21. Yüzyılda Halk Sağlığı : Değişen Dünya, Değişen Sorunlar

21. Yüzyılda Çevresel Maruziyet Değerlendirme Yaklaşımları: Ekspozom Kavramı
Environmental Exposure Assessment Approaches in 21st Century: Exposome Concept
Gülden SARIa,b
aSağlık Bilimleri Üniversitesi Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi SUAM,
bHalk Sağlığı AD, İş ve Meslek Hastalıkları Programı, Ankara Üniversitesi Tıp Fakültesi, Ankara, TÜRKİYE
Sarı G. 21. yüzyılda çevresel maruziyet değerlendirme yaklaşımları: Ekspozom kavramı. Piyal B, editör. 21. Yüzyılda Halk Sağlığı: Değişen Dünya, Değişen Sorunlar. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.46-54.
Article Language: TR
ÖZET
Resmi olarak 1990'da başlayan ve 2003 yılında tamamlanan İnsan Genom Projesinin ardından, bu projenin hastalıkların tedavisi ve yeni ilaçlar geliştirmesi yönünde devrim yaratacağı düşünülmüştür. Araştırmacıların, insanın Ay'a ilk kez ayak basmasıyla karşılaştırdığı projenin sonunda beklentilerin yüksek olmasındaki en önemli sebep, genetik haritanın %99,9'unun çözüldüğünün bildirilmesi olabilir. Oysa günümüzde kronik hastalık gelişimine neden olan etmenlerin %70-90'ının çevresel olduğunu biliyoruz. Çevresel maruziyetle ilgili olarak daha geniş bir bakış açısı geliştirmek için, maruz kalınan etkenlerin vücuttaki toksik etkilerini, vücut içindeki kritik molekülleri, hücreleri ve fizyolojik süreçleri değiştiren kimyasallar aracılığıyla gerçekleştirdiğini bilmek önemlidir. Bu görüş altında, maruziyetler, hava, su veya besinler yoluyla vücuda giren kimyasal maddelerle sınırlandırılmamalı, enflamasyon, oksidatif stres, lipit peroksidasyonu, enfeksiyonlar, bağırsak florası ve diğer doğal süreçler tarafından üretilen kimyasallar da bu kapsamda değerlendirilmelidir. Bireylerin çevresel maruziyetlerinin belirlenmesi için, genom konusundaki yüksek duyarlılıkta olduğu gibi, yöntemler geliştirmeye ciddi gereksinim olduğunu belirten Paul Wild tarafından 2005 yılında, genomla eşleşecek bir 'ekspozom' kavramı önerilmiştir. Böylece maruziyet değerlendirmelerinde metodolojik gelişmelere olan gereksinime dikkat çekmek amaçlanmıştır. Wild, ekspozomu doğum öncesi dönemden itibaren yaşam boyu maruz kalınan etmenlerin (yaşam biçimlerinden kaynaklı etmenler dahil) tamamı olarak tanımlamıştır. Bugün çevresel etmenlerin hastalıklarla ilişkilerini inceleyen bir grup bilim insanı, kronik hastalıkların gerçek anlamda anlaşılabilmesi için, tıpkı tüm genetik bilgimizi inceleyen 'genom' yaklaşımı gibi, maruz kaldığımız tüm çevresel etmenleri bir bütün olarak ele alan bir 'ekspozom' yaklaşımının benimsenmesi yönünde çalışmalar yapmaktadır. Bu çalışmada; 21. yüzyılda çevresel maruziyet değerlendirme yaklaşımları ve holistik bir bakış açısı sunan ekspozom konusundaki bilgiler derlenmiştir. Ekspozom yaklaşımı, çeşitli disiplinlerden katılımı, birçok teknik ve istatistiksel zorluğun aşılmasını gerektiren, emekleme aşamasındadır.

Anahtar Kelimeler: Ekspozom; çevresel maruziyetler; maruziyet değerlendirmesi; çevresel kirleticiler; çevre toksikolojisi
ABSTRACT
The Human Genome Project, which began in 1990 and completed in 2003, is thought to revolutionize the treatment of diseases and the development of new drugs. The most important reason for the researchers' high expectations at the end of the project may be due to 99.9% of the genetic map has been solved. However, nowadays we know that 70-90% of the factors causing chronic disease development are environmental. For developing a broader view of environmental exposure, it's important to understand that the agents that are exposed, carry toxic effects to the body through chemicals that alter critical molecules, cells and physiological processes in the body. So, the chemicals produced by inflammation, oxidative stress, lipid peroxidation, infections, intestinal flora and other natural processes are not limited to chemical substances entering the body via exposures, air, water or nutrients. In 2005, stating that there is a serious need to develop methods for the identification of individual environmental exposures, Paul Wild proposed the 'exposome' concept that would match genome to draw attention to the methodological advances in exposure assessments. Exposome encompasses life course environmental exposures (including lifestyle factors) from the prenatal period onwards. Today scientists, who study environmental factors related to chronic diseases, like the 'genome' approach which explores our genetic information, are working on the adoption of an 'exposome' approach that evaluates all the environmental factors we have exposed. In this study, environmental exposure assessment approaches in the 21st century and the information on the subject of 'exposome', that offering a holistic point of view, are presented. The "exposome" approach that discussed in this article is in the inception phase and requires participation from various disciplines and needs to overcome many technical&statistical challenges.

Keywords: Exposome; environmental exposure; exposure assessment environmental pollutants; environmental toxicology

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