Osteoarthritis(OA)is the most common form of arthritis that has a major impact on patient morbidity and health care services.Despite its prevalence and impact,we do not have any effective management strategy to preven...Osteoarthritis(OA)is the most common form of arthritis that has a major impact on patient morbidity and health care services.Despite its prevalence and impact,we do not have any effective management strategy to prevent or control their manifestations.Several decades of pharmacological development have failed to deliver a disease-modifying solution to OA.This editorial article outlines the lacunae in the research efforts of the past,the challenges that we are facing at present,and the exciting opportunities we have in the future for the management of OA.OA research has to be made more personalized concerning the phenotypic and endotypic disease variants.To begin with,robust disease classification criteria need to be defined for early OA,and biomarkers to detect such early diseases to aid in patient stratification.We also need to refine our clinical research design to make them more objective to meet the demands of the patient and the regulatory agencies.Embracing the current technologies such as artificial intelligence along with the use of genomic profiling from the omics platforms,the future of OA is more promising in developing appropriate management of OA.展开更多
Asthma is a common disease affecting millions of people worldwide and exerting an enormous strain on health resources in many countries. Evidence is increasing that asthma is unlikely to be a single disease but rather...Asthma is a common disease affecting millions of people worldwide and exerting an enormous strain on health resources in many countries. Evidence is increasing that asthma is unlikely to be a single disease but rather a series of complex, overlapping individual diseases or phenotypes, each defined by its unique interaction between genetic and environmental factors. Asthma phenotypes were initially focused on combinations ofclinical characteristics, but they are now evolving to link pathophysiological mechanism to subtypes of asthma. Better characterization of those phenotypes is expected to be most useful for allocating asthma therapies. This article reviews different published researches in terms of unbiased approaches to phenotype asthma and emphasizes how the phenotyping exercise is an important step towards proper asthma treatment. It is structured into three sections; the heterogeneity of asthma, the impact of asthma heterogeneity on asthma management and different trials for phenotyping asthma.展开更多
The intestinal tract(i.e.,the gut),is where the body’s nutrients are absorbed,and is simultaneously inhabited by numerous microbes.An increasing body of literature suggests a crucial role for the gut microbiome in mo...The intestinal tract(i.e.,the gut),is where the body’s nutrients are absorbed,and is simultaneously inhabited by numerous microbes.An increasing body of literature suggests a crucial role for the gut microbiome in modulating systemic inflammatory disease.Psoriasis is a chronic systemic inflammatory disease and its pathogenesis is related to the interaction between genetic susceptibility,immune response and environmental triggers.The omics era has allowed physicians to assess different aspects of psoriasis pathogenesis such as the microbiome,infectome,and autoinfectome.Furthermore,diet appears to play an important role in modulating disease activity,perhaps by influencing gut microbes.Given these observations,we aimed to summarize the current knowledge regarding skin-microbiome-gut-nutrients and psoriasis.展开更多
Chronic obstructive pulmonary disease(COPD)is one of the leading causes of mortality and morbidity worldwide.One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms ...Chronic obstructive pulmonary disease(COPD)is one of the leading causes of mortality and morbidity worldwide.One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms episodically worsen.Exacerbations accounted for over 140000 hospital admissions in 2012 in the United Kingdom with considerably more exacerbations being treated in primary care.Despite significant research in this area in recent years,treatment of acute exacerbations in the community remains limited to oral glucocorticoids,antibiotics and bronchodilators.One of the issues with unpicking the complexity of exacerbations is trying to find out the exact underlying cause and mechanism that leads to symptoms and lung destruction.Currently symptoms are initially guided by symptoms alone though multiple causes of exacerbations have common presentations.This includes viral and bacterial infections and episodes relating to environmental triggers such as pollen and pollution.There is also evidence that cardiovascular factors can contribute to symptoms of breathlessness that can mimic COPD exacerbations.In this editorial we discuss recent advances in the use of precision medicine to more accurately treat exacerbations of COPD.This includes identification of phenotypes that could help rationalise treatment and more importantly identify novel drug targets.We also consider the future role of precision medicine in preventing exacerbations and identifying COPD patients that are at increased risk of developing them.展开更多
Sepsis is a heterogeneous disease with variable clinical course and several clinical phenotypes.As it is associated with an increased risk of death,patients with this condition are candidates for receipt of a very wel...Sepsis is a heterogeneous disease with variable clinical course and several clinical phenotypes.As it is associated with an increased risk of death,patients with this condition are candidates for receipt of a very well-structured and protocolized treatment.All patients should receive the fundamental pillars of sepsis management,which are infection control,initial resuscitation,and multiorgan support.However,specific subgroups of patients may benefit from a personalized approach with interventions targeted towards specific pathophysiological mechanisms.Herein,we will review the framework for identifying subpopulations of patients with sepsis,septic shock,and multiorgan dysfunction who may benefit from specific therapies.Some of these approaches are still in the early stages of research,while others are already in routine use in clinical practice,but together will help in the effective generation and safe implementation of precision medicine in sepsis.展开更多
Asthma affects about 300 million people worldwide, placing an enormous strain on health resources inmany countries. Evidence is increasing that asthma is a complex condition with different underlying pathophysiologies...Asthma affects about 300 million people worldwide, placing an enormous strain on health resources inmany countries. Evidence is increasing that asthma is a complex condition with different underlying pathophysiologiesJ Scientists around the world have devoted much effort to unveiling this heterogeneity, from phenotyping initially focused on combinations of clinical characteristics, towards endotypes evolving which link pathophysiological mechanism to subtypes of asthma.2 The identification of these endotypes, either by matching biology, genetics and therapeutic responses with clinically defined phenotypes or through unbiased genomic approaches, remains limited.3 Moving forward, ongoing studies that expand on these insights into the molecular signatures should enhance our ability to define the endotypes and lead to more targeted approaches to asthma therapy.4展开更多
文摘Osteoarthritis(OA)is the most common form of arthritis that has a major impact on patient morbidity and health care services.Despite its prevalence and impact,we do not have any effective management strategy to prevent or control their manifestations.Several decades of pharmacological development have failed to deliver a disease-modifying solution to OA.This editorial article outlines the lacunae in the research efforts of the past,the challenges that we are facing at present,and the exciting opportunities we have in the future for the management of OA.OA research has to be made more personalized concerning the phenotypic and endotypic disease variants.To begin with,robust disease classification criteria need to be defined for early OA,and biomarkers to detect such early diseases to aid in patient stratification.We also need to refine our clinical research design to make them more objective to meet the demands of the patient and the regulatory agencies.Embracing the current technologies such as artificial intelligence along with the use of genomic profiling from the omics platforms,the future of OA is more promising in developing appropriate management of OA.
文摘Asthma is a common disease affecting millions of people worldwide and exerting an enormous strain on health resources in many countries. Evidence is increasing that asthma is unlikely to be a single disease but rather a series of complex, overlapping individual diseases or phenotypes, each defined by its unique interaction between genetic and environmental factors. Asthma phenotypes were initially focused on combinations ofclinical characteristics, but they are now evolving to link pathophysiological mechanism to subtypes of asthma. Better characterization of those phenotypes is expected to be most useful for allocating asthma therapies. This article reviews different published researches in terms of unbiased approaches to phenotype asthma and emphasizes how the phenotyping exercise is an important step towards proper asthma treatment. It is structured into three sections; the heterogeneity of asthma, the impact of asthma heterogeneity on asthma management and different trials for phenotyping asthma.
文摘The intestinal tract(i.e.,the gut),is where the body’s nutrients are absorbed,and is simultaneously inhabited by numerous microbes.An increasing body of literature suggests a crucial role for the gut microbiome in modulating systemic inflammatory disease.Psoriasis is a chronic systemic inflammatory disease and its pathogenesis is related to the interaction between genetic susceptibility,immune response and environmental triggers.The omics era has allowed physicians to assess different aspects of psoriasis pathogenesis such as the microbiome,infectome,and autoinfectome.Furthermore,diet appears to play an important role in modulating disease activity,perhaps by influencing gut microbes.Given these observations,we aimed to summarize the current knowledge regarding skin-microbiome-gut-nutrients and psoriasis.
文摘Chronic obstructive pulmonary disease(COPD)is one of the leading causes of mortality and morbidity worldwide.One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms episodically worsen.Exacerbations accounted for over 140000 hospital admissions in 2012 in the United Kingdom with considerably more exacerbations being treated in primary care.Despite significant research in this area in recent years,treatment of acute exacerbations in the community remains limited to oral glucocorticoids,antibiotics and bronchodilators.One of the issues with unpicking the complexity of exacerbations is trying to find out the exact underlying cause and mechanism that leads to symptoms and lung destruction.Currently symptoms are initially guided by symptoms alone though multiple causes of exacerbations have common presentations.This includes viral and bacterial infections and episodes relating to environmental triggers such as pollen and pollution.There is also evidence that cardiovascular factors can contribute to symptoms of breathlessness that can mimic COPD exacerbations.In this editorial we discuss recent advances in the use of precision medicine to more accurately treat exacerbations of COPD.This includes identification of phenotypes that could help rationalise treatment and more importantly identify novel drug targets.We also consider the future role of precision medicine in preventing exacerbations and identifying COPD patients that are at increased risk of developing them.
文摘Sepsis is a heterogeneous disease with variable clinical course and several clinical phenotypes.As it is associated with an increased risk of death,patients with this condition are candidates for receipt of a very well-structured and protocolized treatment.All patients should receive the fundamental pillars of sepsis management,which are infection control,initial resuscitation,and multiorgan support.However,specific subgroups of patients may benefit from a personalized approach with interventions targeted towards specific pathophysiological mechanisms.Herein,we will review the framework for identifying subpopulations of patients with sepsis,septic shock,and multiorgan dysfunction who may benefit from specific therapies.Some of these approaches are still in the early stages of research,while others are already in routine use in clinical practice,but together will help in the effective generation and safe implementation of precision medicine in sepsis.
基金This work was supported by agrant from the National Natural Science Foundation of China（No.30900648）
文摘Asthma affects about 300 million people worldwide, placing an enormous strain on health resources inmany countries. Evidence is increasing that asthma is a complex condition with different underlying pathophysiologiesJ Scientists around the world have devoted much effort to unveiling this heterogeneity, from phenotyping initially focused on combinations of clinical characteristics, towards endotypes evolving which link pathophysiological mechanism to subtypes of asthma.2 The identification of these endotypes, either by matching biology, genetics and therapeutic responses with clinically defined phenotypes or through unbiased genomic approaches, remains limited.3 Moving forward, ongoing studies that expand on these insights into the molecular signatures should enhance our ability to define the endotypes and lead to more targeted approaches to asthma therapy.4
