When you see “bespoke,” think “custom,” “fit for purpose,” or “made for order.” Basically, something you can’t just get off a shelf as a one size fits all. Rather, you (or a company or scientists etc.) have to custom-make something to meet the specific requirements, designs, specifications, etc. of the task at hand.
(If it’s something you’re ordering, you can also think of “bespoke” = expensive and if it’s something you’re trying to design yourself in the lab for your experiment, you can also think of “bespoke” = lots of trial, error, and optimization!)
For example, maybe you’re trying to order some specifically-modified chemical but it’s not in a company’s catalog because there’s no demand (other than from you). You’d then have to go a “bespoke” route and make it yourself or pay the company to potentially make it for you. But then they’d charge a lot more because they’d have to figure out how to make it (typically they don’t even guarantee that they’ll be able to) and they will only be selling it to one customer probably.
For example, you may be able to order an off-the-shelf kit measuring activity of any kinase indirectly by measuring the production of ADP as ATP’s third phosphate group gets transferred onto a substrate. But then you may have to customize a protocol for studying the particular kinase-substrate phosphorylation reaction you are interested in.
Or a company might do an initial screen looking for compounds that kill cancer cells based on results of a “cell death” assay (experiment), but then they develop a “bespoke” assay looking precisely at some specific effect of the drug inside the cell.
Or you may be able to follow one of those published “general protocols” for purifying a protein, but then you’ll have to optimize for the protein you’re trying to purify (altering salt concentrations, pH, etc.).
Increasing numbers of “bespoke” treatments are found these days as gene therapies and cell therapies start hitting the market.
Often times, gene therapies have to be tailor-made to match the genetic sequences of the patients, as was the case with the headline-grabbing treatment of a baby with a rare metabolic disorder, CPS-1 deficiency. Doctors and scientists saved his life with a bespoke gene therapy. Which was great for the baby, and a major scientific milestone, but the therapy as given may not be able to help many other people, even if they had the exact same disease. Because it was custom-made for the baby’s DNA sequences.
More on that story here: https://thebumblingbiochemist.com/365-days-of-science/cps1crispr/ & https://youtu.be/1pSInDZ3rN4
How about cell therapies? In order to avoid provoking a (potentially deadly) immune response whereby a patient’s body sees delivered cells as “foreign” rather than therapeutic, many cell therapy treatments rely on “autologous” cell therapies, where a patient’s own (auto) cells are altered outside of their body (e.g., such as by de-differentiating them (returning them to stem cell status), engineering them to have immune cell receptors, or altering their DNA to fix a mutation)).
Although these treatments are exciting, they’re also bespoke, and thus, basically by definition, have a very limited scope public-health-wise. This is a key reason why scientists are still, sometimes increasingly, searching for treatment strategies that don’t need to be bespoke!
Sometimes, this involves searching for new and/or improved “small molecules” (your conventional pharmaceutical “drugs”). It can alternatively involve finding ways to make currently-bespoke therapy routes less bespoke – things like using gene therapy to target mechanisms of a disease’s damage (typically shared among patients), rather than its root genetic cause (which can involve various mutations) or making cells for cell therapy treatments more “blah” and less likely to set off an immune attack.
Customization can be great, though, so scientists are also trying to make bespoke things easier to make with the increasing use of modular techniques, such as large collections (libraries) of chemical fragments that are easy to join to one another, offering endless combinations (which can even be modeled and tested “in silico” (on computers) before trying to synthesize them.
Bespoke therapies can benefit from technological advances in manufacturing and delivery that can be broadly applied. There are also increasing efforts to develop new regulatory paradigms and protocols for dealing with bespoke therapies rather than treating each as a new “n=1” (single “subject”) case.
More on that here: Ahrens-Nicklas, R. C.; Musunuru, K. How to Create Personalized Gene Editing Platforms: Next Steps toward Interventional Genetics. The American Journal of Human Genetics2025, 112 (12), 2826–2829. https://doi.org/10.1016/j.ajhg.2025.10.006.
