Department of Gastroenterology and Hepatology, Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. fiocchc @ ccf.org
Dig Dis. 2012;30 Suppl 3:2-11. doi: 10.1159/000342585. Epub 2013 Jan 3.
It is becoming increasingly evident that the old paradigm of disease pathogenesis where a given genotype would determine a phenotype and this would lead to a particular disease is no longer acceptable. Many novel components are now recognized to be involved in the predisposition, triggering, progression and outcome of chronic inflammatory diseases like inflammatory bowel disease (IBD). Accordingly, investigation of IBD must recognize this complexity and take all potential components into account, if a full understanding of disease pathophysiology is to be reached and truly effective therapies developed based on this new global understanding. Essential to this approach is the notion of functional integration. Groups of functionally related pathogenic components must be assembled and studied as 'omes' like, for instance, the genome and the microbiome; at the same time all relevant 'omes' must be functionally and meaningfully integrated into the 'interactome', while the 'epigenome' should be used to dissect and understand the connections underlying the interactome. This is an ideal but also realistic scenario for the immediate future, as some of the 'omes' are already being explored in greater depth and their interactions examined through investigation of gene-gene (GXG) and gene-environment (GXE) interactions. Current knowledge of GXG and GXE and their impact on IBD pathogenesis is the focus of this review.
越来越明显的是,疾病发病机制的旧范式,即特定的基因型将决定表型,而这将导致特定的疾病,已经不再被接受。现在许多新的成分被认为参与了慢性炎症性疾病(如炎症性肠病)的易感性、触发、进展和结果。因此,如果要全面了解疾病的病理生理学,并在此新的全球认识基础上开发真正有效的治疗方法,对 IBD 的研究必须认识到这种复杂性,并考虑所有潜在的成分。这种方法的关键是功能整合的概念。必须将功能相关的致病性成分组组装并作为“组学”进行研究,例如基因组和微生物组;同时,所有相关的“组学”必须在功能上和有意义地整合到“互作组”中,而“表观基因组”则用于剖析和理解互作组的基础连接。这是一个理想但也是现实的情景,因为一些“组学”已经在更深入地探索,并且通过研究基因-基因(GXG)和基因-环境(GXE)相互作用来检查它们的相互作用。本综述的重点是目前对 GXG 和 GXE 及其对 IBD 发病机制的影响的了解。
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