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Cinti C, Trivella MG, Joulie M, Ayoub H, Frenzel M. The Roadmap toward Personalized Medicine: Challenges and Opportunities. J Pers Med 2024; 14:546. [PMID: 38929767 PMCID: PMC11204408 DOI: 10.3390/jpm14060546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/06/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024] Open
Abstract
In 2019, the International Consortium for Personalised Medicine (ICPerMed) developed a vision on how the use of personalized medicine (PM) approaches will promote "next-generation" medicine in 2030 more firmly centered on the individual's personal characteristics, leading to improved health outcomes within sustainable healthcare systems through research, development, innovation, and implementation for the benefit of patients, citizens, and society. Nevertheless, there are significant hurdles that healthcare professionals, researchers, policy makers, and patients must overcome to implement PM. The ICPerMed aims to provide recommendations to increase stakeholders' awareness on actionable measures to be implemented for the realization of PM. Starting with best practice examples of PM together with consultation of experts and stakeholders, a careful analysis that underlined hurdles, opportunities, recommendations, and information, aiming at developing knowledge on the requirements for PM implementation in healthcare practices, has been provided. A pragmatic roadmap has been defined for PM integration into healthcare systems, suggesting actions to overcome existing barriers and harness the potential of PM for improved health outcomes. In fact, to facilitate the adoption of PM by diverse stakeholders, it is mandatory to have a comprehensive set of resources tailored to stakeholder needs in critical areas of PM. These include engagement strategies, collaboration frameworks, infrastructure development, education and training programs, ethical considerations, resource allocation guidelines, regulatory compliance, and data management and privacy.
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Affiliation(s)
| | | | - Michael Joulie
- Agence Nationale de la Recherche (ANR), 75013 Paris, France (M.F.)
| | - Hussein Ayoub
- Agence Nationale de la Recherche (ANR), 75013 Paris, France (M.F.)
| | - Monika Frenzel
- Agence Nationale de la Recherche (ANR), 75013 Paris, France (M.F.)
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2
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Mersha TB. From Mendel to multi-omics: shifting paradigms. Eur J Hum Genet 2024; 32:139-142. [PMID: 37468578 PMCID: PMC10853174 DOI: 10.1038/s41431-023-01420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Tesfaye B Mersha
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
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3
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Arsène S, Parès Y, Tixier E, Granjeon-Noriot S, Martin B, Bruezière L, Couty C, Courcelles E, Kahoul R, Pitrat J, Go N, Monteiro C, Kleine-Schultjann J, Jemai S, Pham E, Boissel JP, Kulesza A. In Silico Clinical Trials: Is It Possible? Methods Mol Biol 2024; 2716:51-99. [PMID: 37702936 DOI: 10.1007/978-1-0716-3449-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Modeling and simulation (M&S), including in silico (clinical) trials, helps accelerate drug research and development and reduce costs and have coined the term "model-informed drug development (MIDD)." Data-driven, inferential approaches are now becoming increasingly complemented by emerging complex physiologically and knowledge-based disease (and drug) models, but differ in setup, bottlenecks, data requirements, and applications (also reminiscent of the different scientific communities they arose from). At the same time, and within the MIDD landscape, regulators and drug developers start to embrace in silico trials as a potential tool to refine, reduce, and ultimately replace clinical trials. Effectively, silos between the historically distinct modeling approaches start to break down. Widespread adoption of in silico trials still needs more collaboration between different stakeholders and established precedence use cases in key applications, which is currently impeded by a shattered collection of tools and practices. In order to address these key challenges, efforts to establish best practice workflows need to be undertaken and new collaborative M&S tools devised, and an attempt to provide a coherent set of solutions is provided in this chapter. First, a dedicated workflow for in silico clinical trial (development) life cycle is provided, which takes up general ideas from the systems biology and quantitative systems pharmacology space and which implements specific steps toward regulatory qualification. Then, key characteristics of an in silico trial software platform implementation are given on the example of jinkō.ai (nova's end-to-end in silico clinical trial platform). Considering these enabling scientific and technological advances, future applications of in silico trials to refine, reduce, and replace clinical research are indicated, ranging from synthetic control strategies and digital twins, which overall shows promise to begin a new era of more efficient drug development.
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4
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Yang Q, Li M, Yang X, Xiao Z, Tong X, Tuerdi A, Li S, Lei L. Flourishing tumor organoids: History, emerging technology, and application. Bioeng Transl Med 2023; 8:e10559. [PMID: 37693042 PMCID: PMC10487342 DOI: 10.1002/btm2.10559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 09/12/2023] Open
Abstract
Malignant tumors are one of the leading causes of death which impose an increasingly heavy burden on all countries. Therefore, the establishment of research models that closely resemble original tumor characteristics is crucial to further understanding the mechanisms of malignant tumor development, developing safer and more effective drugs, and formulating personalized treatment plans. Recently, organoids have been widely used in tumor research owing to their advantages including preserving the structure, heterogeneity, and cellular functions of the original tumor, together with the ease of manipulation. This review describes the history and characteristics of tumor organoids and the synergistic combination of three-dimensional (3D) culture approaches for tumor organoids with emerging technologies, including tissue-engineered cell scaffolds, microfluidic devices, 3D bioprinting, rotating wall vessels, and clustered regularly interspaced short palindromic repeats-CRISPR-associated protein 9 (CRISPR-Cas9). Additionally, the progress in research and the applications in basic and clinical research of tumor organoid models are summarized. This includes studies of the mechanism of tumor development, drug development and screening, precision medicine, immunotherapy, and simulation of the tumor microenvironment. Finally, the existing shortcomings of tumor organoids and possible future directions are discussed.
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Affiliation(s)
- Qian Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Mengmeng Li
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Xinming Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Zian Xiao
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Xinying Tong
- Department of Hemodialysis, the Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Ayinuer Tuerdi
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Shisheng Li
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Lanjie Lei
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
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5
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Feng L, Yang W, Ding M, Hou L, Gragnoli C, Griffin C, Wu R. A personalized pharmaco-epistatic network model of precision medicine. Drug Discov Today 2023; 28:103608. [PMID: 37149282 DOI: 10.1016/j.drudis.2023.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/12/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
Precision medicine, the utilization of targeted treatments to address an individual's disease, relies on knowledge about the genetic cause of that individual's drug response. Here, we present a functional graph (FunGraph) theory to chart comprehensive pharmacogenetic architecture for each and every patient. FunGraph is the combination of functional mapping - a dynamic model for genetic mapping and evolutionary game theory guiding interactive strategies. It coalesces all pharmacogenetic factors into multilayer and multiplex networks that fully capture bidirectional, signed and weighted epistasis. It can visualize and interrogate how epistasis moves in the cell and how this movement leads to patient- and context-specific genetic architecture in response to organismic physiology. We discuss the future implementation of FunGraph to achieve precision medicine. Teaser: We present a functional graph (FunGraph) theory to draw a complete picture of pharmacogenetic architecture underlying interindividual variability in drug response. FunGraph can characterize how each gene acts and interacts with every other gene to mediate therapeutic response.
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Affiliation(s)
- Li Feng
- Center for Computational Biology, College of Biological Sciences and Technology, Beijing Forestry University, Beijing 100083, China
| | - Wuyue Yang
- Beijing Yanqi Lake Institute of Mathematical Sciences and Applications, Beijing 101408, China
| | - Mengdong Ding
- Center for Computational Biology, College of Biological Sciences and Technology, Beijing Forestry University, Beijing 100083, China
| | - Luke Hou
- Ward Melville High School, East Setauket, NY 11733, USA
| | - Claudia Gragnoli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; Division of Endocrinology, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA; Molecular Biology Laboratory, Bios Biotech Multi-Diagnostic Health Center, Rome 00197, Italy
| | - Christipher Griffin
- Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802, USA
| | - Rongling Wu
- Center for Computational Biology, College of Biological Sciences and Technology, Beijing Forestry University, Beijing 100083, China; Beijing Yanqi Lake Institute of Mathematical Sciences and Applications, Beijing 101408, China; Yau Mathematical Sciences Center, Tsinghua University, Beijing 100084, China.
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6
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Wu H, Eckhardt CM, Baccarelli AA. Molecular mechanisms of environmental exposures and human disease. Nat Rev Genet 2023; 24:332-344. [PMID: 36717624 PMCID: PMC10562207 DOI: 10.1038/s41576-022-00569-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/01/2023]
Abstract
A substantial proportion of disease risk for common complex disorders is attributable to environmental exposures and pollutants. An appreciation of how environmental pollutants act on our cells to produce deleterious health effects has led to advances in our understanding of the molecular mechanisms underlying the pathogenesis of chronic diseases, including cancer and cardiovascular, neurodegenerative and respiratory diseases. Here, we discuss emerging research on the interplay of environmental pollutants with the human genome and epigenome. We review evidence showing the environmental impact on gene expression through epigenetic modifications, including DNA methylation, histone modification and non-coding RNAs. We also highlight recent studies that evaluate recently discovered molecular processes through which the environment can exert its effects, including extracellular vesicles, the epitranscriptome and the mitochondrial genome. Finally, we discuss current challenges when studying the exposome - the cumulative measure of environmental influences over the lifespan - and its integration into future environmental health research.
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Affiliation(s)
- Haotian Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Christina M Eckhardt
- Department of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
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7
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Alqahtani AA, Ahmed MM, Mohammed AA, Ahmad J. 3D Printed Pharmaceutical Systems for Personalized Treatment in Metabolic Syndrome. Pharmaceutics 2023; 15:pharmaceutics15041152. [PMID: 37111638 PMCID: PMC10144629 DOI: 10.3390/pharmaceutics15041152] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
The current healthcare system is widely based on the concept of “one size fit for all”, which emphasizes treating a disease by prescribing the same drug to all patients with equivalent doses and dosing frequency. This medical treatment scenario has shown varied responses with either no or weak pharmacological effects and exaggerated adverse reactions preceded by more patient complications. The hitches to the concept of “one size fits all” have devoted the attention of many researchers to unlocking the concept of personalized medicine (PM). PM delivers customized therapy with the highest safety margin for an individual patient’s needs. PM has the potential to revolutionize the current healthcare system and pave the way to alter drug choices and doses according to a patient’s clinical responses, providing physicians with the best treatment outcomes. The 3D printing techniques is a solid-form fabrication method whereby successive layers of materials based on computer-aided designs were deposited to form 3D structures. The 3D printed formulation achieves PM goals by delivering the desired dose according to patient needs and drug release profile to achieve a patient’s personal therapeutic and nutritional needs. This pre-designed drug release profile attains optimum absorption and distribution, exhibiting maximum efficacy and safety profiles. This review aims to focus on the role of the 3D printing technique as a promising tool to design PM in metabolic syndrome (MS).
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Affiliation(s)
- Abdulsalam A. Alqahtani
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 11001, Saudi Arabia
| | - Mohammed Muqtader Ahmed
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdul Aleem Mohammed
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 11001, Saudi Arabia
| | - Javed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 11001, Saudi Arabia
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8
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Developing CIRdb as a catalog of natural genetic variation in the Canary Islanders. Sci Rep 2022; 12:16132. [PMID: 36168029 PMCID: PMC9514705 DOI: 10.1038/s41598-022-20442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
The current inhabitants of the Canary Islands have a unique genetic makeup in the European diversity landscape due to the existence of African footprints from recent admixture events, especially of North African components (> 20%). The underrepresentation of non-Europeans in genetic studies and the sizable North African ancestry, which is nearly absent from all existing catalogs of worldwide genetic diversity, justify the need to develop CIRdb, a population-specific reference catalog of natural genetic variation in the Canary Islanders. Based on array genotyping of the selected unrelated donors and comparisons against available datasets from European, sub-Saharan, and North African populations, we illustrate the intermediate genetic differentiation of Canary Islanders between Europeans and North Africans and the existence of within-population differences that are likely driven by genetic isolation. Here we describe the overall design and the methods that are being implemented to further develop CIRdb. This resource will help to strengthen the implementation of Precision Medicine in this population by contributing to increase the diversity in genetic studies. Among others, this will translate into improved ability to fine map disease genes and simplify the identification of causal variants and estimate the prevalence of unattended Mendelian diseases.
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9
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Ryu MH, Gómez C, Yuen ACY, Brook JR, Wheelock CE, Carlsten C. Urinary Eicosanoid Levels Reflect Allergen and Diesel Exhaust Coexposure and Are Linked to Impaired Lung Function. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:7107-7118. [PMID: 35044166 DOI: 10.1021/acs.est.1c07268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Eicosanoids are potent regulators of homeostasis and inflammation. Co-exposure to allergen and diesel exhaust (DE) have been shown to lead to eosinophilic inflammation, impaired airflow, and increased airway responsiveness. It is not clear whether eicosanoids mediate the mechanism by which these exposures impair lung function. We conducted a randomized, double-blinded, and four-arm crossover study. Fourteen allergen-sensitized participants were exposed to four conditions: negative control; allergen-alone exposure; DE and allergen coexposure; coexposure with particle-reducing technology applied. Quantitative metabolic profiling of urinary eicosanoids was performed using LC-MS/MS. As expected, allergen inhalation increased eicosanoids. The prostacyclin metabolite 2,3-dinor-6-keto-PGF1α (PGF1α, prostaglandin F1α) increased with coexposure, but particle depletion suppressed this pathway. Individuals with a high genetic risk score demonstrated a greater increase in isoprostane metabolites following coexposure. Causal mediation analyses showed that allergen induced airflow impairment was mediated via leukotriene E4 and tetranor-prostaglandin D metabolite. Overall, DE exposure did not augment the allergen's effect on urinary eicosanoids, except insofar as variant genotypes conferred susceptibility to the addition of DE in terms of isoprostane metabolites. These findings will add to the body of previous controlled human exposure studies and provide greater insight into how complex environmental exposures in urban air may influence individuals with sensitivity to aeroallergens.
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Affiliation(s)
- Min Hyung Ryu
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Cristina Gómez
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm SE-171 65, Sweden
- Unit of Lung and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Agnes C Y Yuen
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jeffrey R Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 1P8, Canada
| | - Craig E Wheelock
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm SE-171 65, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm SE-171 76, Sweden
- Gunma University Initiative for Advanced Research (GIAR), Gunma University, Maebashi, Gunma 371-8511, Japan
| | - Christopher Carlsten
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
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10
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Wright RO. Nature versus nurture—on the origins of a specious argument. EXPOSOME 2022; 2:osac005. [PMID: 35965946 PMCID: PMC9366178 DOI: 10.1093/exposome/osac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022]
Abstract
The concept of heritability parses out genetic and environmental causes of diseases and does not fit the underlying biology of complex diseases that arise from interactions among genetics and environment. Exposomics places environment on a similar scale as genomics and allows for more modern research approaches that estimate time-varying genome by exposome interactions. By addressing the biological underpinnings of disease comprehensively, we will find the “missing heritability” which is not solely based on genetic variation but is instead driven by time, life stage, and geographic variability in our exposome as it interacts with our genome.
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Affiliation(s)
- Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai , New York, NY, USA
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11
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Nardini C, Osmani V, Cormio PG, Frosini A, Turrini M, Lionis C, Neumuth T, Ballensiefen W, Borgonovi E, D'Errico G. The evolution of personalized healthcare and the pivotal role of European regions in its implementation. Per Med 2021; 18:283-294. [PMID: 33825526 DOI: 10.2217/pme-2020-0115] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Personalized medicine (PM) moves at the same pace of data and technology and calls for important changes in healthcare. New players are participating, providing impulse to PM. We review the conceptual foundations for PM and personalized healthcare and their evolution through scientific publications where a clear definition and the features of the different formulations are identifiable. We then examined PM policy documents of the International Consortium for Personalised Medicine and related initiatives to understand how PM stakeholders have been changing. Regional authorities and stakeholders have joined the race to deliver personalized care and are driving toward what could be termed as the next personalized healthcare. Their role as a key stakeholder in PM is expected to be pivotal.
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Affiliation(s)
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento 38123, Italy
| | - Paola G Cormio
- Sant'Anna School of Advanced Studies, Istituto di BioRobotica, Pisa 56127, Italy
| | | | - Mauro Turrini
- Institute of Public Goods & Policies - Consejo Superior de Investigaciones Científicas, Madrid 28037, Spain
| | - Christos Lionis
- School of Medicine, University of Crete, Clinic of Social & Family Medicine (CSFM), Crete 71003, Greece
| | - Thomas Neumuth
- University of Leipzig, Innovation Center Computer Assisted Surgery (ICCAS), Leipzig 04103, Germany
| | - Wolfgang Ballensiefen
- Deutsche Zentrum für Luft- und Raumfahrt Projektträger (DLR PT), Bonn 53227, Germany
| | - Elio Borgonovi
- Department of Social & Political Sciences, Bocconi University, Milan 20136, Italy
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12
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Mohammadi T, Sadatsafavi M, Carlsten C. The economics of precision health: preventing air pollution-induced exacerbation in asthma. ERJ Open Res 2021; 7:00790-2020. [PMID: 33778052 PMCID: PMC7983226 DOI: 10.1183/23120541.00790-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
The demonstrable value of precision medicine, in the context of common environmental exposures, has scarcely been explored. This study evaluated the cost effectiveness of a preventive personalised intervention to reduce the adverse effect of air pollution in the context of asthma. A decision–analytic model was used to conduct a cost-utility analysis of prevention interventions in case of acute exposure to air pollution in mild asthma. Three different strategies, as follows, were compared: no preventive intervention; precision health strategy based on information from genotype testing, followed with treating high-risk patients; and prescribing additional medication to all mild asthmatics as a preventive intervention. The costs and quality-adjusted life years (QALYs) in the base case and alternative scenarios were obtained through probabilistic analysis. The results showed that the precision prevention intervention (anticipatory intervention for asthmatics, guided by relevant genetic abnormality, in the face of acute air pollution) is a cost-effective strategy compared with no such intervention, with an incremental cost-effectiveness ratio of CAD 49 555 per QALY. Furthermore, this strategy is a dominant strategy compared with an intervention that prescribes medication indiscriminately to all asthmatics. The incorporation of genomic testing to stratify risk of asthmatics to pollution-driven exacerbations, and then tailoring a preventive intervention accordingly, may be cost effective relative to untailored methods. These results lend plausibility to the use of precision medicine for limiting asthma exacerbation in the context of air pollution and, potentially, other exposures. Glutathione-S-transferase genotyping to determine the use of preventive asthma medication in the face of air pollution is cost effective in this model. Precision prevention in the setting of common environmental exposures may be used in other contexts.https://bit.ly/35Lab4b
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Affiliation(s)
- Tima Mohammadi
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
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13
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Castner J, Barnett R, Moskos LH, Folz RJ, Polivka B. Home environment allergen exposure scale in older adult cohort with asthma. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:97-106. [PMID: 32557284 PMCID: PMC7851287 DOI: 10.17269/s41997-020-00335-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Home environmental exposures are a primary source of asthma exacerbation. There is a gap in decision support models that efficiently aggregate the home exposure assessment scores for focused and tailored interventions. Three development methods of a home environment allergen exposure scale for persons with asthma (weighted by dimension reduction, unweighted, precision biomarker-based) were compared, and racial disparity tested. METHODS Baseline measures from a longitudinal cohort of 187 older adults with asthma were analyzed using humidity and particulate matter sensors, allergy testing, and a home environment checklist. Weights for the dimension reduction scale were obtained from factor analysis, applied for loadings > 0.35. Scales were tested in linear regression models with asthma control and asthma quality of life outcomes. Racial disparities were tested using t tests. Scale performance was tested using unadjusted regression analyses with asthma control and asthma quality of life outcomes, separately. RESULTS The 7-item empirically weighted scale demonstrated best performance with asthma control associations (F = 4.65, p = 0.03, R2 = .02) and quality of life (F = 6.45, p = 0.01, R2 = .03) as follows: evidence of roach/mice, dust, mold, tobacco smoke exposure, properly venting bathroom fan, self-report of roach/mice/rats, and access to a HEPA filter vacuum. Pets indoors loaded on a separate scale. Racial differences were observed (t = - 3.09, p = 0.004). CONCLUSION The Home Environment Allergen Exposure Scale scores were associated with racial disparities. Replicating these methods in populations residing in high-risk/low-income housing may generate a clinically meaningful, tailored assessment of asthma triggers. Further consideration for variables that address allergic reactivity and biomarker results is indicated to enhance the potential for a precision prevention score.
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Affiliation(s)
- Jessica Castner
- Castner Incorporated, Stony Point Road, Grand Island, NY, 14072, USA.
| | - Russell Barnett
- Kentucky Institute for the Environment and Sustainable Development, University of Louisville, Louisville, KY, USA
| | | | - Rodney J Folz
- UH Respiratory Health Center, Chief, Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University & University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Barbara Polivka
- University of Kansas School of Nursing, Kansas City, KS, USA
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14
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Goobie GC, Nouraie M, Zhang Y, Kass DJ, Ryerson CJ, Carlsten C, Johannson KA. Air Pollution and Interstitial Lung Diseases: Defining Epigenomic Effects. Am J Respir Crit Care Med 2020; 202:1217-1224. [PMID: 32569479 PMCID: PMC7605178 DOI: 10.1164/rccm.202003-0836pp] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Gillian C. Goobie
- Department of Human Genetics, Graduate School of Public Health and
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Yingze Zhang
- Department of Human Genetics, Graduate School of Public Health and
- Department of Medicine and
| | | | - Christopher J. Ryerson
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada; and
| | - Christopher Carlsten
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada; and
| | - Kerri A. Johannson
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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Huff RD, Carlsten C, Hirota JA. An update on immunologic mechanisms in the respiratory mucosa in response to air pollutants. J Allergy Clin Immunol 2020; 143:1989-2001. [PMID: 31176381 DOI: 10.1016/j.jaci.2019.04.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
Abstract
Every day, we breathe in more than 10,000 L of air that contains a variety of air pollutants that can pose negative consequences to lung health. The respiratory mucosa formed by the airway epithelium is the first point of contact for air pollution in the lung, functioning as a mechanical and immunologic barrier. Under normal circumstances, airway epithelial cells connected by tight junctions secrete mucus, airway surface lining fluid, host defense peptides, and antioxidants and express innate immune pattern recognition receptors to respond to inhaled foreign substances and pathogens. Under conditions of air pollution exposure, the defenses of the airway epithelium are compromised by reductions in barrier function, impaired host defense to pathogens, and exaggerated inflammatory responses. Central to the mechanical and immunologic changes induced by air pollution are activation of redox-sensitive pathways and a role for antioxidants in normalizing these negative effects. Genetic variants in genes important in epithelial cell function and phenotype contribute to a diversity of responses to air pollution in the population at the individual and group levels and suggest a need for personalized approaches to attenuate the respiratory mucosal immune responses to air pollution.
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Affiliation(s)
- Ryan D Huff
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Carlsten
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeremy A Hirota
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Firestone Institute for Respiratory Health, Division of Respirology, Department of Medicine, Hamilton, Ontario, Canada; McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biology, University of Waterloo, Waterloo, Ontario, Canada.
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16
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Alonso SG, de la Torre Díez I, Zapiraín BG. Predictive, Personalized, Preventive and Participatory (4P) Medicine Applied to Telemedicine and eHealth in the Literature. J Med Syst 2019; 43:140. [PMID: 30976942 DOI: 10.1007/s10916-019-1279-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
The main objective of this work is to provide a review of existing research work into predictive, personalized, preventive and participatory medicine in telemedicine and ehealth. The academic databases used for searches are IEEE Xplore, PubMed, Science Direct, Web of Science and ResearchGate, taking into account publication dates from 2010 up to the present day. These databases cover the greatest amount of information on scientific texts in multidisciplinary fields, from engineering to medicine. Various search criteria were established, such as ("Predictive" OR "Personalized" OR "Preventive" OR "Participatory") AND "Medicine" AND ("eHealth" OR "Telemedicine") selecting the articles of most interest. A total of 184 publications about predictive, personalized, preventive and participatory (4P) medicine in telemedicine and ehealth were found, of which 48 were identified as relevant. Many of the publications found show how the P4 medicine is being developed in the world and the benefits it provides for patients with different illnesses. After the revision that was undertaken, it can be said that P4 medicine is a vital factor for the improvement of medical services. It is hoped that one of the main contributions of this study is to provide an insight into how P4 medicine in telemedicine and ehealth is being applied, as well as proposing outlines for the future that contribute to the improvement of prevention and prediction of illnesses.
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Affiliation(s)
- Susel Góngora Alonso
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011, Valladolid, Spain
| | - Isabel de la Torre Díez
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011, Valladolid, Spain.
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Eid A, Mhatre I, Richardson JR. Gene-environment interactions in Alzheimer's disease: A potential path to precision medicine. Pharmacol Ther 2019; 199:173-187. [PMID: 30877021 DOI: 10.1016/j.pharmthera.2019.03.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/01/2019] [Indexed: 12/19/2022]
Abstract
Alzheimer's disease (AD) is the leading cause of dementia in the United States and afflicts >5.7 million Americans in 2018. Therapeutic options remain extremely limited to those that are symptom targeting, while no drugs have been approved for the modification or reversal of the disease itself. Risk factors for AD including aging, the female sex, as well as carrying an APOE4 genotype. These risk factors have been extensively examined in the literature, while less attention has been paid to modifiable risk factors, including lifestyle, and environmental risk factors such as exposures to air pollution and pesticides. This review highlights the most recent data on risk factors in AD and identifies gene by environment interactions that have been investigated. It also provides a suggested framework for a personalized therapeutic approach to AD, by combining genetic, environmental and lifestyle risk factors. Understanding modifiable risk factors and their interaction with non-modifiable factors (age, susceptibility alleles, and sex) is paramount for designing personalized therapeutic interventions.
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Affiliation(s)
- Aseel Eid
- Department of Environmental Health, Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, United States of America
| | - Isha Mhatre
- Department of Environmental Health, Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, United States of America; Department of Neurosciences, School of Biomedical Sciences, Kent State University, Kent, OH
| | - Jason R Richardson
- Department of Environmental Health, Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, United States of America.
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Villanueva AG, Cook-Deegan R, Robinson JO, McGuire AL, Majumder MA. Genomic Data-Sharing Practices. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:31-40. [PMID: 30994063 PMCID: PMC6730666 DOI: 10.1177/1073110519840482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Making data broadly accessible is essential to creating a medical information commons (MIC). Transparency about data-sharing practices can cultivate trust among prospective and existing MIC participants. We present an analysis of 34 initiatives sharing DNA-derived data based on public information. We describe data-sharing practices captured, including practices related to consent, privacy and security, data access, oversight, and participant engagement. Our results reveal that data-sharing initiatives have some distance to go in achieving transparency.
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Affiliation(s)
- Angela G Villanueva
- Angela G. Villanueva, M.P.H., is a Research Associate at the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Robert Cook-Deegan, M.D., is a Professor in the School for the Future of Innovation in Society at Arizona State University. He is a physician and molecular biologist who turned to policy and then entered academe through Georgetown, Stanford, and Duke Universities before joining ASU. Jill O. Robinson, M.A., is the Research Manager at the Center for Medical Ethics and Health Policy, Baylor College of Medicine. She received her B.A. in sociology and political science and her M.A. in sociology from the University of Houston. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine at the Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Robert Cook-Deegan
- Angela G. Villanueva, M.P.H., is a Research Associate at the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Robert Cook-Deegan, M.D., is a Professor in the School for the Future of Innovation in Society at Arizona State University. He is a physician and molecular biologist who turned to policy and then entered academe through Georgetown, Stanford, and Duke Universities before joining ASU. Jill O. Robinson, M.A., is the Research Manager at the Center for Medical Ethics and Health Policy, Baylor College of Medicine. She received her B.A. in sociology and political science and her M.A. in sociology from the University of Houston. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine at the Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Jill O Robinson
- Angela G. Villanueva, M.P.H., is a Research Associate at the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Robert Cook-Deegan, M.D., is a Professor in the School for the Future of Innovation in Society at Arizona State University. He is a physician and molecular biologist who turned to policy and then entered academe through Georgetown, Stanford, and Duke Universities before joining ASU. Jill O. Robinson, M.A., is the Research Manager at the Center for Medical Ethics and Health Policy, Baylor College of Medicine. She received her B.A. in sociology and political science and her M.A. in sociology from the University of Houston. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine at the Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Amy L McGuire
- Angela G. Villanueva, M.P.H., is a Research Associate at the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Robert Cook-Deegan, M.D., is a Professor in the School for the Future of Innovation in Society at Arizona State University. He is a physician and molecular biologist who turned to policy and then entered academe through Georgetown, Stanford, and Duke Universities before joining ASU. Jill O. Robinson, M.A., is the Research Manager at the Center for Medical Ethics and Health Policy, Baylor College of Medicine. She received her B.A. in sociology and political science and her M.A. in sociology from the University of Houston. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine at the Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Mary A Majumder
- Angela G. Villanueva, M.P.H., is a Research Associate at the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Robert Cook-Deegan, M.D., is a Professor in the School for the Future of Innovation in Society at Arizona State University. He is a physician and molecular biologist who turned to policy and then entered academe through Georgetown, Stanford, and Duke Universities before joining ASU. Jill O. Robinson, M.A., is the Research Manager at the Center for Medical Ethics and Health Policy, Baylor College of Medicine. She received her B.A. in sociology and political science and her M.A. in sociology from the University of Houston. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine at the Center for Medical Ethics and Health Policy, Baylor College of Medicine
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19
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Goetz LH, Schork NJ. Personalized medicine: motivation, challenges, and progress. Fertil Steril 2019; 109:952-963. [PMID: 29935653 DOI: 10.1016/j.fertnstert.2018.05.006] [Citation(s) in RCA: 280] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 01/07/2023]
Abstract
There is a great deal of hype surrounding the concept of personalized medicine. Personalized medicine is rooted in the belief that since individuals possess nuanced and unique characteristics at the molecular, physiological, environmental exposure, and behavioral levels, they may need to have interventions provided to them for diseases they possess that are tailored to these nuanced and unique characteristics. This belief has been verified to some degree through the application of emerging technologies such as DNA sequencing, proteomics, imaging protocols, and wireless health monitoring devices, which have revealed great inter-individual variation in disease processes. In this review, we consider the motivation for personalized medicine, its historical precedents, the emerging technologies that are enabling it, some recent experiences including successes and setbacks, ways of vetting and deploying personalized medicines, and future directions, including potential ways of treating individuals with fertility and sterility issues. We also consider current limitations of personalized medicine. We ultimately argue that since aspects of personalized medicine are rooted in biological realities, personalized medicine practices in certain contexts are likely to be inevitable, especially as relevant assays and deployment strategies become more efficient and cost-effective.
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Affiliation(s)
| | - Nicholas J Schork
- The Translational Genomics Research Institute, Phoenix, Arizona; The City of Hope/TGen IMPACT Center, Duarte, California; J. Craig Venter Institute, La Jolla, California; The University of California, San Diego, La Jolla, California.
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20
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Verma M, Hontecillas R, Tubau-Juni N, Abedi V, Bassaganya-Riera J. Challenges in Personalized Nutrition and Health. Front Nutr 2018; 5:117. [PMID: 30555829 PMCID: PMC6281760 DOI: 10.3389/fnut.2018.00117] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 11/14/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Meghna Verma
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States.,Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, United States
| | - Raquel Hontecillas
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States
| | - Nuria Tubau-Juni
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States
| | - Vida Abedi
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States.,Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, PA, United States
| | - Josep Bassaganya-Riera
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States
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21
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Horesh Bergquist S, Lobelo F. The Limits and Potential Future Applications of Personalized Medicine to Prevent Complex Chronic Disease. Public Health Rep 2018; 133:519-522. [PMID: 29969575 DOI: 10.1177/0033354918781568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Felipe Lobelo
- 2 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,3 Exercise Is Medicine Global Research and Collaboration Center, Atlanta, GA, USA
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22
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Carlsten C. Synergistic Environmental Exposures and the Airways Capturing Complexity in Humans: An Underappreciated World of Complex Exposures. Chest 2018; 154:918-924. [PMID: 29909283 DOI: 10.1016/j.chest.2018.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/18/2018] [Accepted: 06/03/2018] [Indexed: 12/31/2022] Open
Abstract
Paradoxically, the vast majority of research models intended to understand the relationship between exogenous exposures and lung disease are reduced to a single inhalant. This approach is understandable given the practical challenges of investigation, but it is problematic in terms of translation to the real-world human condition. Furthermore, use of data from such models can lead to underestimation of effect, which may adversely influence regulatory imperatives to protect public health based on the most robust information. Efforts to incrementally introduce layers of complexity to observational and experimental systems have revealed pathophysiology previously "hidden" within simplified models. Capturing the effects of co-exposure to traffic-related air pollution and allergens is a paradigmatic example and illustrates the influence of co-exposures across a plethora of clinical and subclinical end points within the respiratory tract. From DNA methylation in the epithelium, to inflammatory mediators and allergen-specific antibodies in the airway, to airflow limitation and symptoms, the addition of a common second exposure induces profound changes. In addition, genetic variation significantly alters the product of these relationships, and capturing multidimensional interactions may reveal susceptible populations who are particularly affected by these exposures and may merit focused measures for protection. Collectively, better modeling, and ultimately deeper knowledge, of these complex relationships has important implications for personalized health and prevention, development and refinement of pharmacologic agents, and public health responses to climate change and the staggering burden of pollution-driven disease worldwide.
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Affiliation(s)
- Christopher Carlsten
- Department of Medicine, School of Population and Public Health and Chan-Yeung Centre for Occupational and Environmental Lung Disease, University of British Columbia, Vancouver, BC, Canada.
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23
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Abstract
Jose Ordovas and colleagues consider that nutrition interventions tailored to individual characteristics and behaviours have promise but more work is needed before they can deliver
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Affiliation(s)
- Jose M Ordovas
- JM-USDA-HNRCA at Tufts University, Boston, MA, USA
- Centro Nacional Investigaciones Cardiovasculares, Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Lynnette R Ferguson
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
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24
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Brook JR, Setton EM, Seed E, Shooshtari M, Doiron D. The Canadian Urban Environmental Health Research Consortium - a protocol for building a national environmental exposure data platform for integrated analyses of urban form and health. BMC Public Health 2018; 18:114. [PMID: 29310629 PMCID: PMC5759244 DOI: 10.1186/s12889-017-5001-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/19/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Multiple external environmental exposures related to residential location and urban form including, air pollutants, noise, greenness, and walkability have been linked to health impacts or benefits. The Canadian Urban Environmental Health Research Consortium (CANUE) was established to facilitate the linkage of extensive geospatial exposure data to existing Canadian cohorts and administrative health data holdings. We hypothesize that this linkage will enable investigators to test a variety of their own hypotheses related to the interdependent associations of built environment features with diverse health outcomes encompassed by the cohorts and administrative data. METHODS We developed a protocol for compiling measures of built environment features that quantify exposure; vary spatially on the urban and suburban scale; and can be modified through changes in policy or individual behaviour to benefit health. These measures fall into six domains: air quality, noise, greenness, weather/climate, and transportation and neighbourhood factors; and will be indexed to six-digit postal codes to facilitate merging with health databases. Initial efforts focus on existing data and include estimates of air pollutants, greenness, temperature extremes, and neighbourhood walkability and socioeconomic characteristics. Key gaps will be addressed for noise exposure, with a new national model being developed, and for transportation-related exposures, with detailed estimates of truck volumes and diesel emissions now underway in selected cities. Improvements to existing exposure estimates are planned, primarily by increasing temporal and/or spatial resolution given new satellite-based sensors and more detailed national air quality modelling. Novel metrics are also planned for walkability and food environments, green space access and function and life-long climate-related exposures based on local climate zones. Critical challenges exist, for example, the quantity and quality of input data to many of the models and metrics has changed over time, making it difficult to develop and validate historical exposures. DISCUSSION CANUE represents a unique effort to coordinate and leverage substantial research investments and will enable a more focused effort on filling gaps in exposure information, improving the range of exposures quantified, their precision and mechanistic relevance to health. Epidemiological studies may be better able to explore the common theme of urban form and health in an integrated manner, ultimately contributing new knowledge informing policies that enhance healthy urban living.
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Affiliation(s)
- Jeffrey R. Brook
- Processes Research Section, Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Evan Seed
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Dany Doiron
- Research Institute of McGill University Health Centre, Montreal, Canada
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CRAWFORD DANAC, MORGAN ALEXANDERA, DENNY JOSHUAC, ARONOW BRUCEJ, BRENNER STEVENE. PRECISION MEDICINE: FROM DIPLOTYPES TO DISPARITIES TOWARDS IMPROVED HEALTH AND THERAPIES. PACIFIC SYMPOSIUM ON BIOCOMPUTING. PACIFIC SYMPOSIUM ON BIOCOMPUTING 2018; 23:389-399. [PMID: 29218899 PMCID: PMC6182117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Precision medicine research efforts both in basic science discovery and clinical implementation are well underway and promise to provide individualized preventions and treatments, improving overall health care delivery. To achieve these goals, advances in data capture and analysis are needed spanning different types of 'omic and clinical data. The efforts to enhance precise treatments for all may accentuate healthcare disparities unless specific challenges are identified and addressed. This session of the 2018 Pacific Symposium on Biocomputing presents the latest developments in this transdisciplinary research space of genomics, medicine, and population health.
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Affiliation(s)
- DANA C. CRAWFORD
- Population and Quantitative Health Sciences, Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, 44106 USA,
| | | | - JOSHUA C. DENNY
- Vanderbilt University Medical Center, Nashville, TN 37203 USA,
| | - BRUCE J. ARONOW
- Center for Computational Medicine, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Cincinnati, OH 45229 USA,
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Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, Gordon D. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res 2017; 120:366-380. [PMID: 28104770 PMCID: PMC5268076 DOI: 10.1161/circresaha.116.309115] [Citation(s) in RCA: 505] [Impact Index Per Article: 72.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023]
Abstract
If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease and stroke has been the success story of the century's past 4 decades. The early phase of this decline in coronary heart disease and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the US population aged. However, in 1978, the participants in a conference convened by the National Heart, Lung, and Blood Institute concluded that a significant recent downtick in coronary heart disease and stroke mortality rates had definitely occurred, at least in the US Since 1978, a sharp decline in mortality rates from coronary heart disease and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The National Heart, Lung, and Blood Institute, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.
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Affiliation(s)
- George A Mensah
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD.
| | - Gina S Wei
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Paul D Sorlie
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lawrence J Fine
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Yves Rosenberg
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Peter G Kaufmann
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael E Mussolino
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lucy L Hsu
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Ebyan Addou
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael M Engelgau
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - David Gordon
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
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Clifford RL, Jones MJ, MacIsaac JL, McEwen LM, Goodman SJ, Mostafavi S, Kobor MS, Carlsten C. Inhalation of diesel exhaust and allergen alters human bronchial epithelium DNA methylation. J Allergy Clin Immunol 2016; 139:112-121. [PMID: 27321436 DOI: 10.1016/j.jaci.2016.03.046] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Allergic disease affects 30% to 40% of the world's population, and its development is determined by the interplay between environmental and inherited factors. Air pollution, primarily consisting of diesel exhaust emissions, has increased at a similar rate to allergic disease. Exposure to diesel exhaust may play a role in the development and progression of allergic disease, in particular allergic respiratory disease. One potential mechanism underlying the connection between air pollution and increased allergic disease incidence is DNA methylation, an epigenetic process with the capacity to integrate gene-environment interactions. OBJECTIVE We sought to investigate the effect of allergen and diesel exhaust exposure on bronchial epithelial DNA methylation. METHODS We performed a randomized crossover-controlled exposure study to allergen and diesel exhaust in humans, and measured single-site (CpG) resolution global DNA methylation in bronchial epithelial cells. RESULTS Exposure to allergen alone, diesel exhaust alone, or allergen and diesel exhaust together (coexposure) led to significant changes in 7 CpG sites at 48 hours. However, when the same lung was exposed to allergen and diesel exhaust but separated by approximately 4 weeks, significant changes in more than 500 sites were observed. Furthermore, sites of differential methylation differed depending on which exposure was experienced first. Functional analysis of differentially methylated CpG sites found genes involved in transcription factor activity, protein metabolism, cell adhesion, and vascular development, among others. CONCLUSIONS These findings suggest that specific exposures can prime the lung for changes in DNA methylation induced by a subsequent insult.
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Affiliation(s)
- Rachel L Clifford
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meaghan J Jones
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia L MacIsaac
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa M McEwen
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah J Goodman
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara Mostafavi
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada; Canadian Institute for Advanced Research, Toronto, Ontario, Canada
| | - Michael S Kobor
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Canadian Institute for Advanced Research, Toronto, Ontario, Canada; Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Chan-Yeung Centre for Occupational and Environmental Lung Disease, Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Anaya JM, Ramirez-Santana C, Alzate MA, Molano-Gonzalez N, Rojas-Villarraga A. The Autoimmune Ecology. Front Immunol 2016; 7:139. [PMID: 27199979 PMCID: PMC4844615 DOI: 10.3389/fimmu.2016.00139] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/29/2016] [Indexed: 12/21/2022] Open
Abstract
Autoimmune diseases (ADs) represent a heterogeneous group of disorders that affect specific target organs or multiple organ systems. These conditions share common immunopathogenic mechanisms (i.e., the autoimmune tautology), which explain the clinical similarities they have among them as well as their familial clustering (i.e., coaggregation). As part of the autoimmune tautology, the influence of environmental exposure on the risk of developing ADs is paramount (i.e., the autoimmune ecology). In fact, environment, more than genetics, shapes immune system. Autoimmune ecology is akin to exposome, that is all the exposures - internal and external - across the lifespan, interacting with hereditary factors (both genetics and epigenetics) to favor or protect against autoimmunity and its outcomes. Herein, we provide an overview of the autoimmune ecology, focusing on the immune response to environmental agents in general, and microbiota, cigarette smoking, alcohol and coffee consumption, socioeconomic status (SES), gender and sex hormones, vitamin D, organic solvents, and vaccines in particular. Inclusion of the autoimmune ecology in disease etiology and health will improve the way personalized medicine is currently conceived and applied.
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Affiliation(s)
- Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario , Bogotá , Colombia
| | - Carolina Ramirez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario , Bogotá , Colombia
| | - Maria A Alzate
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario , Bogotá , Colombia
| | - Nicolas Molano-Gonzalez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario , Bogotá , Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario , Bogotá , Colombia
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Controlled diesel exhaust and allergen coexposure modulates microRNA and gene expression in humans: Effects on inflammatory lung markers. J Allergy Clin Immunol 2016; 138:1690-1700. [PMID: 27283384 DOI: 10.1016/j.jaci.2016.02.038] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/31/2016] [Accepted: 02/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Air pollution's association with asthma may be due to its augmentation of allergenic effects, but the role of microRNA (miRNA) and gene expression in this synergy is unknown. OBJECTIVE We sought to determine whether exposure to allergen, exposure to diesel exhaust (DE), or coexposures modulate miRNA, gene expression, or inflammatory pathways and whether these measurements are correlated. METHODS Fifteen participants with atopy completed this controlled study of 2 hours of filtered air or DE (300 μg PM2.5/m3) exposure, followed by saline-controlled segmental bronchial allergen challenge. Gene and miRNA expression in bronchial brushings and lung inflammatory markers were measured 48 hours later, in study arms separated by approximately 4 weeks. Expression of miRNAs, messenger RNAs, and inflammatory markers and their interrelationships were determined using regression. RESULTS Robust linear models indicated that DE plus saline and DE plus allergen significantly modulated the highest number of miRNAs and messenger RNAs, respectively, relative to control (filtered air plus saline). In mixed models, allergen exposure modulated (q ≤ 0.2) miRNAs including miR-183-5p, miR-324-5p, and miR-132-3p and genes including NFKBIZ and CDKN1A, but DE did not significantly modify this allergenic effect. Repression of CDKN1A by allergen-induced miR-132-3p may contribute to shedding of bronchial epithelial cells. CONCLUSIONS Expression of specific miRNAs and genes associated with bronchial immune responses were significantly modulated by DE or allergen. However, DE did not augment the effect of allergen at 48 hours, suggesting that adjuvancy may be transient or require higher or prolonged exposure. In silico analysis suggested a possible mechanism contributing to epithelial wall damage following allergen exposure.
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Zeinalian M, Eshaghi M, Naji H, Marandi SMM, Sharbafchi MR, Asgary S. Iranian-Islamic traditional medicine: An ancient comprehensive personalized medicine. Adv Biomed Res 2015; 4:191. [PMID: 26605230 PMCID: PMC4617002 DOI: 10.4103/2277-9175.166151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/11/2015] [Indexed: 11/04/2022] Open
Abstract
Personalized medicine (PM) is a novel term used for a medical model in which all diagnostic, prognostic, and therapeutic aspects of a disease are individualized for a patient using specific molecular testing. In Iranian-Islamic traditional medicine (IITM) an ancient paradigm for PM has been described which has been introduced in this paper. We reviewed the ancient resources of IITM and many valid recent studies on personalized medicine and described an ancient feature of personalized medicine in comparison with new ones. According to IITM scholars, every person has an individual temperament which is concluded of four basic humors combination. The individual temper is influenced by internal and external factors such as age, gender, ethnicity, season, and environment. This variability leads to different physical and mental behaviors toward a particular condition; so if we could identify the patient's temper, we would predict his/her health-related behaviors rather than predisposition and prognosis to different diseases, and select the best treatment. This holistic viewpoint of IITM to the human health and disease justifies the variable phenotypes among similar illnesses; the fact around which more advanced high-tech researches are being developed to explore all specific molecular pathways. IITM offers an ancient comprehensive PM (APM) which is more available and inexpensive compared to the modern PM (MPM). Moreover, APM focuses more on fitness than illness in comparison to MPM. It seems more attention to APM introduced by IITM could help us to promote health community. Design studies using high-tech MPM techniques would likely lead to clarification of most molecular aspects of APM.
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Affiliation(s)
- Mehrdad Zeinalian
- Entekhab Cancer Preven on and Control Research Center, Ala Charity Foundation, Isfahan University of medical Sciences, Isfahan, Iran ; Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Isfahan, Iran
| | - Mehdi Eshaghi
- Entekhab Cancer Preven on and Control Research Center, Ala Charity Foundation, Isfahan University of medical Sciences, Isfahan, Iran
| | - Homayoun Naji
- Entekhab Cancer Preven on and Control Research Center, Ala Charity Foundation, Isfahan University of medical Sciences, Isfahan, Iran
| | - Sayyed Mohammad Masoud Marandi
- Entekhab Cancer Preven on and Control Research Center, Ala Charity Foundation, Isfahan University of medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sharbafchi
- Entekhab Cancer Preven on and Control Research Center, Ala Charity Foundation, Isfahan University of medical Sciences, Isfahan, Iran ; Department of Psychiatry, School of Medicine, Isfahan University of medical Sciences, Isfahan, Iran
| | - Sedigheh Asgary
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of medical Sciences, Isfahan, Iran
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