Impact of exposome on the course of lung diseases

Project Information

REMEDIA

Grant agreement ID: 874753

DOI

10.3030/874753

Project closed

EC signature date 6 December 2019

Start date 1 January 2020

End date 30 June 2025

Funded under

• SOCIETAL CHALLENGES - Health, demographic change and well-being

Total cost

€ 11 013 022,14

EU contribution

€ 11 013 022,14

Coordinated by

INSTITUT NATIONAL DE LA SANTE ET DE LA RECHERCHE MEDICALE
France

Periodic Reporting for period 4 - REMEDIA (Impact of exposome on the course of lung diseases)

Reporting period: 2024-01-01 to 2025-06-30

Summary of the context and overall objectives of the project

Chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF) are two very debilitating non-communicable diseases that are of particular interest to consider in parallel in a human exposome study. Their roots are opposite: COPD is currently considered to be mainly related to the external exposome, while factors outside of the exposome play a major role in CF. However, COPD and CF share common characteristics such as high phenotypic variability of unknown origin, which prevents good therapeutic efficacy. The overall picture must thus be supplemented by considering additional components of the exposome. The overall objective of the REMEDIA project was to extend the understanding of the contribution of the exposome, taken as a complex set of different components, to COPD and CF diseases. We collected and integrated health and environmental data from existing cohorts and population registries, gathering phenotype and exposome information; we developed a handy individual sensor device combining environmental and biomarker toolkits; and used a versatile atmospheric simulation chamber to simulate the health effects of complex exposomes.
Thanks to machine learning supervised analyses and causal inference models we identified relevant risk factors; and developed econometric and cost-effectiveness models to assess the costs, performance, and cost-effectiveness of a selection of prevention strategies. Based on these results, we developed guidelines to better predict disease risks and create a REMEDIA toolbox (global unified database, sensor device, versatile atmospheric simulation chamber, machine learning supervised analyses, causal inference model, Pan-European multi-criteria risk assessment tool, econometric and cost-effectiveness models, new guidelines and recommendations).
REMEDIA was also part of the European Human Exposome Network established between the 9 projects funded within the Human Exposome programme call H2020-SC1-BHC-2018-2020.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

Integrated Exposome Data and Health Associations
This part of the project was dedicated to the collection and integration of multiple datasets with all pre-existing health and environmental data relevant to REMEDIA’s research objectives from the participating cohorts and registries.
Thanks to unsupervised multidimensional phenotyping approaches, the project was able to identify distinct lung function trajectories among children with cystic fibrosis, revealing marked heterogeneity in disease progression; patients in the poorest-performing cluster were more frequently exposed to second-hand smoke and higher levels of air pollution (particularly NO2 and PM10).
The project showed that living near green spaces during pregnancy might offer some protective effects for urban children, particularly against eczema, children of mothers living in urban areas during pregnancy seemed more affected by air pollution.
The project also explored the long-term impact of air pollution exposure on COPD using Danish cohort data, confirming substantial links between ambient pollutants (depending on their source) and chronic respiratory disease progression, with stronger associations among women, never smokers and those with an asthma diagnosis.

Sensor Toolkit Innovations
REMEDIA advanced sensor technology for health assessment with the development of a biosensor device for exhaled breath biomarkers and a body-worn multi-pollutant sensor, opening new possibilities for personal exposome monitoring and fine-scale environmental health research.

Simulation Chamber Innovations
REMEDIA developed two atmospheric simulation chambers protocols, offering fully versatile platform for simulating realistic atmospheric exposures. These chambers can be adapted to investigate exposome effects not only in respiratory disease models but also in cardiac and neurological diseases as an example, expanding their relevance well beyond COPD and CF research.

Risk Assessment and Economic Evaluation
A systematic assessment of exposome factors was conducted using geospatial mapping across Europe to support multicriteria risk analyses. Econometric modelling illuminated trends in COPD mortality and cystic fibrosis prevalence, establishing foundations for data-driven policy planning. Additionally, the project evaluated the cost-benefit of CFTR modulators in treating cystic fibrosis.

Legal, Ethical, and Clinical Perspectives
The project considered legal and ethical dimensions of public health recommendations for pulmonary diseases, critical for ensuring the legitimacy and social acceptance of scientific proposals.

Broader Impact and Future Applications
The project’s findings extend relevance beyond COPD and CF, with identified exposome components potentially relevant to other (respiratory) diseases. The toolbox's resources support research into how environmental exposures shape phenotypes and guide prevention strategies for multiple high-burden conditions.

REMEDIA Toolbox: Enabling Collaboration
To summarize the work and results of the 66 months of work within REMEDIA, the project chose to gather everything under the REMEDIA toolbox, which enables access to data, methodologies, and devices designed to advance both personal health management and policy-making across Europe. https://h2020-remedia.eu/toolbox/
Central to the toolbox are opportunities for collaboration, contact links for further involvement, and access to selected project data. The REMEDIA toolbox has the potential to continue to empower researchers, clinicians, policymakers, and the broader public to advance knowledge, guide interventions, and improve disease outcomes linked to the exposome across Europe.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

On completion of the project, we contributed to advancing the understanding on the global burden of COPD and CF diseases attributable to environmental factors, and more specifically to external and internal exposome components. Deciphering the impact of environmental components throughout life on the phenotypic variability of COPD and CF could represent a major breakthrough in reducing morbidity and mortality associated with these two non-curable diseases and would lead to the identification of modifiable risk factors on which preventive action could be implemented.
The findings obtained in REMEDIA project will be relevant to populations that are largely beyond patients with COPD or CF. Indeed, these two diseases are only iconic examples of small airway diseases (SAD), and SAD are associated with other (non)-communicable diseases of major importance, reaching the pulmonary system (asthma, bronchiolitis, connective tissue diseases - interstitial lung diseases, pleural diseases), but also other organs (rheumatoid arthritis, Sjögren’s syndrome and inflammatory bowel diseases to name a few). Therefore, the identification of exposome components as essential modifiers of COPD and CF phenotypes should be applicable to other SAD and thus could have a global impact on several diseases of high burden.

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