Systems Medicine Approaches for the Definition of Complex Phenotypes in Chronic Diseases and Ageing. From Concept to Implementation and Policies
Jean Bousquet, Christian Jorgensen, Michel Dauzat, Alfredo Cesario, Thierry Camuzat, Rodolphe Bourret, Nicolas Best, Josep M. Anto, Frederic Abecassis, Pierre Aubas, Antoine Avignon, Melanie Badin, Anna Bedbrook, Hubert Blain, Arnaud Bourdin, Jacques Bringer, William Camu, Guilhaume Cayla, David J. Costa, Philippe Courtet, Jean-Paul Cristol, Pascal Demoly, Jean-Emmanuel de la Coussaye, Pierre Fesler, Fares Gouzi, Jean-Christophe Gris, Bernard Guillot, Maurice Hayot, Claude Jeandel, Olivier Jonquet, Laurent Journot, Sylvain Lehmann, Gwenaelle Mathieu, Jacques Morel, Gregory Ninot, Jacques Pelissier, Marie-Christine Picot, Francoise Radier-Pontal, Jean-Marie Robine, Michel Rodier, Francois Roubille, Ariane Sultan, Anne Wojtusciszyn, Charles Auffray, Rudi Balling, Cristina Barbara, Anne Cambon-Thomsen, Niels H. Chavannes, Alexander Chuchalin, George Crooks, Antoni Dedeu, Leonardo M. Fabbri, Judith Garcia-Aymerich, Jawad Hajjam, Elisabete Melo Gomes, Susana Palkonen, Francois Piette, Christophe Pison, David Price, Boleslaw Samolinski, Holger J. Schunemann, Peter J. Sterk, Panayiotis Yiallouros, Josep Roca, Philippe Van de Perre and Jacques Mercier
Affiliation: University of Montpellier 1, France.
Keywords: Chronic disease, co-morbidities, health system, systems medicine, patient, active and healthy ageing, MeDALL, MACVIA-LR.
Chronic diseases are diseases of long duration and slow progression. Major NCDs (cardiovascular diseases, cancer, chronic
respiratory diseases, diabetes, rheumatologic diseases and mental health) represent the predominant health problem of the Century. The
prevention and control of NCDs are the priority of the World Health Organization 2008 Action Plan, the United Nations 2010 Resolution
and the European Union 2010 Council. The novel trend for the management of NCDs is evolving towards integrative, holistic approaches.
NCDs are intertwined with ageing. The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has
prioritised NCDs. To tackle them in their totality in order to reduce their burden and societal impact, it is proposed that NCDs should be
considered as a single expression of disease with different risk factors and entities. An innovative integrated health system built around
systems medicine and strategic partnerships is proposed to combat NCDs. It includes (i) understanding the social, economic, environmental,
genetic determinants, as well as the molecular and cellular mechanisms underlying NCDs; (ii) primary care and practice-based
interprofessional collaboration; (iii) carefully phenotyped patients; (iv) development of unbiased and accurate biomarkers for comorbidities,
severity and follow up of patients; (v) socio-economic science; (vi) development of guidelines; (vii) training; and (viii) policy
decisions. The results could be applicable to all countries and adapted to local needs, economy and health systems. This paper reviews
the complexity of NCDs intertwined with ageing. It gives an overview of the problem and proposes two practical examples of systems
medicine (MeDALL) applied to allergy and to NCD co-morbidities (MACVIA-LR, Reference Site of the European Innovation Partnership
on Active and Healthy Ageing).
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