1 132 179 AACR WHITE PAPER: SHAPING THE FUTURE OF CANCER PREVENTION - A ROADMAP FOR ADVANCING SCIENCE AND PUBLIC HEALTH. THE RECENT PACE, EXTENT, AND IMPACT OF PARADIGM-CHANGING CANCER PREVENTION SCIENCE HAS BEEN REMARKABLE. THE AMERICAN ASSOCIATION FOR CANCER RESEARCH (AACR) CONVENED A 3-DAY SUMMIT, ALIGNED WITH FIVE RESEARCH PRIORITIES: (I) PRECANCER ATLAS (PCA). (II) CANCER INTERCEPTION. (III) OBESITY-CANCER LINKAGE, A GLOBAL EPIDEMIC OF CHRONIC LOW-GRADE INFLAMMATION. (IV) IMPLEMENTATION SCIENCE. (V) CANCER DISPARITIES. ALIGNED WITH THESE PRIORITIES, AACR CO-LED THE LANCET COMMISSION TO FORMALLY ENDORSE AND ACCELERATE THE NCI CANCER MOONSHOT PROGRAM, FACILITATING NEW GLOBAL COLLABORATIVE EFFORTS IN CANCER CONTROL. THE EXPANDING SCOPE OF CREATIVE IMPACT IS PERHAPS MOST STARTLING-FROM NCI-FUNDED BUILT ENVIRONMENTS TO AACR TEAM SCIENCE AWARDED STUDIES OF ASIAN CANCER GENOMES INFORMING GLOBAL PRIMARY PREVENTION POLICIES; CELL-FREE EPIGENETIC MARKS IDENTIFYING INCIPIENT NEOPLASTIC SITE; PRACTICE-CHANGING GENOMIC SUBCLASSES IN MYELOPROLIFERATIVE NEOPLASIA (INCLUDING GERMLINE VARIANT TIGHTLY LINKED TO JAK2 V617F HAPLOTYPE); UNIVERSAL GERMLINE GENETIC TESTING FOR PANCREATIC CANCER; AND REPURPOSING DRUGS TARGETING IMMUNE- AND STEM-CELL SIGNALS (E.G., IL-1BETA, PD-1, RANK-L) TO CANCER INTERCEPTION. MICROBIOTA-DRIVEN IL-17 CAN INDUCE STEMNESS AND TRANSFORMATION IN PANCREATIC PRECURSORS (IDENTIFYING ANOTHER REPURPOSING OPPORTUNITY). NOTABLE PROGRESS ALSO INCLUDES HOSTING AN OBESITY SPECIAL CONFERENCE (CONNECTING EPIDEMIOLOGIC AND MOLECULAR PERSPECTIVES TO INFORM CANCER RESEARCH AND PREVENTION STRATEGIES), CO-LEADING CONCERTED NATIONAL IMPLEMENTATION EFFORTS IN HPV VACCINATION, AND CHARTING THE FUTURE ELIMINATION OF CANCER DISPARITIES BY INTEGRATING NEW SCIENCE TOOLS, DISCOVERIES AND PERSPECTIVES INTO COMMUNITY-ENGAGED RESEARCH, INCLUDING TARGETED COUNTER ATTACKS ON E-CIGARETTE AD EXPLOITATION OF CHILDREN, HISPANICS AND BLACKS. FOLLOWING THIS SUMMIT, TWO UNPRECEDENTED FUNDING INITIATIVES WERE CATALYZED TO DRIVE CANCER PREVENTION RESEARCH: THE NCI CANCER MOONSHOT (E.G., PCA AND DISPARITIES); AND THE AACR-STAND UP TO CANCER BOLD "CANCER INTERCEPTION" INITIATIVE. 2018 2 6548 28 TRANSCULTURAL DIABETES CARE IN THE UNITED STATES - A POSITION STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS. THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS (AACE) HAS CREATED A TRANSCULTURALIZED DIABETES CHRONIC DISEASE CARE MODEL THAT IS ADAPTED FOR PATIENTS ACROSS A SPECTRUM OF ETHNICITIES AND CULTURES. AACE HAS CONDUCTED SEVERAL TRANSCULTURAL ACTIVITIES ON GLOBAL ISSUES IN CLINICAL ENDOCRINOLOGY AND COMPLETED A 3-CITY SERIES OF CONFERENCES IN DECEMBER 2017 THAT FOCUSED ON DIABETES CARE FOR ETHNIC MINORITIES IN THE U.S. PROCEEDINGS FROM THE "DIABETES CARE ACROSS AMERICA" SERIES OF TRANSCULTURAL SUMMITS ARE PRESENTED HERE. INFORMATION FROM COMMUNITY LEADERS, PRACTICING HEALTH CARE PROFESSIONALS, AND OTHER STAKEHOLDERS IN DIABETES CARE IS ANALYZED ACCORDING TO BIOLOGICAL AND ENVIRONMENTAL FACTORS. FOUR SPECIFIC U.S. ETHNICITIES ARE DETAILED: AFRICAN AMERICANS, LATINO/HISPANICS, ASIAN AMERICANS, AND NATIVE AMERICANS. A CORE SET OF RECOMMENDATIONS TO CULTURALLY ADAPT DIABETES CARE IS PRESENTED THAT EMPHASIZES CULTURALLY APPROPRIATE TERMINOLOGY, TRANSCULTURALIZATION OF WHITE PAPERS, CULTURALLY ADAPTING CLINIC INFRASTRUCTURE, FLEXIBLE OFFICE HOURS, BEHAVIORAL MEDICINE-ESPECIALLY MOTIVATIONAL INTERVIEWING AND BUILDING TRUST-CULTURALLY COMPETENT NUTRITIONAL MESSAGING AND HEALTH LITERACY, COMMUNITY PARTNERSHIPS FOR CARE DELIVERY, TECHNOLOGY INNOVATION, CLINICAL TRIAL RECRUITMENT AND RETENTION OF ETHNIC MINORITIES, AND MORE FUNDING FOR SCIENTIFIC STUDIES ON EPIGENETIC MECHANISMS OF CULTURAL IMPACT ON DISEASE EXPRESSION. IT IS HOPED THAT THROUGH EDUCATION, RESEARCH, AND CLINICAL PRACTICE ENHANCEMENTS, DIABETES CARE CAN BE OPTIMIZED IN TERMS OF PRECISION AND CLINICAL OUTCOMES FOR THE INDIVIDUAL AND U.S. POPULATION AS A WHOLE. 2019 3 705 23 BUILDING RISK-ON-A-CHIP MODELS TO IMPROVE BREAST CANCER RISK ASSESSMENT AND PREVENTION. PREVENTIVE ACTIONS FOR CHRONIC DISEASES HOLD THE PROMISE OF IMPROVING LIVES AND REDUCING HEALTHCARE COSTS. FOR SEVERAL DISEASES, INCLUDING BREAST CANCER, MULTIPLE RISK AND PROTECTIVE FACTORS HAVE BEEN IDENTIFIED BY EPIDEMIOLOGISTS. THE IMPACT OF MOST OF THESE FACTORS HAS YET TO BE FULLY UNDERSTOOD AT THE ORGANISM, TISSUE, CELLULAR AND MOLECULAR LEVELS. IMPORTANTLY, COMBINATIONS OF EXTERNAL AND INTERNAL RISK AND PROTECTIVE FACTORS INVOLVE COOPERATIVITY THUS, SYNERGIZING OR ANTAGONIZING DISEASE ONSET. MODELS ARE NEEDED TO MECHANISTICALLY DECIPHER CANCER RISKS UNDER DEFINED CELLULAR AND MICROENVIRONMENTAL CONDITIONS. HERE, WE BRIEFLY REVIEW BREAST CANCER RISK MODELS BASED ON 3D CELL CULTURE AND PROPOSE TO IMPROVE RISK MODELING WITH LAB-ON-A-CHIP APPROACHES. WE SUGGEST EPITHELIAL TISSUE POLARITY, DNA REPAIR AND EPIGENETIC PROFILES AS ENDPOINTS IN RISK ASSESSMENT MODELS AND DISCUSS THE DEVELOPMENT OF 'RISKS-ON-CHIPS' INTEGRATING BIOSENSORS OF THESE ENDPOINTS AND OF GENERAL TISSUE HOMEOSTASIS. RISKS-ON-CHIPS WILL HELP IDENTIFY BIOMARKERS OF RISK, SERVE AS SCREENING PLATFORMS FOR CANCER PREVENTIVE AGENTS, AND PROVIDE A BETTER UNDERSTANDING OF RISK MECHANISMS, HENCE RESULTING IN NOVEL DEVELOPMENTS IN DISEASE PREVENTION. 2013 4 4809 30 OBESITY PREVENTION. ONCE CONSIDERED A PROBLEM ONLY IN HIGH-INCOME COUNTRIES (HICS), OBESITY HAS BECOME A MAJOR CONTRIBUTOR TO THE GLOBAL DISEASE BURDEN (FINUCANE AND OTHERS 2011; MISRA AND KHURANA 2008). EXCESS ADIPOSITY, PARTICULARLY AROUND THE VISCERAL ABDOMINAL REGION, IS AN IMPORTANT RISK FACTOR FOR MORBIDITY AND MORTALITY FROM TYPE 2 DIABETES, CARDIOVASCULAR DISEASES, AND SOME CANCERS (DANAEI AND OTHERS 2009; WHITLOCK AND OTHERS 2009; WHO 2009). ALTHOUGH SOME STUDIES HAVE SUGGESTED LOWER MORTALITY AMONG OVERWEIGHT OR OBESE PERSONS THAN AMONG HEALTHY-WEIGHT PERSONS (CARNETHON AND OTHERS 2012), THIS OUTCOME HAS NOT BEEN OBSERVED IN STUDIES THAT PROPERLY ACCOUNT FOR THE CONFOUNDING EFFECTS OF SMOKING, PREEXISTING CHRONIC CONDITIONS, AND OTHER BIASES (GLOBAL BMI MORTALITY COLLABORATION 2016; TOBIAS, PAN, AND HU 2014). THE COSTS OF OBESITY AND COMORBID CONDITIONS ARE STAGGERING AS MEASURED BY BOTH HEALTH CARE EXPENDITURES AND QUALITY OF LIFE, UNDERSCORING THE IMPORTANCE OF IMPLEMENTING OBESITY PREVENTION STRATEGIES AND TREATMENT STRATEGIES ON A GLOBAL SCALE. THE CHANGES NEEDED TO REVERSE GLOBAL TRENDS IN OBESITY WILL LIKELY REQUIRE NUMEROUS INTERVENTIONS AND POLICY RECOMMENDATIONS THAT TARGET DIET, LIFESTYLE, ACCESS TO CARE, AND ENVIRONMENTAL RISK FACTORS. IN THIS CHAPTER, WE SUMMARIZE THE GLOBAL BURDEN OF OBESITY AND THE IMPACT OF A SPECTRUM OF OBESITY RISK FACTORS, RANGING FROM SOCIOPOLITICAL AND ECONOMIC FORCES THAT ARE LARGELY BEYOND AN INDIVIDUAL'S CONTROL TO MODIFIABLE LIFESTYLE FACTORS, AND DISCUSS GENETIC AND EPIGENETIC RISKS. WE ALSO REVIEW THE EFFECTIVENESS OF POPULATION-BASED INTERVENTIONS AND POLICIES FOR PREVENTING OBESITY, SOME INDIVIDUAL-LEVEL TREATMENT OPTIONS ACROSS VARIOUS PLATFORMS, AND THE COST-EFFECTIVENESS OF SELECT INTERVENTIONS. 2017 5 5224 35 PRIORITIZED RESEARCH FOR THE PREVENTION, TREATMENT, AND REVERSAL OF CHRONIC DISEASE: RECOMMENDATIONS FROM THE LIFESTYLE MEDICINE RESEARCH SUMMIT. DECLINING LIFE EXPECTANCY AND INCREASING ALL-CAUSE MORTALITY IN THE UNITED STATES HAVE BEEN ASSOCIATED WITH UNHEALTHY BEHAVIORS, SOCIOECOLOGICAL FACTORS, AND PREVENTABLE DISEASE. A GROWING BODY OF BASIC SCIENCE, CLINICAL RESEARCH, AND POPULATION HEALTH EVIDENCE POINTS TO THE BENEFITS OF HEALTHY BEHAVIORS, ENVIRONMENTS AND POLICIES TO MAINTAIN HEALTH AND PREVENT, TREAT, AND REVERSE THE ROOT CAUSES OF COMMON CHRONIC DISEASES. SIMILARLY, INNOVATIONS IN RESEARCH METHODOLOGIES, STANDARDS OF EVIDENCE, EMERGENCE OF UNIQUE STUDY COHORTS, AND BREAKTHROUGHS IN DATA ANALYTICS AND MODELING CREATE NEW POSSIBILITIES FOR PRODUCING BIOMEDICAL KNOWLEDGE AND CLINICAL TRANSLATION. TO UNDERSTAND THESE ADVANCES AND INFORM FUTURE DIRECTIONS RESEARCH, THE LIFESTYLE MEDICINE RESEARCH SUMMIT WAS CONVENED AT THE UNIVERSITY OF PITTSBURGH ON DECEMBER 4-5, 2019. THE SUMMIT'S GOAL WAS TO REVIEW CURRENT STATUS AND DEFINE RESEARCH PRIORITIES IN THE SIX CORE AREAS OF LIFESTYLE MEDICINE: PLANT-PREDOMINANT NUTRITION, PHYSICAL ACTIVITY, SLEEP, STRESS, ADDICTIVE BEHAVIORS, AND POSITIVE PSYCHOLOGY/SOCIAL CONNECTION. FORTY INVITED SUBJECT MATTER EXPERTS (1) REVIEWED EXISTING KNOWLEDGE AND GAPS RELATING LIFESTYLE BEHAVIORS TO COMMON CHRONIC DISEASES, SUCH AS CARDIOVASCULAR DISEASE, DIABETES, MANY CANCERS, INFLAMMATORY- AND IMMUNE-RELATED DISORDERS AND OTHER CONDITIONS; AND (2) DISCUSSED THE POTENTIAL FOR APPLYING CUTTING-EDGE MOLECULAR, CELLULAR, EPIGENETIC AND EMERGING SCIENCE KNOWLEDGE AND COMPUTATIONAL METHODOLOGIES, RESEARCH DESIGNS, AND STUDY COHORTS TO ACCELERATE CLINICAL APPLICATIONS ACROSS ALL SIX DOMAINS OF LIFESTYLE MEDICINE. NOTABLY, FEDERAL HEALTH AGENCIES, SUCH AS THE DEPARTMENT OF DEFENSE AND VETERANS ADMINISTRATION HAVE BEGUN TO ADOPT "WHOLE-PERSON HEALTH AND PERFORMANCE" MODELS THAT ADDRESS THESE LIFESTYLE AND ENVIRONMENTAL ROOT CAUSES OF CHRONIC DISEASE AND ASSOCIATED MORBIDITY, MORTALITY, AND COST. RECOMMENDATIONS STRONGLY SUPPORT LEVERAGING EMERGING RESEARCH METHODOLOGIES, SYSTEMS BIOLOGY, AND COMPUTATIONAL MODELING IN ORDER TO ACCELERATE EFFECTIVE CLINICAL AND POPULATION SOLUTIONS TO IMPROVE HEALTH AND REDUCE SOCIETAL COSTS. NEW AND ALTERNATIVE HIERARCHIES OF EVIDENCE ARE ALSO BE NEEDED IN ORDER TO ASSESS THE QUALITY OF EVIDENCE AND DEVELOP EVIDENCE-BASED GUIDELINES ON LIFESTYLE MEDICINE. CHILDREN AND UNDERSERVED POPULATIONS WERE IDENTIFIED AS PRIORITIZED GROUPS TO STUDY. THE COVID-19 PANDEMIC, WHICH DISPROPORTIONATELY IMPACTS PEOPLE WITH CHRONIC DISEASES THAT ARE AMENABLE TO EFFECTIVE LIFESTYLE MEDICINE INTERVENTIONS, MAKES THE SUMMIT'S FINDINGS AND RECOMMENDATIONS FOR FUTURE RESEARCH PARTICULARLY TIMELY AND RELEVANT. 2020 6 3007 27 GENETIC, IMMUNOLOGIC, AND ENVIRONMENTAL BASIS OF SARCOIDOSIS. SARCOIDOSIS IS A MULTISYSTEM DISEASE WITH TREMENDOUS HETEROGENEITY IN DISEASE MANIFESTATIONS, SEVERITY, AND CLINICAL COURSE THAT VARIES AMONG DIFFERENT ETHNIC AND RACIAL GROUPS. TO BETTER UNDERSTAND THIS DISEASE AND TO IMPROVE THE OUTCOMES OF PATIENTS, A NATIONAL HEART, LUNG, AND BLOOD INSTITUTE WORKSHOP WAS CONVENED TO ASSESS THE CURRENT STATE OF KNOWLEDGE, GAPS, AND RESEARCH NEEDS ACROSS THE CLINICAL, GENETIC, ENVIRONMENTAL, AND IMMUNOLOGIC ARENAS. WE ALSO EXPLORED TO WHAT EXTENT THE INTERPLAY OF THE GENETIC, ENVIRONMENTAL, AND IMMUNOLOGIC FACTORS COULD EXPLAIN THE DIFFERENT PHENOTYPES AND OUTCOMES OF PATIENTS WITH SARCOIDOSIS, INCLUDING THE CHRONIC PHENOTYPES THAT HAVE THE GREATEST HEALTHCARE BURDEN. THE POTENTIAL USE OF CURRENT GENETIC, EPIGENETIC, AND IMMUNOLOGIC TOOLS ALONG WITH STUDY APPROACHES THAT INTEGRATE ENVIRONMENTAL EXPOSURES AND PRECISE CLINICAL PHENOTYPING WERE ALSO EXPLORED. FINALLY, WE MADE EXPERT PANEL-BASED CONSENSUS RECOMMENDATIONS FOR RESEARCH APPROACHES AND PRIORITIES TO IMPROVE OUR UNDERSTANDING OF THE EFFECT OF THESE FACTORS ON THE HEALTH OUTCOMES IN SARCOIDOSIS. 2017 7 1377 26 DEVELOPMENTAL PROGRAMMING: STATE-OF-THE-SCIENCE AND FUTURE DIRECTIONS-SUMMARY FROM A PENNINGTON BIOMEDICAL SYMPOSIUM. OBJECTIVE: ON DECEMBER 8-9, 2014, THE PENNINGTON BIOMEDICAL RESEARCH CENTER CONVENED A SCIENTIFIC SYMPOSIUM TO REVIEW THE STATE-OF-THE-SCIENCE AND FUTURE DIRECTIONS FOR THE STUDY OF DEVELOPMENTAL PROGRAMMING OF OBESITY AND CHRONIC DISEASE. THE OBJECTIVES OF THE SYMPOSIUM WERE TO DISCUSS: (I) PAST AND CURRENT SCIENTIFIC ADVANCES IN ANIMAL MODELS, POPULATION-BASED COHORT STUDIES, AND HUMAN CLINICAL TRIALS, (II) THE STATE-OF-THE-SCIENCE OF EPIGENETIC-BASED RESEARCH, AND (III) CONSIDERATIONS FOR FUTURE STUDIES. RESULTS: THIS SYMPOSIUM PROVIDED A COMPREHENSIVE ASSESSMENT OF THE STATE OF THE SCIENTIFIC FIELD AND IDENTIFIED RESEARCH GAPS AND OPPORTUNITIES FOR FUTURE RESEARCH IN ORDER TO UNDERSTAND THE MECHANISMS CONTRIBUTING TO THE DEVELOPMENTAL PROGRAMMING OF HEALTH AND DISEASE. CONCLUSIONS: IDENTIFYING THE MECHANISMS WHICH CAUSE OR CONTRIBUTE TO DEVELOPMENTAL PROGRAMMING OF FUTURE GENERATIONS WILL BE INVALUABLE TO THE SCIENTIFIC AND MEDICAL COMMUNITY. THE ABILITY TO INTERVENE DURING CRITICAL PERIODS OF PRENATAL AND EARLY POSTNATAL LIFE TO PROMOTE LIFELONG HEALTH IS THE ULTIMATE GOAL. CONSIDERATIONS FOR FUTURE RESEARCH INCLUDING THE USE OF ANIMAL MODELS, THE STUDY DESIGN IN HUMAN COHORTS WITH CONSIDERATIONS ABOUT THE TIMING OF THE INTRAUTERINE EXPOSURE, AND THE RESULTING TISSUE-SPECIFIC EPIGENETIC SIGNATURE WERE EXTENSIVELY DISCUSSED AND ARE PRESENTED IN THIS MEETING SUMMARY. 2016 8 4871 25 OUR GENES ARE NOT OUR DESTINY: INCORPORATING MOLECULAR MEDICINE INTO CLINICAL PRACTICE. IN MANY DEVELOPED NATIONS, THE STATE OF PUBLICLY ADMINISTERED HEALTH CARE IS INCREASINGLY PRECARIOUS AS A RESULT OF ESCALATING NUMBERS OF CHRONICALLY ILL PATIENTS, INADEQUATE MEDICAL PERSONNEL AND HOSPITAL FACILITIES, AS WELL AS SPARSE FUNDING FOR ONGOING UPGRADES TO STATE-OF-THE-ART DIAGNOSTIC AND THERAPEUTIC TECHNOLOGY - AN INCREASED EMPHASIS ON AETIOLOGY-CENTRED MEDICINE SHOULD BE CONSIDERED IN ORDER TO ACHIEVE IMPROVED HEALTH FOR PATIENTS AND POPULATIONS. MEDICAL PRACTICE PATTERNS WHICH ARE DESIGNED TO PROVIDE QUICK AND EFFECTIVE AMELIORATION OF SIGNS AND SYMPTOMS ARE FREQUENTLY NOT AN ENDURING SOLUTION TO MANY HEALTH AFFLICTIONS AND CHRONIC DISEASE STATES. RECENT SCIENTIFIC DISCOVERY HAS RENDERED THE DRUG-ORIENTED ALGORITHMIC PARADIGM COMMONLY FOUND IN CONTEMPORARY EVIDENCE-BASED MEDICINE TO BE A REDUCTIONIST APPROACH TO CLINICAL PRACTICE. UNFOLDING EVIDENCE APPEARS TO SUPPORT A GENETIC PREDISPOSITION MODEL OF HEALTH AND ILLNESS RATHER THAN A FATALISTIC PREDESTINATION CONSTRUCT - MODIFIABLE EPIGENETIC AND ENVIRONMENTAL FACTORS HAVE ENORMOUS POTENTIAL TO INFLUENCE CLINICAL OUTCOMES. BY UNDERSTANDING AND APPLYING FUNDAMENTAL CLINICAL PRINCIPLES RELATING TO THE EMERGING FIELDS OF MOLECULAR MEDICINE, NUTRIGENOMICS AND HUMAN EXPOSURE ASSESSMENT, DOCTORS WILL BE EMPOWERED TO ADDRESS CAUSALITY OF AFFLICTION WHEN POSSIBLE AND ACHIEVE SUSTAINED REPRIEVE FOR MANY SUFFERING PATIENTS. 2008 9 3116 22 GEROSCIENCE: ADDRESSING THE MISMATCH BETWEEN ITS EXCITING RESEARCH OPPORTUNITIES, ITS ECONOMIC IMPERATIVE AND ITS CURRENT FUNDING CRISIS. THERE IS AT PRESENT A HUGE DISCONNECT BETWEEN LEVELS OF FUNDING FOR BASIC RESEARCH ON FUNDAMENTAL MECHANISMS OF BIOLOGICAL AGING AND, GIVEN DEMOGRAPHIC PROJECTIONS, THE ANTICIPATED ENORMOUS SOCIAL AND ECONOMIC IMPACTS OF A LITANY OF CHRONIC DISEASES FOR WHICH AGING IS BY FAR THE MAJOR RISK FACTOR: ONE VALUABLE APPROACH, RECENTLY INSTIGATED BY FELIPE SIERRA & COLLEAGUES AT THE US NATIONAL INSTITUTE ON AGING, IS THE DEVELOPMENT OF A GEROSCIENCE INTEREST GROUP AMONG VIRTUALLY ALL OF THE NIH INSTITUTES. A COMPLEMENTARY APPROACH WOULD BE TO SEEK MAJOR ESCALATIONS OF PRIVATE FUNDING. THE AMERICAN FEDERATION FOR AGING RESEARCH, THE PAUL GLENN FOUNDATION AND THE ELLISON MEDICAL FOUNDATION PIONEERED EFFORTS BY THE PRIVATE SECTOR TO PROVIDE SUBSTANTIAL SUPPLEMENTS TO PUBLIC SOURCES OF FUNDING. IT IS TIME FOR OUR COMMUNITY TO ORGANIZE EFFORTS TOWARDS THE ENHANCEMENTS OF SUCH CRUCIAL CONTRIBUTIONS, ESPECIALLY IN SUPPORT OF THE EMERGING GENERATION OF YOUNG INVESTIGATORS, MANY OF WHOM ARE LEAVING OUR RANKS TO SEEK ALTERNATIVE EMPLOYMENT. TO DO SO, WE MUST PROVIDE POTENTIAL DONORS WITH STRONG ECONOMIC, HUMANITARIAN AND SCIENTIFIC RATIONALES. AN INITIAL APPROACH TO SUCH EFFORTS IS BRIEFLY OUTLINED IN THIS MANUSCRIPT AS A BASIS FOR WIDER DISCUSSIONS WITHIN OUR COMMUNITY. 2017 10 28 25 A BIOMIMETIC NATURAL SCIENCES APPROACH TO UNDERSTANDING THE MECHANISMS OF AGEING IN BURDEN OF LIFESTYLE DISEASES. THE WORLDWIDE LANDSCAPE OF AN AGEING POPULATION AND AGE-RELATED DISEASE BRINGS WITH IT HUGE SOCIO-ECONOMIC AND PUBLIC HEALTHCARE CONCERNS ACROSS NATIONS. CORRESPONDINGLY, MONUMENTAL HUMAN AND FINANCIAL RESOURCES HAVE BEEN INVESTED IN BIOMEDICAL RESEARCH, WITH A MISSION TO DECODE THE MECHANISMS OF AGEING AND HOW THESE CONTRIBUTE TO AGE-RELATED DISEASE. MULTIPLE HALLMARKS OF AGEING HAVE BEEN IDENTIFIED THAT ARE COMMON ACROSS TAXA, HIGHLIGHTING THEIR FUNDAMENTAL IMPORTANCE. THESE INCLUDE DYSREGULATED MITOCHONDRIAL METABOLISM AND TELOMERES BIOLOGY, EPIGENETIC MODIFICATIONS, CELL-MATRIX INTERACTIONS, PROTEOSTASIS, DYSREGULATED NUTRIENT SENSING, STEM CELL EXHAUSTION, INFLAMMAGEING AND IMMUNO-SENESCENCE. WHILE OUR UNDERSTANDING OF THE MOLECULAR BASIS OF AGEING IS IMPROVING, IT REMAINS A COMPLEX AND MULTIFACTORIAL PROCESS THAT REMAINS TO BE FULLY UNDERSTOOD. A KEY ASPECT OF THE SHORTFALL IN OUR UNDERSTANDING OF THE AGEING PROCESS LIES IN TRANSLATING DATA FROM STANDARD ANIMAL MODELS TO HUMANS. CONSEQUENTLY, WE SUGGEST THAT A 'BIOMIMETIC' AND COMPARATIVE APPROACH, INTEGRATING KNOWLEDGE FROM SPECIES IN THE WILD, AS OPPOSED TO INBRED GENETICALLY HOMOGENOUS LABORATORY ANIMALS, CAN PROVIDE POWERFUL INSIGHTS INTO HUMAN AGEING PROCESSES. HERE WE DISCUSS SOME PARTICULARITIES AND COMPARATIVE PATTERNS AMONG SEVERAL SPECIES FROM THE ANIMAL KINGDOM, ENDOWED WITH LONGEVITY OR SHORT LIFESPANS AND UNIQUE METABOLIC PROFILES THAT COULD BE POTENTIALLY EXPLOITED TO THE UNDERSTANDING OF AGEING AND AGE-RELATED DISEASES. BASED UPON LESSONS FROM NATURE, WE ALSO HIGHLIGHT SEVERAL AVENUES FOR RENEWED FOCUS IN THE PATHOPHYSIOLOGY OF AGEING AND AGE-RELATED DISEASE (I.E. DIET-MICROBIOME-HEALTH AXIS, OXIDATIVE PROTEIN DAMAGE, ADAPTIVE HOMOEOSTASIS AND PLANETARY HEALTH). WE PROPOSE THAT A BIOMIMETIC ALLIANCE WITH COLLABORATIVE RESEARCH FROM DIFFERENT DISCIPLINES CAN IMPROVE OUR UNDERSTANDING OF AGEING AND AGE-RELATED DISEASES WITH LONG-TERM SUSTAINABLE UTILITY. 2021 11 4852 29 OPPORTUNITIES AND CHALLENGES IN DRUG DEVELOPMENT FOR PEDIATRIC CANCERS. THE USE OF TARGETED SMALL-MOLECULE THERAPEUTICS AND IMMUNOTHERAPEUTICS HAS BEEN LIMITED TO DATE IN PEDIATRIC ONCOLOGY. RECENTLY, THE NUMBER OF PEDIATRIC APPROVALS HAS RISEN, AND REGULATORY INITIATIVES IN THE UNITED STATES AND EUROPE HAVE AIMED TO INCREASE THE STUDY OF NOVEL ANTICANCER THERAPIES IN CHILDREN. CHALLENGES OF DRUG DEVELOPMENT IN CHILDREN INCLUDE THE RARITY OF INDIVIDUAL CANCER DIAGNOSES AND THE HIGH PREVALENCE OF DIFFICULT-TO-DRUG TARGETS, INCLUDING TRANSCRIPTION FACTORS AND EPIGENETIC REGULATORS. ONGOING PEDIATRIC ADAPTATION OF BIOMARKER-DRIVEN TRIAL DESIGNS AND FURTHER EXPLORATION OF AGENTS TARGETING NON-KINASE DRIVERS CONSTITUTE HIGH-PRIORITY OBJECTIVES FOR FUTURE PEDIATRIC ONCOLOGY DRUG DEVELOPMENT. SIGNIFICANCE: INCREASING ATTENTION TO DRUG DEVELOPMENT FOR CHILDREN WITH CANCER BY REGULATORS AND PHARMACEUTICAL COMPANIES HOLDS THE PROMISE OF ACCELERATING THE AVAILABILITY OF NEW THERAPIES FOR CHILDREN WITH CANCER, POTENTIALLY IMPROVING SURVIVAL AND DECREASING THE ACUTE AND CHRONIC TOXICITIES OF THERAPY. HOWEVER, UNIQUE APPROACHES ARE NECESSARY TO STUDY NOVEL THERAPIES IN CHILDREN THAT TAKE INTO ACCOUNT LOW PATIENT NUMBERS, THE PEDIATRIC CANCER GENOMIC LANDSCAPE AND TUMOR MICROENVIRONMENT, AND THE NEED FOR PEDIATRIC FORMULATIONS. IT IS ALSO CRITICAL TO EVALUATE THE POTENTIAL FOR UNIQUE TOXICITIES IN GROWING HOSTS WITHOUT AFFECTING THE PACE OF DISCOVERY FOR CHILDREN WITH THESE LIFE-THREATENING DISEASES. 2021 12 6422 25 THE THIN-FAT PHENOTYPE AND GLOBAL METABOLIC DISEASE RISK. PURPOSE OF REVIEW: THERE HAS BEEN A GREAT DEAL OF INTEREST IN THE THIN-FAT PHENOTYPE EVIDENT IN ASIAN INDIANS AND ITS RISK ASSOCIATIONS IN THE EPIDEMIC OF NONCOMMUNICABLE CHRONIC DISEASE ASSOCIATED WITH IT. THE CAUSE OF THIS PHENOTYPE IS PROBABLY RELATED TO LIFESTYLE AND ENVIRONMENT; HOWEVER, GENOTYPIC AND EPIGENETIC MODIFICATIONS IN UTERO ALSO HAVE BEEN CONSIDERED. RECENT FINDINGS: THE THIN-FAT PHENOTYPE OCCURS WHEN FAT IS ADDED TO AN ALREADY THIN FRAME. THIS MAY OCCUR WITH RURAL-URBAN MIGRATION, WHEN POSITIVE ENERGY BALANCE OCCURS IN A MIGRATING POPULATION WHO WERE PREDOMINANTLY THIN AND PHYSICALLY ACTIVE TO BEGIN WITH. THE ROLE OF THE PRE-EXISTING SKELETAL MUSCLE MASS AND ITS INTERACTION WITH NEWLY DEPOSITED FAT MUST BE CONSIDERED. THE THIN-FAT PHENOTYPE MAY BE PROGRAMMED DURING FETAL GROWTH, BUT THE EVIDENCE FOR THIS PHENOMENON IS STILL NOT COMPLETELY CLEAR. FINALLY, ALTHOUGH THERE IS INCREASED CHRONIC DISEASE MORBIDITY AT LOWER BMI AND YOUNGER AGE IN SOUTH ASIAN POPULATIONS, BMI-RELATED MORTALITY DOES NOT APPEAR TO FOLLOW THIS TREND. SUMMARY: AT PRESENT, THE WEIGHT OF EVIDENCE APPEARS TO LINK THE THIN-FAT PHENOTYPE TO AN ENVIRONMENTAL AND LIFESTYLE PHENOMENON OCCURRING IN PREVIOUSLY THIN PEOPLE. THIS IS PARTICULARLY RELEVANT IN INDIA, GIVEN THE PACE OF TRANSITION OVER THE LAST TWO DECADES. 2011 13 421 29 ANIMAL MODELS IN EPIGENETIC RESEARCH: INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE CONSIDERATIONS ACROSS THE LIFESPAN. THE RAPID EXPANSION AND EVOLUTION OF EPIGENETICS AS A CORE SCIENTIFIC DISCIPLINE HAVE RAISED NEW QUESTIONS ABOUT HOW ENDOGENOUS AND ENVIRONMENTAL FACTORS CAN INFORM THE MECHANISMS THROUGH WHICH BIOLOGICAL FORM AND FUNCTION ARE REGULATED. EXISTING AND PROPOSED ANIMAL MODELS USED FOR EPIGENETIC RESEARCH HAVE TARGETED A MYRIAD OF HEALTH AND DISEASE ENDPOINTS THAT MAY BE ACUTE, CHRONIC, AND TRANSGENERATIONAL IN NATURE. INITIATING EVENTS AND OUTCOMES MAY EXTEND ACROSS THE ENTIRE LIFESPAN TO ELICIT UNANTICIPATED PHENOTYPES THAT ARE OF PARTICULAR CONCERN TO INSTITUTIONAL ANIMAL CARE AND USE COMMITTEES (IACUCS). THE DYNAMICS AND PLASTICITY OF EPIGENETIC MECHANISMS PRODUCE EFFECTS AND CONSEQUENCES THAT ARE MANIFEST DIFFERENTIALLY WITHIN DISCREET SPATIAL AND TEMPORAL CONTEXTS, INCLUDING PRENATAL DEVELOPMENT, STEM CELLS, ASSISTED REPRODUCTIVE TECHNOLOGIES, PRODUCTION OF SEXUAL DIMORPHISMS, SENESCENCE, AND OTHERS. MANY DIETARY AND NUTRITIONAL INTERVENTIONS HAVE ALSO BEEN SHOWN TO HAVE A SIGNIFICANT IMPACT ON BIOLOGICAL FUNCTIONS AND DISEASE SUSCEPTIBILITIES THROUGH ALTERED EPIGENETIC PROGRAMMING. THE ENVIRONMENTAL, CHEMICAL, TOXIC, THERAPEUTIC, AND PSYCHOSOCIAL STRESSORS USED IN ANIMAL STUDIES TO ELICIT EPIGENETIC CHANGES CAN BECOME EXTREME AND SHOULD RAISE IACUC CONCERNS FOR THE WELL-BEING AND PROPER CARE OF ALL RESEARCH ANIMALS INVOLVED. EPIGENETICS RESEARCH IS RAPIDLY BECOMING AN INTEGRAL PART OF THE SEARCH FOR MECHANISMS IN EVERY MAJOR AREA OF BIOMEDICAL AND BEHAVIORAL RESEARCH AND WILL FOSTER THE CONTINUED DEVELOPMENT OF NEW ANIMAL MODELS. FROM THE IACUC PERSPECTIVE, CARE MUST BE TAKEN TO ACKNOWLEDGE THE PARTICULAR NEEDS AND CONCERNS CREATED BY SUPERIMPOSITION OF EPIGENETIC MECHANISMS OVER DIVERSE FIELDS OF INVESTIGATION TO ENSURE THE PROPER CARE AND USE OF ANIMALS WITHOUT IMPEDING SCIENTIFIC PROGRESS. 2012 14 761 24 CATEGORIZING THE CHARACTERISTICS OF HUMAN CARCINOGENS: A NEED FOR SPECIFICITY. THE INTERNATIONAL AGENCY FOR RESEARCH ON CANCER (IARC) HAS RECENTLY PROPOSED EMPLOYING "TEN KEY CHARACTERISTICS OF HUMAN CARCINOGENS" (TKCS) TO DETERMINE THE POTENTIAL OF AGENTS FOR HARMFUL EFFECTS. THE TKCS SEEM LIKELY TO CONFUSE THE UNSATISFACTORY CORRELATION FROM TESTING REGIMES THAT HAVE IGNORED THE DIFFERENCES EVIDENT WHEN CELLULAR CHANGES ARE COMPARED IN SHORT AND LONG-LIVED SPECIES, WITH THEIR VERY DIFFERENT STEM CELL AND SOMATIC CELL PHYLOGENIES. THE PROPOSED CHARACTERISTICS ARE SO BROAD THAT THEIR USE WILL LEAD TO AN INCREASE IN THE CURRENT UNACCEPTABLY HIGH RATE OF FALSE POSITIVES. IT COULD BE AN INFORMATIVE EXPERIMENT TO TAKE WELL-ESTABLISHED APPROVED THERAPEUTICS WITH WELL-KNOWN HUMAN SAFETY PROFILES AND TEST THEM AGAINST THIS NEW TKC PARADIGM. CANCERS ARE INITIATED AND DRIVEN BY HERITABLE AND TRANSIENT CHANGES IN GENE EXPRESSION, EXPAND CLONALLY, AND PROGRESS VIA ADDITIONAL ASSOCIATED ACQUIRED MUTATIONS AND EPIGENETIC ALTERATIONS THAT PROVIDE CELLS WITH AN EVOLUTIONARY ADVANTAGE. THE GENOTOXICITY TESTING PROTOCOLS CURRENTLY EMPLOYED AND REQUIRED BY REGULATION, EMPHASIZE TESTING FOR THE MUTATIONAL POTENTIAL OF THE TEST AGENT. TWO-YEAR, CHRONIC RODENT CANCER BIOASSAYS ARE INTENDED TO TEST FOR THE ENTIRE SPECTRUM OF CARCINOGENIC TRANSFORMATION. THE USE OF CYTOTOXIC DOSES CAUSING INCREASED, SUSTAINED CELL PROLIFERATION THAT FACILITATES ACCUMULATED GENETIC DAMAGE LEADS TO A HIGH FALSE-POSITIVE RATE OF TUMOR INDUCTION. CURRENT CANCER HAZARD ASSESSMENT PROTOCOLS AND WEIGHT-OF-THE-EVIDENCE ANALYSIS OF AGENT-SPECIFIC CANCER RISK ALIGN POORLY WITH THE PATHOGENESIS OF HUMAN CARCINOMA AND SO NEED MODERNIZATION AND IMPROVEMENT IN WAYS SUGGESTED HERE. 2021 15 4833 26 ON THE CUTTING EDGE OF ORAL CANCER PREVENTION: FINDING RISK-PREDICTIVE MARKERS IN PRECANCEROUS LESIONS BY LONGITUDINAL STUDIES. EARLY IDENTIFICATION AND MANAGEMENT OF PRECANCEROUS LESIONS AT HIGH RISK OF DEVELOPING CANCERS IS THE MOST EFFECTIVE AND ECONOMICAL WAY TO REDUCE THE INCIDENCE, MORTALITY, AND MORBIDITY OF CANCERS AS WELL AS MINIMIZING TREATMENT-RELATED COMPLICATIONS, INCLUDING PAIN, IMPAIRED FUNCTIONS, AND DISFIGURATION. RELIABLE CANCER-RISK-PREDICTIVE MARKERS PLAY AN IMPORTANT ROLE IN ENABLING EVIDENCE-BASED DECISION MAKING AS WELL AS PROVIDING MECHANISTIC INSIGHT INTO THE MALIGNANT CONVERSION OF PRECANCEROUS LESIONS. THE FOCUS OF THIS ARTICLE IS TO REVIEW UPDATES ON MARKERS THAT MAY PREDICT THE RISK OF ORAL PREMALIGNANT LESIONS (OPLS) IN DEVELOPING INTO ORAL SQUAMOUS CELL CARCINOMAS (OSCCS), WHICH CAN LOGICALLY BE DISCOVERED ONLY BY PROSPECTIVE OR RETROSPECTIVE LONGITUDINAL STUDIES THAT ANALYZE PRE-PROGRESSION OPL SAMPLES WITH LONG-TERM FOLLOW-UP OUTCOMES. THESE RISK-PREDICTIVE MARKERS ARE DIFFERENT FROM THOSE THAT PROGNOSTICATE THE SURVIVAL OUTCOME OF CANCERS AFTER THEY HAVE BEEN DIAGNOSED AND TREATED, OR THOSE THAT DIFFERENTIATE BETWEEN DIFFERENT LESION TYPES AND STAGES. UP-TO-DATE KNOWLEDGE ON CANCER-RISK-PREDICTIVE MARKERS DISCOVERED BY LONGITUDINALLY FOLLOWED STUDIES WILL BE REVIEWED. THE GOAL OF THIS ENDEAVOR IS TO USE THIS INFORMATION AS A STARTING POINT TO ADDRESS SOME KEY CHALLENGES LIMITING OUR PROGRESS IN THIS AREA IN THE HOPE OF ACHIEVING EFFECTIVE TRANSLATION OF RESEARCH DISCOVERIES INTO NEW CLINICAL INTERVENTIONS. 2022 16 3385 34 HOMEOSTATIC IMBALANCE AND COLON CANCER: THE DYNAMIC EPIGENETIC INTERPLAY OF INFLAMMATION, ENVIRONMENTAL TOXINS, AND CHEMOPREVENTIVE PLANT COMPOUNDS. THE ADVENT OF MODERN MEDICINE HAS ALLOWED FOR SIGNIFICANT ADVANCES WITHIN THE FIELDS OF EMERGENCY CARE, SURGERY, AND INFECTIOUS DISEASE CONTROL. HEALTH THREATS THAT WERE HISTORICALLY RESPONSIBLE FOR IMMEASURABLE TOLLS ON HUMAN LIFE ARE NOW ALL BUT ERADICATED WITHIN CERTAIN POPULATIONS, SPECIFICALLY THOSE THAT ENJOY HIGHER DEGREES OF SOCIO-ECONOMIC STATUS AND ACCESS TO HEALTHCARE. HOWEVER, MODERNIZATION AND ITS RESULTING LIFESTYLE TRENDS HAVE USHERED IN A NEW ERA OF CHRONIC ILLNESS; ONE IN WHICH AN UNPRECEDENTED NUMBER OF PEOPLE ARE ESTIMATED TO CONTRACT CANCER AND OTHER INFLAMMATORY DISEASES. HERE, WE EXPLORE THE IDEA THAT HOMEOSTASIS HAS BEEN REDEFINED WITHIN JUST A FEW GENERATIONS, AND THAT DISEASES SUCH AS COLORECTAL CANCER ARE THE RESULT OF FLUCTUATING PHYSIOLOGICAL AND MOLECULAR IMBALANCES. PHYTOCHEMICAL-DEPRIVED, PRO-INFLAMMATORY DIETS COMBINED WITH LOW-DOSE EXPOSURES TO ENVIRONMENTAL TOXINS, INCLUDING BISPHENOL-A (BPA) AND OTHER ENDOCRINE DISRUPTORS, ARE NOW LINKED TO INCREASING INCIDENCES OF CANCER IN WESTERNIZED SOCIETIES AND DEVELOPING COUNTRIES. THERE IS RECENT EVIDENCE THAT DISEASE DETERMINANTS ARE LIKELY SET IN UTERO AND FURTHER PERPETUATED INTO ADULTHOOD DEPENDENT UPON THE INNATE AND ENVIRONMENTALLY ACQUIRED PHENOTYPE UNIQUE TO EACH INDIVIDUAL. IN ORDER TO ADDRESS A DISEASE AS MULTI-FACTORIAL, CASE-SPECIFIC, AND REMARKABLY ADAPTIVE AS CANCER, RESEARCH MUST FOCUS ON ITS ROOT CAUSES IN ORDER TO ELUCIDATE THE MOLECULAR MECHANISMS BY WHICH THEY CAN BE PREVENTED OR COUNTERACTED VIA PLANT-DERIVED COMPOUNDS SUCH AS EPIGALLOCATECHIN-3-GALLATE (EGCG) AND RESVERATROL. THE SIGNIFICANT ROLE OF EPIGENETICS IN THE REGULATION OF THESE COMPLEX PROCESSES IS EMPHASIZED HERE TO FORM A COMPREHENSIVE VIEW OF THE DYNAMIC INTERACTIONS THAT INFLUENCE MODERN-DAY CARCINOGENESIS, AND HOW SENSIBLY RESTORING HOMEOSTATIC BALANCE MAY BE THE KEY TO THE CANCER RIDDLE. 2012 17 1 17 ON DECEMBER 5, 2017, THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE HOSTED A PUBLIC WORKSHOP TITLED NUTRIGENOMICS AND THE FUTURE OF NUTRITION IN WASHINGTON, DC, TO REVIEW CURRENT KNOWLEDGE IN THE FIELD OF NUTRIGENOMICS AS IT RELATES TO NUTRITION. WORKSHOP PARTICIPANTS EXPLORED THE INFLUENCE OF GENETIC AND EPIGENETIC EXPRESSION ON NUTRITIONAL STATUS AND THE POTENTIAL IMPACT OF PERSONALIZED NUTRITION ON HEALTH MAINTENANCE AND CHRONIC DISEASE PREVENTION. THIS PUBLICATION SUMMARIZES THE PRESENTATIONS AND DISCUSSIONS FROM THE WORKSHOP. 2018 18 6070 25 THE DISCOVAIR PROJECT: A ROADMAP TOWARDS THE HUMAN LUNG CELL ATLAS. THE HUMAN CELL ATLAS (HCA) CONSORTIUM AIMS TO ESTABLISH AN ATLAS OF ALL ORGANS IN THE HEALTHY HUMAN BODY AT SINGLE-CELL RESOLUTION TO INCREASE OUR UNDERSTANDING OF BASIC BIOLOGICAL PROCESSES THAT GOVERN DEVELOPMENT, PHYSIOLOGY AND ANATOMY, AND TO ACCELERATE DIAGNOSIS AND TREATMENT OF DISEASE. THE LUNG BIOLOGICAL NETWORK OF THE HCA AIMS TO GENERATE THE HUMAN LUNG CELL ATLAS AS A REFERENCE FOR THE CELLULAR REPERTOIRE, MOLECULAR CELL STATES AND PHENOTYPES, AND CELL-CELL INTERACTIONS THAT CHARACTERISE NORMAL LUNG HOMEOSTASIS IN HEALTHY LUNG TISSUE. SUCH A REFERENCE ATLAS OF THE HEALTHY HUMAN LUNG WILL FACILITATE MAPPING THE CHANGES IN THE CELLULAR LANDSCAPE IN DISEASE. THE DISCOVAIR PROJECT IS ONE OF SIX PILOT ACTIONS FOR THE HCA FUNDED BY THE EUROPEAN COMMISSION IN THE CONTEXT OF THE H2020 FRAMEWORK PROGRAMME. DISCOVAIR AIMS TO ESTABLISH THE FIRST DRAFT OF AN INTEGRATED HUMAN LUNG CELL ATLAS, COMBINING SINGLE-CELL TRANSCRIPTIONAL AND EPIGENETIC PROFILING WITH SPATIALLY RESOLVING TECHNIQUES ON MATCHED TISSUE SAMPLES, AS WELL AS INCLUDING A NUMBER OF CHRONIC AND INFECTIOUS DISEASES OF THE LUNG. THE INTEGRATED HUMAN LUNG CELL ATLAS WILL BE AVAILABLE AS A RESOURCE FOR THE WIDER RESPIRATORY COMMUNITY, INCLUDING BASIC AND TRANSLATIONAL SCIENTISTS, CLINICAL MEDICINE, AND THE PRIVATE SECTOR, AS WELL AS FOR PATIENTS WITH LUNG DISEASE AND THE INTERESTED LAY PUBLIC. WE ANTICIPATE THAT THE HUMAN LUNG CELL ATLAS WILL BE THE FOUNDING STONE FOR A MORE DETAILED UNDERSTANDING OF THE PATHOGENESIS OF LUNG DISEASES, GUIDING THE DESIGN OF NOVEL DIAGNOSTICS AND PREVENTIVE OR CURATIVE INTERVENTIONS. 2022 19 1927 28 ENVIRONMENTAL EPIGENOMICS AND DISEASE SUSCEPTIBILITY. KEYSTONE SYMPOSIA ON MOLECULAR AND CELLULAR BIOLOGY. THE GROVE PARK HOTEL & SPA, ASHVILLE, NC, USA, 27 MARCH-1 APRIL 2011. THE MAIN OBJECTIVE OF THIS CONFERENCE WAS TO PROVIDE SOLID EVIDENCE THAT ENVIRONMENTAL EXPOSURES DURING EARLY DEVELOPMENT CAN AFFECT FAITHFUL REPRODUCTION OF INDIVIDUAL PARENTAL EPIGENOMES WITHOUT CHANGING DNA SEQUENCE IN THE OFFSPRING. NO DOUBT, THIS IMPORTANT GOAL HAS BEEN SUCCESSFULLY ACHIEVED OWING TO THE HIGH QUALITY OF PRESENTED EPIDEMIOLOGICAL AND EXPERIMENTAL STUDIES AND ENGAGING DISCUSSIONS OF MANY YET TO BE PUBLISHED RESULTS. COMPELLING DATA SUGGESTED A STRONG CAUSAL LINK BETWEEN PRENATAL VULNERABILITY OF FUTURE PARENTAL EPIGENOMES TO DAMAGING ENVIRONMENTAL FACTORS AGGRAVATED BY ABNORMAL SOCIO-CULTURAL CONDITIONS (INCLUDING, FOR INSTANCE, MALNUTRITION AND CHRONIC STRESS) AND THE ALARMING RISK OF DEVELOPING HERITABLE COMPLEX MEDICAL CONDITIONS LATER IN LIFE, SUCH AS ASTHMA, AUTISM, CANCER, CARDIOVASCULAR DISEASE, DIABETES, OBESITY, SCHIZOPHRENIA AND A WHOLE RANGE OF RARE NEUROMUSCULAR PATHOLOGIES. IT WAS CONCLUDED THAT MODERN EPIGENETIC RESEARCH PROMISES TO MARKEDLY IMPROVE OUR ABILITY TO DIAGNOSE, PREVENT AND TREAT THESE AND OTHER PATHOLOGICAL CONDITIONS OF HUMANS. HOWEVER, THE COMPLEX HERITABILITY PATTERN OF 'EPIGENETIC SYNDROMES' ALSO INTRODUCES UNIQUE LEGAL AND ETHICAL ISSUES THAT WERE DISCUSSED AT THE END OF THIS OUTSTANDING MEETING. 2011 20 4167 20 MEDICINE AND PHLEBOLYMPHOLOGY: TIME TO CHANGE? BIOMEDICAL SCIENCE IS UNDERGOING A REAPPRAISAL OF ITS SCIENTIFIC ADVANCEMENT PROCESS AND OF THE RELATED HEALTHCARE MANAGEMENT. PROGRESS IN MEDICINE SHOULD COMBINE IMPROVEMENTS OF KNOWLEDGE, EFFICACY, AND SAFETY OF DIAGNOSTIC/THERAPEUTIC PROCEDURES, WITH ADEQUATE COST-EFFECTIVENESS PROFILES. THIS NARRATIVE REVIEW IS AIMED AT ASSESSING IN MEDICINE, MORE SPECIFICALLY IN PHLEBOLOGY AND LYMPHOLOGY: (A) SCIENTIFIC LITERATURE POSSIBLE BIASES, (B) THE LEVEL OF EVIDENCE, COMPREHENSIVENESS, AND COST-EFFECTIVENESS OF THE MAIN THERAPEUTIC OPTIONS, AND (C) THE POSSIBLE CONTRIBUTION OF INTEGRATIVE AND TRANSLATIONAL MEDICINE. CURRENT MEDICAL RESEARCH MAY HAVE COGNITIVE BIASES, OR INDUSTRY-TIED INFLUENCES, WHICH IMPACTS CLINICAL PRACTICE. SOME REDUCTIONISM, WITH AN INCREASING USE OF DRUGS AND TECHNOLOGY, OFTEN NEGLECTING THE UNDERSTANDING AND CARE OF THE ROOT CAUSATIVE PATHWAYS OF THE DISEASES, IS AFFECTING BIOMEDICAL SCIENCE AS WELL. AGING BRINGS A RELEVANT BURDEN OF CHRONIC DEGENERATIVE DISEASES AND DISABILITIES, WITH RELEVANT SOCIO-ECONOMIC REPERCUSSIONS; THUS, A MAJOR ATTENTION TO COST-EFFECTIVENESS AND APPROPRIATENESS OF HEALTHCARE IS WARRANTED. IN THIS SCENARIO, COSTLY AND INNOVATIVE BUT RELATIVELY VALIDATED THERAPIES MAY TEND TO BE ADOPTED IN VENOUS AND LYMPHATIC DISEASES, SUCH AS VARICOSE VEINS, LEG VENOUS ULCER, POST-THROMBOTIC SYNDROME, PELVIC CONGESTION SYNDROME, AND LYMPHEDEMA. CONVERSELY, A MORE COMPREHENSIVE APPROACH TO THE BASIC PATHOPHYSIOLOGY OF CHRONIC VENOUS AND LYMPHATIC INSUFFICIENCY AND THE INCLUSION OF PHARMACOECONOMICS ANALYSES WOULD BENEFIT OVERALL PATIENTS' MANAGEMENT. ERRONEOUS LIFESTYLE AND NUTRITION, TOGETHER WITH CHRONIC STRESS-INDUCED SYNDROMES, SIGNIFICANTLY INFLUENCE CHRONIC DEGENERATIVE PHLEBO-LYMPHATIC DISEASES. THE MAIN ACTIVE EPIGENETIC SOCIO-BIOLOGIC FACTORS ARE OBESITY, DYSFUNCTIONS OF MUSCULO-RESPIRATORY-VASCULAR PUMPS, PRO-INFLAMMATORY NUTRITION, HYPERACTIVATION OF STRESS AXIS, AND SEDENTARISM. AN OVERALL CRITICAL VIEW OF THE SCIENTIFIC EVIDENCE AND INNOVATIONS IN PHEBOLYMPHOLOGY COULD BE OF HELP TO IMPROVE EFFICACY, SAFETY, AND SUSTAINABILITY OF CURRENT PRACTICE. TRANSLATIONAL AND INTEGRATIVE MEDICINE MAY CONTRIBUTE TO A PATIENT-CENTERED APPROACH. CONVERSELY, REDUCTIONISM, EMINENCE/REIMBURSEMENT-BASED DECISIONAL PROCESSES, PATIENTS' LACK OF EDUCATION, INDUSTRY-INFLUENCED SCIENCE, AND PHYSICIAN'S IMPROVABLE AWARENESS, MAY COMPROMISE EFFICACY, SAFETY, APPROPRIATENESS, AND COST-EFFECTIVENESS OF FUTURE DIAGNOSTIC AND THERAPEUTIC PATTERNS OF PHLEBOLOGY AND LYMPHOLOGY. 2020