The Exposome in the Era of the Quantified Self

UVREK: Development and Analysis of an Expression Profile Knowledgebase of Biomolecules Induced by Ultraviolet Radiation Exposure

Humans encounter diverse environmental factors which can have impact on their health. One such environmental factor is ultraviolet (UV) radiation, which is part of the physical component of the exposome. UV radiation is the leading cause of skin cancer and is a significant global health concern. A large body of published research has been conducted to uncover the mechanisms underlying the adverse outcomes of UV radiation exposure on living beings. These studies involve identifying the biomolecules induced upon UV radiation exposure. A few previous efforts have attempted to compile this information in the form of a database, but such earlier efforts have certain limitations. To fill this gap, we present a structured database named UVREK (UltraViolet Radiation Expression Knowledgebase), containing manually curated data on biomolecules induced by UV radiation exposure from the published literature. UVREK has compiled information on 985 genes, 470 proteins, 54 metabolites, and 77 miRNAs along with their metadata. Thereafter, an enrichment analysis performed on the human gene set of the UVREK database showed the importance of transcription-related processes in UV-related response and enrichment of pathways involved in cancer and aging. While significantly contributing toward characterizing the physical component of the exposome, we expect that the compiled data in UVREK will serve as a valuable resource for the development of better UV protection mechanisms such as UV sensors and sunscreens. Noteworthily, UVREK is the only resource to date compiling varied types of biomolecular responses to UV radiation with the corresponding metadata. UVREK is openly accessible at https://cb.imsc.res.in/uvrek/.

Patient-informed exploration of the aftermath of a diagnostic problem or mistake based on results of a national survey

Introduction

Despite the prevalence and devastating consequences of diagnostic breakdowns, there have been minimal efforts to systematically collect patient insight into diagnostic problems and mistakes. Collaborating with patient advocates to guide how patient-derived insights are interpreted and used is a critical, yet often overlooked, approach to identifying actionable solutions that speak to patients' priorities.

Objective

We collaborated with patient advocate co-authors to guide our understanding of findings from a mixed methods survey on diagnostic problems and mistakes, and report implications for patient engagement at three levels of action: (1) individual level before, during, after encounters (micro); (2) within health service delivery systems (meso); and (3) policy advocacy (macro).

Methods

Our research team applied narrative elicitation methods to conduct a novel survey about Americans' diagnostic experiences in a national, population-based survey. We shared early results with patient co-authors who highlighted the importance of further exploring how health systems and clinicians address the aftermath of diagnostic mishaps. Based on their input, we summarized the quantitative and qualitative survey results about the aftermath and worked with our patient co-authors to explore how findings might inform actionable next steps, including efforts to catalyze patient action, quality improvement efforts, and policy reform.

Results

Of the 3,684 survey respondents, about a third (33.0%, 1,216/3,684) of screened households reported diagnostic problems and mistakes in the past four years involving either themselves (18.9%, 697/3,684) or someone close to them (14.1%, 519/3,684). In the aftermath of a diagnostic mishap, over a third reported that someone in the healthcare setting where the mistake occurred acknowledged the mistake (35.9%, 432/1,204). In qualitative findings, reports that the health system "did nothing" surfacing as the most common response. Patient co-authors confirmed the results resonated with their experiences and emphasized the need for health systems to take accountability when a mishap occurs and to take follow-up actions to prevent future mishaps.

Discussion

Patients and care partners not only want and deserve acknowledgement of diagnostic problems or mistakes in their own care, they also want assurance that steps are being taken to prevent similar events from happening to others. Across micro-, meso-, and macro-levels of action, working with patients to understand and act on contributors to diagnostic breakdowns is aligned with high-reliability organizing principles.

Dynamic lipidome alterations associated with human health, disease and ageing

Lipids can be of endogenous or exogenous origin and affect diverse biological functions, including cell membrane maintenance, energy management and cellular signalling. Here, we report >800 lipid species, many of which are associated with health-to-disease transitions in diabetes, ageing and inflammation, as well as cytokine-lipidome networks. We performed comprehensive longitudinal lipidomic profiling and analysed >1,500 plasma samples from 112 participants followed for up to 9 years (average 3.2 years) to define the distinct physiological roles of complex lipid subclasses, including large and small triacylglycerols, ester- and ether-linked phosphatidylethanolamines, lysophosphatidylcholines, lysophosphatidylethanolamines, cholesterol esters and ceramides. Our findings reveal dynamic changes in the plasma lipidome during respiratory viral infection, insulin resistance and ageing, suggesting that lipids may have roles in immune homoeostasis and inflammation regulation. Individuals with insulin resistance exhibit disturbed immune homoeostasis, altered associations between lipids and clinical markers, and accelerated changes in specific lipid subclasses during ageing. Our dataset based on longitudinal deep lipidome profiling offers insights into personalized ageing, metabolic health and inflammation, potentially guiding future monitoring and intervention strategies.

Exploring Single-Cell Exposomics by Mass Spectrometry

Single-cell exposomics, a revolutionary approach that investigates cell-environment interactions at cellular and subcellular levels, stands distinct from conventional bulk exposomics. Leveraging advancements in mass spectrometry, it provides a detailed perspective on cellular dynamics, interactions, and responses to environmental stimuli and their impacts on human health. This work delves into this innovative realm, highlighting the nuanced interplay between environmental stressors and biological responses at cellular and subcellular levels. The application of spatial mass spectrometry in single-cell exposomics is discussed, revealing the intricate spatial organization and molecular composition within individual cells. Cell-type-specific exposomics, shedding light on distinct susceptibilities and adaptive strategies of various cell types to environmental exposures, is also examined. The Perspective further emphasizes the integration with molecular and cellular biology approaches to validate hypotheses derived from single-cell exposomics in a comprehensive biological context. Looking toward the future, we anticipate continued technological advancements and convergence with other -omics approaches and discuss implications for environmental health research, disease progression studies, and precision medicine. The final emphasis is on the need for robust computational tools and interdisciplinary collaboration to fully leverage the potential of single-cell exposomics, acknowledging the complexities inherent to this paradigm.

Charting the landscape of the environmental exposome

The exposome depicts the total exposures in the lifetime of an organism. Human exposome comprises exposures from environmental and humanistic sources. Biological, chemical, and physical environmental exposures pose potential health threats, especially to susceptible populations. Although still in its nascent stage, we are beginning to recognize the vast and dynamic nature of the exposome. In this review, we systematically summarize the biological and chemical environmental exposomes in three broad environmental matrices-air, soil, and water; each contains several distinct subcategories, along with a brief introduction to the physical exposome. Disease-related environmental exposures are highlighted, and humans are also a major source of disease-related biological exposures. We further discuss the interactions between biological, chemical, and physical exposomes. Finally, we propose a list of outstanding challenges under the exposome research framework that need to be addressed to move the field forward. Taken together, we present a detailed landscape of environmental exposome to prime researchers to join this exciting new field.

Precision environmental health monitoring by longitudinal exposome and multi-omics profiling

Conventional environmental health studies have primarily focused on limited environmental stressors at the population level, which lacks the power to dissect the complexity and heterogeneity of individualized environmental exposures. Here, as a pilot case study, we integrated deep-profiled longitudinal personal exposome and internal multi-omics to systematically investigate how the exposome shapes a single individual's phenome. We annotated thousands of chemical and biological components in the personal exposome cloud and found they were significantly correlated with thousands of internal biomolecules, which was further cross-validated using corresponding clinical data. Our results showed that agrochemicals and fungi predominated in the highly diverse and dynamic personal exposome, and the biomolecules and pathways related to the individual's immune system, kidney, and liver were highly associated with the personal external exposome. Overall, this data-driven longitudinal monitoring study shows the potential dynamic interactions between the personal exposome and internal multi-omics, as well as the impact of the exposome on precision health by producing abundant testable hypotheses.

Increased Urinary Cadmium Levels in Foreign-Born Asian Women-An NHANES Study of 9639 U.S. Participants

The purpose of this study was to determine the disparities and trends in demographics, social behaviors, and occupations for cadmium exposure in the U.S. Data were obtained from the NHANES database from 2007 to 2016. Analysis of variance tests were used to compare the association of the geometric mean values of urinary cadmium levels and various demographic and behavioral characteristics. We also conducted multivariable logistic regression while adjusting for these factors to determine the risk of toxic urinary cadmium levels (≥2 µg/g) across various patient characteristics. Of the 9639 participants, 52.8% were ≥45 years old, 51.7% female, and 48.3% male. White, Black, Mexican American, other Hispanic, and Asian comprised 66.4%, 11.5%, 8.7%, 5.8%, and 5.5%, respectively. Over 82% of participants were U.S. born. A total of 19.6% were current smokers. On multivariate analysis, older age (OR: 8.87), current smoking (OR = 5.74), Asian race (OR = 4.52), female sex (OR = 4.32), and foreign nativity (OR = 1.83) were significantly associated with higher cadmium levels. Older, Asian, foreign-born females showed a measurement of 0.69 μg/g, a value more than three-fold the sample population’s mean of 0.20 μg/g. A trend analysis demonstrated a cadmium level decrease over time (OR = 0.47). Asians had the highest urinary cadmium levels, especially older, foreign-born females. Smoking and poverty were also associated with significant elevations in cadmium levels.