Moving forward in precision medicine entails a holistic approach through an understanding of the history of disease progression
A recent review published in Clinical Chemistry (January 2018) by Danish Diabetes Academy PhD student Angela Estampador describes concepts of precision medicine in obesity and type 2 diabetes and outlines how molecular information obtained in pregnancy and early-life can improve prediction algorithms of disease trajectories. The review discusses proof-of-concept studies and advancements in molecular technologies, as well as current challenges in precision medicine.
PREGNANCY AS A METABOLIC STRESS TEST
Pregnancy is a period with high metabolic demands, effectively acting as a ‘natural’ metabolic stress test. For those who enter pregnancy with compromised beta cells, physiological stressors that arise during pregnancy and the demand for increased insulin production can trigger the onset of gestational diabetes mellitus. In this way, pregnancy has the potential to reveal underlying metabolic dysfunction in the pregnant woman as well as elicit fetal adaptations in response to adversities faced during early development.
THE BLIND SPOT IN PRECISION MEDICINE
The review briefly describes the ongoing private-public partnership initiatives that have recently established large-scale precision medicine consortia in Europe, the United States and China, tasked with discovering and validating biomarkers that might aid in disease prevention and management of its complications. The authors point out that at present, none focus on pregnancy or early-life risk factors.
SPACE FOR THREE? — THE INTRAUTERINE “TRIOME”
According to Angela Estampador and supervisor Paul Franks, an important aspect lacking from current initiatives in precision medicine is information on early-life events. Thus, moving forward in precision medicine would entail a holistic, life-course approach through an understanding of the history of disease progression in its entirety, rather than remain fixated on a single point or limited interval in time.
Furthermore, maternal-paternal-offspring interactions collectively make up what the authors term the intrauterine “triome”, a kind of highly adaptive and quickly evolving biological cross-talk between mother, father, and developing child. The challenge is great but not insurmountable, as recent advancements in cutting-edge molecular technologies and informatics are paving the way for future initiatives, enabling scientists to begin to probe the ‘black box’ of pregnancy.
AUTHORS AND AFFILIATION
Estampador AC1,2, Franks PW3,4,5,6
1Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
2Danish Diabetes Academy, Odense, Denmark
3Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
4Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
5Department of Nutrition, Harvard School of Public Health, Boston, MA
6Oxford Center for Diabetes, Endocrinology, and Metabolism, Radcliff Department of Medicine, University of Oxford, Oxford, UK
Source: Clinical Chemistry