A Tale of Two Patients — 2

Allow me to explain. We’ve known for a long time that lifestyle factors—diet, exercise, and sleep—play an important role in health span. But that knowledge has greatly expanded to what I call the dimension of “lifestyle+” because it now includes broadly defined environmental exposures. Being outdoors in nature, pollution, social determinants of health including loneliness, specifics of physical activity including strength, and precision dieting including time-restricted eating are all aspects of lifestyle+. The cliché “the devil is in the details” is particularly fitting.

2. Cells

The latest understanding of the nearly thirty-seven trillion cells in our body offers an entirely new range of insights. Each week researchers are publishing new work involving molecular sequencing, determining the genetic material of hundreds of thousands to millions of single cells. We understand not only their workings across time and space but also how we can manipulate and rebuild them. This changes everything. T cells can be taken out of our body and engineered to substantially rev up our immune response to cancer, or alternatively to suppress a self-directed immune response. We are making that process faster, cheaper, and simpler by transforming a person’s own immune cells inside their body. We can take an organ from another species, a heart, say, edit the genes that provoke an immune response, and potentially solve the dearth of human donor organs. We can change a person’s white blood cells into stem cells and then make, for instance, pancreatic cells that produce insulin. We can even grow cells in a dish into beating, multichamber hearts—or even brains. These organoids can preview how a person’s brain will respond to a treatment for cancer or neurologic conditions.

3. Omics

Within our cells and body tissue there are many layers of biologic information that have become known collectively as omics. This term originated with the study of our genome, comprised of three billion DNA letters. The other principal layers include our RNA, proteins, epigenetics (the packaging of our genome), and microbiome. In aggregate, this rich set of biological data is critical to defining our uniqueness as individuals and lays the foundation for individualized medicine.

The advances in omic science are stunning. By sequencing our DNA, we can identify common and rare gene variants that tell us about risks of major diseases well beyond our family history. Detecting tumor DNA in the plasma portion of the blood, known as a “liquid biopsy,” can enable early diagnosis and treatment of cancer; abnormal proteins or RNA can indicate the beginning of a neurodegenerative disease or the earliest sign of preeclampsia. A cluster of proteins in our plasma can tell us about the aging clock for each of our organs. The microbiome of our gut is busy sending signals to our brain and shaping our immune response.