Inherited and somatic components in the pathogenetics of common diseases

It is known that the pathogenesis of common diseases (CDs) is determined by a complex and nonlinear interaction of genetic predisposition, epigenetic modifications, and environmental factors. However, in addition to inherited genetic variants, somatic mutations play a key role in the pathological phenotype, shaping cell-type-specific genetic landscapes and influencing regional predisposition of target organs, age of onset, and variability in clinical manifestations. Thus, according to current concepts, CDs develop as a result of the combined influence of inherited germline variants and somatic mutations acquired during life, the interaction of which is realized through cell-specific molecular networks. Therefore, this review sequentially examines the main factors, classical and modern models of complex pathological phenotypes, as well as the achievements and prospects of analyzing inherited genetic variants in relation to CDs. The role of somatic mutations in the development of pathology is discussed using the example of atherosclerosis ontogenesis and the concept of athero-oncology through the assessment of somatic genomic variability in smooth muscle cells of atherosclerotic plaques, where the sequential accumulation of "driver" mutations confers a selective advantage and triggers clonal evolution in the tissue microenvironment. Special attention is given to the concept of "paradominant" inheritance - a special form of non-Mendelian transmission of complex traits that combines inherited predisposition and somatic mutations that arise early in ontogenesis. Based on an analysis of current data, we propose an integrative hypothesis postulating that inherited genetic variants form a body-wide predisposition to CDs, while somatic mutations, arising and selectively increasing in specific cellular compartments of target organs, are critical events explaining the regional specificity, temporal dynamics (age of onset), and variability in the severity of the clinical phenotype. A new paradigm for predictive medicine for CDs is based on a comprehensive characterization of the continuum of genetic variants (inherited and somatic), an analysis of their interactions with cell-specific molecular networks, and a transition from population-based risk assessments to causal models of individual pathogenesis.