Past approaches for designing studies and evaluating collected data have tended to focus on a limited number of environmental factors and/or measures of outcome and are rarely conducted with children. The (MICA) study design represents an integrative approach in children's health research that incorporates exposure metrics, internal dose measures, clinical indicators and blood gene expression measures to decipher the biological complexity inherent in diseases with etiology related to complex gene-environment interactions. The coordinated collection of these complimentary data provides a platform for applying systems approaches to evaluate complex relationships between environmental factors, physiological biomarkers, and health outcomes. The study can be used to inform the design of future environmental health studies and facilitate the interpretation of study results for public health decision making.
The analysis of transcriptional responses in blood coupled with biomonitoring data should provide mechanistic insight into the biological pathways that are perturbed in response to single chemicals or complex mixture exposures. Bioindicators for these biological pathways can then be incorporated into future biomonitoring studies to link the biomarkers of exposure to a relevant apical endpoint.
While MICA is an asthma study, this rich data set can be explored for relationships between early indicators of cardiovascular disease, obesity, and asthma and to demonstrate the complex nature of childhood health and environmental disease. For example, a myriad of disease risk factors/modifiers often compromise the evaluation of a single disease. The risk of developing heart disease increases to over six fold  with the combination of the following three risk factors: high blood pressure, high cholesterol and diabetes. Obesity is associated with numerous co-morbidities such as cardiovascular diseases, type 2 diabetes, hypertension, and certain cancers . Metabolic syndrome as described by Wilson et al.  occurs as a constellation of obesity, hypertension, dyslipidemia, and insulin resistance leading to diabetes. MICA blood gene expression data, viewed in the context of phenotypic data relevant to asthma, cardiovascular risk, and obesity, may provide insight into exposure assessment, pathophysiology of asthma and early indications of cardiovascular disease and metabolic syndrome.
MICA provides an opportunity to pilot the application of a more holistic analytical approach to improve the interpretation of biomarker data to advance both mechanistic based toxicology and risk assessments of chemical (single, multiple, and complex mixtures) exposures. Whether and to what extent these exposures impact such a distinctive and diverse set of health outcomes such as asthma, cardiovascular disease and metabolic syndrome, are central to the MICA study objectives. Ultimately, the goal is to identify a specific and sensitive panel of molecular and traditional environmental and clinical markers from the myriad of indicators included in the MICA study design, and in doing so, gain mechanistic understanding of potential gene environment interactions that will inform design of future clinical and epidemiological studies in humans.