The Physiopathology, Metabolism and Nutrition Institute covers a very broad field of physiology, experimental medicine and human diseases. The areas covered are the lungs, heart and blood vessels, haemostasis, endocrine glands, liver, kidneys, skin, bones and joints, and all the organs involved in nutrition, from controlling appetite and dietary behaviour to the digestive processes and control of the use and storage of substrates.
The Institute is based on an Expert Committee representing each of the subject areas and representing the various research organisations involved. Research efforts are split, 29% in cardiovascular and haemostasis, 25% in metabolism, nutrition and diabetes, and 46% spread almost equally across osteoarticular, pneumology, nephrology, hepatology, endocrinology, gastroenterology and dermatology.
Metabolic and nutritional diseases are a major public health issue, because of their complications, particularly cardiovascular. Diabetes, hyperlipidaemia, obesity and kidney failure are major precursors of cardiovascular diseases, leading cause of death in industrialised countries. The continuing high incidence, despite major therapeutic advances, is explained by the increasing incidence of diabetes, obesity and ageing of the population. Diabetes alone affects 7.1% of the French population aged between 20 and 70 years old, obesity about 15%. Paradoxically, malnutrition is also a major problem. Malnutrition is observed in 40% of chronic diseases, in 30% to 50% of hospital patients, taking all pathologies combined. Other diseases falling into the Institutes subject areas are frequent and/or serious. They pose fundamental questions, whether they are autoimmune and inflammatory diseases, perfect example of multigenic and multifactorial diseases, monogenic genetic diseases, often disabling, numerous cancers or infectious diseases.
The biological problems posed involve a huge spectrum of disciplines, from genetics to developmental biology, cell biology, immunology, imaging, engineering, the biology of ageing and clinical research. The spectacular increase in the incidence of common diseases poses the question of the role of the environment as well as its interaction with a genome whose variability is becoming accessible as these diseases appear suddenly. Apart from rare monogenic diseases, common diseases are arising across a multigenic field that combines gene variants controlling as many intermediate phenotypic traits. Besides the genes that contribute to initiating these diseases, others yet to be identified contribute to their progression. These diseases require us to have biomarkers for their triggering and progression. There is a priority need for relevant preclinical models and extensively phenotyped patient cohorts.
For many of these diseases, current treatments are inadequate, often symptomatic or palliative. When they are based on mechanisms, they often clash with the risks they cause. When a preventive measure exists (atherosclerosis), it is often limited to targeting associated risk factors, which could only typify the physiopathological mechanisms involved. Organ replacement strategies, widespread in numerous fields of medicine, come up against the shortage of donors, the toxicity of immunosuppressants or the complexity of the surgical procedure. Changes are unavoidable to generate cells or tissues in vitro for use in transplants, to develop cell regeneration strategies, to make the immune system tolerate transplanted organs or to create artificial organs.
They are of three types: scientific, organisational and technological.
Ten scientific priorities have been identified:
The 9 functional priorities are:
Finally, the technological priorities relate to continuing to implement metabolomic platforms coordinated with existing genomic, transcriptomic and metabolomic platforms and to develop bio-informatics and biostatistics platforms. This technological policy must be considered in a coordinated way with objectives set by other institutes, particularly in the field of genetics and the genome, inflammation, public health and, of course, healthcare technologies.
Director of the Physiopathology, Metabolism and Nutrition Institute