Can metabolic profiling provide a new description of osteoarthritis and enable a personalised medicine approach?
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PERSPECTIVES IN RHEUMATOLOGY
Can metabolic profiling provide a new description of osteoarthritis and enable a personalised medicine approach? M. K. J. Jaggard 1,2 & C. L. Boulangé 2,3 & G. Graça 2 & U. Vaghela 4 H. R. T. Williams 2,5,6 & J. C. Lindon 2 & C. M. Gupte 1,6,7
&
P. Akhbari 1,2 & R. Bhattacharya 1 &
Received: 18 February 2020 / Revised: 30 March 2020 / Accepted: 16 April 2020 # The Author(s) 2020
Abstract Osteoarthritis (OA) is a multifactorial disease contributing to significant disability and economic burden in Western populations. The aetiology of OA remains poorly understood, but is thought to involve genetic, mechanical and environmental factors. Currently, the diagnosis of OA relies predominantly on clinical assessment and plain radiographic changes long after the disease has been initiated. Recent advances suggest that there are changes in joint fluid metabolites that are associated with OA development. If this is the case, biochemical and metabolic biomarkers of OA could help determine prognosis, monitor disease progression and identify potential therapeutic targets. Moreover, for focussed management and personalised medicine, novel biomarkers could sub-stratify patients into OA phenotypes, differentiating metabolic OA from post-traumatic, age-related and genetic OA. To date, OA biomarkers have concentrated on cytokine action and protein signalling with some progress. However, these remain to be adopted into routine clinical practice. In this review, we outline the emerging metabolic links to OA pathogenesis and how an elucidation of the metabolic changes in this condition may provide future, more descriptive biomarkers to differentiate OA subtypes. Keywords Metabolic profiling . Osteoarthritis . Personalised medicine . Metabonomics . Metabolomics
Metabolic profiling (also known as metabolomics, metabonomics and metabolic phenotyping) is emerging as a strategy to provide biomarker diagnostics capable of disease prediction, monitoring and early detection. It is defined as “the quantitative measurement of the dynamic multiparametric
* U. Vaghela [email protected] 1
Department of Orthopaedics & Trauma, Imperial College Healthcare NHS Trust, London, UK
2
Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
3
Nestle Research Centre, Lausanne, Switzerland
4
School of Medicine, Imperial College London, South Kensington, London SW7 2AZ, UK
5
Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
6
NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
7
Department of Surgery and Cancer, Imperial College London, London, UK
response of a living system to pathophysiological stimuli or genetic modification” [1]. Metabolites are the end points of molecular biology and variations in their profile reflect a response to the patient’s disease, environment, diet and lifestyle. Metabolic profiling has already established itself as a robust technique in oncology, epidemiology, gastrointestinal diseas
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