Department of Psychiatry, College of Osteopathic Medicine, 965 Fee Road, East Fee Hall Room 225, Michigan State University, East Lansing, Michigan 48824, USA.
International Neurologic and Psychiatric Epidemiology Program (INPEP), West Fee Hall Room 321, Michigan State University, East Lansing, Michigan 48824-1315, USA.
Nature. 2015 Nov 19;527(7578):S155-60. doi: 10.1038/nature16029.
We define neurodevelopment as the dynamic inter-relationship between genetic, brain, cognitive, emotional and behavioural processes across the developmental lifespan. Significant and persistent disruption to this dynamic process through environmental and genetic risk can lead to neurodevelopmental disorders and disability. Research designed to ameliorate neurodevelopmental disorders in low- and middle-income countries, as well as globally, will benefit enormously from the ongoing advances in understanding their genetic and epigenetic causes, as modified by environment and culture. We provide examples of advances in the prevention and treatment of, and the rehabilitation of those with, neurodevelopment disorders in low- and middle-income countries, along with opportunities for further strategic research initiatives. Our examples are not the only possibilities for strategic research, but they illustrate problems that, when solved, could have a considerable impact in low-resource settings. In each instance, research in low- and middle-income countries led to innovations in identification, surveillance and treatment of a neurodevelopmental disorder. These innovations have also been integrated with genotypic mapping of neurodevelopmental disorders, forming important preventative and rehabilitative interventions with the potential for high impact. These advances will ultimately allow us to understand how epigenetic influences shape neurodevelopmental risk and resilience over time and across populations. Clearly, the most strategic areas of research opportunity involve cross-disciplinary integration at the intersection between the environment, brain or behaviour neurodevelopment, and genetic and epigenetic science. At these junctions a robust integrative cross-disciplinary scientific approach is catalysing the creation of technologies and interventions for old problems. Such approaches will enable us to achieve and sustain the United Nations moral and legal mandate for child health and full development as a basic global human right.
我们将神经发育定义为遗传、大脑、认知、情感和行为过程在整个发育过程中的动态相互关系。环境和遗传风险对这一动态过程的显著和持续破坏可能导致神经发育障碍和残疾。旨在减轻低收入和中等收入国家以及全球神经发育障碍的研究将极大地受益于对其遗传和表观遗传原因的不断深入理解,这些原因受到环境和文化的影响。我们提供了在低收入和中等收入国家预防、治疗和康复神经发育障碍方面的进展示例,以及进一步开展战略研究倡议的机会。我们的例子并不是战略研究的唯一可能性,但它们说明了一些问题,如果这些问题得到解决,可能会对资源匮乏的环境产生重大影响。在每种情况下,低收入和中等收入国家的研究都导致了对神经发育障碍的识别、监测和治疗的创新。这些创新也与神经发育障碍的基因型图谱相结合,形成了具有高影响力的重要预防和康复干预措施。这些进展最终将使我们能够了解表观遗传影响如何随着时间的推移和在不同人群中塑造神经发育风险和恢复力。显然,最具战略意义的研究机会领域涉及环境、大脑或行为神经发育以及遗传和表观遗传学科学之间的交叉学科整合。在这些交汇点上,强大的综合跨学科科学方法正在推动针对旧问题的技术和干预措施的创建。这种方法将使我们能够实现并维持联合国关于儿童健康和全面发展的道德和法律授权,将其作为一项基本的全球人权。