#38: Exposomics
Predicting science's next moonshot.
Setting Precedent
In 2003, the Human Genome Project (HGP) provided the full instruction manual for life—a map of our genetic blueprint that has transformed medicine, diagnostics, and drug development. It was a scientific moonshot that has catalyzed a trillion dollars worth of economic growth.
The HGP spurred:
New genetic tests revealing predispositions to certain diseases.
Targeted drug development based on genetic markers.
Biotech innovations such as next-generation sequencing (NGS).
We now stand in the early days of a new frontier in science, one that builds on the foundations laid by genomics. This time, however, scientists are not so much focused on what’s inside us, but on everything that surrounds us. Enter the era of exposomics.
From Genome to Exposome
First introduced by Dr. Christopher Wild in 2005, the exposome refers to the totality of environmental exposures we encounter from conception to death. Think: the water we drink, air we breathe, chemicals we interact with daily.
These exposures include:
Chemical Factors: Pollutants like particulate matter, pesticides, and endocrine disruptors (phthalates, bisphenols).
Physical Factors: Noise pollution, artificial light, UV radiation, and extreme temperatures.
Biological Factors: Pathogens, microbiota, and allergens.
Psychosocial Factors: Stressors stemming from socioeconomic status, workplace conditions, and social relationships.
Unlike our genome, which stays relatively stable over time (with some exceptions), the exposome is dynamic—constantly in flux. If our genome is like our biological source code, the exposome is the operating system that shapes how the source code is interpreted and executed.
Uneven Split
Many of the diseases that drive expensive health spend and poor health outcomes cannot be fully explained by genes alone. For the majority of chronic illnesses—cancer, heart disease, neurodegenerative conditions—genetics typically accounts for 10-30% of overall risk. The other ~70% can be explained by our environmental exposures and lifestyle behaviors. That 70% is the focus of the exposome.
If we’ve built multi-billion-dollar industries around the genetic 30%, imagine if we invested in understanding the environmental 70%?
Admittedly, the exact genome-to-exposome ratio varies among studies (90/10, 80/20, or 70/30). Still, a recent Nature publication reported results from UK Biobank data that skew heavily in favor of the environment being a major driver of non-communicable disease. Figures in the full paper describe what factors constitute the human exposome.
Whatever the number, given that genetics can only explain a fraction of disease, the exposome (in theory) should be much more valuable in determining how to address chronic disease mitigation.
“When it comes to many diseases, particularly common ones, genetics alone helps to explain only a small percentage of those conditions. This means that in most cases, we are concurrently dealing with both genetics and environmental factors.”
~ Dr. Konstantinos Lazaridis, Executive Director of Mayo Clinic’s Center for Individualized Medicine
Why Now?
Up until now, I’ve painted a fairly rosy picture of why we should care about environmental exposures.
If you still aren’t convinced, here are some startling warning signs to pay attention to:
Microplastics. Nat Friedman’s PlasticList analyzes 100 everyday foods and highlights the presence of plastics. Some people are legitimately walking around with a 2 x 10 Lego brick in their brains.
PFAS. Forever chemicals have been linked to immune and thyroid dysfunction.
Phthalates, bisphenols, formaldehyde. Chemicals found in everything from food packaging to household products that disrupt hormones in food packaging and cosmetics.
Particulate Matter. Air pollution is now considered a leading cause of premature death.
Heavy metals. Contaminating crops and water, heavy metals can harm multiple organ systems.
Why Now? Pt. 2
Exposures aside, other tailwinds will unlock viable business models for the first generation of exposome companies.
The costs of sensors + infrastructure required for environmental pollutants have come down the cost curve. SafetySpect, for example, is using mass spectroscopy technology to detect contamination in food manufacturing, hospitals, and the military.
Calls for a National Exposome Project benefit from existing smaller initiatives such as those at Johns Hopkins, Mayo Clinic, and The Human Exposome Project).
AI wasn’t really around for the Human Genome Project.
Exposomics in Action
One way I’m anticipating the emerging innovation landscape in exposomics is by looking at technologies and services across three scales:
Industrial / In-the-field
A majority of human exposures happen at the industrial level. As such, technologies measuring toxin/pollutant levels at the source will be extremely important—combatting exposures way upstream of where consumers ever engage. Certain industries face existential risk unless they can remediate toxicity/exposures.
Smart Homes & Workplaces
Humans spend nearly 90% of their time indoors, but beyond smoke detectors, there hasn’t been much innovation solving for unhealthy home environments.
Formaldehyde, for example, is in almost everything…furniture, flooring, wallpaper, carpets, candles, fireplaces, gas stoves, hair products, cosmetics, etc. Furniture goes through a process called off-gassing where chemicals they contain are released into the air over time. Because homes are highly insulated, formaldehyde gets trapped in the air and onto surfaces.
“[Formaldehyde is] holding together our built environment and also chemically corroding use at the same time.”
~ Nicholas Shapiro, Director of the Carceral Ecologies Lab at UCLA
One study tested the amount of formaldehyde found in common household items and found levels that were 13 times the EPA threshold for continuous exposure. Indoor air pollution was responsible for ~3.2 million deaths per year in 2020 according to the WHO.
Individual/Consumer-Level Tools
The initial entry point for exposome companies at the individual level will likely be within high-exposure populations like firefighters. These populations are chronically exposed to harmful chemicals, so naturally much of the innovation has been geared toward developing specific solutions for them.
Most of the existing consumer startups in this space have built wearables for air pollution monitoring: Wynd, AirBeam, Huma-i, Plume Labs, to name a few. Other companies sell everything from at-home tests for whole-body PFAS analysis to mobile apps that recommend healthier/safer food + beverage choices.
The startups below are amongst the earliest building exposome companies.
In-the-field
Sporecyte: AI-powered mold sport and air particulate analysis.
HealthSurveil: Mapping environmental exposures to prevent non-communicable diseases.
Forever Analytical Solutions: PFAS detection in the field.
Clarity: Air pollution management system.
Aprisium: On-site contaminant testing/monitoring
Bluumbio: Removing toxic chemicals from industrial waste streams
Oxyle: Nanocatalyst-based system that destroys PFAS.
Talam Biotech: Microbial soil remediation and heavy metal blocking.
Smart Homes / Workplaces
Haven: Central air monitoring system.
Lightwork: Testing homes for unhealthy light sources, excess EMFs, toxic products, etc. (Smart Homes / Workplaces)
MoldCo: Lab testing for mold in homes.
NeoPlants: Engineered houseplants removing indoor air pollutants.
PurpleAir: Measuring airborne particulate matter.
Wynd: Smoke and noise detection.
Airform: Next-gen heat pump that enhances indoor air quality and airflow based on sensor data.
Individual / Consumer
Atmo: Wearable, portable PM2.5 and VOC air quality monitor.
Cambiotics: Probiotics for PFAS detoxification.
Million Marker: Pathological services measuring exposure to environmental chemicals.
Oasis: App that analyzes water quality data from different brands.
Relentless Health: PFAS blood tests.
Yuka: App analyzing food/cosmetic products and their nutritional qualities + toxicity.
Breaking New Ground
There are inherent challenges standing in the way of the science and commercialization of exposomics. While genomic information can be readily turned into drug targets (thus “closing the loop” between diagnostic and intervention), exposome data presents a more complex challenge. Environmental exposure research is largely epidemiological, often based on observational studies. This makes it difficult for researchers to establish causal relationships—one reason why the field of exposomics is still considered "emerging.”
Nonetheless, if we can expect to see breakthroughs and businesses similar to those that followed the Human Genome Project, exposomics will become another category-defining field in science, health, and medicine—ushering in a new generation of enduring companies building at the frontier of science.
What I’m reading this week:
Is ChatGPT going to increase inequality?, American Inequality
The Business of Promoting Longevity and Healthspan, Ground Truths
Every doctor is a writer: On the end of note-writing and meaning-making in medicine, STAT