A new scientific frontier is taking shape at Mayo Clinic, where a team is addressing one of medicine’s most detailed puzzles: the exposome. Unlike the Human Genome Project, which decoded the human genetic blueprint, the exposome maps every environmental influence a person encounters throughout life—air quality, water contaminants, chemical residues, noise levels, social environments, and even artificial lighting—and examines how these factors influence health outcomes and disease development.
Konstantinos Lazaridis, M.D., who leads Mayo Clinic’s Center for Individualized Medicine, has outlined this vision in a new article published in Mayo Clinic Proceedings. He and his colleagues argue that exposome research must achieve the same level of precision and scale as genomic studies did in the early 2000s. “I believe we are entering another moment of that magnitude,” Lazaridis states.
The exposome encompasses a wide array of influences. It includes toxic substances like lead and arsenic, agricultural chemicals, microscopic plastic particles, air and water pollutants, dietary habits, physical activity levels, and social isolation. Some exposures pose clear dangers—studies have connected lead to fatty liver disease, traffic noise to atrial fibrillation, and air pollution to declining kidney function. Others may offer protective benefits, such as access to green spaces, balanced nutrition, or bioactive compounds found in beverages like coffee and tea.
Yet the exposome presents significant complexity. Exposures do not operate in isolation; they interact, accumulate over time, and often leave no direct biological trace by the moment symptoms emerge. While an individual’s genetic code remains fixed from birth, their exposome evolves continuously. “Disease doesn’t happen in a vacuum,” Lazaridis explains. “We are born with our genome, but we also live in an environment that affects how we develop, how we age and what diseases we may face.”
Mapping the exposome with AI and biology
The core challenge lies in measurement. Lazaridis directs Precure Research, an initiative designing the tools needed to track these influences systematically. By analyzing biological samples, blood, urine, stool, and saliva, they will monitor how the body responds to exposures, from heavy metals to nanoplastics. These findings will be integrated with genomic and clinical data, while artificial intelligence processes vast datasets to identify patterns across populations.
Initial investigations are focusing on heavy metals, particularly lead. Although severe exposure has been well-documented, researchers are now exploring whether prolonged exposure to lower concentrations might contribute to conditions like fatty liver disease. Geolocation data will help correlate environmental factors, such as proximity to highways or agricultural areas, with biological measurements.
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The research extends beyond disease risk assessment. By measuring chemical levels in blood, the team aims to clarify why genetic factors alone cannot always explain why patients respond differently to the same medication. For patients, the implications could be transformative. Early detection of harmful exposures, and their biological effects before symptoms appear, might enable preventive interventions before irreversible damage occurs. Lazaridis envisions a future where clinicians routinely discuss environmental factors with patients, identifying specific exposures that may impact health and recommending mitigation strategies.
From genomics to environmental health breakthroughs
This initiative builds on Lazaridis’s earlier work in genomics, which transformed medicine two decades ago. Just as the Human Genome Project unlocked new possibilities, the exposome project now seeks to open another chapter in medical science.
Detecting the Exposome’s Faintest Traces
Precure Research is developing methods to identify subtle biological changes caused by long-term exposures, even when the original exposure has disappeared. For example, prolonged exposure to nighttime artificial light, linked to Alzheimer’s disease, may disrupt circadian rhythms and brain function over years, yet its direct presence in tissues often goes undetected. By examining proteins, metabolites, and epigenetic markers in blood and urine, researchers aim to uncover these “ghost exposures,” revealing lingering effects of past environmental influences.
Translating Research into Clinical Practice
The diabetes medication study marks a critical step toward integrating exposome data into treatment decisions. Investigators are analyzing whether common chemicals, such as parabens in personal care products or phthalates in plastics, interfere with drug-metabolizing enzymes. Preliminary findings suggest these compounds may alter how quickly the body processes medications, potentially accounting for why some patients fail to respond to standard dosages. If validated, such insights could lead to exposure-adjusted prescribing, where doctors consider a patient’s chemical exposure when selecting therapies.
Uncovering hidden chemical impacts on medicine
The research team will examine additional biological markers beyond traditional toxicants. Blood, urine, stool, and saliva samples will be tested for pesticides, synthetic chemicals, and other environmental substances not yet widely studied. As analytical techniques improve, the study will also track microscopic and nanoscale plastic particles in the body.