Precision medicine in complex diseases - Molecular subgrouping for improved prediction and treatment stratification

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  • Åsa Johansson
  • Ole A. Andreassen
  • Brunak, Søren
  • Paul W. Franks
  • Harald Hedman
  • Loos, Ruth
  • Benjamin Meder
  • Erik Melén
  • Craig E. Wheelock
  • Bo Jacobsson

Complex diseases are caused by a combination of genetic, lifestyle, and environmental factors and comprise common noncommunicable diseases, including allergies, cardiovascular disease, and psychiatric and metabolic disorders. More than 25% of Europeans suffer from a complex disease, and together these diseases account for 70% of all deaths. The use of genomic, molecular, or imaging data to develop accurate diagnostic tools for treatment recommendations and preventive strategies, and for disease prognosis and prediction, is an important step toward precision medicine. However, for complex diseases, precision medicine is associated with several challenges. There is a significant heterogeneity between patients of a specific disease—both with regards to symptoms and underlying causal mechanisms—and the number of underlying genetic and nongenetic risk factors is often high. Here, we summarize precision medicine approaches for complex diseases and highlight the current breakthroughs as well as the challenges. We conclude that genomic-based precision medicine has been used mainly for patients with highly penetrant monogenic disease forms, such as cardiomyopathies. However, for most complex diseases—including psychiatric disorders and allergies—available polygenic risk scores are more probabilistic than deterministic and have not yet been validated for clinical utility. However, subclassifying patients of a specific disease into discrete homogenous subtypes based on molecular or phenotypic data is a promising strategy for improving diagnosis, prediction, treatment, prevention, and prognosis. The availability of high-throughput molecular technologies, together with large collections of health data and novel data-driven approaches, offers promise toward improved individual health through precision medicine.

OriginalsprogEngelsk
TidsskriftJournal of Internal Medicine
Vol/bind294
Udgave nummer4
Sider (fra-til)378-396
Antal sider19
ISSN0954-6820
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
This work has been supported by the Swedish Research Council (AJ, 2019‐01497. EM, 2016‐0386, 2018‐05619 PERMEABLE), the Swedish Heart‐Lung foundation (AJ, 20200687. EM, 20210546, CEW 20210519, 20200693), The Swedish Brain Foundation (AJ), and the Swedish Cancer Society (AJ, 22 2222 Pj), Research Council of Norway (OAA, 223273, 300309, 324252, 3244999). SB acknowledges the Novo Nordisk Foundation (grants NNF17OC0027594 and NNF14CC0001), and RJFL is supported by grants from the National Institutes of Health (R01DK110113, R01DK124097) and the Novo Nordisk Foundation (NNF20OC0059313) and a Danish National Research Foundation Chair (DNRF161). BM thanks for third‐party funding from Informatics for Life (Klaus Tschira Foundation), the German Center for Cardiovascular Research (DZHK), and the German Research Foundation (DFG: CRC1550).

Publisher Copyright:
© 2023 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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