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Written by Nera Kuljanic.
Exposure to ‘forever chemicals’, air pollution, stress and many other factors depends on where a person lives and their lifestyle choices. These exposures combine over the course of a lifetime, affecting human biology and health. The ‘exposome’ concept offers a framework for understanding and analysing this complex reality, and ultimately for informing the shaping of evidence-based policy on chemicals, food and the workplace, as well as on pollution, public health and the environment more generally.
Many chronic diseases result from the complex interplay between a person’s genetic predisposition for developing a disease and ‘outside’ factors linked to lifestyle and/or the environment. The totality of environmental exposures that a person experiences over their lifetime, the interaction between those exposures, and the way these relate to health can be referred to as the ‘exposome‘. Chemicals – whether naturally occurring or anthropogenic – are an obvious example of problematic exposure, from sources such as polluted air or water, diet, lifestyle and the workplace.
However, the exposome is more than that. It comprises numerous very diverse factors that can be categorised into three interlinked clusters. ‘Internal’ factors include, for example, metabolic processes, inflammation, endogenous hormones, oxidative stress and gut microflora. ‘Specific external exposures’ include infectious agents, chemicals and other environmental contaminants, diet and lifestyle factors. A ‘general external category’ includes socioeconomic and psychological influences.
Exposome science is about understanding the effects of the complex interactions between environmental exposures and genetics on a person from conception to death, and how those exposures affect that person’s biology and health. It is closely related to exposure science, which studies ‘the contact between stressors and receptors, and the associated sources, pathways and processes potentially leading to impacts on human health and the natural and built environment’. Exposome-based thinking, supported by innovative data collection and analysis, biomonitoring tools, high-throughput ‘omics‘ technologies and enhanced computational and analytical capacities, allows for more comprehensive and faster data collection and analysis of exposures and their associated biological responses. This improves understanding of diseases’ cause, development, prevention and treatment. The huge potential that artificial intelligence and advanced analytics offer when it comes to untangling the vast amount of exposome-related data has given rise to the term ‘exposome intelligence‘.
Potential impacts and developments
Understanding the exposome is important for advancing scientific research to address the challenges posed by environmental and other exposures on human health. It can provide a valuable framework for informing risk assessment and regulation, and for developing effective intervention strategies to promote health, ensuring they are based on comprehensive data on exposure and health outcomes.
Exposome research can help identify risk factors – including previously unknown factors – that contribute to the development of certain diseases, such as cancers, neurological disorders, respiratory disorders, cardiovascular diseases and obesity. These factors also offer new lenses through which to study sensitive population groups or critical life periods such as childhood. Research can explore the link between the exposome, epigenetic changes (i.e. reversible changes in gene expression that do not involve modifying the DNA sequence) and individuals’ biological adaptive capacity. Exposome research can detect soft outcomes such as environmental exposures resulting in detectable molecular changes in a body that could be linked to a disease onset later in life. It can also lead to an understanding of time sequence in a disease onset, or of complex, multiple or simultaneous exposures. This knowledge can lead to better disease prevention, and to strategies – both targeted ones and strategies aimed at the general population – to reduce harmful exposures and promote healthier living and working conditions. It can provide evidence for the regulation of environmental pollutants and toxins, influencing policies relating to air and water quality, chemicals, pollution, the safety of products such as toys, and occupational health and safety.
There are also considerable limitations and challenges.The human exposome is incredibly complex, which makes it challenging to quantify and analyse all exposures comprehensively, despite advanced technological capabilities. Problems relate to data quality, consistency and the lack of established standards for exposome research. This includes the identification and interpretation of the most relevant biomarkers for specific health outcomes, which can lead to varying approaches and hinder comparability between studies. The exposome approach may also struggle to account for variability between individuals and its impact on health outcomes: unique individual patterns of environmental exposures (including historical ones) based on factors such as occupation, lifestyle and geography can make it difficult to isolate the direct effects of individual exposures. Furthermore, the collection and use of extensive personal environmental and health data raise ethical and privacy concerns.
Conducting exposome research requires significant resources, including funding, expertise and infrastructure for data collection, analysis and interpretation. Translating research findings into actionable interventions and strategies is not straightforward, given the complexity of exposures and their interactions. Addressing these challenges will be crucial to further advancing exposome research and realising its potential to inform public policies and personalised healthcare interventions.
Anticipatory policymaking
In both public policy and research, the interactions between the environment and health are increasingly recognised as a critical area of focus. On a global level, seeking to protect health, address challenges such as the emergence of infectious diseases, antimicrobial resistance and food safety, and promote the health and integrity of ecosystems, the One Health initiative acknowledges that the health of humans, animals, plants and the wider environment are intertwined. The EU has developed a comprehensive framework of thematic programmes, strategic objectives and regulatory actions relating to the environment and health, such as those for chemicals (including endocrine disruptors), pollution (including microplastics) and health and safety at work. However, the legislation is often focused on individual factors of concern.
For exposome science to deliver on its ambitious potential to inform evidence-based policies, a dedicated scientific capacity is needed to advance the research and produce conclusive evidence. This means creating educational opportunities such as degree programmes, earmarking funding for exposome research and setting up calls for research projects. Examples include the EU-funded Human Exposome Network (EHEN), the world’s largest network of projects studying the impact of environmental exposure on human health, and the International Human Exposome Network (IHEN), which aims to put in place longer-term, multi-sectoral collaboration to improve global research and cooperation on the exposome.
The development of standards for producing strong evidence is crucial. This relates to methods, techniques and practices for data collection, analysis and reporting. The research results need to be translated to policy by, for example, linking them to existing institutional structures and encouraging interdisciplinarity in policy development. Ultimately, exposome-informed policies could include new ‘protective’ legislation to prevent harm to the environment, human health and safety, to update standards or to change monitoring practices.
Read this ‘at a glance note’ on ‘What if focusing on the system, not just the symptoms, were key to health?‘ in the Think Tank pages of the European Parliament.
Listen to podcast ‘What if focusing on the system, not just the symptoms, were key to health?‘ on YouTube.
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