Rehabilomics: A Conceptual Framework to Drive Biologics Research

the Table of l.org Contemporary research and clinical care increasingly have been incorporating bot ical remedies (often termed biologics) and pharmaceutical treatments into the repe treating many types of diseases. Other contributions in this supplement review the that other disciplines, such as orthopedic surgery, have taken into the realm of b therapies. In orthopedics, biologics have been used as substrates for procedures, a have been raised about U.S. Food and Drug Administration regulation, off-label dosing for some of these substances. Although the issues for biologics use in orthop not necessarily identical to those faced in rehabilitation medicine, there are many c alities in which a higher level of scientific rigor regarding mechanisms of action and utilization are needed before widespread clinical use. Both the limitations and po that biologic treatments hold can be of great interest to physiatrists and other reha practitioners as we look to integrate the most effective combinations and appro patient care. Over the past several years, the term “biologics” has been vari definition, with the term often used interchangeably with others such as biopharma biotherapeutic, and biotechnology drugs [1]. Biologics fundamentally differ from ceuticals in that they are in some way derived from living organisms. In the rehabilitation, the concept of biologics can be extended to include those thera interventions “generated by the living organism.” Within this framework, exer activity-based interventions can be considered biologics-based treatments. Furt exercise and other activities can be combined with other biologics therapies, for nutraceuticals, to potentiate treatment outcomes. However, the need to understan anisms of action and adverse effects for biologics, as well as the optimal timing, do use in combination with rehabilitation approaches, is similar to that with tr pharmaceutical treatments. Clinically, biomarkers are routinely used in medicine to monitor biological an logic processes that ultimately aid in patient management and assessment of treat significant portion of biomarker research is exploratory in nature; yet the t processes by which to conduct biomarker measurements are similar across di Biomarkers have been used on a very limited scale in physical medicine and reha (PM&R) care. Genomic and proteomic biomarkers are being used to a limited d rehabilitation-focused research. For example, genetic variation can influence outco risk for seizures after brain trauma [2,3]. Also, gene expression profiles can be link mechanical forces involved in intervertebral disk degeneration [4,5]. However, PM not tapped into the full potential that biomarkers can provide to create a sound fo from which to understand and validate the treatments used in physiatry. Biomarker has the capacity to unlock important clues about the molecular biology of injury plasticity, and recovery. Importantly, biomarker research can provide a valuable from which to discover the molecular substrates for treatment effectiveness for ma rehabilitation interventions. Biomarkers also can serve as a dynamic and man endophenotype, that is, a subclinical trait or vulnerability marker, which reflects t response. PM&R is faced with the challenging issue of having to justify treatment effectiv many of its specialty-specific procedures and treatments to payers and other re entities. The same issues that PM&R has historically struggled with, such as the d with conducting rigorous clinical trials while preserving the theranostic prin individualized care, can be addressed by the successful adoption and integration of biolo