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Sunday 15 September 2019
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Integrated, multi-'omic' studies of asthma could lead to precision treatment

In an invited review article published in the Journal of Allergy and Clinical Immunology, Scott Tyler, PhD, and Supinda Bunyavanich, MD, MPH, report that numerous studies have shown the value of applying transcriptomics and other 'omic' approaches for defining asthma subtypes - but they also cite the need for more studies aimed at pulling together these disparate data streams for a more comprehensive view of the disease.
Asthma is a highly heterogeneous disease, presenting with a broad range of symptoms. According to the American Lung Association, more than 26 million Americans have asthma. It is the third most common cause for hospitalisation among children. Much effort has gone toward establishing clinical and molecular subtypes - known as endotypes - of asthma in order to better understand the disease and hone treatment recommendations for patients in each group.
"Endotypes are important for physicians and biomedical researchers because they organise the way we think about asthma, which manifests in many different ways across patient populations," said Dr. Bunyavanich, faculty allergist/immunologist and Associate Professor of Pediatrics and of Genetics and Genomic Sciences, at the Icahn School of Medicine at Mount Sinai. "By strategically integrating clinical and molecular data, it should be possible to identify meaningful endotypes that both enhance our mechanistic understanding of asthma and guide our clinical care of asthma toward the best treatments for each subtype. This is important for optimizing patient outcomes."
The review covers several types of omic studies that have been applied to asthma already, including transcriptomics, epigenomics, metabolomics, proteomics, and microbiome analysis. But, as the authors note, each approach captures only one dimension of the disease biology. More complex studies that integrate multiple layers of data have begun, but additional work is needed.
"We are in the early stages of these more sophisticated and comprehensive analyses of asthma, but the growth in available patient cohorts, data repositories, technology, and analytical tools gives us confidence that this kind of approach is rapidly becoming more feasible," said Dr. Tyler, a postdoctoral fellow in the Bunyavanich Lab at Mount Sinai. "As this concept gains traction, it will be essential for researchers to ensure careful study design and implement rigorous methodology for the most reliable results for future use in precision medicine."
Tyler S, Bunyavanich S. Leveraging -omics for asthma endotyping. J Allergy Clinic Immunol 2019;144(1):13 DOI: 10.1016/j.jaci.2019.05.015