candidate drug compounds is getting
more difficult. Pharmaceutical companies have to siftthrough more than 300,000 molecules to come up
with a single candidate, which then has a goodchance of failing in clinical trials.23
Despite the latest incorporation of new technologies24
arising out of fundamental sciences (which include the
Human Genome Project, advances in compound
synthesis and screening technologies), the number of
new drugs gaining regulatory approval has stayed
constant over the last five to ten years, while thepercentage of drug candidates failing during thedevelopment process has increased.25 The entire
process of drug discovery and drug development has
become so diverse and complex that only a limited
number of countries possess the full range of R&D
experience to fully contribute to this undertaking.
10 | Chemistry for Better Health

The high-throughput screening (HTS) techniquesmade popular in the 1990s have been successful indelivering lead drug compounds for drug discovery
and candidate compounds for clinical development.
However, many drugs fail in clinical development as aresult of poor biological target validation, suboptimal
animal and human safety and heterogeneous clinical
trials (rather than those utilising targeted patient
sub-groups). The end result is not only a dearth of new
drugs, but also that those few drugs that do reach themarket are expensive and often less well-understood,
further increasing health costs and preventing theiruse in low-income countries.
By maximising the chances of technical success, thepharmaceutical sector has focused on therapeuticareas likely to generate the most revenue, instead ofareas where there is greatest medical need.
Therapeutic areas such as neuroscience, obesity,malaria, HIV/AIDS and tuberculosis have been
downsized because research is technically challenging
and drugs to treat these diseases are costly to develop.
This is despite the urgent need for new treatments,
limited effectiveness of current therapies andsignificant healthcare costs in this area.
Many companies are now shifting towards a moretargeted approach to drug discovery, coupled with amore balanced portfolio of programmes, eachtargeting a smaller patient population. However,continued investment in key areas of medical need
will be required to address the current and futureneeds of patients. Meagre returns on investment havelargely forced the pharmaceutical industry to exit
antibiotic R&D even though the World HealthOrganisation has forecast a disaster because of rapid
and unchecked increases in microbial resistance.26 The
devastating effects of HIV and methicillin-resistant
Staphylococcus aureus (MRSA) underline the need for astrong pharmaceutical R&D sector to invent new drugs
to control known and unexpected medical challenges
in the 21st century.

The patent on Pfizer’s cholesterol-lowering drug Lipitor, which had sales of$12.5 billion in 2009, expired in 2011. Bristol-Myers Squibb’s blood clotting
inhibitor Plavix, which had sales of $9.8 billion in 2009, is due to expire in 2012.
It has been estimated that the expiry of the patents for these and other drugs
between 2010 and 2013 will knock almost $30 billion and $11 billion off Pfizer’sand Bristol-Myers Squibb’s annual revenues, respectively.

a	2. Chemistry and disease
Infectious disease is a continuing risk to thedeveloping world, and non-infectious diseases
like Alzheimer’s disease pose a growing risk to theageing population in high-income countries. Only
when chemical scientists further understand themolecular processes of disease, and the biochemicalaction of drugs, will we be able to better diagnose
and treat these diseases.
Chemistry needs be fully integrated at the early stagesof life science research. Chemical scientists can provide
the necessary fundamental understanding of themolecular processes that underpin all biologicalsystems, both in healthy and diseased states. Chemical
scientists are already helping us gain a more complete
understanding of existing biological principles, while
harnessing chemical science to answer new biologicalquestions in the world around us.

2.1 Understanding disease onset andprogression: chemical medicine
Diseases are fundamentally caused by malfunctionof the molecular machinery in biological systems.
A better understanding of the chemistry of diseaseis needed to tackle global health challenges of the
21st century.
Many existing biological explanations of diseaseremain unproven because we do not have the detailed
understanding of the molecular processes andmechanisms that are involved. Current simple models
have been useful, but are now outdated. We need tomove beyond simply identifying the structure of
biological molecules towards gaining a fullunderstanding of their mechanism of action. A detailed
understanding of how the molecular pathways of
disease vary between, and even within, individuals will
enable healthcare systems to take advantage of theemerging field of personalised medicine.

By way of example, a better understanding of thechemistry of the immune system could allow us to use
the body’s natural defences in more sophisticatedways to tackle disease. In addition to priming theimmune system against specific diseases (using
vaccines), we can find ways to increase its ability tofight infectious disease and even non-infectious
diseases such as cancer. An increased understandingof the immune system would also allow us tointervene when it goes awry. Autoimmune diseases
such as rheumatoid arthritis, multiple sclerosis andtype I diabetes result from the body mistakenly
recognising its own constituent parts as non self(which initiates an immune response against its own
cells and tissues) and are becoming increasingly
prevalent in the developed world. Rheumatoid arthritis
is thought to affect approximately 0.5% of the world’s
population.27
Chemists are helping to improve our understanding of
the molecular basis for antibiotic resistancemechanisms. This will enable scientists to develop
more efficient antibiotics for tackling antibiotic
resistant bacteria.
A more detailed appreciation of the chemistry,
signalling and function of all cells (including stem
cells), and their networks, would give us a morethorough understanding of developmental biology
and would enable health systems to more quickly reap
the benefits of regenerative medicine.
Our understanding of enzymes and other large
biomolecules is improving through the study ofkinetics and applying chemical understanding to thefields of systems biology and synthetic biology.
Chemists are moving beyond looking at whether amolecule simply binds to a biological target towards
studying specifically how it binds, for how long andwhat biological pathways are affected. Chemists are
helping to understand how protein folding in
biological systems influences the development ofdiseases such as Alzheimer’s and Huntington’sdisease.15,28

Chemistry for Better Health | 11

2.2 Genes and non-infectious disease
Genes play an important part in the developmentof many non-infectious diseases, but a detailed
molecular understanding of this is lacking.
A detailed understanding of exactly how our genetic
information influences the onset and progression ofmany non-infectious diseases is urgently needed.
Some diseases, such as Huntington’s disease, arecaused by a single genetic defect whereas other, morewidespread conditions, such as cardiovascular disease,cancer and Alzheimer’s disease, can result from thecomplex interaction between our genes and anumber of environmental factors. Scientists have yet
to piece together the full suite of factors involved inmost non-infectious diseases and how they interact
with each other.15,28
Chemical scientists are now developing a better
understanding of the genetic causes of non-infectious
disease by increasing our understanding at themolecular level. The sequencing of the humangenome has made a big impact in understanding
human diseases such as cancer. However, sequencing
the genome is only the starting point towards
determining which molecular processes are
responsible for disease, and how therapeuticintervention can be achieved.
Environment and diet are likely to have a greater
impact on diseased tissue than healthy tissue, andchemists can help to develop a better appreciation of
the impact of environmental factors in these systems.
The central biological dogma states that information
flows in one direction, from our genes to the cellular
structure. This model is now becoming outdated as weare learning that environment can influence ourgenes. Despite the fact that the human genome wassequenced over 10 years ago, the interaction between
our genes and environmental factors is so complex
that scientists are still far from working out the details.

12 | Chemistry for Better Health

Epigenetics is the study of changes in gene expression
caused by mechanisms other than changes in theunderlying DNA sequence. Chemists are helping toelucidate how our genes are modified byenvironmental influences, how this affects gene
expression and the development of many noninfectious diseases. One of the ways our cells switch
genes on and off is through chemical modification,and this pattern of chemical modification is influenced
by environmental factors such as diet, ageing,smoking, lifestyle and even by the oxygen we breathe.
It is now known that these patterns of genetic
modification can be inherited, providing a way fortraits acquired during our lifetime to be passed on.
Epigenetics is beginning to offer an innovative way to
explore non-infectious diseases, and chemical
scientists are beginning to make significant
breakthroughs. Better understanding of epigenetic
processes will enable us to move beyond simply
treating the symptoms of many non-infectious
diseases towards providing real cures.

2.3 Oxygen and disease
Chemists will provide a greater understanding of therole of oxygen in disease progression.
Oxygen is involved in regulating multiple biochemical
pathways in all aerobic organisms, including humans.
Reactive oxygen species (ROS) are highly reactive
molecules containing oxygen that are generated bynormal cellular metabolism that are responsible formuch of the wear and tear our bodies experienceduring our lifetime. ROS have been implicated in thedevelopment of many age-related diseases. Lack ofoxygen in cells is linked with diseases including cancer,
cardiovascular disease and diabetes.
Chemists are helping to elucidate a better
understanding of the role of ROS in regulating gene
expression at a number of different levels.
Understanding, harnessing and sensing oxygen in
biological systems offers new routes towards
developing a better understanding of diseaseprogression.

2.4 The brain and disease

2.5 Analysing biological processes

Understanding the little-known chemistry of thebrain will be essential to treating neurodegenerative
disorders such as Alzheimer’s disease.

A new generation of measurement techniques andanalysis is needed to better understand disease.

An improved understanding of the molecular basis ofmemory and the chemistry of the brain could enable
us to better tackle many neurological disorders.
Chemists are working to develop a better
understanding of the chemistry of the brain, and themolecular basis of memory, as a first step towards
providing more effective treatments for many
debilitating neurological disorders. Diseases such as
depression and schizophrenia can strike at any time
during our lives, but often first appear in young adults.
There is a strong genetic influence on thedevelopment of these diseases, but scientists are yet topinpoint the molecular processes involved. Indeed, weare very far from a working model for understanding
the chemical processes that underpin the progressionof diseases in the brain.
An improved understanding of the effects of ageingon the brain would enable us to better appreciate therole of the fibrous protein aggregates implicated inmany age-related diseases. Amyloid aggregates arefamously thought to play a major role in thedevelopment of Alzheimer’s disease. They may also
play an important role in other diseases, including
Parkinson’s disease, Type II diabetes and amyloid A (AA)amyloidosis.15,28,29
The precise role of amyloids in these diseases remains
theoretical, yet the Amyloid Hypothesis has led to thedevelopment of Alzheimer’s therapeutics that target
the amyloid protein and the enzymes responsible forits production. Many of these treatments to date havebeen unsuccessful and the Amyloid Hypothesis, likemany other hypothesises of disease, remains
unproven.
Chemical scientists play an important part in gaining abetter molecular understanding of brain and agerelated diseases, by helping to test existing biologicalhypotheses and developing new molecular theories.
This will lead to the development of innovative andbetter-targeted drugs and therapies.

Chemists are helping to integrate many analytical‘omics’ techniques in biology (such as genomics,
glycomics and proteomics) by uniting them through afundamental understanding of the underlying chemical
principles. Chemists are combining traditional
detection techniques with new technology to deliver
cutting-edge devices that can analyse tiny samples,
including the contents of single biological cells.
Chemists are developing improved methods forquantitatively measuring molecules in biologicalsystems and for detecting biological events both
inside and outside of the cell with remarkable
resolution and accuracy. Shedding light on theinteractions between individual molecules in a cell willallow us to study biological processes in greater detailand to understand how we can fix malfunctions that
occur during disease development.
Many existing methods for detecting chemical eventsand identifying biomolecules in biological systems relyon antibodies that bind to specific biological targets.
Unfortunately antibodies are often inadequate forstudying processes inside cells, due to their large size.
Chemists are developing streamlined antibody-likemolecules that retain the unique specificity of an
antibody while being small enough to gain access tobiological processes inside cells. New molecular
probes like these molecules will be able to interact
with individual biological molecules, including specificmetabolites, proteins and strands of DNA and will
therefore improve disease detection.
New analytical technologies will enable us toaccurately measure the concentration of proteins incells, measure the structural changes of proteins inreal-time in live cells and determine the structures ofmembrane-bound proteins (which is a challenge using
existing standard techniques).
Chemists are now building complex biomoleculesfrom simple starting materials and the burgeoning
field of ‘in vivo’ chemistry is enabling specific chemicaltransformations to be carried out inside live cells and,one day, inside whole organisms.

Chemistry for Better Health | 13

3. Novel chemistry for diagnosis
Recognising the molecular origins, symptoms andprogress of a disease is vital for effective treatment.
By developing new chemistry tools to detect diseaseearlier, and more sensitive detection methods tomonitor progress more closely, chemical scientists
will enable quicker diagnosis and more effective,
less invasive monitoring of disease.

3.1 Biomarkers
We need to identify more reliable, specific biomarkers
to detect disease at early stages, and chemists will
be central to discovering and harnessing them.
Biomarkers are specific proteins or metabolites that are
produced by infected or defective cells or generated
by damage to tissues or organs. For instance, they canbe proteins produced by cancer cells or metabolites
generated as a result of damage to heart cells.
Detecting specific biomarkers at an early stage of
disease would allow cancer to be treated before it hasa chance to spread and cardiovascular disease to betreated before it results in a heart attack.
Many biomarkers in current clinical use are unreliable
and not specific to the disease they are being used todiagnose. Biomarker levels often vary dramaticallybetween patients. The levels of prostate specific antigen(PSA) in blood, for instance, are not necessarily specificto prostate cancer at the levels they are commonlymeasured. Diseases such as cancer are highly variableand differ in their physiology and biochemistry
between patients. As such, two patients suffering fromthe same form of cancer may express an entirely
different set of biomarkers associated with their disease.
Chemists are helping to identify better biomarkers by
gaining a greater understanding of diseaseprogression.30 Long-term studies are needed to record
how proteins and metabolites associated with diseasechange over time. This will help to identify truly usefulbiomarkers that can be detected at very early stages of
disease development.
Chemists will help to provide better tools for validating
biomarkers, to ensure they are accurate and specific,
and for determining their normal function in biologicalsystems. This in turn will help to reveal whether abiomarker plays an important role in a disease process
or is more likely produced in response to general
physiological stress. 31,32
14 | Chemistry for Better Health

3.2 Probes
Chemical scientists will design and use newmolecular probes for diagnosis and imaging.
Chemical probes enable scientists to explore biologicalsystems by interacting specifically with a biomoleculeand thereby providing information on the biologicalrole, or to measure the levels of a biomarker in apatient. It is difficult to deliver existing probes into thepatient and to localise them to the specific site at
which they are needed.
Many diagnostic techniques are antibody-based andare often susceptible to false positive or false negative
results. New, antibody-free methods of diagnosing
disease are needed, particularly if we are to takeadvantage of point-of-care diagnostic technologies.
The probes need to be safe and need to be able toaccess the target site. Chemical scientists areinvestigating next generation probes that can
specifically bind to target biomarkers to enable theirconcentration to be measured and for potential use in
new point-of-care technologies.
Significant challenges remain, particularly relating toprobe delivery to their biological site of action. Many
nucleic acid probes are now available as a researchtool for the discovery of gene function, however thechemistry underlying many technologies needs toimprove efficiency and cost. These probes enable
scientists to target specific genes in a cell (usually byturning off their function) in order to understand theirrole in biological systems. Chemistry will help us tobetter target nucleic acid probes to cells, improve cell
entry, and better understand gene function, with theeventual aim of developing therapeutic nucleic acids.

3.3 Molecular imaging and diagnostics
To make use of newly discovered biological targets,chemists will develop new methods for molecularimaging and measuring biomarker levels.
Molecular imaging differs from traditional imaging inthat specific biomarkers are used to detect certain
molecular patterns and characteristics in a targetedbiological system. The biomarkers interact chemicallywith their surroundings and, in turn, alter the image
according to molecular changes that occur within thearea of interest. This ability to image fine molecularchanges opens up an incredible number of exciting
possibilities for medical application, including early
detection and treatment of disease and basic
pharmaceutical development.
Chemists will play an important role in delivering new,sensitive (and ideally non-invasive) techniques tomeasure novel biomarker properties inside individual
cells, for probing the molecular basis of disease.
Disease biomarkers tend to be present at very low
concentrations in biological fluids, such as blood, andcan be difficult to detect using traditional methods. In
the future, we should be able to diagnose disease, andstart appropriate treatment before the appearance ofphysical symptoms, by detecting small biochemicalchanges in the body.
In order to reap the benefits of personalised medicine,
improvements in our ability to identify genes
associated with certain diseases is urgently needed.
This will require cheap, accurate and efficienttechnologies for screening individual genomes forgenes known to be associated with certain diseases.
Chemists are working with other scientists andclinicians to deliver a new set of personalised
diagnostics and imaging technologies to detect
unique abnormalities associated with cancer andamyloid diseases, such as Alzheimer’s disease, at an
early stage of disease development. New approaches
will move beyond simply detecting protein expression
in a biological sample towards understanding relative
patterns of protein expression and real-timemonitoring of changes in these patterns. This, in turn,will lead to a new suite of personalised treatments that
selectively tackle the disease while avoiding unwantedside effects.15,28

Chemists are helping to develop affordable genome
sequencing devices that will enable healthcare
professionals to warn individuals that have a genetic
predisposition towards a particular disease, which may
allow them to take preventative measures. However,
the ability to provide individual genome sequences
alone will not pave the way for personalised medicine,
we need an accompanying molecular understandingof how an individual’s genome sequence leads todisease onset and progression. (see chapter 2:
Chemistry and disease).
Chemists are investigating a range of cheaper andsimpler imaging technologies for clinical use that areable to cover a wide range of scales. Imaging for
diagnosing disease in the clinic is currently carried out
on large scales using expensive equipment. Point-ofcare technologies that can swiftly and accurately makea diagnosis at the bedside have the potential to change
healthcare systems and improve people’s lives
worldwide.
As new technologies emerge, they will be able tosupport existing and reliable large scale facilities. A new
mass spectrometry technology that can work with solid
samples by directly capturing compounds on cellsurfaces to produce an image of the diseased tissue isemerging (see case study 2). New imaging methods tomake biological cells as ‘transparent’ as possible will be
important for rapid and accurate diagnosis at thebedside. Emerging techniques will help to distinguishcancerous from healthy tissues for guided cancer
surgery.

Case study 2:
Mass spectrometry at the bedside
Chemists have significant expertise in mass
spectrometry (MS), and it may be possible tocouple MS with new point-of-care technologies
for rapid and accurate diagnosis at the bedside.
MS could be coupled with polymerase chain
reaction (PCR) techniques to rapidly identify
genetic biomarkers for personalised medicine anddiagnosis of many non-infectious diseases. New
MS technology will enable us to undertake
quantitative analysis of the protein expression
patterns associated with many cancers for more
rapid diagnosis.33

Chemistry for Better Health | 15

4. Chemistry and drugs
Chemists can help to bring research anddevelopment into the modern age by uncovering
better-validated biological targets for urgent
clinical needs, modernising drug discovery andmanufacturing, and developing therapeutic
approaches.
Chemistry can assist in expanding the available
sources of new drugs, and improving success rates
and costs for bringing new drugs to the market. New,
low-cost and readily-available drugs for infectious
diseases will improve the lives of billions of people
around the world.
A new, more rational approach to drug discovery is
emerging that embeds chemistry at all stages of thedevelopment process. Chemistry plays an integral partin enhancing our understanding of how drugs interact
with disease pathways inside cells, and for creating
new inventions and products that can better control
the biological systems involved with disease.

4.1 Target validation
Chemists will find new and improved biologicaltargets for drugs to underpin drug discovery
programmes that have a higher success rate and thatcan deliver more effective and targeted medicines.
Target validation aims to link specific genes and their
biological products with disease.
Drug discovery programmes that have pursued
non-validated biological targets have been heavily
responsible for the high attrition rate (or failure) of
many drug candidates over the last 20 years. Many
drug candidates have failed not simply because of
toxicity or safety concerns, but often because thebiological target was not the main cause of disease.
Pharmaceutical researchers have often found that adrug candidate simply does not work as well inhumans as in the laboratory animals used earlier
in the development process. Current preclinicalmodels cannot predict human pharmacology,
pharmacokinetics and drug metabolism with a highdegree of certainty.
It has been estimated that scientists have so far
uncovered 4500 possible molecular targets for drugs,
within both human cells, whether infected orcancerous, and pathogens.32 Yet all the drugs
approved by the US Food and Drug Administration
focus on just 324 molecular targets, around 60% of
which are found on the cell surface and half of which
are encoded by just four gene families.32 This suggeststhat we have yet to investigate a vast proportion of
disease targets, any of which could offer entirely novel
ways of treating both infectious and non-infectious
diseases.35
Chemists will be able to uncover a huge suite of novel
drug targets by helping to better understand themolecular basis of disease (see chapter 2: Chemistry
and Disease). This would empower pharmaceuticalresearchers to design a modern set of safer drugcandidates with a greater chance of successfully
making it through the drug development process andonto the market. By working with biologists and otherscientists, chemists can investigate the full suite ofinteractions between drug candidates and biologicalmolecules such as proteins and DNA.

16 | Chemistry for Better HealthNew cell-surface and intracellular receptors will be
revealed as drug targets, and will enable us to better
understand the causes of drug side-effects toimprove drug discovery strategies. More reliabledisease biomarkers for diagnosis and monitoring willbe identified.36
There are vast areas of biomolecular science yet to be
fully explored for drug discovery, including proteinnucleic acid interactions.37 Genome mining also has
the potential to unveil a number of important biologicaltargets and biomarkers of disease, while adding to ourmechanistic understanding of disease pathways.
Chemistry will enable us to understand how genetic
differences between people cause them to react very
differently to drugs, such that a drug that works perfectly
well in certain people fails to work in others. This would
lead us towards developing better targeted medicines.
Rather than trying to develop one drug that can treat a
disease in all people, which may not always be
possible, we may develop multiple drugs targeted at
specific groups or people with specific sets of genes(personalised medicines). This will require scientists tomove beyond sequencing the genome, towards amolecular understanding of its biomolecular products.
A targeted approach offers a better way to deploy novelanti-infective agents. Instead of developing a broadspectrum antibiotic that kills all bacteria inside us, evenbeneficial ones, chemists will help to develop more
selective antibiotics that target specific bacterial species.

4.2 Designing more effective drugs
Using chemical insight and advanced computer
software, chemists will replace the mass screening
approach of drug testing with strategies that use
fewer, more targeted drug candidates.
Chemists are particularly successful in inventing thesynthetic molecules that make cost effective oral
therapies. These are mainstays of advanced healthcare
systems. While drugs that are based on specificbiological properties are making a significant impact,
this therapeutic class will not remove the need foraffordable small molecule drugs that can beadministered orally to treat chronic diseases.
It is still a challenge to synthesise compounds that are
specifically designed to bind to a biological target andat the same time mimic toxicity and maintain sufficient
exposure at the site of action. It is important to design
drugs with previous drug failures and problems inmind (see Executive summary). Chemists aredeveloping new approaches to drug design, based ona better understanding of disease pathways andbiological targets. We may eventually be able to better
predict and design drug candidates using advancedrug discovery software before carrying out asynthetic step in the laboratory.
The drug discovery process has been limited for many
years by the use of quantitative measures of drug
effectiveness. By incorporating improved knowledgeof drug mechanism of action (such as speed of drug
binding, length of stay and time of release) into ourdrug design, chemists will be able to focus on morequalitative measures to assemble more rational
chemical compound libraries.
The natural world remains a rich source of biologically
active molecules that could form the basis for novel
drug compounds. It has been estimated that less than
1% of all microorganism species are easily cultured andless than 15% of higher plant species have been
examined for bioactivity.36 New molecular approaches
may help us to take advantage of the medicinal
properties of complex natural products (derived fromorganisms such plants or microbes) more efficiently.
Genome mining technology offers a means ofscreening the genomes of plants and microbes forgenes that may give rise to natural products oftherapeutic interest.

Chemistry for Better Health | 17

4.3 New synthetic methods

4.4 Process automation

Cutting-edge organic chemistry gives modern drugs
and designers of therapies cheaper, more varied
starting materials, and a wider toolbox to craft them.

Robotic processes will take mundane, routine jobs
away from skilled chemists, enabling them to focus
on creative new chemistry.

For many years, synthetic chemists around the world
have provided breakthroughs in the way in which weare able to assemble organic (carbon-based)
molecules, which form the basis of the living world
around us. Indeed, most of the drugs on the market
today originate from (or are closely related to)molecules found in nature.37

Chemists are increasingly taking advantage of robotics
and automated processes for performing simple
reactions, leaving them free to concentrate on the
more complex and innovative methodology. The
development of microwave and flow chemistry andother technologies has enabled chemists to accessnew chemical scaffolds while providing new options
for safe and reproducible large-scale procedures.

Synthetic chemistry continues to develop
breakthrough methods to expand our access to newand exciting molecular architectures. Emerging
methodology is using cheaper and more readilyavailable starting materials, reagents and catalysts thanever before. Procedures are becoming more
reproducible, making them more reliable for largescale manufacturing. New catalysts are emerging thatare made from readily available and inexpensive
materials, to replace those based on rare andexpensive materials.
Our understanding of chemistry and chemical
reactivity will expand significantly to access thehundreds of novel disease targets that are beyond thereach of current drug templates. Chemists will deliver
new suites of reactions that are able to modify specificparts of a molecule while keeping other parts intact,and new ways to synthesise biomolecules.
Chemists are developing a better understanding of
the molecular transformations taking place inbiosynthesis and are exploiting these processes for use
on an industrial scale. They will deliver new synthetic
biology methods, based on a detailed understandingof molecular mechanisms, which will support
traditional synthetic approaches but apply these tobiomolecules or inside organisms.

Improved robotic and automated synthetic methods
offer the opportunity to make drug discovery andmanufacture more efficient. Highly skilled and creative
chemists often spend large amounts of their time on
simple, routine or repetitive tasks that could be
automated. Such tasks include purification, theproduction of building blocks for chemical synthesis
and the synthesis of chemical analogues (of drugcandidates) that rely on the same or very similar
synthetic methods used to make the originalcompound. Improved automation offers theopportunity for highly trained chemists to spend theirtime exploring new synthetic methods, chasing
further breakthroughs and expanding scientificknowledge. Chemists, working with engineers, candevelop new automated methods for carrying out
routine and repetitive laboratory tasks in both theacademic laboratory and the industrial plant.
Many existing technologies are bespoke, designed andmade for a specific user and application. As such,standardisation is the key challenge and costs are high.
Optimisation becomes difficult for new users, which inturn creates barriers to widespread adoption.
The development of these new robotic technologies
may even open the opportunity to explore new
synthetic chemistry, especially for catalysis, in a waythat was previously the realm of the bench chemist.
This will succeed only if methods for generic
implementation are explored.
Implementing robotic technologies also requires
well-trained chemists or technicians to operate them.
Operators will need a solid fundamental training inchemistry together with sound technical skill toefficiently replicate the automated procedure.

18 | Chemistry for Better Health4.5 Drug delivery
Chemists are helping to develop new technologies
that give us more control over where a drug
is released, while enabling continuous releaseover time to maintain the right therapeutic
concentration.
Drugs have to pass several hurdles to get to theirlocation of action and the first step for many therapies
is getting from the gut into the bloodstream.
Treatments for diseases of the brain must cross the
blood-brain-barrier in order to reach their site ofaction, and many drugs need to gain access to theinside of cells to have the desired effect. We need a far
better understanding of the chemistry of theseprocesses in order to develop more effective drugdelivery systems.

The development of nanomedicine is not without
problems, however, with one of the main concerns
being the fate of medicine-containing nanoparticles inthe environment. To lessen these concerns, chemists
are helping to develop, for example, nanoparticles thatnaturally break down into harmless compounds either
in the body or in the environment.
New implant technologies, which act as a long-termstore of drug in the body, also offer the opportunity forcontrolled drug release. Next generation implants
could monitor physiological conditions within the
body and only release the drug when it’s needed.
Chemical scientists are already developing implantsthat release drugs to treat heart disease at the firstphysiological signs of an oncoming heart attack, which
could be abnormal behaviour of the heart or thepresence of specific biomarkers in the blood.

New, innovative drug delivery systems need to be
developed in parallel with new therapies. Traditionally,
drugs are formulated to make them stable and to
maximise their delivery to the bloodstream. The
weakness of this approach is that drugs are thendistributed quite widely throughout the body, rather
than targeting the specific sites where they are needed
for therapeutic action. We need ways to transport
drugs to specific areas of the body, and then get theminside tissues and cells.
Chemists will help to develop a whole suite ofsophisticated methods for delivering drugs,
incorporating novel targeting molecules, novel
materials and novel mechanisms of release. Therapeutic
agents particularly sensitive to degradation by the
body’s metabolism (such as emerging nucleic acidtherapies) could be housed in protective nanoparticles(nanomedicine), for instance, to enable them to reach
their site of action. Controlled release of therapeutic
agents at their site-of-action would be especiallyvaluable for drugs that are toxic to healthy cells, suchas cancer chemotherapy drugs, to reduce the severityof commonly-experienced side effects.

Chemistry for Better Health | 19

4.6 New approaches to treating disease
Chemists are looking beyond the traditional
conventions of drug design and are investigating
the potential of newly-discovered chemistry,including tissue engineering and synthetic biologics,
to enhance therapeutics
Small molecule therapy will be important for the short
to medium term and for treating many common
diseases long into the future. Chemists are also
developing whole new approaches to treating disease.
Chemists are helping to improve stem cell technology,
for the regeneration of diseased or damaged tissue, bydelivering a more detailed appreciation of thechemistry, signalling and function of stem cells, andtheir networks. Novel chemistry is being deployed on
surfaces to promote cell adhesion, improve cellfunction and encourage the development offunctioning tissue. By incorporating stem cells into
three-dimensional scaffolds, scientists are working
towards the longer-term goal of growing wholegenetically-matched organs in the laboratory before
transplanting them into patients.

Case study 3:
Nanotechnology increases efficacy incancer drugs
Pacitaxel (sold as Taxol®) is a potent anti-tumor
agent that was originally isolated from a natural
product, the bark of the Pacific Yew tree (Taxus
brevifolia). It is a cancer chemotherapy drug that
inhibits cell division by interfering with the internal
protein scaffold in cancer cells.
Chemical synthesis enabled the invention of thesynthetic biologic Abraxane® – a protein-boundform of the anti-cancer drug Taxol® that has beensuccessfully used as injectable formulation in thetreatment of certain types of cancer. Abraxane is
Taxol® that is bound to albumin nano-particles,
which act as an alternative delivery agent. The
bound protein assists in targeting the drug
towards tumour cells.40.41

Chemistry is now being used to build very large
biomolecules and convert promising biologicallyactive molecules into effective therapeutic agents. It
has already been shown that small parts of DNA canbe built using chemical synthesis. It may eventually bepossible to create larger systems such as synthetic
genomes.
The synthesis, manipulation and redesign of naturallyoccurring biomolecules allows biochemicalmechanisms to be probed and potential therapeuticstrategies to be developed. Better biologicaltherapeutics can be designed based on a greater
understanding of the molecular interactions
underlying the intended biological response.
Science Photo Library

The cancer chemotherapeutic Taxol

20 | Chemistry for Better Health4.7 Sustainable manufacturing
New approaches to drug manufacture will provide
opportunities to re-use and recycle waste products
to improve cost- and resource-efficiency andto reduce the amount of pharmaceutical waste
entering the environment.
There is a huge opportunity for chemistry to improvethe entire pipeline of drug manufacture to increase
global access to medicines, but there are many
challenges to overcome. We are limited by thecurrent number of synthetic chemical reactions(or transformations) available. The cost of
manufacturing drugs is high due to the need to ensure
quality and purity. The current technology for
manufacturing drugs means that many people aroundthe world have limited supplies of the drugs needed totreat both common and rare diseases. Many of thesolutions to these challenges would improve both
upstream drug discovery and development anddownstream manufacturing.

Case study 4:
Chemical analysis ensures drug purity
and quality
Counterfeit medicines continue to be a problem,
particularly in developing countries.42 We urgently
need improved methods of guaranteeing thepurity and quality of registered drug products,
while detecting and monitoring products on themarket for dangerous counterfeits and impurities.
Contamination of imported heparin withoversulfated chondroitin sulfate (OSCS) led toseveral deaths in the US 2008.43,44 Heparin is usedclinically as a blood thinner and is commonly
given to patients undergoing heart surgery or
dialysis. Even a basic chemical analysis could havebeen performed on the samples to detect any
impurities and would have avoided widespread
distribution throughout the US healthcare system.

The reactions we use in drug manufacturing need tobe more sustainable, efficient, flexible and scalable. The
perfect chemical reaction would be 100% efficient andgenerate zero waste. It is unlikely that any
manufacturing process would ever be entirely efficientor generate no waste at all. However chemists will
enable us to get extremely close, in particular bydeveloping new catalysts.45
Pharmaceutical and chemical scientists will be able todevelop and take advantage of new feedstocks fromplants and other biomass, to help reduce global
dependency on feedstocks from fossil fuels (Figure 4).
Chemists will be central to the development ofindustrial biotechnology methods for making new
platform chemicals available from biomass that will
replace petrochemicals as starting materials formaking numerous consumer products including fuels,
plastics and drugs, and will link these processes withbiosynthesis. Chemists will help to adapt existing
manufacturing processes to accommodate a newgeneration of chemical feedstocks, such as thoseavailable from carbohydrates.

Chemistry for Better Health | 21

Any waste generated from manufacturing should be
degradable. Chemists can help to deliver a better
understanding of the pathways of biological andchemical degradation of manufacturing waste in theenvironment, together with a better appreciation of
the role and effect on soil ecosystems. This
understanding will require a better appreciation of
how different chemical functional groups aretransformed and degraded in the environment. This
will, in turn, lead to the development of improved
manufacturing processes that minimise the impact on
the environment.

We need a better understanding of the long-term fateof drugs in the environment after use. Pharmaceuticalwaste is not just generated by the manufacture ofdrugs, but also by their use. Drugs are administered topatients, metabolised in the body and the resultant
drug metabolites are excreted, eventually finding theirway into the environment. We know little about what
happens to drug metabolites when they reach theenvironment, although they have been blamed forcertain environmental problems, such as polluting
waterways with high levels of endocrine disrupters,such as estrogen from oral contraceptives andhormone replacement therapies.

StarchStarchThermochemical

SyngasFischer-Tropsch
Synthesis

Synthetic
fuel
Ethanol,butanol

Cellulose
SugarsLignocellulose

Fermentation

Cellulose
LigninHemi-cellulose

Bioconversion

Bio-based
products

Hemicellulose

LigninAromatics

Cellulose Bundles

Pharmaceuticals
and drugs

Figure 4: The production of pharmaceuticals and other important materials from renewable biomass

22 | Chemistry for Better Health5. Opportunities for the chemical sciences
5.1 Chemistry and disease
5.1.1 Understanding disease onset and progression: chemical medicine
Validating existing biological hypotheses and using chemistry to gain a detailed molecular understanding of
biological systems and processes
Making new breakthroughs in systems biology by providing the molecular understanding and technologies
needed to manipulate biological networks
Developing a better insight into the molecular principles of infection and the chemistry of important infectious
diseases such as malaria, HIV/AIDS and tuberculosis (TB)
Developing a better molecular understanding of the resistance mechanisms in infectious pathogens
Developing a greater understanding of the immune system to enable infectious, non-infectious, inflammatory
and auto-immune diseases to be treated more effectively
Understanding the role of chemical signalling in reprogramming biological cells
Improving our understanding of large biological molecules (such as DNA and proteins) by deciphering thespecific molecular interactions that give rise to biological function
Understanding partially unfolded proteins or protein domains and investigating their interaction with otherbiomolecules, to give a deeper understanding of how to influence biological systems important in disease
Achieve a more rigorous understanding of the kinetics of enzymes and other biomolecules in cells andorganisms
5.1.2 Genes and non-infectious disease
Developing a better understanding of the molecular basis of disease and how molecular malfunction leads tothe onset of disease
Delivering new methods for analysing individual genes involved in non-infectious diseases and theirrelationship with other genes in disease pathways
Developing better tools for investigating the chemical changes that genes undergo during disease progression
Developing new methods to analyse post-translational modifications of biological molecules and their rolein diseases
Delivering new methods for analysing the effect of environment and diet on both healthy and diseased tissue
Understanding how epigenetic modification of DNA and modification of proteins leads to different phenotypes
and how we can modify and control epigenetics in vivo to affect disease progression
Clarifying the role of reactive oxygen species (ROS) in important biochemical and disease-progression pathways
Improving our understanding of the chemistry of the brain, the molecular basis of memory and age to enable
us to better understand and treat diseases of the brain

Chemistry for Better Health | 23

5.1.3 Analysing biological processes
Helping to integrate the ‘omics’ disciplines through a fundamental understanding of the underpinning chemistry
Developing more applicable versions of existing analytical techniques like nuclear magnetic resonance (NMR)
spectroscopy, liquid chromatography and mass spectrometry
Developing new devices for accurately analysing tiny biological samples, including the contents of a single
biological cell
Developing further new non-invasive analytical methods for understanding disease at the molecular level
Creating methods to study the molecules present in living cells and to monitor how they change over time
Exploring combinations of NMR spectroscopy, X-ray diffraction, electron microscopy and new technologies forunderstanding biological processes, to identify ways to interfere when malfunctions in biological systems leadto disease
Developing a better chemical understanding of how molecules enter cells in order to exploit different types ofcompounds for discovery biology
Developing alternatives to antibodies as analytical tools
Investigating candidates for molecular probes that are able to interact with specific biomolecules (including
metabolites, proteins, RNA and DNA strands) to measure biomolecule concentration
Developing new in vivo techniques for carrying out chemistry inside cells and organisms
Developing new methods for delivering RNA and DNA into cells

24 | Chemistry for Better Health5.2 Novel chemistry for diagnosis
5.2.1 Biomarkers
Developing new and better tools for validating disease biomarkers to ensure they are accurate and specific
Discovering new and improved biomarkers for the identification of many infectious and non-infectious diseases
Working with biologists and clinicians to develop new, alternative markers of disease, including patterns ofprotein expression
Identifying new biomarkers that can better predict the progress of disease as a step towards selecting the mostappropriate treatment
5.2.2 Probes
Developing new probes with improved properties for delivery and localisation into cells, in order to access all
biological targets
Delivering new probes that are more stable than existing probes, more resistant to metabolism and enable theconcentration of disease biomarkers to be determined more accurately
Designing new ‘activation-specific’ probes for molecular imaging
Developing new small-molecule alternatives to antibodies for rapid and accurate diagnosis of disease
Developing new antibody-free diagnostic technologies for point-of-care diagnostics
Improving the chemistry of nucleic acid diagnostics to dramatically reduce the need for individual genome
sequencing
Development of delivery systems for nucleic acids (eg RNA interference (RNAi))
5.2.3 Improved imaging and diagnostics
Exploring methods to measure specific molecular changes to biomarkers, including protein stability andmisfolding, and changes caused by reactive oxygen species (ROS)
Developing a new suite of rapid point-of-care diagnostic technologies that will diagnose a range of diseases,
including disease-causing microorganisms, in a non-invasive fashion at the bedside
Developing methods to measure specific molecular changes and monitor single molecules in biologicalsystems, to monitor disease progression in real time
Delivering new personalised medicine technologies for the rapid identification of genes associated with many
non-infectious diseases
Developing new molecular imaging tools, such as by using positron emission tomography (PET) for quick andsafe recognition of disease biomarkers
Developing new recognition tools for detecting patient-specific abnormalities in disease (eg cancer)
Developing advanced imaging techniques to characterise cancer and differentiate benign from cancerous areas
during surgical intervention

Chemistry for Better Health | 25

5.3 Chemistry and drugs
5.3.1 Target validation
Developing a better understanding of disease pathways and validating improved targets for drug discovery
Achieving a better mechanistic understanding of the causes of many common drug side effects
Developing quantitative measures of drug effectiveness, based on understanding of molecular mechanism ofaction, including kinetics and lifetime of action
Developing a better understanding of drug resistance in both infectious and non-infectious disease
Working with other scientists and clinicians to deliver a better capacity to monitor resistance as it emerges inhealth systems and to develop strategies for mitigation
Using the principles of kinetics to study the mechanism of action of drug candidates to garner information on
slow effects, such as time taken to bind, time bound to target and release time
Identifying new cell-surface and intracellular receptors as validated drug targets for drug discovery programmes
Using analytical genome mining techniques to identify ‘sleeping’ gene clusters associated with many disease
pathways
5.3.2 Designing more effective drugs
Establishing focused compound libraries, based on the complete knowledge of the origins of a disease and ofexisting biological compounds from synthetic or natural sources
Developing fundamentally-new simulation methods for designing therapeutic agents to fit validated diseasetargets
Identifying new drug-like natural products and synthesising new chemical compounds as drug candidates
Building improved compound libraries containing compounds that are likely to bind to new, validated diseasetargets, which include fragment-based design principles
Gaining a greater understanding of molecular binding kinetics and advances in both computer modeling andchemical synthesis, in order to bring about more rational drug design and development

26 | Chemistry for Better Health5.3.3 New synthetic methods
Expanding known and exploring unknown ‘chemical space’ for new molecular scaffolds and architectures
Developing more reproducible and modular synthetic methods, especially catalysts, that work undersustainable, mild, standard conditions, on a range of diverse chemical substrates, and that do not rely on rareand expensive metals
Developing new C-C and C-H activation methods for synthesis, which avoid the need for reactive and unstablefunctional groups, while creating the opportunity to explore new molecular scaffolds and architectures
Developing new chemical ‘redox’ methods for changing the oxidation state of substrate molecules
Developing sustainable reactions that are functional-group specific yet avoid the need for wasteful andproblematic catalysts and protecting groups
Developing new ‘microreaction’ methods that will enable us to perform chemical transformations on an
extremely small scale
Improving our understanding of the molecular transformations taking place within biosynthesis
5.3.4 Process Automation
Developing new automated methods for producing the standard building blocks required for exploringchemical synthesis, drug discovery and drug manufacture
Developing standardised and cost-efficient robotics equipment that can be universally adopted for automatedlaboratory procedures
5.3.5 Drug delivery
Improving drugs to overcome biological barriers, such as stability against degradation in the gut, liver and blood
Improving transport from gut to blood, from blood to brain and from blood into the cytosol of target cells
Improving control of drug release at the site of action by developing systems that respond to biological signals
and feedback
Developing new drug delivery systems that include implants and nanomedicines
Converting biologically active peptides into oral drugs
Developing methods for selectively targeting therapeutic agents to receptors in specific tissues
Developing a better understanding of zwitterion systems drug delivery

Chemistry for Better Health | 27

5.3.6 New approaches to treating disease
Exploring novel chemistry for tissue engineering, including new scaffolds for optimising the growth andremodelling of specific cells and tissues
Deploying novel chemistry to scaffold surfaces to promote cell adhesion, improve cell function and encourage
development of functioning tissue for regenerative medicine
Designing, modifying and synthesising biomolecules as synthetic biologics for understanding and treating
diseaseDeveloping synthetic capability to create new ‘building blocks’ for synthetic biology
5.3.7 Sustainable manufacturing
Developing new cost-effective and reliable analytical methods for detecting impurities in drug products andguaranteeing quality during manufacturing
Improving manufacturing processes to make them more efficient, flexible and scalable
Developing new manufacturing processes that maximise atom economy and minimise waste products as far
as possible
Developing a more complete understanding of the biological and chemical degradation pathways ofpharmaceuticals and waste in the environment
Developing a more robust understanding of how different chemical functional groups are modified during
waste degradation in the environment
Working with other scientists and engineers to develop new industrial biotechnology methods for drug manufacture
Delivering new and efficient synthetic methods that utilise biomass-derived starting materials for drug manufacture
Developing new ‘retrosynthetic’ or design strategies for drug discovery and manufacture that utilise
biomass-derived platform chemicals as starting materials

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19. Overlook for the next 5 years in drug innovation, Berggren R, Nature Reviews Drug Discovery 11, 435-436, 2012,
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Chemistry for Better Health | 31

Appendix: Chemical Sciences and Society Summit (CS3) 2011 participants
Lihe Zhang (Scientific Chair)
Duanqing Pei
Xiaohong Fang
Zhen Xi
Biao Yu
Weiliang Zhu

Peking University, Beijing
Guangzhou Institute of Biomedicine and Health, CAS
Institute of Chemistry, CAS, Beijing
Nankai University, Tianjin
Shanghai Institute of Organic Chemistry, CAS
Shangai Institute of Materia Medica, CAS

Horst Kessler (Co-Chair)
Gerhard Klebe
Rolf MüllerStephan A. Sieber
Günther Wess
Andreas Marx

Technical University Munich
The Philipp University of Marburg
Saarland University, Saarbrücken
Technical University Munich
Helmhotz Center Munich
University of Konstanz

Tohru Fukuyama (Co-Chair)
Kazunari Akiyoshi
Kazuya Kikuchi
Hideaki Oikawa
Hiroaki Suga
Takashi Takahashi

University of Tokyo
Kyoto University
Osaka University
Hokkaido University, Sapporo
University of Tokyo
Tokyo Institute of Technology

Ben Davis (Co-Chair)
Tim Bugg
Neil CameronJohn Overington
Chris Schofield
Tony Ng

University of Oxford
University of Warwick
Durham University
European Bioinformatics Institute, Saffron Walden
University of Oxford
King’s College London

Gunda Georg (Co-Chair)
Joseph Fortunak
Cynthia Burrows
Wilfredo Colón
Shaoyi Jiang
Nicola Pohl

University of Minnesota, Minneapolis
Howard University, Washington
University of Utah, Salt Lake City
Rensselaer Polytechnic Institute, New York
University of Washington, Seattle
University of Iowa

Jon Evans

Science Writer

Organising committee
Zhigang Shuai
Yongjun Chen
Hans-Georg Weinig
Markus Behnke
Nobuyuki Kawashima
Hiroyuki Ohno
James Hutchinson
Clare Bumphrey
Steven Meyers
Zeev Rosenzweig

32 | Chemistry for Better Health

Chinese Chemical Society
National Science Foundation of China
German Chemical Society (GDCh)
German Research Foundation (DFG)
The Chemical Society of Japan
Japan Society for the Promotion of Science
Royal Society of ChemistryEngineering Physical Sciences Research, UK
American Chemical Society
National Science Foundation, US

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