This is not a fantasy article about the medicine of the future, where all ailments in the body are fixed with a single touch of a magic tool. Let us find out what modern scientific discoveries could truly achieve in improving human health over the next decade. Some of these possibilities are already being used today, but only in a limited scope or experimentally. Researchers and doctors at Rīga Stradiņš University (RSU) reveal real diagnostic and treatment opportunities for the coming decade.
Cancer: Greater Opportunities to Detect Genetically Inherited Forms Early
Scientists and doctors around the world and in Latvia are already devoting considerable attention to medical cancer prevention in cases where there is a possibility of genetically inherited cancer. What does this mean? Let us explain with the example of genetic breast cancer. If a woman has had early breast cancer among her close blood relatives — for example, her mother, grandmother or paternal aunt — before the age of 50, it is already possible to carry out special blood tests to determine the risk of this cancer by identifying mutations in the BRCA1 and BRCA2 genes. These are the genes in which mutations are most commonly found.
If the mutations are confirmed, there are specific steps a woman can choose to take in order to avoid breast cancer or increase the chances of detecting it in time, explains Associate Professor Arvīds Irmejs, Director of the RSU Institute of Oncology and Molecular Genetics. For example, if there is an increased risk of breast cancer, it is recommended to undergo breast magnetic resonance imaging once a year from the age of 25. From the age of 40, preventive screening also includes mammography. Of course, the prevention plan is also adapted to the woman’s life situation, for example by replacing magnetic resonance imaging with breast ultrasonography during pregnancy or breastfeeding.
A more radical alternative to these annual check-ups is risk-reducing mastectomy, or the removal of tissue from both breasts, which in this case is carried out preventively. This may seem dramatic to someone whose family has not experienced breast cancer, but for those who have gone through this experience, this step does not seem so radical compared with the possible suffering in the event of the disease.
Women in Latvia can already undergo testing for genetic breast cancer by contacting the Inherited Cancer Clinic at Pauls Stradiņš Clinical University Hospital or Riga East Clinical University Hospital. However, in the near future, determining genetic cancer risks already at the general practitioner’s office should become standard practice.
There is a high probability that within the next five years there will be another alternative early diagnostic method — liquid biopsies. In that case, women will not need to undergo magnetic resonance imaging with contrast once a year; a specific blood test will be sufficient.
Each type of cancer has its own evidence-based recommendations for determining genetic risk and for the recommended course of action — these will differ.
RSU has already carried out a study on inherited breast and ovarian cancer risk¹, in which an increased cancer risk was identified in eight out of 540 participants. This illustrates the direction in which modern medicine is developing — the ability to prevent disease or detect it at an early stage, thereby reducing suffering.
Precisely Targeted Cancer Medicines — No Longer Shooting “Blindly”
Precision medicine is currently taking major steps forward, especially in oncology. In simple terms, it aims to identify the most effective possible treatment for each patient.
Research is currently under way in two areas of precision medicine: genomic and functional. In the first case, the genetics of cancer cells can be studied and the most suitable therapy can be sought accordingly. However, in this case, the answers are only partly helpful, because in addition to genetics there are other factors, such as epigenetics, which influence which genes will be “switched on” and which will not. Nevertheless, gene identification helps to divide cancer more accurately into subgroups and to choose therapy more effectively.
Functional precision medicine, in turn, provides additional opportunities — it helps to test which medicines work best in a specific case on the patient’s own cells. This is the area of precision medicine advocated for and studied in depth by Inese Čakstiņa-Dzērve, Leading Researcher at the RSU Institute of Microbiology and Virology.
She explains: “Oncology patients currently receive the treatment that has proven to be statistically the most effective for the specific type of cancer. At present, this is the best possible form of treatment. However, a person is not a statistic; each individual has their own physiological characteristics.”
The researcher is already conducting significant studies² on more individualised cancer treatment and believes that these methods could be used in practice within the next decade. Several clinical studies are already under way worldwide. In Latvia, we are currently studying this more at the scientific preclinical level, but there is also hope for a clinical study in the near future: “In Latvia, as elsewhere in the world, we are now beginning to study the method scientifically by taking a patient’s cancer cells, growing them in the laboratory and testing how different therapies affect them. The first results are promising.”
When the method has been studied in greater depth, in the future, before a course of chemotherapy is prescribed, the most effective therapy for the patient will be identified in order to achieve the best possible result without losing valuable time or causing the patient unnecessary suffering. The most successful possible destruction of “resistant” cancer cells would minimise the likelihood of the malignant disease recurring.
Blood cancers have been studied the most in precision medicine, because it is easier to obtain cells in these cases. In the case of solid tumours, obtaining cells is more difficult, a biopsy must be performed and the number of cells may be insufficient to draw conclusions, but this “technical” difficulty will also be resolved.
Chronic Fatigue Syndrome — No Longer Will Everything Be Attributed to Stress
There are diseases whose patients have lived for years in the shadow of disbelief, including chronic fatigue syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and fibromyalgia. Until now, the examinations used in diagnostics often did not reveal clear health problems in these specific diseases, and patients’ complaints were therefore often explained by stress, anxiety or heightened sensitivity. The diagnosis of these diseases is mainly based on clinical criteria that include the assessment of symptoms. At the same time, there are no specific laboratory tests or validated biomarkers that would allow these diagnoses to be confirmed unequivocally. However, in recent years, the body of evidence on the biological basis of both diseases has been growing, promoting the development of more accurate diagnostics and treatment.
Long COVID brought a significant turning point to the situation, prompting doctors and researchers to take seriously the reality that ME/CFS patients have been describing for decades. Viral infections can sometimes cause a prolonged disease state that affects the body’s ability to produce energy, regulate immune system function and recover after exertion. In some patients, symptoms do not resolve for months or even years after infection, creating a condition that in many respects resembles ME/CFS. Research on ME/CFS has been carried out for a long time at the Institute of Microbiology and Virology of the RSU Science Centre. In this context, the studies³ of the newly established research group (“Prusty Lab”), led by RSU Tenure Professor Bhupesh Kumar Prusty, mark a turning point.
One of the central aspects of the study is mitochondria — cellular structures that ensure energy production, regulate immune system signals and determine the cellular response to stress. The research group has shown that factors present in the blood of patients with ME/CFS and long COVID are able to disrupt the structure and function of mitochondria in healthy cells, indicating the role of biological signals circulating in the blood in sustaining these diseases.
Modern studies increasingly indicate that ME/CFS and long COVID are complex post-viral conditions in which immune system regulation disorders, changes in vascular function, mitochondrial dysfunction and shifts in the regulation of nervous system signals interact with one another. The combination of these processes may contribute to chronic inflammation, pain and pronounced lack of energy. Importantly, these processes are linked to objectively observable biological changes, although their precise mechanisms are still being studied.
“The future of ME/CFS research is beginning to look more coherent,” says RSU Tenure Professor Bhupesh Kumar Prusty. “The goal is no longer to make the patient adapt to the disease, but rather to identify biological subtypes, develop objective diagnostic tests and work with the mechanisms underlying the disease. Blood biomarkers, immune system characteristics and metabolic profiles are being actively studied. Treatment will most likely be gradual, involving approaches that stabilise immune system function, support mitochondrial function or influence pathological processes sustained by infection. Progress will not be immediate, but for the first time in decades it is moving in the right direction.”
Fibromyalgia — No Longer Will Patients Have to Wait Six Years for a Diagnosis
Fibromyalgia is also a disease whose diagnosis has long been complex — on average, patients receive a diagnosis approximately six years after the onset of symptoms. However, the latest studies in Latvia and worldwide are gradually improving understanding of this disease, creating opportunities for more accurate diagnostics and more effective treatment. Fibromyalgia is a chronic disease that causes pain in various parts of the body, fatigue, sleep disturbances, difficulty concentrating and, in some cases, gastrointestinal problems. Many patients also experience so-called “fibro fog” — a feeling that thinking has become slower, it is difficult to concentrate and there is a slight fog in the head. Depression and anxiety often coexist as well.
The symptoms of the disease overlap with those of other conditions, and various perceptions and prejudices about its origin still exist in the medical community. However, in recent years, the situation has begun to change. An increasing body of scientific evidence indicates that the disease is based on so-called central sensitisation — a condition in which the brain and nervous system respond to pain signals much more intensely than usual.
One of the studies⁴ on fibromyalgia is being carried out by RSU in cooperation with Israel’s Sheba Medical Center. Zaiga Nora-Krūkle, Leading Researcher at the RSU Institute of Microbiology and Virology, explains that this study helps to better understand the biological mechanisms of fibromyalgia and to identify biomarkers — specific molecules or processes that would make it possible to diagnose fibromyalgia more accurately and earlier.
The project analyses three interrelated areas: changes in the microbiome that may affect immune system function; mechanisms of viral activation that could act as disease-triggering or disease-aggravating factors; and immunological patterns that could help identify specific immune response pathways in fibromyalgia patients.
This approach makes it possible to view fibromyalgia not merely as a chronic pain syndrome, but as a possible result of interactions between the immune system, the nervous system and the microbiome, which may provide a new and deeper understanding of the nature of the disease.
Nora-Krūkle emphasises: “Scientists increasingly understand that the disease is most likely not linked only to dysfunction in a single body system, but rather to a complex interaction between the nervous system, immunity, the gut microbiome and muscles. If these findings are confirmed in larger studies, fibromyalgia patients could in the future have access to both more accurate diagnostics and individually tailored treatment. This could mean an integrated approach in which medication, lifestyle recommendations and specially adapted exercise programmes are combined to improve patients’ condition.”
Alternatives When Antibiotics No Longer Work
One of the alarming problems in modern medicine is antibiotic resistance, or the failure of antibiotics to work against various bacteria. The most serious risk is the development of severe, debilitating infections or even death. Therefore, alongside more considered use of antibiotics, modern science is looking for new options that could be used instead of antibiotics.
For several years, Kārlis Rācenis, a researcher in the RSU Phage Research Group⁵, together with his colleagues, has been studying this kind of alternative. His team’s work in phage therapy research has gained wider attention in connection with assistance provided to patients injured in the war in Ukraine who had severe wounds and bacterial infections. Kārlis Rācenis explains: “Bacteriophage therapy means that we take bacterial viruses — specific viruses that infect bacteria and are able to kill them, but cannot infect humans. We use this principle to give a person a virus that cures them of an infection caused by bacteria.”
Before antibiotics were developed, the use of bacterial viruses to combat infections was, incidentally, fairly widespread precisely during wartime. However, because the therapy is more complex than a course of antibiotics, it quickly disappeared from everyday practice in Western medicine. Today, however, with antibiotic resistance becoming increasingly relevant, it is an important resource to study in a more modern way.
Kārlis Rācenis and his colleagues have focused on bacteriophage research, particularly in cases involving multidrug-resistant bacteria. “In such cases, people have bacteria with very high resistance to various antibiotics. To kill them, one, two or three antibiotics are needed, and these are often toxic. This means that the person has to be given toxic antibiotics. We know that if we give the medicines for longer, there may be, for example, partial or complete hearing loss or kidney damage. In this way, we are trying to save lives,” Kārlis Rācenis emphasises, referring to cases in which bacteriophages can replace antibiotics.
Mākslīgais intelekts kļūs vēl noderīgāks, bet ārsti neizzudīs
Nākotnes medicīnas kontekstā nevaram nepieminēt mākslīgo intelektu (MI). Jau šobrīd gan pasaulē, gan Latvijā norit pētījumi, kuros MI tiek izmantots medicīnā – lai kalpotu par "vēl vienām acīm" diagnostikā un ārstēšanā un lai būtiski paātrinātu ārsta darbu. RSU notiek vairāki šādi pētījumi.
Viens no RSU pētniekiem, kurš strādā tieši medicīnas un mākslīgā intelekta krustpunktā, ir RSU pētnieks Dr. Edgars Edelmers. Viņa ceļš vijas cauri trim zinātnes jomām – bioloģijai, datorzinātnei un medicīnai –, un tieši šī starpdisciplinaritāte ļauj radīt MI risinājumus, kas ir gan tehniski precīzi, gan izmantojami praktiski ārstēšanā. 2025. gadā viņš aizstāvēja promocijas darbu par morfoloģisko struktūru automātisku noteikšanu un segmentāciju no medicīniskajiem attēliem, izmantojot dziļo neironu tīklu tehnoloģijas.
Vienā no saviem pētījumiem6 Edelmers pievērsās histoloģisko attēlu analīzes automatizācijai: "Manis radītā MI programma automatizē Cajal intersticiālo šūnu detektēšanu un skaitīšanu. Es apmācīju MI rīku atpazīt noteikta veida šūnas lielos histoloģiskajos attēlos. Mūsu rīcībā bija 42 pacientu biopsiju kohorta, no kuras attēliem MI iemācīju šīs šūnas atpazīt tā, lai tās nesajauktu ar citām struktūrām. Parasti histologi šūnas skaita manuāli, skatoties mikroskopā. Cilvēks tās visas saskaitīt nespēj, tāpēc, piemēram, ļoti lielā – 10 gigabaitu – attēlā izvēlas desmit redzes laukumus, kuros šūnas saskaita un pēc tam vispārina to skaitu visā paraugā. Variet iedomāties, cik neprecīza ir šī metode! MI šo procesu var automatizēt un skaitīt šūnas nevis ierobežotā laukumā, bet visā paraugā uzreiz – plašāk, precīzāk un ātrāk."
Otrs Edelmera pētniecības virziens ir vērsts uz kaulu metastāžu diagnostiku7.
"Kopā ar RSU tenūrprofesori Maiju Radziņu strādājam ar kaulu metastāzēm, un mūsu komandas uzmanības centrā ir mugurkauls, kurā bieži lokalizējas vēža attālinātās izsējas – metastāzes. Mēs izstrādājam MI sistēmu, kas šos perēkļus spēj automātiski atrast un iezīmēt datortomogrāfijas un magnētiskās rezonanses attēlos. Ideālā gadījumā ārstam vairs nevajadzētu katru perēkli meklēt un izmērīt manuāli – to var paveikt un analizēt MI," stāsta pētnieks.
MI arvien vairāk iesaistās klīniskajā darbplūsmā, palīdzot noteikt gadījumu prioritāti – akūtajā medicīnā tam ir milzīga nozīme.
"MI spēj rēķināt, izmērīt un salīdzināt automātiski, bezkaislīgi un ātri. Piemēram, skrīninga programmā tas var norādīt, kuriem attēliem ārstam vajadzētu pievērst pastiprinātu uzmanību. MI nevar un nedrīkst pieņemt lēmumu ārsta vietā, taču tehniskus, atkārtojošus uzdevumus tas paveic izcili," skaidro Edelmers.
Vai MI apdraud mūsu darba lietderību? Edelmers uz šo jautājumu raugās niansēti: "MI palīdzēs atklāt arī tādas vēža formas, kas attīstās bez izteiktiem simptomiem. Tomēr tas ir un paliek tehnoloģiju un cilvēka kopīgs darbs – viens bez otra nespēj."
Atsauces:
(1) RSU Onkoloģijas un molekulārās ģenētikas institūta ar privāto ziedojumu finansēts projekts "Pārmantota krūts un olnīcu vēža riska ģenētiskais skrīnings".
(3) Liu, Z. et al. Immunoglobulin G complexes from post-infectious ME/CFS, including post-COVID ME/CFS disrupt cellular energetics and alter inflammatory marker secretion. Brain, Behavior, & Immunity - Health 52, 101187 (2026).
(4) Fibromialģijas projekts: Projekts "RSU iekšējā un RSU ar LSPA ārējā konsolidācija" (Nr.5,2,1,1.i.0/2/24/I/CFLA/005) tiek finansēts Eiropas Savienības Atveseļošanas un noturības mehānisma plāna un valsts budžeta ietvaros; Projekta Nr. RSU-PAG-2024/1-0009 "Fibromialģijas autoimūno dimensiju izpēte: mikrobioma, vīrusu un imunoloģisko modeļu atšifrēšana uz pacientu orientētas pieejas veicināšanai"
