Exposomics 101: Environmental impacts on health

Over the past 15 years, rates of cancer have skyrocketed. It is almost certain that someone close to you has been diagnosed with this life-altering disease. The Canadian Cancer Society reports that 2 in 5 Canadians are expected to be diagnosed with cancer in their lifetime, and approximately 1 in 4 Canadians are expected to die from the disease.1 We know the well-documented causes of cancer including tobacco use, genetics and family history, and increased exposure to pollution and carcinogens. An area of study gaining more traction is that of exposomics. This is the study of the exposome, which encompasses the totality of environmental exposures (including chemical agents, lifestyle choices, social factors, and other internal and external sources) we encounter throughout our lifetime and how these interact with our genetics to influence our health.2Exposomics consists of areas of study including genomics, metabonomics, lipidomics, transcriptomics, proteomics and advanced data analysis techniques to assess both internal and external exposures.The exposome encompasses three main domains:31. General External Exposome: This includes environmental factors such as air pollution, climate, and our networks of relationships.2. Specific External Exposome: This consists of individual-level exposures, such as diet, physical activity, tobacco smoke, and specific environmental contaminants. The Environmental Working Group (EWG) has the most comprehensive database of contaminants found in water, food, cleaning products, and cosmetic products. You can search for a product you currently use or read guides on choosing a home water filter using their site found HERE.3. Internal Exposome: The internal exposome refers to biological responses to external factors. These can be detected through molecular analysis and would include examining your metabolism, gut microbiome, system inflammation and levels of oxidative stress in your body. What is your level of awareness about the cleaning products you are using, the processed food you are eating or the air and water you are consuming? There is growing evidence the sum of these factors has a noticeable impact on longevity and quality of your life. Read: Pharmacogenomics and MS carePrecision MedicinePrecision medicine plays a definitive role in treating diseases influenced by the exposome by tailoring prevention, diagnosis, and treatment strategies to individual genetic, environmental, and lifestyle factors.2 It takes the complex exposome factors and combines this with an individual’s genetic makeup and clinical presentation to develop a more comprehensive understanding of disease cause and progression.For example, by understanding the unique exposome profile of an individual, pharmacists can recommend changes in diet, lifestyle, or environment that may reduce the risk of developing certain diseases or improve treatment outcomes. The key is to get ahead and start these interventions early.Some specific examples of how precision medicine can help include;Identifying biomarkers of exposure through advanced technologies like high-resolution mass spectrometry, which can measure a wide range of exposures in biological samples.4Informing Drug-Exposome Interactions:5 Investigating how environmental exposures interact with drugs, which can influence treatment efficacy. This includes how the sun impacts photosensitizing drugs, counselling on dietary interactions with drugs (e.g., grapefruit), how BPA can interact with cancer medication, alcohol increasing the sedative effects of CNS depressants and the importance of proper drug storage.Empowering Personalized Decision-Making: Providing opportunities for personalized decision-making to arm people with information to avoid areas with higher exposure to pollutants/contaminants. This may include pharmacogenomic testing looking at detoxifying pathways such as methylation and glutathione.Advancing Exposome Research: Encouraging the collection of exposome data in large-scale studies to better understand the causes of diseases and inform public health strategies.6Implementing pharmacogenetic testing: Community pharmacists are involved in the practical aspects of pharmacogenetic testing, from collecting samples to interpreting results and integrating these findings into clinical practice. Pharmacogenomics also plays a role in reducing adverse drug reactions and improving treatment outcomes. Armed with this information community pharmacists can help with dose adjustments and minimize the accumulation of toxic metabolites. An example of this is looking at a patient’s CYP2D6 activity when starting them on an SSRI. An ultrarapid metabolizer of this P450 enzyme may require higher doses or alternative medications to achieve therapeutic efficacyACTION ITEMSPharmacists can refer patients to specialists for further evaluation of environmental exposures that may be impacting their health. This can include referrals to allergists, occupational health specialists, or environmental health expertsAdvocate for integrating exposomic data into dispensing software to allow for real-time alerts and recommendations based on environmental exposures that could impact drug safety and efficacy.Take a deeper dive into the carbon footprint of your pharmacy. Reach out to the Canadian Association of Pharmacy for the Environment (CAPhE) for more information on what you can do to minimize the pollution you may be adding to the environment. Manjit Hansra is the founder of Rx for Renewal (www.rx-renewal.ca). Through keynote speaking, 1:1 coaching, corporate wellness programs and curated retreats, he shares evidence-based and practical tools to help pharmacy organizations and pharmacists prevent and manage burnout. Subscribe to his weekly newsletter HERE.References:[1] https://cancer.ca/en/research/cancer-statistics[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025320/[3]https://thorax.bmj.com/content/69/9/876[4] https://www.nature.com/articles/s41467-023-37626-2[5] https://pubmed.ncbi.nlm.nih.gov/33186555/[6] https://www.insideprecisionmedicine.com/topics/precision-medicine/fully-exposed-understanding-the-exposome-can-drive-the-future-of-health-and-wellness/

Exposomics 101: Environmental impacts on health

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