Precision prevention: A focused response to shifting paradigms in healthcare

Advancing translational exposomics: bridging genome, exposome and personalized medicine

Understanding the interplay between genetic predisposition and environmental and lifestyle exposures is essential for advancing precision medicine and public health. The exposome, defined as the sum of all environmental exposures an individual encounters throughout their lifetime, complements genomic data by elucidating how external and internal exposure factors influence health outcomes. This treatise highlights the emerging discipline of translational exposomics that integrates exposomics and genomics, offering a comprehensive approach to decipher the complex relationships between environmental and lifestyle exposures, genetic variability, and disease phenotypes. We highlight cutting-edge methodologies, including multi-omics technologies, exposome-wide association studies (EWAS), physiology-based biokinetic modeling, and advanced bioinformatics approaches. These tools enable precise characterization of both the external and the internal exposome, facilitating the identification of biomarkers, exposure-response relationships, and disease prediction and mechanisms. We also consider the importance of addressing socio-economic, demographic, and gender disparities in environmental health research. We emphasize how exposome data can contextualize genomic variation and enhance causal inference, especially in studies of vulnerable populations and complex diseases. By showcasing concrete examples and proposing integrative platforms for translational exposomics, this work underscores the critical need to bridge genomics and exposomics to enable precision prevention, risk stratification, and public health decision-making. This integrative approach offers a new paradigm for understanding health and disease beyond genetics alone.

Precision Prevention through Social Media: Report of Four Cases

BACKGROUND

Precision prevention involves using biological, behavioral, socioeconomic, and epidemiological data to improve health for a particular individual or group. With almost 63% of the global population using social media, these platforms show promise to deliver tailored messaging and personalized interventions to individuals.

OBJECTIVES

To describe the personalization elements and behavior components used in a sample of precision prevention interventions delivered through social media.

METHODS

To identify examples of cases, a search was done on clinicaltrials.gov, searching for 'other terms: prevention' + 'Intervention/Treatment: social media intervention' + 'study results: With results. The selected cases were described, personalization elements reported, and their adopted intervention components were coded according to the Behavior Change Wheel (BCW) framework.

RESULTS

A total of four cases employing personalization in their interventions were identified. Three of these cases targeted women's health. The intervention period varied from two to eight months, with participant commitment ranging from active involvement on five out of seven days to monthly participation. The BCW interventions of persuasion and incentivization, were most frequently utilized, while education and coercion were used sparingly in the selected cases. Notably, none of the four cases reported the use of training, restrictions, or modeling.

CONCLUSIONS

Social media has the potential to serve as a tool for digital phenotyping and contribute to the advancement of precision prevention. Challenges include the social media platform set-up and ensuring all ethical considerations are met.

Evaluating Information Technology-enabled Precision Prevention Initiatives in Health and Care

Information technology-enabled precision prevention is a relatively new approach designed to improve population health. It forms an organic development linking principles of optimizing added value from health-related information technology and data systems with clinical aspirations to add longer-term problem prevention to immediate illness treatment. It includes drawing on information technology to identify persons at risk for developing certain conditions and then developing targeted behavioral and psychosocial approaches to modifying the behaviors of individuals or specific groups. We here discuss evaluation challenges associated with information technology-enabled precision prevention approaches to facilitate the development of an empirical evidence base. Challenges associated with measuring the impact of information technology-enabled precision prevention initiatives include considerations surrounding the relevance and fit of external data sources, the accuracy of prediction models, establishing added benefits of preventative activities, measuring pre-post outcomes at individual and population levels, and considerations surrounding cost-benefit analysis. Challenges associated with assessing processes of information technology-enabled precision prevention initiatives include the quality of data used to create underlying data models, exploring processes not necessarily related to each other, evolving social and environmental determinants of health and individual circumstances, the evolving nature of needs and interventions over time, and ethical considerations. If these challenges are attended to in evaluation activities, this will help to ensure that information technology-enabled approaches to precision prevention will have a positive impact on individual and population health.

Behavioral Components and Their Tailoring in Participatory Health Interventions for Precision Prevention

OBJECTIVE

To study which behavioral components are implemented within participatory health interventions for precision prevention, specifically how they are realized as part of the interventions and how the tailoring of the interventions is implemented.

METHODS

We selected three case studies of participatory health interventions for precision prevention for three different target groups (children, parents, older adults with chronic conditions). One author with a background in psychology mapped the interventions and the digital functionalities to the 9 intervention functions of the behavioral change wheel (education, persuasion, incentivisation, coercion, training, enablement, modeling, environmental restructuring, restrictions).

RESULTS

While the intervention functions persuasion, incentivisation, education, modeling and coercion are implemented in all three interventions under considerations, two techniques (restrictions, and environmental restructuring) were not implemented in any of the three solutions. Training was only applied in one application and enablement in two interventions. We identified significant evidence gaps in both the tailoring process and the effectiveness of behavior change techniques in precision prevention.

CONCLUSION

We conclude that there is a need for more focused studies on the effects of behavior interventions functions in digital health interventions and for design guidelines to improve these interventions for personalized health outcomes, thereby advancing precision prevention in digital health.

Precision Prevention in Obstructive Sleep Apnea

Sleep-related breathing disorders, encompassing snoring and obstructive sleep apnea (OSA), are highly prevalent worldwide, and there have been important advances in recent years regarding the understanding of underlying pathophysiology mechanisms, diagnosis, and improvement in therapeutic options. The precision medicine and person-centered approaches are based on the concept that every individual is unique and a myriad of elements influence the likelihood of developing the disease, the signs and symptoms expressed, the response to different treatment modalities, and the susceptibility to complications. Thus, health and disease are the result of phenotypic outcomes resulting from interactions between biological factors, environment, and lifestyle.

Long Interspersed Nuclear Element-1 Analytes in Extracellular Vesicles as Tools for Molecular Diagnostics of Non-Small Cell Lung Cancer

Aberrant expression of the oncogenic retrotransposon LINE-1 is a hallmark of various cancer types, including non-small cell lung cancers (NSCLCs). Here, we present proof-of-principle evidence that LINE-1 analytes in extracellular vesicles (EVs) serve as tools for molecular diagnostics of NSCLC, with LINE-1 status in tumor cells and tissues mirroring the LINE-1 mRNA and ORF1p cargos of EVs from lung cancer cell culture conditioned media or human plasma. The levels of LINE-1 analytes in plasma EVs from ostensibly healthy individuals were higher in females than males. While the profiles of LINE-1 mRNA and ORF1p in African Americans compared to Hispanics were not significantly different, African Americans showed slightly higher ORF1p content, and 2-3 times greater ranges of LINE-1 values compared to Hispanics. Whole plasma ORF1p levels correlated with EV ORF1p levels, indicating that most of the circulating LINE-1 protein is contained within EVs. EV LINE-1 mRNA levels were elevated in patients with advanced cancer stages and in select patients with squamous cell carcinoma and metastatic tumors compared to adenocarcinomas. The observed EV LINE-1 mRNA profiles paralleled the patterns of ORF1p expression in NSCLC tissue sections suggesting that LINE-1 analytes in plasma EVs may serve to monitor the activity of LINE-1 retroelements in lung cancer.

Long interspersed nuclear element-1 methylation status in the circulating DNA from blood of patients with malignant and chronic inflammatory lung diseases

Along with other malignant diseases, lung cancer arises from the precancerous lung tissue state. Aberrant DNA methylation (hypermethylation of certain genes and hypomethylation of retrotransposons) is known as one of the driving forces of malignant cell transformation. Epigenetic changes were shown to be detectable in DNA, circulating in the blood (cirDNA) of cancer patients, indicating the possibility to use them as cancer markers. The current study is the first to compare the Long interspersed nuclear element-1 (LINE-1) methylation level in the blood from lung cancer patients before treatment versus different control groups as healthy subjects, patients with bronchitis and patients with chronic obstructive pulmonary disease (COPD). The concentration of LINE-1 methylated fragments, region 1 (LINE-1 methylated, LINE-1-met) was estimated by quantitative methyl-specific PCR. The total concentration of the circulating LINE-1 copies was measured by qPCR specific for LINE-1 region 2, which was selected due to its CpG methylation-independent sequence (LINE-1-Ind). Both LINE-1 methylation level and LINE-1 methylation index (LINE-1-met/LINE-1-Ind ratio) was decreased in lung cancer patients compared with the joint control group (healthy subjects + patients with bronchitis + COPD patients) (Mann-Whitney U-test, P = 0.016). We also found that the tendency of LINE-1 methylation index decreases in the cirDNA from lung cancer patients versus COPD patients (Mann-Whitney U-test, P = 0.07). Our data indicate that the quantitative analysis of the LINE-1 methylation level in the cirDNA is valuable for discrimination of lung cancer patients from patients with chronic inflammatory lung diseases.