title: Predictive medicine: outcomes, challenges and opportunities in the Synergy-COPD project.
abstract: BACKGROUND
  Chronic Obstructive Pulmonary Disease (COPD) is a major challenge for healthcare. Heterogeneities in clinical manifestations and in disease progression are relevant traits in COPD with impact on patient management and prognosis. It is hypothesized that COPD heterogeneity results from the interplay of mechanisms governing three conceptually different phenomena: 1) pulmonary disease, 2) systemic effects of COPD and 3) co-morbidity clustering.
  
  
  OBJECTIVE
  To assess the potential of systems medicine to better understand non-pulmonary determinants of COPD heterogeneity. To transfer acquired knowledge to healthcare enhancing subject-specific health risk assessment and stratification to improve management of chronic patients.
  
  
  METHODS
  Underlying mechanisms of skeletal muscle dysfunction and of co-morbidity clustering in COPD patients were explored with strategies combining deterministic modelling and network medicine analyses using the Biobridge dataset. An independent data driven analysis of co-morbidity clustering examining associated genes and pathways was done (ICD9-CM data from Medicare, 13 million people). A targeted network analysis using the two studies: skeletal muscle dysfunction and co-morbidity clustering explored shared pathways between them.
  
  
  RESULTS
  (1) Evidence of abnormal regulation of pivotal skeletal muscle biological pathways and increased risk for co-morbidity clustering was observed in COPD; (2) shared abnormal pathway regulation between skeletal muscle dysfunction and co-morbidity clustering; and, (3) technological achievements of the projects were: (i) COPD Knowledge Base; (ii) novel modelling approaches; (iii) Simulation Environment; and, (iv) three layers of Clinical Decision Support Systems.
  
  
  CONCLUSIONS
  The project demonstrated the high potential of a systems medicine approach to address COPD heterogeneity. Limiting factors for the project development were identified. They were relevant to shape strategies fostering 4P Medicine for chronic patients. The concept of Digital Health Framework and the proposed roadmap for its deployment constituted relevant project outcomes.
authors.forename: Felip
authors.initials: F
authors.lastname: Miralles
authors.forename: David
authors.initials: D
authors.lastname: Gomez-Cabrero
authors.forename: Magí
authors.initials: M
authors.lastname: Lluch-Ariet
authors.forename: Jesper
authors.initials: J
authors.lastname: Tegnér
authors.forename: Marta
authors.initials: M
authors.lastname: Cascante
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
mesh_terms: D002908:Chronic Disease; D016000:Cluster Analysis; D015897:Comorbidity; D006801:Humans; D008171:Lung Diseases / Q000503:physiopathology*; D008962:Models, Theoretical; D018482:Muscle, Skeletal / Q000503:physiopathology; D011379:Prognosis; D016730:Program Development; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D015272:Pulmonary Medicine / Q000639:trends; D018570:Risk Assessment; D057170:Translational Research, Biomedical / Q000639:trends