Molecular prevention of chronic non-communicable diseases: How close are we?

Abstract

Chronic non-communicable diseases (CNDs) are a leading cause of death worldwide; preterm mortality in people younger than 70 years accounts for 40% of the total of 38 million deaths due to CNDs. Heterogeneity and complexity of CNDs cause shifting the prevention focus towards the molecular level in order to contribute to the global decrease of disease burden. Given that fact, the aims of molecular prevention are determination of crucial genetic, epigenetic and environmental factors that influence different responses to agents, as well as those that modify responses to agent exposure and tendency of development of chronic diseases. Also, it is important to mention the recognition of new pathways of pharmacologic modulation. Although basic postulates of molecular preventions are still at their beginning, the fact that significant results in the field of clarifying CNDs etiology and early pathogenesis, risk assessment and modeling, as well as targeting of agents with high preventable efficacy have already been achieved, it is clear that there is a possibility to decrease CNDs burden in the earliest phases of its natural course. Accordingly, it is important to change the belief that a person without clinical symptoms and signs of disease is necessarily healthy. On the other hand, there is a need to balance the risks and health; molecular prevention has its own place in that interspace. Studies investigating the effects of potential preventive measures at molecular level have clearly determined high-risk cohorts, outcomes and other design elements, similarly to clinical studies. There is an intensive development of new research fields, like nutrigenomics which investigates the impact of diet on metabolic pathways and homeostasis, that is, their regulation in early stages of diseases associated with nutrition, as well as the level of susceptibility of person with certain genotype to those diseases. The investigations in the fields of molecular prevention may contribute to new biomarkers development or help the setting of strategies for CNDs molecular prevention and nanotherapy. In other words, they represent the marker of genomics applying in population sciences.