Grant to support exposomic research into respiratory, other health


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Healio Interviews


Disclosures:
Wright reports no relevant financial disclosures.


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Key takeaways:

  • Exposomics can be defined as the health impact of all exposures experienced in a lifetime.
  • Exposures can include materials such as particulate matter as well as experiences such as violence.

The Institute for Exposomic Research at Mount Sinai has received a 5-year grant totaling $8.45 million from the NIH to support research studying how the environment impacts health across the lifespan.

Genetics explain less than even half of the risk of developing asthma and other common diseases such as diabetes and autism, according to a Mount Sinai press release. Exposures to climate change, plastics, pollution, social conditions and other factors represent the other half, the release continued.



The Institute for Exposomic Research at Mount Sinai uses technology to examine how multiple variables simultaneously impact human health, both individually and in combination.

The Institute for Exposomic Research at Mount Sinai uses technology to examine how multiple variables simultaneously impact human health, both individually and in combination. Image: Mount Sinai

What is exposomics?

“In the ideal, exposomics is working to as comprehensively as possible simultaneously measure the health-relevant environmental factors that are contributing to our health and development as well as adverse outcomes and diseases,” Rosalind J. Wright, MD, MPH, co-director of the Institute for Exposomic Research at Mount Sinai, told Healio.

Rosalind J. Wright

Traditionally, scientists have examined the impacts of toxins such as lead, arsenic and cadmium on the body considering each toxin individually, according to Wright, who also is a pulmonologist, the Horace W. Goldsmith Professor in Children’s Health Research and professor of pediatrics at Mount Sinai Kravis Children’s Hospital and Icahn School of Medicine.

The same goes for bisphenol A and phthalates as well as air pollution resulting from tobacco smoke, vehicle exhaust, industrial emissions and wildfires, Wright continued.

“You can also think about other sources for factors impacting our health like what we eat and ingest,” Wright said.

“Some of those can be healthy and are protective of our health. But you can also take in toxins through the things that we eat because of some of the packaging in our food, for example,” Wright said.

The social environment is yet another factor, Wright added.

“Psychological stress is another toxin that can affect our body and health,” she said.

Instead of measuring these variables one at a time, Wright said, exposomics uses big data and available tools such as machine learning and artificial intelligence to assess them in combination, which is closer to real life.

“We’re not exposed to one thing at a time. We’re bombarded by multiple factors,” Wright said. “And our body needs to adapt and respond to that mixture.”

For instance, she said, even low levels of lead may be more toxic if they are traveling with high levels of other toxins such as particulate matter air pollution from wildfire smoke.

“We have tools now and the capacity to measure tens, hundreds, even thousands of these at one time, which is exciting,” Wright said. “That’s the idea of exposomics — bigger and bigger data measuring more and more of the total environment.”

Information sources in the big data needed to better inform health includes, for example, electronic health records, genetic testing, and environmental data from individuals as well as the communities in which we live, Wright said. Calculating the impact of these complex mixtures quickly go beyond what the human brain can do, she continued.

“We need to use tools such as machine learning to enable researchers to find patterns in the data and translate that information into potential intervention and prevention strategies more quickly,” Wright said.

Applications in respiratory health

Previous studies have uncovered the dangers of particulate matter air pollution in asthma and respiratory health, Wright noted. For example, children born to women exposed to air pollution during pregnancy are more likely to develop asthma.

“The children are developing in utero. Their lungs are forming. Their immune systems are developing at the same time,” Wright said. “As the pregnant woman and, consequently, the infant respond to environmental challenges in the womb, this is priming the immune system and other biological systems to change the way the airways grow and develop and respond to triggers in the environment after birth.”

Exposomics also can identify resiliency factors that maintain optimal health. Nutrition may counter these toxic influences, Wright continued.

“If you have a healthy diet high in antioxidants, you might be able to mitigate the effects of toxic metals or traffic-related air pollution,” Wright said.

Exposomics can sort through these multiple factors to identify those most important to our health, Wright suggested.

“If you looked at that mixture — environmental air pollution, and then what nutritional factors might be involved at a given developmental time — you might see greater risk if the individual has a poor diet on top of high levels of exposure to air pollution. You might see some protective effect of an optimal diet in others,” she explained.

These kinds of studies foster interdisciplinary partnerships between scientists that cross disciplines and departments both at Mount Sinai and at other institutions, based on the respective experience and expertise that they can bring to the effort.

“This funding is critical in encouraging collaboration across groups that have not traditionally come together to incorporate the environment, and particularly exposomics, in the research they do,” Wright said.

Expanding the number of investigators who incorporate environmental science into their research is one of the goals of the funding, Wright said, as they begin thinking about how complex environmental factors contribute to all health outcomes.

“It might be somebody with a data science background or specifically artificial intelligence expertise, but they’ve never before thought about the environment,” Wright said.

Importantly, these researchers may form partnerships through the seed grants that the NIH funding will support, which builds new science, Wright said.

“They may begin to recognize the potential and say, ‘Hey, you should partner with me. I’m doing respiratory research, and I need the expertise in AI, and I have these great data on the environment,’” Wright suggested. “‘So, let’s come together and do something that neither one of us would have done alone.’”

One example of what can come of such collaborations is prior work the institute has supported into how increases in particulate matter air pollution from wildfires and other sources have interacted with social stressors to lead to worse respiratory outcomes.

“If you look across our communities that are experiencing greater levels of community violence, as well as higher air pollution, it might have increased risk for things like asthma, allergy, respiratory disease and sleep disorders,” Wright said. “We encourage those grants that look at interactions across the different types of environmental exposures.”

Another study examined the relationship between air pollution exposure in the community, sleep disorders, socioeconomic disparities and psychological stress.

“Community partners have noted sleep as a big problem in the communities served across our health system, so we’re responding to a community need, what they are identifying as a major factor that they are concerned about,” Wright said.

Impacts on clinical care

The institute is also focused on translating their research findings into better health outcomes and greater well-being in these communities, Wright said. Already, the institute’s findings on how the antioxidant effects of good nutrition can mitigate the negative impacts of air pollution and toxic stress are being put into action.

“Usually, you don’t prescribe better nutrition in the clinical setting,” Wright said. “But there are a lot of community outreach activities going on to enhance access to healthy foods.”

The institution may not fund those programs directly, Wright said.

“But the research that comes out of the center and the collaborations that it builds lead to data that can be leveraged to support and inform those kinds of prevention and intervention strategies,” she said.

The research also leads to educational tools and materials that can be shared with health care providers to raise awareness of the importance of the exposome and how these cumulative factors affect their patients, Wright said.

“We had a lot of outreach last week because of the wildfires. Everybody could feel, see and smell what was in the air, and they knew it was different,” Wright said. “It got to a hazardous level for all of us, even if we didn’t have underlying lung disease or heart disease. There could still be health effects.”

People contacted their providers as well as leaders at the institute to find out what they should do to protect themselves, Wright said.

“Stay indoors. Close the windows. Run your air conditioner. Use your mask again. Those kinds of things,” she said.

This research may inform policy as well, as Wright noted the U.S. Environmental Protection Agency’s (EPA’s) recent reassessment of various standards for individual pollutants in the air such as fine particulate matter.

“If you have an average daily exposure to X, it’s OK. It’s acceptable. That’s what we’re driving toward, to get people to intervene to bring us down to that level but changing the way we build cars, what kinds of traffic patterns we have, etc,” she said.

“Now we start to do mixtures. Now we start to apply more exposomic types of approaches to analyzing multiple pollutants in the air together,” Wright said.

“These data can be leveraged by the EPA and other agencies to say, ‘We need to do even better. We need to have policy in place to bring these levels down even lower because we’re seeing that even at the level we thought was OK, we’re starting to see health effects when you consider their collective effect,’” she said.

The institute intends to support the research that will provide the kind of data needed to move the policy needle, Wright said.

Further goals

Located in New York City, Wright said that Mount Sinai serves a socioeconomically, ethnically and culturally diverse population.

“Our center focuses a lot on looking across all communities served by our health institution and tries to see the major drivers of health while looking at multiple environmental factors,” Wright said.

“Can we use the research tools that we have to identify within a given community what the major drivers of asthma might be, or the level of lung function or some other respiratory outcome that they’re interested in?” she asked.

Wright said the institute aims to provide useful information that would clarify, for instance, whether air pollution is driving negative outcomes or if access to healthy foods or reducing toxic stress would lead to even more meaningful improvements in these outcomes.

“We might have a bigger bang for our buck if we can prioritize resources toward the major drivers,” she said.

However, she cautioned, one-size-fits-all solutions will not work in translating data to interventions.

“You’re really going to have to take this comprehensive approach to showing what the priority factors are that might be driving outcomes in population A vs. population B as you go across communities,” Wright said. “Exposomics holds the potential to allow us to do just that.”

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