HEDIMED

Human Exposomic Determinants of Immune Mediated Diseases

Hedimed Mission

1.

Type 1 diabetes, celiac disease, asthma and allergies have reached epidemic levels, and there is an urgent need to find cures for them.

2.

In Hedimed, large pregnancy and children cohorts from around Europe are cross-analysed to thoroughly study these diseases.

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3.

Samples from high and low risk countries are analysed for environmental exposures with the combined expertise of 22 consortium partners.

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4.

The aim is to identify disease mechanisms and risk and protective exposures to turn the tide of the epidemic.

Hedimed Mission

1.

Type 1 diabetes, celiac disease, asthma and allergies have reached epidemic levels, and there is an urgent need to find cures for them.

2.

In Hedimed, large pregnancy and children cohorts from around Europe are cross-analysed to thoroughly study these diseases.

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3.

Samples from high and low risk countries are analysed for environmental exposures with the combined expertise of 22 consortium partners.

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4.

Hedimed aims to identify disease mechanisms, and understand what risk and protective exposures for these diseases are present in our modern environment.

Objectives and implementation

HEDIMED aims to identify the disease mechanisms and environmental factors of type 1 diabetes, celiac disease, asthma and allergies.

Immune-mediated diseases have reached epidemic levels affecting a large part of the European population and causing ballooning healthcare costs. A major part of the epidemic are type 1 diabetes, celiac disease, asthma and allergies whose rapid increase can only be explained by environmental exposures.

HEDIMED seeks to understand the interactions of disease-specific and shared environmental determinants in disease development through one of the largest collections of data in the field, and with new technologies and modelling methods.

The results will be used to facilitate the development of treatments and prevention measures for these diseases and to create a toolbox with multiple functions for the research community, patients and policymakers. 

Hedimed includes prospective observational follow-up cohorts and early-age trials with exposomic interventions. We will use state-of-the-art omics and other techniques to study the effects of both internal and external exposomic factors in different Work Packages (WPs). Another important goal is to develop new intelligent sensors to detect exposomic determinants (toxins and pollutants, environmental microbiome, infections etc.) to these factors. Together the generated data allows us to build an exposome toolbox that can be utilised by policymakers, science community, regulatory authorities, patients, patient organisations and industry to model how changes in exposome affect the immune health and incidence of different immune-mediated diseases.

The Exposome

The exposome can be divided into three categories: the general external exposome, the specific external exposome and the internal exposome that interact with each other. The general external environment covers socio-economic, climate and living environment factors whereas the specific external environment covers more pollutants, infections and lifestyle factors etc. The internal exposome includes factors within the body such as the microflora, inflammation, metabolism, hormones etc.

The exposome covers all the environmental exposures throughout life from conception onwards to complement the much better-understood genome. Environmental factors play a huge role in non-communicable diseases, yet the measurement of these factors has been challenging.

With the exposome the emphasis is placed on comprehensively mapping the human-environment interactions ranging from large scale socio-economic phenomena to microscopic factors such as the microflora.

Understanding the exposome allows us to look at the overall effects of multiple exposures on human health rather than associating a single environmental exposure to a single disease.

HEDIMED is in a unique position to measure the effect of many exposures on human health. Conducting new innovative research in many large prospective human cohorts offers an exceptional opportunity to leap towards a comprehensive understanding of the environmental causes of chronic immune-mediated diseases.

Immune Mediated Diseases

Immune-mediated diseases such as allergy, asthma, celiac disease and type 1 diabetes are increasing rapidly in developing countries. The diseases were rare 100 years ago but now constitute an epidemic.

Immune-mediated diseases include the most common chronic diseases affecting a large proportion of people around the world and hundreds of millions of people only in Europe.

Type 1 diabetes (T1D) usually develops in childhood and affects a person for life. It is one of the most common chronic diseases occurring in childhood and adolescence, being frequent in all ages, and its incidence is increasing worldwideThere are an estimated 5 million people with T1D in Europe, and the economic burden of the disease is huge. 

In T1D the immune system destroys the insulin-producing beta cells of the pancreas leading to loss of insulin production. Without daily administration of insulin, the disease is deadly and did kill every one affected until 1922 when 14-year-old Leonard Thompson received the first insulin injection extracted from the pancreas of cattle. 

Although the treatment of T1D has improved to the stage where affected people can live normal lives, the disease causes a significant burden to the patient and the whole family as insulin injections and glucose monitoring are needed daily. T1D patients have a decreased life expectancy and have an increased risk of other chronic diseases such as heart and kidney diseases and neuropathies. The disease is also a huge burden to society costing about 1 million euros per patient to treat. 

More information on T1D: 

https://www.who.int/news-room/fact-sheets/detail/diabetes 

https://diabetesatlas.org/en/ 

https://www.jdrf.org/t1d-resources/ 

 

Celiac disease is a lifelong immune-mediated condition that may develop at almost any age but is often diagnosed in adulthood. Its incidence is increasing and around 1-2% of Europeans are known to be affected, although the majority remain unrecognized. 

The disease process starts when gluten found in wheat, rye and barley causes an autoimmune reaction against the small-bowel mucosa. The damaged intestine cannot absorb nutrients effectively, which eventually leads to various symptoms and complications. The only available treatment is a strict gluten-free diet. 

The symptoms of celiac disease can be very diverse, making it difficult to diagnose. The later the disease is recognized, the greater the chance of developing long-term complications. 

Celiac disease is known to be associated with specific genetics, but only a fraction of the at-risk population is affected. Also, the true incidence varies markedly between closely located geographic areas and has increased rapidly. These observations support the role of additional unknown environmental factors. 

 

More information on celiac disease:  

https://www.keliakialiitto.fi/kuluttajat/keliakia/keliakia-sairautena/ 

https://celiac.org/about-celiac-disease/what-is-celiac-disease/

Asthma is the most common chronic disease in childhood, and by far more common in children than adults. The incidence of asthma increased dramatically in Western and Northern Europe in the late 20th century but is now levelling off. However, in Eastern Europe, the incidence is now increasing. In Europe, the rate of asthma remains one of the highest in the world with more than 10% of the population affected in some countries.

Asthma is a chronic condition with swelling in the small airways in the lungs, which is caused by an over-active immune system. In an asthma attack, the problem is made worse since the small airways contract which further limits the passage of air, leading to troublesome symptoms, which can include coughing, breathlessness, wheezing and a feeling of tightness in the chest. Asthma attacks can be triggered by environmental factors like pollen or airway infections, and the attacks are treated with medication to relieve the symptoms. Moderate and severe asthma is also treated with long-working drugs to dampen the immune reaction.

Asthma attacks can be scary, and asthma impairs the life of children, for example by limiting the ability to exercise. The condition also severely affects the family and society as parents often miss work or give up work completely to care for a child with asthma. Although adults with mild asthma can lead a normal life, 10% of adults with asthma suffer from severe symptoms that dramatically limit their every-day life.

Asthma is hereditary but its rapid increase in Europe and the rest of the world can only be explained by the changes happening in our environments and way of life. These changes can ultimately trigger the genetic risk of disease given to us at birth.

More information on asthma: 

https://www.erswhitebook.org/files/public/Chapters/11_childhood_asthma.pdf

https://www.erswhitebook.org/files/public/Chapters/12_adult_asthma.pdf

Allergies are the most common chronic diseases in Europe, and more than 150 million Europeans suffering from chronic allergy. Allergies are becoming more and more prevalent, and it is predicted that half of the European population will be affected by 2025. Predisposition to allergy is hereditary, but the rapid increase in allergy incidence is most probably due to environmental and lifestyle changes.   

Allergic sensitization against environmental allergens often happens at a young age, although it’s also possible to get sensitized later in life. An allergy may persist throughout life. Allergic reactions range from mild ones, for instance, hay fever or localized urticarial rash to life-threatening severe asthmatic or anaphylactic symptoms.  

Allergy can be managed by avoiding the allergen, which may be possible if the allergen is, e.g., some food, animal or drug. However, avoidance is difficult or even impossible, if the allergen is, e.g., bee’s venom or pollen. In these cases, medication is needed to alleviate symptoms. Also, tolerance against some allergens can be built up by desensitization therapy. In any case, allergies cause a decline in quality of life on account of allergen avoidance procedures, allergy symptoms, fear of severe reactions or even death and need of medications or long-lasting desensitization therapies. Management of allergies results in huge expenses for society. 

 

More information on allergies:  

https://www.eaaci.org/documents/EAACI_Advocacy_Manifesto.pdf