Hochberg Michael E
Institut des Sciences de l'Evolution, Université de Montpellier, 34095 Montpellier, France.
Santa Fe Institute, Santa Fe, NM 87501, USA.
Evol Med Public Health. 2018 Oct 9;2018(1):270-286. doi: 10.1093/emph/eoy032. eCollection 2018.
Pathogens and cancers are pervasive health risks in the human population. I argue that if we are to better understand disease and its treatment, then we need to take an ecological perspective of disease . I generalize and extend an emerging framework that views disease as an ecosystem and many of its components as interacting in a community. I develop the framework for biological etiological agents (BEAs) that multiply within humans-focusing on bacterial pathogens and cancers-but the framework could be extended to include other host and parasite species. I begin by describing why we need an ecosystem framework to understand disease, and the main components and interactions in bacterial and cancer disease ecosystems. Focus is then given to the BEA and how it may proceed through characteristic states, including emergence, growth, spread and regression. The framework is then applied to therapeutic interventions. Central to success is preventing BEA evasion, the best known being antibiotic resistance and chemotherapeutic resistance in cancers. With risks of evasion in mind, I propose six measures that either introduce new components into the disease ecosystem or manipulate existing ones. An ecosystem framework promises to enhance our understanding of disease, BEA and host (co)evolution, and how we can improve therapeutic outcomes.
病原体和癌症是人类普遍面临的健康风险。我认为，如果我们想要更好地理解疾病及其治疗方法，那么就需要从生态学角度看待疾病。我归纳并扩展了一个新兴框架，该框架将疾病视为一个生态系统，其许多组成部分在一个群落中相互作用。我为在人体内繁殖的生物病原体（BEAs）——重点关注细菌病原体和癌症——构建了这个框架，但该框架可以扩展到包括其他宿主和寄生物种。我首先描述为什么我们需要一个生态系统框架来理解疾病，以及细菌和癌症疾病生态系统中的主要组成部分和相互作用。然后重点关注生物病原体及其如何经历包括出现、生长、传播和消退在内的特征阶段。接着将该框架应用于治疗干预措施。成功的关键在于防止生物病原体逃避，最常见的是癌症中的抗生素耐药性和化疗耐药性。考虑到逃避风险，我提出了六项措施，这些措施要么将新的组成部分引入疾病生态系统，要么操纵现有的组成部分。一个生态系统框架有望增进我们对疾病、生物病原体和宿主（共同）进化的理解，以及我们如何能够改善治疗效果。
