Concerns are being raised as to how modern lifestyles may cause physiological defense mechanisms in light of the dramatic increase of people suffering from chronic inflammatory diseases, such as allergies, asthma and irritable bowel syndrome.
Researchers have conducted a perspective foresight study along the lines of the European Science Foundation's (ESF) predictions, evaluating the challenges linked to chronic inflammatory diseases. Their findings, published in a supplement to The Journal of Allergy and Clinical Immunology (JACI), the official journal of the American Academy of Allergy, Asthma & Immunology (AAAAI), report details of 10 key areas with the highest priority for research.
Harald Renz, MD, committee chair of the Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Phillips University in Marburg, Germany comments:
"Many transmissible diseases have been effectively eradicated over the last half century, yet there has been a marked increase in the incidence of chronic inflammatory diseases.
Strategies are urgently needed to determine the causes of these chronic diseases and identify targets for therapy and prevention."
Determining the factors responsible for the development of chronic inflammatory diseases remains challenging. Even though epidemiological evidence clearly indicates environmental influence as being responsible, not everyone within these environments develops diseases; and despite the fact that susceptibility to chronic inflammatory disease evidently play an important role, genetics alone may not be the only determining factor, as susceptibility to disease in later life can be influenced by prenatal exposures. Another influencing factor that determines the likelihood of a person developing diseases like asthma and allergies in later life is whether or not a person is breastfed and exposed to microorganisms after birth.
Dr. Renz and his team from the Scientific Committee of the ESF Forward Look on Gene-Environment Interaction in Chronic Disease (GENESIS) have determined key recommendations from their study listing the highest priority for research into chronic inflammatory diseases:
- To understand chronic inflammatory disease, researchers should apply a global or international approach.
- Effective interdisciplinary research strategies must be established
- The question of tolerance should be a main focus for researchers
- Therapy and prevention must be clearly distinguished in research.
- Large prospective cohort studies that include deep phenotyping must be made priority.
- Effective public-private partnerships must be developed to ensure free exchange of information.
- Large investments are required for infrastructure, personnel, and development of research tools.
- Dedicated funding must be provided for interdisciplinary research.
- Data collection protocols, handling, and storage need to be unified.
- New tools and experimental models must be developed.
Therapy and Prevention.
Due to the complexity of chronic inflammatory diseases, patient treatments need to be based on deep environmental, biological and clinical phenotyping as it is not possible to establish whether potential therapies are clinically ineffective, or just not targeted correctly without phenotyping. The committee is asking for an identification of novel biological markers to improve the classification of patients, as well as for investments in bioinformatics and systems biology in order to realize the full potential of omics data.
Key issues for prevention include selecting appropriate populations and long-term tolerability of putative long-term protective agents. Preventing allergic diseases with probiotics in the form of infant food supplements have produced mixed results in clinical studies. The term 'probiotic' should be used with caution according to the committee. Further research is required to understand the function of gut microbes in health and disease.
Large Cohort Studies.
According to the committee, researchers need to conduct large cohort studies that start prior to birth, and to fully account for the impact of how intrinsic and extrinsic factors determine each individual's probability of being healthy or develop a chronic disease when given the right environmental stimuli. These studies would evaluate biological data including clinical, genomic, and environmental factors as well as psychosocial factors such as stress. International collaborations including coverage of populations with different lifestyles and environmental exposures are important factor for such studies.
The changing worldwide pattern of chronic disease to developing nations provides an opportunity to establish key factors that confer both risk and protection. The committee suggests establishing research projects in regions with low or developing risk of chronic inflammatory disease together with the establishment of parallel birth cohorts in low- and high-risk regions. It is also crucial to establish cross-disciplinary partnerships that extend further than traditional disciplines, such as epidemiology and microbiology to mathematics, ecology and virology. A key driving force for future research is to have effective private-public partnerships with an appropriate flow of information exchange between academia and industry.
Research Tools, Data Generation and Management, and Infrastructure and Personnel.
New research strategies will be required that take the diversity of the microbiome in the choice of experimental models into account as well as the potential reproducibility of results. Due to the complexity initiated by the microbiome, research will require a significant investment needed for the development of bioinformatics and systems biology approaches that are necessary to evaluate the generated datasets. It also requires an electronic infrastructure that supports integrated approaches and open collaboration.
To ensure that no over-presentations of specific disciplines are made in support of unbiased approaches, funding should be provided by panels. It also requires a new generation of biological and medical scientists who will be ready to exploit rapid developments in information technology, and who are able to use insights from a wide spectrum of scientific disciplines including fields, like finance and engineering. The committee recommends creating international graduate schools that provide specific interdisciplinary research training.
In the foreword accompanying the supplement, Lars V. Kristiansen, PhD, Science Officer, European Science Foundation, European Medical Research Councils in Strasbourg, France, and his team comment in the foreword that accompanies the supplement, saying: "The socioeconomic costs of chronic diseases are staggering and ever increasing. There is an urgent need to prioritize resources and identify the most efficient scientific and societal initiatives to be adopted. National collaboration within the European region represents the most efficient manner in which strategies for amelioration of chronic inflammatory diseases in the western world may be achieved."
Written by: Grace Rattue