Mayo Clinic's Precure Research Aims to Catch Disease Before Symptoms Appear

Doctors usually meet a disease late. A tumor shows up on a scan, kidney function drops, a patient develops the symptoms of heart failure, or memory lapses become hard to ignore. Mayo Clinic is betting that the biology behind those diagnoses has often been underway for years, even decades, and that medicine can learn to work in that earlier window.

The effort is called Precure Research. It aims to identify the molecular and physiological changes that occur as people move from health toward disease, and to determine whether physicians can step in before clinical symptoms develop. It starts with diseases of the brain, heart, kidneys, liver and lungs. It draws on genetic information, biological specimens, medical records, environmental exposures, wearable-device data and artificial intelligence.

Mayo points to recent findings as reasons the problem is becoming more tractable. In one large genetic study, its scientists identified inherited risks for cancer and cardiovascular disease in nearly 2,000 participants, many of whom had no prior sign they carried those risks. Other Mayo work has found precancerous changes that can be detected years before cancer develops. In Alzheimer's disease, scientists can increasingly measure biological changes that begin decades before memory problems appear.

The hard question is which of the countless biological changes in a life reliably signal that disease is starting, and which of those doctors can safely act on. The article is careful on one point: finding a signal associated with a disease is not the same as building a useful screening test. The point of the signals is to support tests that let physicians intervene early, often when a condition is easier to treat. A person might also carry a risk-linked genetic variant for a lifetime and never get sick, so researchers want to understand what happens between inherited susceptibility and illness, and when that path might change.

The project also looks beyond DNA to the exposome, the accumulated environmental and lifestyle exposures of a lifetime and their biological effects. These range from diet, exercise and sleep to pollutants, chemicals and air quality. Researchers can increasingly detect traces of some exposures in blood and other specimens and link them to genetics, clinical histories and geographic information. Pilot studies are asking whether long-term air-pollution exposure affects outcomes after solid-organ transplant, and whether environmental chemicals change how the body processes medications. Another is testing saliva-based biosensors for biological changes tied to triggers of head and neck cancers.

The infrastructure is large. Mayo says Precure ultimately aims to build its largest integrated collection of biological specimens and scientific and health data through Mayo Clinic Platform, tying what is found in a blood or tissue sample to molecular measurements, exposures and years of clinical history. It will use existing systems including Digital Pathology, Mayo Clinic Platform and Research Data Atlas. AI is central because the possible relationships among genetic variants, proteins, records, imaging, environmental measurements and wearable readings exceed what people can examine by hand. The resources are meant to support research on biomarkers, diagnostics, therapeutics, clinical trial strategies and new clinical tools.

Mayo frames this as a continuation of more than 160 years of change, including the group practice of medicine and the longitudinal medical record. Where the record let physicians see a patient's history across years, Precure hopes to see the biological history beneath it. That depends on patients who contribute information and specimens over time.

Vijay Shah, M.D., Mayo's Kinney executive dean of research, said research and practice at Mayo are intertwined and must serve the patient first. Heidi Dieter, the chief research administrator, said the shift could change the relationship between patients and the health system: "We're not just treating disease anymore. We're partnering with people throughout their entire life journey."

The longer goal is prevention and what Mayo calls healthspan, the years lived in good health. Researchers will study processes such as inflammation, aging and metabolic dysfunction that cut across specialties, since heart failure, kidney disease and dementia may share pathways years before diagnosis. The test will be whether Precure can show not just who is likely to get sick, but when risk becomes actionable and which intervention changes the course. The pilot studies are the first place to watch.