Integrated, Multi-“omic” Studies of Asthma Could Lead to Precision Treatment
Mount Sinai researchers’ review of asthma classification efforts highlights the importance of multidimensional data for stratifying a complex disease
Carefully designed, integrated multi-“omic” studies could accelerate the use of precision medicine for asthma patients, according to researchers from the Icahn School of Medicine at Mount Sinai. In an invited review article published today in the Journal of Allergy and Clinical Immunology, Scott R. Tyler, PhD, and Supinda Bunyavanich, MD, MPH report that numerous studies have shown the value of applying transcriptomics and other “omic” approaches (the study of the role, relationships, and actions of a system-wide measure of a given molecular type) 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 hospitalization 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 organize 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.”
The Bunyavanich lab is funded by the National Institutes of Health (NIH) R01 AI118833 and NIH U19 AI136053
Paper cited: Scott R. Tyler and Supinda Bunyavanich. Leveraging -Omics for Asthma Endotyping. Journal of Allergy and Clinical Immunology. DOI 10.1016/j.jaci.2019.05.015
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.