Background
In the contemporary world, chronic diseases such as hypertension, diabetes, and colitis are progressively emerging as significant global health threats. According to the World Health Organization (WHO), the prevalence of hypertension has already surpassed 1.28 billion individuals. The latest research published in The Lancet reveals that the number of people affected by diabetes has already exceeded 529 million in 2021 and is projected to surpass 1.3 billion by 2050. Simultaneously, another article published in The Lancet highlights that by 2023, an estimated five million cases of colitis will be reported worldwide with a rising global incidence rate. The escalating occurrence of these ailments imposes a substantial burden on patients and their families while also exerting a profound impact on socio-economic aspects.
Table 1 Age-standardized prevalence of hypertension among adults aged 30-79 years, and among those with hypertension, diagnosis, treatment and effective treatment coverage in 2019, by WHO region
Hypertension refers to the condition of elevated blood pressure in the blood vessels (140/90 mmHg or higher). It is highly prevalent, yet if left untreated, it can lead to severe consequences. Individuals with hypertension may be asymptomatic; thus, measuring their blood pressure is essential for diagnosis. Noteworthy facts include that as of 2021, there are approximately 1.28 billion adults aged 30-79 worldwide affected by hypertension. Alarmingly, around 46% of adult hypertensive patients remain unaware of their condition. Moreover, only 42% of diagnosed and treated adult hypertensive patients receive adequate care while a mere 21% have their condition under control. Presently, hypertension has emerged as a significant contributor to premature mortality globally. According to data provided by the World Health Organization in the table below, the global prevalence rate for individuals aged 30-79 suffering from hypertension has reached an alarming rate of 33% (Table 1).
Diabetes is a chronic condition characterized by insufficient production of insulin by the pancreas or ineffective utilization of the produced insulin within the body. Insulin, a hormone responsible for regulating blood sugar levels, plays a crucial role in maintaining overall health. Uncontrolled diabetes often leads to elevated blood glucose levels, which can progressively damage various bodily systems, particularly the nerves and blood vessels. Notably, it is worth mentioning that the global prevalence of diabetes has surged from 108 million individuals in 1980 to an alarming 529 million individuals in 2021. Moreover, diabetes significantly contributes to severe complications such as vision impairment, kidney failure, heart attacks, strokes, and lower limb amputations. Disturbingly, between 2000 and 2019 alone, deaths attributed to diabetes witnessed a distressing increase of approximately 3%. In fact, during the year 2019 itself, at least two million lives were claimed due to diabetes and its associated renal disorders.
The IDF (International Diabetes Federation) forecast, presented in the table below, indicates that the crude prevalence of diabetes among individuals aged 20-79 worldwide was estimated at 10.5% in 2021, with projected figures of 11.3% and 12.2% for 2030 and 2045 respectively. Moreover, the age-standardized prevalence of diabetes stood at 9.8% in 2021, with a projection of reaching 11.2% by the year 2045 (Table 2).
Table.2 Estimated total number of adults (20-79 years) with diabetes in 2021, 2030 and 2045
According to the IDF's projections for diabetes in 2021, there is an age-related increase in the prevalence of diabetes, and this trend is expected to persist until 2045. The lowest prevalence rate is observed among individuals aged 20-24 (2.2% in 2021); for those aged 75-79, the estimated prevalence of diabetes in 2021 is 24.0%, with a projected rise to 24.7% by 2045. Given the global population aging phenomenon, there will be a continued rise in the proportion of diabetic patients over the age of 60 (Figure 1).
Figure 1 Number of people with diabetes in adults (20-79 years) by age group in 2021 (columns) and estimated prevalence' across age groups in 2045 (black line)
Colitis is a form of inflammatory bowel disease that can significantly impact patients' lives, resulting in long-term complications. In the past decade, the rapid advancement of novel therapies has led to more stringent treatment objectives, encompassing both clinical and endoscopic remission. Research indicates that achieving mucosal healing may represent the ultimate treatment goal. Despite these advancements, remission rates in clinical trials do not surpass 20-30%, while real-life settings observe rates within the range of 30-60%. Consequently, exploring more efficacious treatment modalities remains an imperative matter to be addressed.
Colitis has emerged as a global health challenge, characterized by constantly evolving epidemiological trends. Research indicates a sharp rise in incidence rates particularly in low- and middle-income countries. The provided chart illustrates the worldwide incidence and prevalence of colitis. Notably, both men and women exhibit similar incidence rates for this condition. While the peak age of onset falls between the 20th and 40th years of life, there is an increasing number of cases among individuals aged over 60, accounting for approximately 20% of new diagnoses. This observation underscores the challenges faced by treatment plans when addressing the needs of an aging population (Figure 2).
Figure 2 Worldwide incidence and prevalence of ulcerative colitis 1990-2016
Facing these challenges, our iGEM team has decided to dedicate ourselves to this field, providing innovative solutions for the management of these diseases through synthetic biology methods.
The formation of our team is rooted in a profound comprehension of these chronic illnesses and a compassionate understanding towards the patients' experiences. During a collaborative brainstorming session, we shared personal anecdotes and observations, recognizing that hypertension, diabetes, and colitis not only significantly impact patients' quality of life but also lead to severe complications and premature mortality due to inadequate management and treatment options. These discussions ignited our interest in this field, prompting us to concentrate our research on these diseases.
Subsequently, after conducting extensive literature research and data analysis, we have acquired a comprehensive understanding of the epidemiological characteristics, pathogenic mechanisms, and social impacts associated with these chronic diseases. We have discovered that despite the medical community's existing knowledge about these diseases, there still remain numerous unresolved issues, particularly in disease prevention, early diagnosis, and personalized treatment. The presence of these challenges not only underscores the limitations of the current healthcare system but also presents ample opportunities for our research.
To tackle these challenges, our team has opted for an interdisciplinary research approach, amalgamating expertise from diverse fields including biology, medicine, engineering, and informatics to explore novel therapies for chronic diseases. We firmly believe that synthetic biology can facilitate the design and construction of innovative biological systems, offering fresh insights and tools for disease prevention, diagnosis, and treatment. Our objective is to leverage the engineering principles of synthetic biology in order to target the design, modification, testing, and application of bio-safe synbiotics (probiotics capable of producing prebiotics) - Zymomonas mobilis. This will culminate in a synbiotic therapy encompassing three modules: health preservation measures, diagnostic reporting mechanisms, and responsive treatments. By adopting this approach we aim to promote a holistic lifestyle that emphasizes both disease management during illness and body fortification during wellness while enhancing therapeutic efficacy against these ailments.