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Rodriguez-Mañas L, Araujo de Carvalho I, Bhasin S, Bischoff-Ferrari HA, Cesari M, Evans W, Hare JM, Pahor M, Parini A, Rolland Y, Fielding RA, Walston J, Vellas B. ICFSR Task Force Perspective on Biomarkers for Sarcopenia and Frailty. J Frailty Aging 2020; 9:4-8. [PMID: 32150207 DOI: 10.14283/jfa.2019.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Biomarkers of frailty and sarcopenia are essential to advance the understanding of these conditions of aging and develop new diagnostic tools and effective treatments. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force - a group of academic and industry scientists from around the world -- met in February 2019 to discuss the current state of biomarker development for frailty and sarcopenia. The D3Cr dilution method, which assesses creatinine excretion as a biochemical measure of muscle mass, was suggested as a more accurate measure of functional muscle mass than assessment by dual energy x-ray absorptiometry (DXA). Proposed biomarkers of frailty include markers of inflammation, the hypothalamic-pituitary-adrenal (HPA) axis response to stress, altered glucose insulin dynamics, endocrine dysregulation, aging, and others, acknowledging the complex multisystem etiology that contributes to frailty. Lack of clarity regarding a regulatory pathway for biomarker development has hindered progress; however, there are currently several international efforts to develop such biomarkers as tools to improve the treatment of individuals presenting these conditions.
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Nomura Y, Nakano M, Bush B, Tian J, Yamaguchi A, Walston J, Hasan R, Zehr K, Mandal K, LaFlam A, Neufeld KJ, Kamath V, Hogue CW, Brown CH. Observational Study Examining the Association of Baseline Frailty and Postcardiac Surgery Delirium and Cognitive Change. Anesth Analg 2020; 129:507-514. [PMID: 30540612 DOI: 10.1213/ane.0000000000003967] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Frailty is a geriatric syndrome thought to identify the most vulnerable older adults, and morbidity and mortality has been reported to be higher for frail patients after cardiac surgery compared to nonfrail patients. However, the cognitive consequences of frailty after cardiac surgery have not been well described. In this study, we examined the hypothesis that baseline frailty would be associated with postoperative delirium and cognitive change at 1 and 12 months after cardiac surgery. METHODS This study was nested in 2 trials, each of which was conducted by the same research team with identical measurement of exposures and outcomes. Before surgery, patients were assessed with the validated "Fried" frailty scale, which evaluates 5 domains (shrinking, weakness, exhaustion, low physical activity, and slowed walking speed) and classifies patients as nonfrail, prefrail, and frail. The primary outcome was postoperative delirium during hospitalization, which was assessed using the Confusion Assessment Method, Confusion Assessment Method for the Intensive Care Unit, and validated chart review. Neuropsychological testing was a secondary outcome and was generally performed within 2 weeks of surgery and then 4-6 weeks and 1 year after surgery, and the outcome of interest was change in composite Z-score of the test battery. Associations were analyzed using logistic and linear regression models, with adjustment for variables considered a priori (age, gender, race, education, and logistic European System for Cardiac Operative Risk Evaluation). Multiple imputation was used to account for missing data at the 12-month follow-up. RESULTS Data were available from 133 patients with baseline frailty assessments. Compared to nonfrail patients (13% delirium incidence), the incidence of delirium was higher in prefrail (48% delirium incidence; risk difference, 35%; 95% CI, 10%-51%) and frail patients (48% delirium incidence; risk difference, 35%; 95% CI, 7%-53%). In both univariable and multivariable models, the odds of delirium were significantly higher for prefrail (adjusted odds ratio, 6.43; 95% CI, 1.31-31.64; P = .02) and frail patients (adjusted odds ratio, 6.31; 95% CI, 1.18-33.74; P = .03) compared to nonfrail patients. The adjusted decline in composite cognitive Z-score was greater from baseline to 1 month only in frail patients compared to nonfrail patients. By 1 year after surgery, there were no differences in the association of baseline frailty with change in cognition. CONCLUSIONS Compared to nonfrail patients, both prefrail and frail patients were at higher risk for the primary outcome of delirium after cardiac surgery. Frail patients were also at higher risk for the secondary outcome of greater decline in cognition from baseline to 1 month, but not baseline to 1 year, after surgery.
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Affiliation(s)
- Yohei Nomura
- From the Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsunori Nakano
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian Bush
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Atsushi Yamaguchi
- From the Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | | | - Kenton Zehr
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kaushik Mandal
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew LaFlam
- School of Medicine, Tufts University, Medford, Massachusetts
| | | | - Vidyulata Kamath
- Division of Medical Psychology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles W Hogue
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles H Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Sonsin-Diaz N, Gottesman RF, Fracica E, Walston J, Windham BG, Knopman DS, Walker KA. Chronic Systemic Inflammation Is Associated With Symptoms of Late-Life Depression: The ARIC Study. Am J Geriatr Psychiatry 2020; 28:87-98. [PMID: 31182350 PMCID: PMC6868307 DOI: 10.1016/j.jagp.2019.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The current study examined how the pattern of systemic inflammation in the decades leading up to late-life relates to depression symptoms in older adults. METHODS Within the Atherosclerosis Risk in Communities Study, we measured high-sensitivity C-reactive protein (CRP), a nonspecific marker of systemic inflammation, at three visits: 21 years and 14 years before, and concurrent with the assessment of depression symptoms, defined using the 11-item Center for Epidemiologic Studies Depression (CESD) scale. We categorized participants into one of four groups based on their 21-year longitudinal pattern of elevated (≥3 mg/L) versus low (<3 mg/L) CRP (stable low; unstable low; unstable elevated; stable elevated). Analyses excluded participants with suspected depression during midlife. RESULTS A total of 4,614 participants were included (age at CESD assessment: 75.5 [SD: 5.1]; 59% female; follow-up time: 20.7 years [SD: 1.0]). Compared to participants who maintained low CRP levels (stable low), participants who had elevated CRP at two of three visits (unstable elevated; ß = 0.09; 95% confidence interval [CI]: 0.02, 0.17) and participants who maintained elevated CRP at all three visits (stable elevated; ß = 0.13; 95% CI: 0.05, 0.21) had greater depression symptoms as older adults, after adjusting for confounders. After excluding participants with late-life cognitive impairment, only participants with stable elevated CRP demonstrated significantly greater late-life depression symptoms. In a secondary analysis, stable elevated CRP was associated with increased risk for clinically significant late-life depression symptoms. CONCLUSION Chronic or repeated inflammation in the decades leading up to older adulthood is associated with late-life depression, even in the context of normal cognition.
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Affiliation(s)
| | - Rebecca F Gottesman
- Departments of Neurology and Epidemiology (RFG), Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology (JW), Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - B Gwen Windham
- Department of Medicine (BGW), Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS
| | | | - Keenan A Walker
- Department of Neurology (KAW), Johns Hopkins University School of Medicine, Baltimore, MD.
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Walker KA, Walston J, Gottesman RF, Kucharska-Newton A, Palta P, Windham BG. Midlife Systemic Inflammation Is Associated With Frailty in Later Life: The ARIC Study. J Gerontol A Biol Sci Med Sci 2019. [PMID: 29534173 DOI: 10.1093/gerona/gly045] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Evidence suggests that systemic inflammation may have a mechanistic role in age-related frailty, yet prospective data is limited. We examined whether systemic inflammation during midlife was associated with late-life frailty within the community-based Atherosclerosis Risk in Communities Study. METHODS Plasma levels of four inflammatory markers (fibrinogen, von Willebrand factor, and Factor VIII, and white blood cell count) were measured during Visit 1 (1987-1989; mean age: 52 [5]), standardized into z-scores, and combined to create an inflammation composite score. High-sensitivity C-reactive protein (CRP) was measured 3 (Visit 2, 1990-1992) and 9 (Visit 4, 1996-1999) years later. Frailty was evaluated in 5,760 participants during late life (Visit 5, 2011-2013; mean age: 75 [5]). Analyses were adjusted for demographic and physiological variables, and midlife medical comorbidity using logistic regression. RESULTS A 1 SD increase in midlife inflammation composite score was associated with higher odds of frailty 24 years later (odds ratio [OR] = 1.39, 95% confidence interval [CI]: 1.18-1.65). Similarly, each standard deviation increase in Visit 2 CRP (OR = 1.24, 95% CI: 1.09-1.40) and Visit 4 CRP (OR = 1.35, 95% CI: 1.19-1.53) was associated with a higher odds of frailty 21 and 15 years later. Participants who maintained elevated CRP (≥3 mg/L) at Visits 2 and 4 or transitioned to a state of elevated CRP during this period were more likely to subsequently meet frailty criteria compared to those who maintained low CRP. These associations were stronger among white, compared to African American, participants (p-interactions < .038). CONCLUSIONS Systemic inflammation during midlife may independently promote pathophysiological changes underlying frailty in a subset of the population.
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Affiliation(s)
- Keenan A Walker
- Department of Neurology, Center on Aging and Health, Baltimore, MD
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Center on Aging and Health, Baltimore, MD
| | - Rebecca F Gottesman
- Department of Neurology, Center on Aging and Health, Baltimore, MD.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Priya Palta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - B Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson
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Westbrook R, Chung T, Lovett J, Ward C, Khadeer M, Moaddel R, Walston J, Abadir P. ALTERED TRYPTOPHAN DEGRADATION LINKS CHRONIC INFLAMMATION TO FUNCTIONAL DECLINE & FRAILTY IN MICE AND HUMANS. Innov Aging 2019. [PMCID: PMC6845122 DOI: 10.1093/geroni/igz038.3473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chronic inflammation is associated with frailty and functional decline in older adults but the molecular mechanisms of this linkage are not well understood. We sought to examine metabolic and physiologic states associated with aging and frailty by analyzing the composition of metabolites in the blood of a population of community dwelling young, and older adults. Serum inflammatory cytokines and demographic and physiological covariates were collected in a set of community-dwelling adults age 20-97 (n=166). We then used LC/MS technology to profile 121 metabolites from five substance classes. Associations of the cytokines and metabolites with grip strength, walking speed, falls and outcomes were assessed in young, robust, pre-frail and frail participants. Age and frailty status positively correlated with IL6, TNFα, TNFαR1, IL1β (p<0.0001). Analysis of metabolites revealed significant alterations in tryptophan degradation pathway with aging and frailty. Among the top metabolites to correlate with age and frailty status were kynurenine (p<0.0001) and the kynurenine/tryptophan ratio (p<0.0001). The kynurenine/tryptophan ratio also tightly correlated with serum inflammatory cytokines TNFαR1 (p<0.0001) and IL-6 (p<0.0001). Higher kynurenine/tryptophan levels were associated with weaker grip strength and slower walking speed, even after adjusting for age, gender, BMI and blood pressure. Further dissection of the pathway revealed the accumulation of 3-hydroxykynurenine, a cytotoxic and neurotoxic intermediate from the kynurenine pathway, with frailty. The increased levels of cytotoxic and neurotoxic molecules in this pathway may in part explain the link between inflammation and cognitive and physical decline in frailty.
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Affiliation(s)
- Reyhan Westbrook
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Tae Chung
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jacqueline Lovett
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States
| | - Chris Ward
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Mohammed Khadeer
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States
| | - Ruin Moaddel
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States
| | - Jeremy Walston
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Peter Abadir
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Roth DL, Haley W, Sheehan O, Walston J, Rhodes D, Howard V. DESIGNING FAMILY CAREGIVER STUDIES THAT BALANCE STRESS PROCESS AND HELPING RELATIONSHIP PERSPECTIVES. Innov Aging 2019. [PMCID: PMC6844830 DOI: 10.1093/geroni/igz038.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Family caregiving is often characterized as a chronically stressful situation, and stress process models have been the dominant conceptual foundation underlying caregiving studies for decades. Recently, this perspective has been augmented with more positive views that emphasize potentially healthy and prosocial aspects of caregiving. Replicated findings from population-based studies show that caregivers have lower mortality rates than noncaregivers, consistent with the more balanced conceptual approach. The Caregiving Transitions Study is investigating 251 participants who transitioned into a caregiving role at some point between two blood samples taken 10 years apart in a national epidemiological study and 251 matched controls. Preliminary analyses confirm that caregiving leads to increased psychological distress. Ongoing analyses are examining changes in inflammatory biomarkers, health status, and positive aspects of caregiving. Findings will be examined alongside our recent meta-analysis of convenience samples that found caregiving to have small and inconsistent relationships with biomarkers of inflammation and immunity.
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Affiliation(s)
- David L Roth
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - William Haley
- University of South Florida, Tampa, Florida, United States
| | - Orla Sheehan
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Jeremy Walston
- Johns Hopkins University, Baltimore, Maryland, United States
| | - David Rhodes
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Virginia Howard
- University of Alabama at Birmingham, Birmingham, Alabama, United States
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Walston J, Bandeen‐Roche K, Ferrucci L. Reply to From Frailty to Gerastenia. J Am Geriatr Soc 2019; 67:2210-2211. [DOI: 10.1111/jgs.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine Baltimore Maryland
| | - Karen Bandeen‐Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health Baltimore Maryland
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Gross AL, Walker KA, Moghekar A, Pettigrew C, Soldan A, Albert MS, Walston J. P2-550: PLASMA MEASURES OF INFLAMMATION ASSOCIATED WITH CLINICAL PROGRESSION AND COGNITIVE DECLINE DURING PRECLINICAL AD. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alden L. Gross
- Aging and Health; Johns Hopkins Center on Aging and Health (COAH); Baltimore MD USA
- Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | | | | | | | - Anja Soldan
- Johns Hopkins University School of Medicine; Baltimore MD USA
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Walker KA, Gross AL, Moghekar A, Soldan A, Pettigrew C, Hou X, Lu H, Alfini AJ, Bilgel M, Miller M, Albert MS, Walston J. P3-333: SYSTEMIC INFLAMMATION, SELECTIVE DEGRADATION OF LARGE-SCALE FUNCTIONAL BRAIN NETWORKS, AND AMYLOID DEPOSITION. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Alden L. Gross
- Johns Hopkins Center on Aging and Health; Baltimore MD USA
- Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | | | - Anja Soldan
- Johns Hopkins University School of Medicine; Baltimore MD USA
| | | | - Xirui Hou
- Johns Hopkins University; Baltimore MD USA
| | | | | | - Murat Bilgel
- National Institute on Aging; NIH; Baltimore MD USA
| | - Michael Miller
- Johns Hopkins University Whiting School of Engineering; Baltimore MD USA
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Walston J, Bandeen-Roche K, Buta B, Bergman H, Gill TM, Morley JE, Fried LP, Robinson TN, Afilalo J, Newman AB, López-Otín C, De Cabo R, Theou O, Studenski S, Cohen HJ, Ferrucci L. Moving Frailty Toward Clinical Practice: NIA Intramural Frailty Science Symposium Summary. J Am Geriatr Soc 2019; 67:1559-1564. [PMID: 31045254 DOI: 10.1111/jgs.15928] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/27/2019] [Accepted: 03/19/2019] [Indexed: 01/25/2023]
Abstract
Frailty has long been an important concept in the practice of geriatric medicine and in gerontological research, but integration and implementation of frailty concepts into clinical practice in the United States has been slow. The National Institute on Aging (NIA) Intramural Research Program and the Johns Hopkins Older Americans Independence Center sponsored a symposium to identify potential barriers that impede the movement of frailty into clinical practice and to highlight opportunities to facilitate the further integration of frailty into clinical practice. Primary and subspecialty care providers, and investigators working to integrate and translate new biological aging knowledge into more specific preventive and treatment strategies for frailty provided the meeting content. Recommendations included a call for more specific language that clarifies conceptual differences between frailty definitions and measurement tools; the development of randomized controlled trials to test whether specific intervention strategies for a variety of conditions differently affect frail and non-frail individuals; development of implementation studies and therapeutic trials aimed at tailoring care as a function of pragmatic frailty markers; the use of deep learning and dynamic systems approaches to improve the translatability of findings from epidemiological studies; and the incorporation of advances in aging biology, especially focused on mitochondria, stem cells, and senescent cells, toward the further development of biologically targeted intervention and prevention strategies that can be used to treat or prevent frailty. J Am Geriatr Soc 67:1559-1564, 2019.
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Affiliation(s)
- Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian Buta
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Thomas M Gill
- Department of Geriatric Medicine, Yale University, New Haven, Connecticut
| | - John E Morley
- Division of Geriatrics, St. Louis University, St. Louis, Missouri
| | - Linda P Fried
- Mailman School of Public Health Columbia University, New York, New York
| | | | - Jonathan Afilalo
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlos López-Otín
- Biochemistry and Molecular Biology at the University of Oviedo, Oviedo, Spain
| | - Rafa De Cabo
- National Institute of Health, Baltimore, Maryland
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
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61
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Affiliation(s)
- Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
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62
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Milucky J, Carvalho MDG, Rouphael N, Bennett NM, Talbot HK, Harrison LH, Farley MM, Walston J, Pimenta F, Lessa FC. Streptococcus pneumoniae colonization after introduction of 13-valent pneumococcal conjugate vaccine for US adults 65 years of age and older, 2015-2016. Vaccine 2019; 37:1094-1100. [PMID: 30685247 DOI: 10.1016/j.vaccine.2018.12.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Vaccination of children with 13-valent pneumococcal conjugate vaccine (PCV13) led to declines in vaccine-type pneumococcal nasopharyngeal carriage among adults through indirect effects. In August 2014, PCV13 immunization of all U.S. adults ≥65 years of age was recommended. This study sought to define prevalence and serotype distribution of pneumococcal carriage among adults ≥65 years of age and to describe risk factors for colonization soon after introduction of PCV13 in adults. METHODS A cross-sectional survey of non-institutionalized U.S. adults ≥65 years of age was conducted in four states in 2015-2016. Demographic information, risk factors for disease, PCV13 vaccination history, and nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected. NP and OP swabs were processed separately and pneumococcal isolates were serotyped by Quellung reaction. Antimicrobial susceptibility of pneumococcal isolates was performed. NP swabs also underwent real-time PCR for pneumococcal detection and serotyping. RESULTS Of 2989 participants, 45.3% (1354/2989) had been vaccinated with PCV13. Fifty-five (1.8%) carried pneumococcus (45 identified by culture and 10 by real-time PCR only) and PCV13 serotypes were found in eight (0.3%) participants. Almost half (22/45) of pneumococcal isolates were not susceptible to at least one of the antibiotics tested. Vaccine-type carriage among vaccinated and unvaccinated individuals was similar (0.2% vs. 0.1%, respectively). Respiratory symptoms were associated with higher odds of pneumococcal colonization (adjusted OR: 2.1; 95% CI = 1.1-3.8). CONCLUSIONS Pneumococcal carriage among non-institutionalized adults ≥65 years of age was very low. Less than 0.5% of both vaccinated and unvaccinated individuals in our study carried vaccine-type serotypes. Over a decade of PCV vaccination of children likely led to indirect effects in adults. However, given the low vaccine-type carriage rates we observed in an already high PCV13 adult coverage setting, it is difficult to attribute our findings to the direct versus indirect effects of PCV13 on adult carriage.
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Affiliation(s)
- Jennifer Milucky
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia.
| | - Maria de Gloria Carvalho
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia
| | - Nadine Rouphael
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia; Hope Clinic of the Emory Vaccine Center, Emory University, Decatur, Georgia
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Department of Medicine, Rochester, New York
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monica M Farley
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine
| | - Fabiana Pimenta
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia
| | - Fernanda C Lessa
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia.
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Westbrook R, Le A, Lovett J, Khadeer M, Ferrucci L, Moaddel R, Walston J, Abadir P. ALTERED FRAILTY METABOLOME LINKS CHRONIC INFLAMMATION TO FUNCTIONAL DECLINE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Westbrook
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, Baltimore, Maryland, United States
| | - A Le
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J Lovett
- Bioanalytical Chemistry and Drug Discovery Section, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - M Khadeer
- Bioanalytical Chemistry and Drug Discovery Section, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - L Ferrucci
- Bioanalytical Chemistry and Drug Discovery Section, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - R Moaddel
- Bioanalytical Chemistry and Drug Discovery Section, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - J Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - P Abadir
- Bioanalytical Chemistry and Drug Discovery Section, National Institute on Aging, National Institutes of Health, Baltimore, MD
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Ma L, Westbrook R, Davalos M, Yang H, Walston J, Abadir P. CIRCULATING CELL-FREE APOPTOTIC MITOCHONDRIAL DNA FRAGMENTS IN FRAIL OLD ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Ma
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, USA, Baltimore, Maryland, United States
| | - R Westbrook
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Davalos
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine
| | - H Yang
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - P Abadir
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
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Melzer D, Walston J, Kuchel GA. MECHANISMS UNDERLYING PHYSICAL FRAILTY IN HUMANS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Melzer
- University of Exeter Medical School & University of Connecticut Health Center, Exeter,Engl
| | - J Walston
- Johns Hopkins School of Medicine, Baltimore, Maryl
| | - G A Kuchel
- University of Connecticut, Farmington, Connecticut
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66
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Bywaters SM, Brendle SA, Biryukov J, Wang JW, Walston J, Milici J, Roden RB, Meyers C, Christensen ND. Production and characterization of a novel HPV anti-L2 monoclonal antibody panel. Virology 2018; 524:106-113. [PMID: 30170240 DOI: 10.1016/j.virol.2018.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
The major capsid protein of HPV, L1, assembles into pentamers that form a T = 7 icosahedral particle, but the location of the co-assembled minor capsid protein, L2, remains controversial. Several researchers have developed useful monoclonal antibodies targeting L2, but most react with linear epitopes toward the N-terminus. As a means to better define the virus capsid and better assess the localization and exposure of L2 epitopes in the context of assembled HPV, we have developed a panel of 30 monoclonal antibodies (mAbs) which target the N-terminus of L2 amino acids 11-200, previously defined as a broadly protective immunogen. Select mAbs were processed with enzymes and anti-L2 Fabs were generated. These new mAb/Fab probes will be beneficial in future studies to unravel the placement of L2 and to help better define the role of L2 in the HPV lifecycle and the nature of the broadly protective epitopes.
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Affiliation(s)
- S M Bywaters
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - S A Brendle
- Jake Gittlen Laboratories for Cancer Research, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - J Biryukov
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - J W Wang
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
| | - J Walston
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - J Milici
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - R B Roden
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
| | - C Meyers
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - N D Christensen
- Jake Gittlen Laboratories for Cancer Research, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
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Abstract
Frailty is recognized as a cornerstone of geriatric medicine. It increases the risk of geriatric syndromes and adverse health outcomes in older and vulnerable populations. Although multiple screening instruments have been developed and validated to improve feasibility in clinical practice, frequent lack of agreement between frailty instruments has slowed broad implementation of these tools. Despite this, interventions to improve frailty-related health outcomes developed to date include exercise, nutrition, multicomponent interventions, and individually tailored geriatric care models. Possible strategies to prevent frailty include lifestyle or behavioral interventions, proper nutrition, and increased activity levels and social engagement.
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Affiliation(s)
- Jeremy Walston
- Johns Hopkins University Older Americans Independence Center, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 1A.62, Baltimore, MD 21224, USA.
| | - Brian Buta
- Johns Hopkins University Older Americans Independence Center, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 1A.62, Baltimore, MD 21224, USA
| | - Qian-Li Xue
- Johns Hopkins University Older Americans Independence Center, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 1A.62, Baltimore, MD 21224, USA
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68
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Wang J, Chen Z, Walston J, Gao P, Gao M, Leng SX. α-Synuclein activates innate immunity but suppresses interferon-γ expression in murine astrocytes. Eur J Neurosci 2018; 48:10.1111/ejn.13956. [PMID: 29779267 PMCID: PMC6949420 DOI: 10.1111/ejn.13956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/22/2023]
Abstract
Glial activation and neuroinflammation contribute to pathogenesis of neurodegenerative diseases, linked to neuron loss and dysfunction. α-Synuclein (α-syn), as a metabolite of neuron, can induce microglia activation to trigger innate immune response. However, whether α-syn, as well as its mutants (A53T, A30P, and E46K), induces astrocyte activation and inflammatory response is not fully elucidated. In this study, we used A53T mutant and wild-type α-syns to stimulate primary astrocytes in dose- and time-dependent manners (0.5, 2, 8, and 20 μg/ml for 24 hr or 3, 12, 24, and 48 hr at 2 μg/ml), and evaluated activation of several canonical inflammatory pathway components. The results showed that A53T mutant or wild-type α-syn significantly upregulated mRNA expression of toll-like receptor (TLR)2, TLR3, nuclear factor-κB and interleukin (IL)-1β, displaying a pattern of positive dose-effect correlation or negative time-effect correlation. Such upregulation was confirmed at protein levels of TLR2 (at 20 μg/ml), TLR3 (at most doses), and IL-1β (at 3 hr) by western blotting. Blockage of TLR2 other than TLR4 inhibited TLR3 and IL-1β mRNA expressions. By contrast, interferon (IFN)-γ was significantly downregulated at mRNA, protein, and protein release levels, especially at high concentrations of α-syns or early time-points. These findings indicate that α-syn was a TLRs-mediated immunogenic agent (A53T mutant stronger than wild-type α-syn). The stimulation patterns suggest that persistent release and accumulation of α-syn is required for the maintenance of innate immunity activation, and IFN-γ expression inhibition by α-syn suggests a novel immune molecule interaction mechanism underlying pathogenesis of neurodegenerative diseases.
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Affiliation(s)
- Jintang Wang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing, China
| | - Zheng Chen
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing, China
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peisong Gao
- Johns Hopkins Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maolong Gao
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing, China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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69
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Abadir P, Ko F, Marx R, Powell L, Kieserman E, Yang H, Walston J. Co-Localization of Macrophage Inhibitory Factor and Nix in Skeletal Muscle of the Aged Male Interleukin 10 Null Mouse. J Frailty Aging 2018; 6:118-121. [PMID: 28721426 DOI: 10.14283/jfa.2017.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Chronic inflammation is associated with muscle weakness and frailty in older adults. The antagonistic cross-talk between macrophage migration inhibitory factor (Mif), an anti-apoptotic cytokine and NIP3-like protein X (Nix), a pro-apoptotic mitochondrial protein, may play a role in mitochondrial free radical homeostasis and inflammatory myopathies. We examined Nix-Mif interaction in inflammation and aging using young and old, IL-10tm/tm (a rodent model of chronic inflammation) and C57BL/6 mice. In this study, we observed that Nix and Mif were co-localized in skeletal muscles of aged and inflamed mice. We show an inflammation- and age-related association between Nix and Mif gene expression, with the strongest positive correlation observed in old IL-10tm/tm skeletal muscles. The IL-10tm/tm skeletal muscles also had the highest levels of oxidative stress damage. These observations suggest that Nix-Mif cross-talk may play a role in the interface between chronic inflammation and oxidative stress in aging skeletal muscles.
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Affiliation(s)
- P Abadir
- Peter Abadir, MD, Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Rm 1A-62, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA,
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70
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Thomaier L, Tian J, Wallace R, Walston J, Bandeen-Roche K, Chen C. 35: Pelvic organ prolapse and frailty: A subanalysis of the women’s health initiative hormone therapy clinical trial. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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71
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Abadir P, Hosseini S, Faghih M, Ansari A, Lay F, Smith B, Beselman A, Vuong D, Berger A, Tian J, Rini D, Keenahan K, Budman J, Inagami T, Fedarko N, Marti G, Harmon J, Walston J. Topical Reformulation of Valsartan for Treatment of Chronic Diabetic Wounds. J Invest Dermatol 2018; 138:434-443. [PMID: 29078982 PMCID: PMC10941026 DOI: 10.1016/j.jid.2017.09.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
Chronic wounds are among the most devastating and difficult to treat consequences of diabetes. Dysregulation of the skin renin-angiotensin system is implicated in abnormal wound healing in diabetic and older adults. Given this, we sought to determine the effects of topical reformulations of the angiotensin type 1 receptor blockers losartan and valsartan and the angiotensin-converting enzyme inhibitor captopril on wound healing in diabetic and aged mice with further validation in older diabetic pigs. The application of 1% valsartan gel compared with other tested formulations and placebo facilitated and significantly accelerated closure time and increased tensile strength in mice, and was validated in the porcine model. One percent of valsartan gel-treated wounds also exhibited higher mitochondrial content, collagen deposition, phosphorylated mothers against decapentaplegic homologs 2 and 3 and common mothers against decapentaplegic homolog 4, alpha-smooth muscle actin, CD31, phospho-vascular endothelial growth factor receptor 2, and p42/44 mitogen-activated protein kinase. Knockout of the angiotensin subtype 2 receptors abolished the beneficial effects of angiotensin type 1 receptor blockers, suggesting a role for angiotensin subtype 2 receptors in chronic wound healing.
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Affiliation(s)
- Peter Abadir
- Division of Geriatrics Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Sayed Hosseini
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mahya Faghih
- Division of Geriatrics Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amir Ansari
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frank Lay
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Barbara Smith
- Cell Biology Imaging Facility, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aleksandra Beselman
- Investigational Drug Service Pharmacy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Diep Vuong
- Division of Geriatrics Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alan Berger
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Rini
- Art as Applied to Medicine, Division of Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Keenahan
- Department of Bioengineering Innovation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua Budman
- Department of Bioengineering Innovation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tadashi Inagami
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Neal Fedarko
- Division of Geriatrics Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guy Marti
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Clinique Saint Jean, Melun, France
| | - John Harmon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeremy Walston
- Division of Geriatrics Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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72
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Westbrook RM, Yang HL, Langdon JM, Roy CN, Kim JA, Choudhury PP, Xue QL, di Francesco A, de Cabo R, Walston J. Aged interleukin-10tm1Cgn chronically inflamed mice have substantially reduced fat mass, metabolic rate, and adipokines. PLoS One 2017; 12:e0186811. [PMID: 29267271 PMCID: PMC5739384 DOI: 10.1371/journal.pone.0186811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/06/2017] [Indexed: 12/11/2022] Open
Abstract
Interleukin 10tm1Cgn (IL 10tm) mice have been utilized as a model of chronic inflammation and declining health span because of their propensity to develop chronic activation in NFkB pathways, skeletal muscle and cardiac changes, and mitochondrial dysfunction. We hypothesized that older IL 10tm frail mice would have alterations similar to frail, older humans in measured parameters of glucose metabolism, oxygen consumption (VO2), respiratory quotient (RQ), spontaneous locomotor activity, body composition and plasma adipokine levels. To test this hypothesis, we investigated these metabolic parameters in cohorts of 3, 10, and 20 month old IL 10tm female mice and age and gender matched C57Bl/6 mice. Insulin sensitivity, glucose homeostasis, locomotor activity and RQ were not significantly altered between the two strains of mice. Interestingly, old IL 10tm mice had significantly decreased VO2 when normalized by lean mass, but not when normalized by fat mass or the lean/fat mass ratio. NMR based body composition analysis and dissection weights show that fat mass is decreased with age in IL 10tm mice compared to controls. Further, plasma adiponectin and leptin were also decreased in IL 10tm.These findings suggest that frailty observed in this mouse model of chronic inflammation may in part be driven by alterations in fat mass, hormone secretion and energy metabolism.
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Affiliation(s)
- Reyhan M Westbrook
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Huan Le Yang
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jackie M Langdon
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Cindy N Roy
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jin A Kim
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Parichoy P Choudhury
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Andrea di Francesco
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States of America
| | - Rafa de Cabo
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States of America
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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73
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Cushman M, Jones D, Lange LA, Hindorff LA, Rice K, Jenny NS, Durda JP, Walston J, Carlson CS, Nickerson D, Tracy RP, Reiner AP, Carty CL. Associations between common fibrinogen gene polymorphisms and cardiovascular disease in older adults. Thromb Haemost 2017; 99:388-95. [DOI: 10.1160/th07-08-0523] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryElevated plasma fibrinogen is a risk factor for cardiovascular disease (CVD), but associations between fibrinogen single nucleotide polymorphisms (SNPs) and disease risk are inconsistent. We investigated whether common (≥ 5% minor allele frequency) variation in the fibrinogen genes (FGA, FGB, FGG) is associated with fibrinogen concentration, carotid artery intima-medial thickness (IMT) and risk of incident myocardial infarction (MI), ischemic stroke and CVD mortality in European-(EA) and African-descent (AA) adults (≥ 65 years) from the Cardiovascular Health Study. TagSNPs were genotyped in 3,969 EA and 719 AA free of MI or stroke at baseline. Race-specific models included multiple testing correction and adjustment for sex, age and site. Among EA, minor alleles of FGA3807,FGB1437 and FGG902 were associated with higher fibrinogen levels; whereas FGA251, FGA2224, FGA6534 and FGG10034 were associated with lower levels, p<0.004 for each. Strongest associations were seen for FGB1437;each additional copy of the minor allele was associated with 13 mg/dl (95%CI: 9–16) higher fibrinogen level. Similar trends in AA were not significant. Fibrinogen haplotypes were not significantly associated with internal or common carotid IMT. No associations with MI or CVD mortality were seen in EA, though FGB1038 and FGG902 were significantly associated with increased and decreased risk of stroke in men, respectively, as were related haplotypes. FGB1038 was also associated with CVD mortality in AA, HR=1.9 (95%CI: 1.3–2.7). In conclusion, while fibrinogen genetic variation was strongly associated with fibrinogen levels, there was less evidence of association with the more complex outcomes of IMT and CVD events.
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74
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Walston J, Robinson TN, Zieman S, Eldadah BA, McFarland F, Carpenter CR, Althoff KN, Andrew MK, Blaum CS, Brown PJ, Buta B, Ely EW, Ferrucci L, High KP, Kritchevsky SB, Rockwood K, Schmader KE, Sierra F, Sink KM, Varadhan R, Hurria A. Integrating Frailty Research into the Medical Specialties-Report from a U13 Conference. J Am Geriatr Soc 2017; 65:2134-2139. [PMID: 28422280 PMCID: PMC5641231 DOI: 10.1111/jgs.14902] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although the field of frailty research has expanded rapidly, it is still a nascent concept within the clinical specialties. Frailty, conceptualized as greater vulnerability to stressors because of significant depletion of physiological reserves, predicts poorer outcomes in several medical specialties, including cardiology, human immunodeficiency virus care, and nephrology, and in the behavioral and social sciences. Lack of a consensus definition, proliferation of measurement tools, inadequate understanding of the biology of frailty, and lack of validated clinical algorithms for frail individuals hinders incorporation of frailty assessment and frailty research into the specialties. In 2015, the American Geriatrics Society, the National Institute on Aging (NIA), and the Alliance for Academic Internal Medicine held a conference for awardees of the NIA-sponsored Grants for Early Medical/Surgical Specialists Transition into Aging Research program to review the current state of knowledge regarding frailty in the subspecialties and to highlight examples of integrating frailty research into the medical specialties. Research questions to advance frailty research into specialty medicine are proposed.
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Affiliation(s)
- Jeremy Walston
- Division of Geriatric Medicine and Frailty, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Susan Zieman
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging/National Institutes of Health, Bethesda, MD
| | - Basil A. Eldadah
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging/National Institutes of Health, Bethesda, MD
| | | | - Christopher R. Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Keri N Althoff
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa K. Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Caroline S. Blaum
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University, New York, NY
| | - Patrick J. Brown
- Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
- Program on Healthy Aging and Late Life Brain Disorders, Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY
| | - Brian Buta
- Center on Aging and Health, John Hopkins University, Baltimore, MD
| | - E. Wesley Ely
- Division of Pulmonary and Critical Care and Health Services Research, Vanderbilt University and VA Geriatric Research Education Clinical Center (GRECC), Nashville, TN
| | - Luigi Ferrucci
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging/National Institutes of Health, Bethesda, MD
| | | | - Stephen B. Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Kenneth E. Schmader
- Center for the Study of Aging, Duke University Medical Center, Durham, NC
- GRECC Durham VA Medical Center, Durham, NC
| | - Felipe Sierra
- Division of Aging Biology, National Institute on Aging, NIH, Bethesda, MD
| | - Kaycee M. Sink
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Department of Medical Oncology and Therapeutic Research, Duarte, CA
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75
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Phillip JM, Wu PH, Gilkes DM, Williams W, McGovern S, Daya J, Chen J, Aifuwa I, Lee JSH, Fan R, Walston J, Wirtz D. Biophysical and biomolecular determination of cellular age in humans. Nat Biomed Eng 2017; 1. [PMID: 31372309 DOI: 10.1038/s41551-017-0093] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ageing research has focused either on assessing organ- and tissue-based changes, such as lung capacity and cardiac function, or on changes at the molecular scale such as gene expression, epigenetic modifications and metabolism. Here, by using a cohort of 32 samples of primary dermal fibroblasts collected from individuals between 2 and 96 years of age, we show that the degradation of functional cellular biophysical features-including cell mechanics, traction strength, morphology and migratory potential-and associated descriptors of cellular heterogeneity predict cellular age with higher accuracy than conventional biomolecular markers. We also demonstrate the use of high-throughput single-cell technologies, together with a deterministic model based on cellular features, to compute the cellular age of apparently healthy males and females, and to explore these relationships in cells from individuals with Werner syndrome and Hutchinson-Gilford progeria syndrome, two rare genetic conditions that result in phenotypes that show aspects of premature ageing. Our findings suggest that the quantification of cellular age may be used to stratify individuals on the basis of cellular phenotypes and serve as a biological proxy of healthspan.
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Affiliation(s)
- Jude M Phillip
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Physical Sciences-Oncology Center, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Pei-Hsun Wu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Physical Sciences-Oncology Center, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Daniele M Gilkes
- Johns Hopkins Physical Sciences-Oncology Center, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Wadsworth Williams
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Shaun McGovern
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Jena Daya
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Jonathan Chen
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut 06520, USA
| | - Ivie Aifuwa
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Physical Sciences-Oncology Center, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Jerry S H Lee
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Center for Strategic Scientific Initiatives, Office of the Director, National Cancer Institute, National Institute of Health, Bethesda, Maryland 20892, USA
| | - Rong Fan
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut 06520, USA
| | - Jeremy Walston
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
| | - Denis Wirtz
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Physical Sciences-Oncology Center, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.,Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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76
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Brown CH, Max L, LaFlam A, Kirk L, Gross A, Arora R, Neufeld K, Hogue CW, Walston J, Pustavoitau A. The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery. Anesth Analg 2017; 123:430-5. [PMID: 27096563 DOI: 10.1213/ane.0000000000001271] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Delirium is common after cardiac surgery, and preoperative identification of high-risk patients could guide prevention strategies. We prospectively measured frailty in 55 patients before cardiac surgery and assessed postoperative delirium using a validated chart review. The prevalence of frailty was 30.9%. Frail patients had a higher incidence of delirium (47.1%) compared with nonfrail patients (2.6%; P < 0.001). In multivariable models, the relative risk of delirium was ≥2.1-fold greater in frail compared with nonfrail patients (relative risk, 18.3; 95% confidence interval, 2.1-161.8; P = 0.009). Frailty may identify patients who would benefit from delirium-prevention strategies because of increased baseline risk for delirium.
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Affiliation(s)
- Charles H Brown
- From the *Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and †Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; ‡Department of Surgery, University of Manitoba, St. Boniface Hospital, Winnipeg, Mannitoba, Canada; §Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; and ‖Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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77
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Chung T, Park JS, Kim S, Montes N, Walston J, Höke A. Evidence for dying-back axonal degeneration in age-associated skeletal muscle decline. Muscle Nerve 2017; 55:894-901. [PMID: 27464347 DOI: 10.1002/mus.25267] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Age-associated muscle strength decline is a major contributing factor to increased late-life functional decline and comorbidity, and is strongly associated with early mortality. Although all parts of the neuromuscular system seem to be affected by aging, dying-back of motor axons likely plays a major role. METHODS We compared the degeneration in ventral roots and neuromuscular junction denervation in young and aged mice and correlated the findings with strength and electrophysiological measures. RESULTS With normal aging, there is little decline in motor axon numbers in the ventral roots, but the neuromuscular junctions show marked partial denervation that is associated with increased jitter on stimulated single fiber electromyography and a decrease in muscle strength. CONCLUSIONS These findings suggest that dying-back axonal degeneration may be partially responsible for the electrophysiological and strength changes observed with aging. Muscle Nerve 55: 894-901, 2017.
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Affiliation(s)
- Tae Chung
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jae Sung Park
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, 21205, USA.,Department of Physical Education, Kongju National University, Gongju, Republic of Korea
| | - Sangri Kim
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, 21205, USA
| | - Nataly Montes
- Department of Physical Medicine and Rehabilitation, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Jeremy Walston
- Department of Medicine, Johns Hopkins, Baltimore, Maryland, USA
| | - Ahmet Höke
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, 21205, USA
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78
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Buta B, Choudhury PP, Xue QL, Chaves P, Bandeen-Roche K, Shardell M, Semba RD, Walston J, Michos ED, Appel LJ, McAdams-DeMarco M, Gross A, Yasar S, Ferrucci L, Fried LP, Kalyani RR. The Association of Vitamin D Deficiency and Incident Frailty in Older Women: The Role of Cardiometabolic Diseases. J Am Geriatr Soc 2016; 65:619-624. [PMID: 28008596 DOI: 10.1111/jgs.14677] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Evidence suggests vitamin D deficiency is associated with developing frailty. However, cardiometabolic factors are related to both conditions and may confound and/or mediate the vitamin D-frailty association. We aimed to determine the association of vitamin D concentration with incidence of frailty, and the role of cardiometabolic diseases (cardiovascular disease, diabetes, hyperlipidemia, hypertension) in this relationship. DESIGN Prospective longitudinal cohort study (7 visits from 1994-2008). SETTING Baltimore, Maryland. PARTICIPANTS Three hundred sixty-nine women from the Women's Health and Aging Study II aged 70-79 years, free of frailty at baseline. MEASUREMENTS Serum circulating 25-hydroxyvitamin D (25[OH]D) concentration was assessed at baseline and categorized as: <10; 10-19.9; 20-29.9; and ≥30 ng/mL. Frailty incidence was determined based on presence of three or more criteria: weight loss, low physical activity, exhaustion, weakness, and slowness. Cardiometabolic diseases were ascertained at baseline. Analyses included Cox regression models adjusted for key covariates. RESULTS Incidence rate of frailty was 32.2 per 1,000 person-years in participants with 25(OH)D < 10 ng/mL, compared to 12.9 per 1,000 person-years in those with 25(OH)D ≥ 30 ng/mL (mean follow-up = 8.5 ± 3.7 years). In cumulative incidence analyses, those with lower 25(OH)D exhibited higher frailty incidence, though differences were non-significant (P = .057). In regression models adjusted for demographics, smoking, and season, 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) was associated with nearly three-times greater frailty incidence (hazard ratio (HR) = 2.77, 95% CI = 1.14, 6.71, P = .02). After adjusting for BMI, the relationship of 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) with incident frailty persisted, but was attenuated after further accounting for cardiometabolic diseases (HR = 2.29, 95% CI = 0.92, 5.69, P = .07). CONCLUSION Low serum vitamin D concentration is associated with incident frailty in older women; interestingly, the relationship is no longer significant after accounting for the presence of cardiometabolic diseases. Future studies should explore mechanisms to explain this relationship.
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Affiliation(s)
- Brian Buta
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Qian-Li Xue
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Paulo Chaves
- Benjamin Leon Center for Geriatric Research and Education and Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Michelle Shardell
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Richard D Semba
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy Walston
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alden Gross
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, New York, New York
| | - Rita Rastogi Kalyani
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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79
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McAdams-DeMarco MA, Bae S, Chu N, Gross AL, Brown CH, Oh E, Rosenberg P, Neufeld KJ, Varadhan R, Albert M, Walston J, Segev DL. Dementia and Alzheimer's Disease among Older Kidney Transplant Recipients. J Am Soc Nephrol 2016; 28:1575-1583. [PMID: 27979990 DOI: 10.1681/asn.2016080816] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/06/2016] [Indexed: 11/03/2022] Open
Abstract
Older patients with ESRD who receive a kidney transplant (KT) may develop post-KT dementia and Alzheimer's disease (AD) associated with their long-standing kidney disease and/or neurotoxic immunosuppressant agents. To investigate this possibility, we studied 40,918 older (aged ≥55 years) KT recipients (January 1, 1999 to December 31, 2011) linked to Medicare claims through the US Renal Data System. We estimated dementia and AD risk (cumulative incidence) and studied factors associated with these sequelae using competing risks models. We estimated the risk of death-censored graft loss and mortality after developing dementia or the AD subtype of dementia, separately, using adjusted Cox proportional hazards models. Older recipients had a 10-year dementia risk ranging from 5.1% for recipients aged 55-60 years to 17.0% for recipients aged ≥75 years; 10-year AD risk ranged from 1.0% to 6.7%, respectively. The strongest predictors for dementia and AD were older recipient age and pretransplant diabetes. The 10-year graft loss risk was 28.8% for those who did not develop dementia and 43.1% for those who did, and the corresponding mortality risks were 55.7% and 89.9%, respectively. Older recipients with dementia had a 1.52-fold (95% confidence interval, 1.39 to 1.68) increased risk of graft loss and a 2.38-fold (95% confidence interval, 2.26 to 2.49) increased risk of mortality. We observed similar results for AD. We conclude that older KT recipients have a high risk of post-KT dementia and AD, and these sequelae associate with a profound effect on patient and graft survival.
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Affiliation(s)
- Mara A McAdams-DeMarco
- Departments of Surgery, .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and
| | | | - Nadia Chu
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and
| | | | - Esther Oh
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul Rosenberg
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karin J Neufeld
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi Varadhan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Marilyn Albert
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy Walston
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Departments of Surgery, .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and
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80
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Lessa FC, Milucky J, Rouphael N, Bennett NM, Talbot HK, Harrison L, Farley M, Walston J, Kober D, Pimenta F, Beall B, Whitney CG, Carvalho MDG. Nonpneumococcal Streptococci Confounding Polymerase Chain Reaction Serotyping of Streptococcus pneumoniae in United States Colonized Adults. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fernanda C. Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Milucky
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - H. Keipp Talbot
- Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lee Harrison
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Monica Farley
- Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia
| | - Jeremy Walston
- Medicine/Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane Kober
- New York Emerging Infections Program, Rochester, New York
| | - Fabiana Pimenta
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia G. Whitney
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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81
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Keshtkar-Jahromi M, Ouyang M, Keshtkarjahromi M, Almed S, Li H, Walston J, Rios R, Leng S. Effect of Influenza Vaccine on Tumor Necrosis Factor-Like Weak Inducer of Apoptosis (TWEAK) in Older Population. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maryam Keshtkar-Jahromi
- Medicine/Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Min Ouyang
- Medicine/Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Samah Almed
- Medicine/Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Huifen Li
- Medicine/Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy Walston
- Medicine/Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebeca Rios
- Biostatistics, Epidemiology, and Database (BEAD) Core; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean Leng
- Medicine/Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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82
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Mauthner O, Claes V, Walston J, Engberg S, Binet I, Dickenmann M, Golshayan D, Hadaya K, Huynh-Do U, Calciolari S, De Geest S. ExplorinG frailty and mild cognitive impairmEnt in kidney tRansplantation to predict biomedicAl, psychosocial and health cost outcomeS (GERAS): protocol of a nationwide prospective cohort study. J Adv Nurs 2016; 73:716-734. [DOI: 10.1111/jan.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Oliver Mauthner
- Institute of Nursing Science; University of Basel; Switzerland
| | - Veerle Claes
- Institute of Nursing Science; University of Basel; Switzerland
| | - Jeremy Walston
- Center on Aging and Health; Johns Hopkins University; Baltimore Maryland USA
| | - Sandra Engberg
- Institute of Nursing Science; University of Basel; Switzerland
- School of Nursing; University of Pittsburgh; Pennsylvania USA
| | - Isabelle Binet
- Clinic of Nephrology and Transplantation Medicine; Cantonal Hospital St Gallen; Switzerland
| | - Michael Dickenmann
- Department for Transplantation-Immunology and Nephrology; University Hospital Basel; Switzerland
| | - Déla Golshayan
- Transplantation Centre and Transplantation Immunopathology Laboratory; University Hospital Lausanne; Switzerland
| | - Karine Hadaya
- Department of Nephrology; University Hospital Geneva; Switzerland
| | - Uyen Huynh-Do
- University Clinic for Nephrology, Hypertension and Clinical Pharmacology; University Hospital Bern; Switzerland
| | | | - Sabina De Geest
- Institute of Nursing Science; University of Basel; Switzerland
- Academic Center for Nursing and Midwifery; KU Leuven; Belgium
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Abstract
Aging is a complex, multifaceted process that induces a myriad of physiological changes over an extended period of time. Aging is accompanied by major biochemical and biomechanical changes at macroscopic and microscopic length scales that affect not only tissues and organs but also cells and subcellular organelles. These changes include transcriptional and epigenetic modifications; changes in energy production within mitochondria; and alterations in the overall mechanics of cells, their nuclei, and their surrounding extracellular matrix. In addition, aging influences the ability of cells to sense changes in extracellular-matrix compliance (mechanosensation) and to transduce these changes into biochemical signals (mechanotransduction). Moreover, following a complex positive-feedback loop, aging is accompanied by changes in the composition and structure of the extracellular matrix, resulting in changes in the mechanics of connective tissues in older individuals. Consequently, these progressive dysfunctions facilitate many human pathologies and deficits that are associated with aging, including cardiovascular, musculoskeletal, and neurodegenerative disorders and diseases. Here, we critically review recent work highlighting some of the primary biophysical changes occurring in cells and tissues that accompany the aging process.
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Affiliation(s)
- Jude M Phillip
- Department of Chemical and Biomolecular Engineering, Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland, 21218.,Johns Hopkins Physical Sciences-Oncology Center, Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland, 21218
| | - Ivie Aifuwa
- Department of Chemical and Biomolecular Engineering, Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland, 21218.,Johns Hopkins Physical Sciences-Oncology Center, Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland, 21218
| | - Jeremy Walston
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224
| | - Denis Wirtz
- Department of Chemical and Biomolecular Engineering, Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland, 21218.,Johns Hopkins Physical Sciences-Oncology Center, Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland, 21218.,Departments of Oncology and Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231
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84
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Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? J Geriatr Oncol 2016; 8:8-15. [PMID: 27318797 DOI: 10.1016/j.jgo.2016.06.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/21/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Traditionally used as a descriptive term, frailty is now a recognized medical syndrome identifying individuals with decreased physiologic reserve. Frailty is characterized by diminished strength, endurance, and reduced physiologic function. Several valid frailty screening tools exist in the literature, and these measures have been used to relate frailty to outcomes important to the older patient with cancer. Frail adults are at increased risk of adverse surgical outcomes and early findings suggest that frailty predicts poor chemotherapy tolerance. While much research is needed to explore the biologic relationships between frailty and cancer, there is an urgent need to implement frailty screening and management into the care of the older patient with cancer in order to improve outcomes in this vulnerable subset. The purpose of this paper is to provide an introduction of frailty to oncologists including a review of the definition, frailty screening tools, its clinical relevance to older patients with cancer, and a brief guide to frailty management.
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Affiliation(s)
| | - Jeremy Walston
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, USA
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85
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Gross AL, Xue QL, Bandeen-Roche K, Fried LP, Varadhan R, McAdams-DeMarco MA, Walston J, Carlson MC. Declines and Impairment in Executive Function Predict Onset of Physical Frailty. J Gerontol A Biol Sci Med Sci 2016; 71:1624-1630. [PMID: 27084314 DOI: 10.1093/gerona/glw067] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 03/20/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clinical cognitive impairment and physical frailty often co-occur. However, it is unclear whether preclinical impairment or decline in cognitive domains are associated with onset of physical frailty. We tested this hypothesis and further hypothesized that preclinical impairment and decline in executive functioning are more strongly associated with frailty onset than memory or general cognitive performance. METHODS We used 9 years of data from the Women's Health and Aging Study II (six visits) that longitudinally measured psychomotor speed and executive functioning using the Trail Making Test, parts A and B, respectively, and immediate and delayed word-list recall from the Hopkins Verbal Learning Test. We used Cox proportional hazards models to regress time to frailty on indicators for impairment on these cognitive tests and on rates of change of the tests. Models adjusted for depressive symptoms, age, years of education, and race. RESULTS Of the 331 women initially free of dementia and frailty, 44 (13%) developed frailty. A binary indicator of impaired executive functioning (Trail Making Test, part B [TMT-B]) was most strongly associated with hazard, or risk, of frailty onset (hazard ratio [HR] = 3.3, 95% confidence interval [CI] = 1.4, 7.6) after adjustment for covariates and other tests. Adjusting for baseline cognitive performance, faster deterioration on TMT-B (HR = 0.6, 95% CI = 0.4, 1.0) was additionally associated with hazard of frailty onset. CONCLUSIONS Findings inform the association of executive functioning with transitions to frailty, suggesting both impairments in and declines in executive functioning are associated with risk of frailty onset. It remains to be determined whether these associations are causal or whether shared aging related or other mechanisms are involved.
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Affiliation(s)
- Alden L Gross
- Department of Epidemiology, .,Department of Mental Health
| | - Qian-Li Xue
- Department of Epidemiology.,Division of Geriatric Medicine and Gerontology, Department of Medicine, and.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Division of Geriatric Medicine and Gerontology, Department of Medicine, and.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda P Fried
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Care Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Department of Medicine, and
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86
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Bakulski KM, Feinberg JI, Andrews SV, Yang J, Brown S, L McKenney S, Witter F, Walston J, Feinberg AP, Fallin MD. DNA methylation of cord blood cell types: Applications for mixed cell birth studies. Epigenetics 2016; 11:354-62. [PMID: 27019159 DOI: 10.1080/15592294.2016.1161875] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Epigenome-wide association studies of disease widely use DNA methylation measured in blood as a surrogate tissue. Cell proportions can vary between people and confound associations of exposure or outcome. An adequate reference panel for estimating cell proportions from adult whole blood for DNA methylation studies is available, but an analogous cord blood cell reference panel is not yet available. Cord blood has unique cell types and the epigenetic signatures of standard cell types may not be consistent throughout the life course. Using magnetic bead sorting, we isolated cord blood cell types (nucleated red blood cells, granulocytes, monocytes, natural killer cells, B cells, CD4(+)T cells, and CD8(+)T cells) from 17 live births at Johns Hopkins Hospital. We confirmed enrichment of the cell types using fluorescence assisted cell sorting and ran DNA from the separated cell types on the Illumina Infinium HumanMethylation450 BeadChip array. After filtering, the final analysis was on 104 samples at 429,794 probes. We compared cell type specific signatures in cord to each other and methylation at 49.2% of CpG sites on the array differed by cell type (F-test P < 10(-8)). Differences between nucleated red blood cells and the remainder of the cell types were most pronounced (36.9% of CpG sites at P < 10(-8)) and 99.5% of these sites were hypomethylated relative to the other cell types. We also compared the mean-centered sorted cord profiles to the available adult reference panel and observed high correlation between the overlapping cell types for granulocytes and monocytes (both r=0.74), and poor correlation for CD8(+)T cells and NK cells (both r=0.08). We further provide an algorithm for estimating cell proportions in cord blood using the newly developed cord reference panel, which estimates biologically plausible cell proportions in whole cord blood samples.
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Affiliation(s)
- Kelly M Bakulski
- a Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Center for Epigenetics, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,c Department of Epidemiology , University of Michigan School of Public Health , Ann Arbor , Michigan , USA
| | - Jason I Feinberg
- b Center for Epigenetics, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,d Department of Mental Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Shan V Andrews
- a Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Jack Yang
- e Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Shannon Brown
- a Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA.,f Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Stephanie L McKenney
- g Division of Neonatology, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Frank Witter
- h Division of Gynecology and Obstetrics, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,i Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Jeremy Walston
- e Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Andrew P Feinberg
- b Center for Epigenetics, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,d Department of Mental Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - M Daniele Fallin
- b Center for Epigenetics, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,d Department of Mental Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA.,f Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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87
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McAdams-DeMarco MA, Ying H, Olorundare I, King EA, Desai N, Dagher N, Lonze B, Montgomery R, Walston J, Segev DL. Frailty and Health-Related Quality of Life in End Stage Renal Disease Patients of All Ages. J Frailty Aging 2016; 5:174-179. [PMID: 29240319 PMCID: PMC6205225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND: Frailty is associated with worse health-related quality of life (HRQOL) in older adults and worse clinical outcomes in adults of all ages with end stage renal disease (ESRD). It is unclear whether frail adults of all ages with ESRD are more likely to experience worse HRQOL. OBJECTIVE: The goal of this study was to identify factors associated with worsening HRQOL in this population. DESIGN, SETTING AND MEASUREMENTS: We studied 233 adults of all ages with ESRD enrolled (11/2009-11/2013) in a longitudinal cohort study. Frailty status was measured at enrollment and HRQOL was reported (Excellent, Very Good, Good, Fair or Poor) at the initial assessment and follow-up (median follow-up 9.4 months). We studied factors associated with Fair/Poor HRQOL at follow-up using logistic regression and factors associated with HRQOL change using multinomial regression. All models were adjusted for age, sex, race, education, BMI, diabetes status, history of a previous transplant, type of dialysis and time between assessments. RESULTS: Fair/Poor HRQOL was reported by 28% at initial assessment and 33% at follow-up. 47.2% of participants had stable HRQOL, 22.8% better HRQOL, and 30.0% worse HRQOL at follow-up (P<0.001). In adjusted models, only frailty was associated with Fair/Poor HRQOL at follow-up (OR: 2.79, 95% CI: 1.32-5.90) and worsening HRQOL at follow-up (RR: 2.91, 95%CI: 1.08-7.80). CONCLUSIONS: Frail adults of all ages with ESRD are more likely to experience fair/poor HRQOL and worsening HRQOL over time. Frailty represents a state of decreased physiologic reserve that impacts not only clinical outcomes but also the patient-centered outcome of HRQOL.
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88
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Ko F, Abadir P, Marx R, Westbrook R, Cooke C, Yang H, Walston J. Impaired mitochondrial degradation by autophagy in the skeletal muscle of the aged female interleukin 10 null mouse. Exp Gerontol 2015; 73:23-7. [PMID: 26596403 DOI: 10.1016/j.exger.2015.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/09/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
Mitochondrial dysfunction, chronic inflammation and muscle aging are closely linked. Mitochondrial clearance is a process to dampen inflammation and is a critical pre-requisite to mitobiogenesis. The combined effect of aging and chronic inflammation on mitochondrial degradation by autophagy is understudied. In interleukin 10 null mouse (IL-10(tm/tm)), a rodent model of chronic inflammation, we studied the effects of aging and inflammation on mitochondrial clearance. We show that aging in IL-10(tm/tm) is associated with reduced skeletal muscle mitochondrial death signaling and altered formation of autophagosomes, compared to age-matched C57BL/6 controls. Moreover, skeletal muscles of old IL-10(tm/tm) mice have the highest levels of damaged mitochondria with disrupted mitochondrial ultrastructure and autophagosomes compared to all other groups. These observations highlight the interface between chronic inflammation and aging on altered mitochondrial biology in skeletal muscles.
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Affiliation(s)
- Fred Ko
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, USA.
| | - Peter Abadir
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, USA
| | - Ruth Marx
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, USA
| | - Reyhan Westbrook
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, USA
| | - Carol Cooke
- Johns Hopkins University, Cellular and Molecular Medicine, Microscope Facility, Department of Medicine, USA
| | - Huanle Yang
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, USA
| | - Jeremy Walston
- Johns Hopkins University, Division of Geriatrics Medicine and Gerontology, USA
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Olson NC, Butenas S, Lange LA, Lange EM, Cushman M, Jenny NS, Walston J, Souto JC, Soria JM, Chauhan G, Debette S, Longstreth WT, Seshadri S, Reiner AP, Tracy RP. Coagulation factor XII genetic variation, ex vivo thrombin generation, and stroke risk in the elderly: results from the Cardiovascular Health Study. J Thromb Haemost 2015; 13:1867-77. [PMID: 26286125 PMCID: PMC4946166 DOI: 10.1111/jth.13111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/12/2015] [Accepted: 08/02/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The relationships of thrombin generation (TG) with cardiovascular disease risk are underevaluated in population-based cohorts. OBJECTIVES To evaluate the relationships of TG influenced by the contact and tissue factor coagulation pathways ex vivo with common single-nucleotide polymorphisms (SNPs) and incident cardiovascular disease and stroke. PATIENTS/METHODS We measured peak TG (pTG) in baseline plasma samples of Cardiovascular Health Study participants (n = 5411), both with and without inhibitory anti-factor XIa antibody (pTG/FXIa(-) ). We evaluated their associations with ~ 50 000 SNPs by using the IBCv2 genotyping array, and with incident cardiovascular disease and stroke events over a median follow-up of 13.2 years. RESULTS The minor allele for an SNP in the FXII gene (F12), rs1801020, was associated with lower pTG in European-Americans (β = - 34.2 ± 3.5 nm; P = 3.3 × 10(-22) ; minor allele frequency [MAF] = 0.23) and African-Americans (β = - 31.1 ± 7.9 nm; P = 9.0 × 10(-5) ; MAF = 0.42). Lower FXIa-independent pTG (pTG/FXIa(-) ) was associated with the F12 rs1801020 minor allele, and higher pTG/FXIa(-) was associated with the ABO SNP rs657152 minor allele (β = 16.3 nm; P = 4.3 × 10(-9) ; MAF = 0.37). The risk factor-adjusted ischemic stroke hazard ratios were 1.09 (95% confidence interval CI 1.01-1.17; P = 0.03) for pTG, 1.06 (95% CI 0.98-1.15; P = 0.17) for pTG/FXIa(-) , and 1.11 (95% CI 1.02-1.21; P = 0.02) for FXIa-dependent pTG (pTG/FXIa(+) ), per one standard deviation increment (n = 834 ischemic strokes). In a multicohort candidate gene analysis, rs1801020 was not associated with incident ischemic stroke (β = - 0.02; standard error = 0.08; P = 0.81). CONCLUSIONS These results support the importance of contact activation pathway-dependent TG as a risk factor for ischemic stroke, and indicate the importance of F12 SNPs for TG ex vivo and in vivo.
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Affiliation(s)
- N C Olson
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - S Butenas
- Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA
| | - L A Lange
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - E M Lange
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - M Cushman
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - N S Jenny
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - J Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J C Souto
- Department of Hematology, Institute of Biomedical Research (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J M Soria
- Unit of Genomics of Complex Diseases, Institute of Biomedical Research (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - G Chauhan
- INSERM U897, University of Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - S Debette
- INSERM U897, University of Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
- Bordeaux University Hospital, Bordeaux, France
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - S Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - A P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - R P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
- Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA
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90
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Durda P, Sabourin J, Lange EM, Nalls MA, Mychaleckyj JC, Jenny NS, Li J, Walston J, Harris TB, Psaty BM, Valdar W, Liu Y, Cushman M, Reiner AP, Tracy RP, Lange LA. Plasma Levels of Soluble Interleukin-2 Receptor α: Associations With Clinical Cardiovascular Events and Genome-Wide Association Scan. Arterioscler Thromb Vasc Biol 2015; 35:2246-53. [PMID: 26293465 PMCID: PMC5395092 DOI: 10.1161/atvbaha.115.305289] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Interleukin (IL) -2 receptor subunit α regulates lymphocyte activation, which plays an important role in atherosclerosis. Associations between soluble IL-2Rα (sIL-2Rα) and cardiovascular disease (CVD) have not been widely studied and little is known about the genetic determinants of sIL-2Rα levels. APPROACH AND RESULTS We measured baseline levels of sIL-2Rα in 4408 European American (EA) and 766 African American (AA) adults from the Cardiovascular Health Study (CHS) and examined associations with baseline CVD risk factors, subclinical CVD, and incident CVD events. We also performed a genome-wide association study for sIL-2Rα in CHS (2964 EAs and 683 AAs) and further combined CHS EA results with those from two other EA cohorts in a meta-analysis (n=4464 EAs). In age, sex- and race- adjusted models, sIL-2Rα was positively associated with current smoking, type 2 diabetes mellitus, hypertension, insulin, waist circumference, C-reactive protein, IL-6, fibrinogen, internal carotid wall thickness, all-cause mortality, CVD mortality, and incident CVD, stroke, and heart failure. When adjusted for baseline CVD risk factors and subclinical CVD, associations with all-cause mortality, CVD mortality, and heart failure remained significant in both EAs and AAs. In the EA genome-wide association study analysis, we observed 52 single-nucleotide polymorphisms in the chromosome 10p15-14 region, which contains IL2RA, IL15RA, and RMB17, that reached genome-wide significance (P<5×10(-8)). The most significant single-nucleotide polymorphism was rs7911500 (P=1.31×10(-75)). The EA meta-analysis results were highly consistent with CHS-only results. No single-nucleotide polymorphisms reached statistical significance in the AAs. CONCLUSIONS These results support a role for sIL-2Rα in atherosclerosis and provide evidence for multiple-associated single-nucleotide polymorphisms at chromosome 10p15-14.
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Affiliation(s)
- Peter Durda
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Jeremy Sabourin
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Ethan M Lange
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Mike A Nalls
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Josyf C Mychaleckyj
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Nancy Swords Jenny
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Jin Li
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Jeremy Walston
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Tamara B Harris
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Bruce M Psaty
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - William Valdar
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Yongmei Liu
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Mary Cushman
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Alex P Reiner
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
| | - Russell P Tracy
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.).
| | - Leslie A Lange
- From the Departments of Pathology (P.D., N.S.J., M.C., R.P.T.), Medicine (M.C.), and Biochemistry (R.P.T.), University of Vermont College of Medicine, Burlington; Departments of Genetics (J.S., E.M.L., J.L., W.V., L.A.L.), Biostatistics (E.M.L., W.V.), Lineberger Comprehensive Cancer Center, School of Medicine (J.S., E.M.L., W.V.), University of North Carolina, Chapel Hill; Laboratory of Neurogenetics, Porter Neuroscience Research Center, National Institute on Aging, National Institute of Health, Bethesda, MD (M.A.N.); Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville (J.C.M.); Johns Hopkins Medical Institutions, Department of Medicine Geriatrics, Johns Hopkins University, John R. Burton Pavilion, Baltimore, MD (J.D.W.); Geriatric Epidemiology Section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Cardiovascular Health Research Unit (B.M.P.), Departments of Medicine (B.M.P.) and Epidemiology (B.M.P., A.P.R.), University of Washington, Seattle; Group Health Research Institute, Division of Cardiology, Group Health Cooperative, Seattle, WA (B.M.P.); and Wake Forest University School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC (Y.L.)
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McAdams-DeMarco MA, Isaacs K, Darko L, Salter ML, Gupta N, King EA, Walston J, Segev DL. Changes in Frailty After Kidney Transplantation. J Am Geriatr Soc 2015; 63:2152-7. [PMID: 26416770 DOI: 10.1111/jgs.13657] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To understand the natural history of frailty after an aggressive surgical intervention, kidney transplantation (KT). DESIGN Prospective cohort study (December 2008-March 2014). SETTING Baltimore, Maryland. PARTICIPANTS Kidney transplantation recipients (N = 349). MEASUREMENTS The Fried frailty score was measured at the time of KT and during routine clinical follow-up. Using a Cox proportional hazards model, factors associated with improvements in frailty score after KT were identified. Using a longitudinal analysis, predictors of frailty score changes after KT were identified using a multilevel mixed-effects Poisson model. RESULTS At KT, 19.8% of recipients were frail; 1 month after KT, 33.3% were frail; at 2 months, 27.7% were frail; and at 3 months, 17.2% were frail. On average, frailty scores had worsened by 1 month (mean change 0.4, P < .001), returned to baseline by 2 months (mean change 0.2, P = .07), and improved by 3 months (mean change -0.3, P = .04) after KT. The only recipient or transplant factor associated with improvement in frailty score after KT was pre-KT frailty (hazard ratio = 2.55, 95% confidence interval (CI) = 1.71-3.82, P < .001). Pre-KT frailty status (relative risk (RR) = 1.49, 95% CI = 1.29-1.72, P < .001), recipient diabetes mellitus (RR = 1.26, 95% CI = 1.08-1.46, P = .003), and delayed graft function (RR = 1.22, 95% CI = 1.04-1.43, P = .02) were independently associated with long-term changes in frailty score. CONCLUSION After KT, in adult recipients of all ages, frailty initially worsens but then improves by 3 months. Although KT recipients who were frail at KT had higher frailty scores over the long term, they were most likely to show improvements in their physiological reserve after KT, supporting the transplantation in these individuals and suggesting that pretransplant frailty is not an irreversible state of low physiological reserve.
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Affiliation(s)
- Mara A McAdams-DeMarco
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kyra Isaacs
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Louisa Darko
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Megan L Salter
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Natasha Gupta
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth A King
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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92
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Theou O, Walston J, Rockwood K. Operationalizing Frailty Using the Frailty Phenotype and Deficit Accumulation Approaches. Interdiscip Top Gerontol Geriatr 2015; 41:66-73. [PMID: 26301980 DOI: 10.1159/000381164] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In both demographic and clinical studies, frailty is understood as a multidimensional state of increased vulnerability compared with the status of others of the same age. Of the many theoretical definitions of frailty, two are commonly employed: the physical frailty/phenotypic approach and the deficit accumulation approach. The purpose of this chapter is to discuss how frailty is conceptualized and operationalized based on these two approaches.
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Affiliation(s)
- Olga Theou
- Geriatric Medicine, Faculty of Medicine, Dalhousie University, Halifax, N.S., Canada
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93
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Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, DiPietro L, Falanga V, Fife C, Gardner S, Grice E, Harmon J, Hazzard WR, High KP, Houghton P, Jacobson N, Kirsner RS, Kovacs EJ, Margolis D, McFarland Horne F, Reed MJ, Sullivan DH, Thom S, Tomic-Canic M, Walston J, Whitney JA, Williams J, Zieman S, Schmader K. Chronic wound repair and healing in older adults: current status and future research. J Am Geriatr Soc 2015; 63:427-38. [PMID: 25753048 DOI: 10.1111/jgs.13332] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Older adults are more likely to have chronic wounds than younger people, and the effect of chronic wounds on quality of life is particularly profound in this population. Wound healing slows with age, but the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The effect of age and accompanying multimorbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables; lack of standardization in data collection; and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this article, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify research questions to guide future study of age-associated changes in chronic wound healing.
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Affiliation(s)
- Lisa Gould
- Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, Rhode Island
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94
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Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, DiPietro L, Falanga V, Fife C, Gardner S, Grice E, Harmon J, Hazzard WR, High KP, Houghton P, Jacobson N, Kirsner RS, Kovacs EJ, Margolis D, McFarland Horne F, Reed MJ, Sullivan DH, Thom S, Tomic-Canic M, Walston J, Whitney J, Williams J, Zieman S, Schmader K. Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen 2015; 23:1-13. [PMID: 25486905 DOI: 10.1111/wrr.12245] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/19/2014] [Indexed: 12/21/2022]
Abstract
The incidence of chronic wounds is increased among older adults, and the impact of chronic wounds on quality of life is particularly profound in this population. It is well established that wound healing slows with age. However, the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The impact of age and accompanying multi-morbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables, lack of standardization in data collection, and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this paper, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify key research questions to guide future study of age-associated changes in chronic wound healing.
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Affiliation(s)
- Lisa Gould
- Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, Rhode Island
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95
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McAdams-DeMarco MA, Law A, King E, Orandi B, Salter M, Gupta N, Chow E, Alachkar N, Desai N, Varadhan R, Walston J, Segev DL. Frailty and mortality in kidney transplant recipients. Am J Transplant 2015; 15:149-54. [PMID: 25359393 PMCID: PMC4332809 DOI: 10.1111/ajt.12992] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 01/25/2023]
Abstract
We have previously described strong associations between frailty, a measure of physiologic reserve initially described and validated in geriatrics, and early hospital readmission as well as delayed graft function. The goal of this study was to estimate its association with postkidney transplantation (post-KT) mortality. Frailty was prospectively measured in 537 KT recipients at the time of transplantation between November 2008 and August 2013. Cox proportional hazards models were adjusted for confounders using a novel approach to substantially improve model efficiency and generalizability in single-center studies. We precisely estimated the confounder coefficients using the large sample size of the Scientific Registry of Transplantation Recipients (n = 37 858) and introduced these into the single-center model, which then estimated the adjusted frailty coefficient. At 5 years, the survivals were 91.5%, 86.0% and 77.5% for nonfrail, intermediately frail and frail KT recipients, respectively. Frailty was independently associated with a 2.17-fold (95% CI: 1.01-4.65, p = 0.047) higher risk of death. In conclusion, regardless of age, frailty is a strong, independent risk factor for post-KT mortality, even after carefully adjusting for many confounders using a novel, efficient statistical approach.
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Affiliation(s)
- M. A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Corresponding authors: Dorry L. Segev, and Mara A. McAdams-DeMarco,
| | - A. Law
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E. King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - B. Orandi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - M. Salter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - N. Gupta
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E. Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - N. Alachkar
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - N. Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R. Varadhan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J. Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D. L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Corresponding authors: Dorry L. Segev, and Mara A. McAdams-DeMarco,
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96
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Brown CH, Morrissey C, Ono M, Yenokyan G, Selnes OA, Walston J, Max L, LaFlam A, Neufeld K, Gottesman RF, Hogue CW. Impaired olfaction and risk of delirium or cognitive decline after cardiac surgery. J Am Geriatr Soc 2015; 63:16-23. [PMID: 25597555 PMCID: PMC4299936 DOI: 10.1111/jgs.13198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the prevalence of impaired olfaction in individuals presenting for cardiac surgery and the independent association between impaired olfaction and postoperative delirium and cognitive decline. DESIGN Nested prospective cohort study. SETTING Academic hospital. PARTICIPANTS Individuals undergoing coronary artery bypass, valve surgery, or both (n = 165). MEASUREMENTS Olfaction was measured using the Brief Smell Identification Test, with impaired olfaction defined as an olfactory score below the fifth percentile of normative data. Delirium was assessed using a validated chart review method. Cognitive performance was assessed using a neuropsychological testing battery at baseline and 4 to 6 weeks after surgery. RESULTS Impaired olfaction was identified in 54 of 165 participants (33%) before surgery. Impaired olfaction was associated with greater adjusted risk of postoperative delirium (relative risk = 1.90, 95% confidence interval = 1.17-3.09, P = .009). There was no association between impaired olfaction and change in composite cognitive score in the overall study population. CONCLUSION Impaired olfaction is prevalent in individuals undergoing cardiac surgery and is associated with greater adjusted risk of postoperative delirium but not cognitive decline. Impaired olfaction may identify unrecognized vulnerability to postoperative delirium in individuals undergoing cardiac surgery.
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Affiliation(s)
- Charles H. Brown
- Assistant Professor, Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Candice Morrissey
- Fellow, Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Masahiro Ono
- Fellow, Department of Cardiac Surgery, Texas Heart Institute; Houston, TX 77030
| | - Gayane Yenokyan
- Assistant Scientist, Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Ola A. Selnes
- Professor, Department of Neurology, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Jeremy Walston
- Professor, Department of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Laura Max
- Research Assistant, Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Andrew LaFlam
- Research Assistant, Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Karin Neufeld
- Associate Professor, Department of Psychiatry, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Rebecca F. Gottesman
- Associate Professor, Department of Neurology, The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
| | - Charles W. Hogue
- Professor, Department of Anesthesiology & Critical Care Medicine; The Johns Hopkins University School of Medicine; Baltimore, MD, 21287
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97
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Lin R, Zhang P, Cheetham AG, Walston J, Abadir P, Cui H. Dual peptide conjugation strategy for improved cellular uptake and mitochondria targeting. Bioconjug Chem 2014; 26:71-7. [PMID: 25547808 PMCID: PMC4306504 DOI: 10.1021/bc500408p] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Mitochondria are critical regulators of cellular function and survival. Delivery of therapeutic and diagnostic agents into mitochondria is a challenging task in modern pharmacology because the molecule to be delivered needs to first overcome the cell membrane barrier and then be able to actively target the intracellular organelle. Current strategy of conjugating either a cell penetrating peptide (CPP) or a subcellular targeting sequence to the molecule of interest only has limited success. We report here a dual peptide conjugation strategy to achieve effective delivery of a non-membrane-penetrating dye 5-carboxyfluorescein (5-FAM) into mitochondria through the incorporation of both a mitochondrial targeting sequence (MTS) and a CPP into one conjugated molecule. Notably, circular dichroism studies reveal that the combined use of α-helix and PPII-like secondary structures has an unexpected, synergistic contribution to the internalization of the conjugate. Our results suggest that although the use of positively charged MTS peptide allows for improved targeting of mitochondria, with MTS alone it showed poor cellular uptake. With further covalent linkage of the MTS-5-FAM conjugate to a CPP sequence (R8), the dually conjugated molecule was found to show both improved cellular uptake and effective mitochondria targeting. We believe these results offer important insight into the rational design of peptide conjugates for intracellular delivery.
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Affiliation(s)
- Ran Lin
- Department of Chemical and Biomolecular Engineering, ‡Institute for NanoBioTechnology, §Division of Geriatrics Medicine and Gerontology, and ⊥Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University , Baltimore, Maryland 21218, United States
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98
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Abstract
OBJECTIVES To estimate mortality and death-censored graft loss according to year of kidney transplant (KT) between 1990 and 2011. DESIGN Cohort study. SETTING The Scientific Registry of Transplant Recipients (SRTR). PARTICIPANTS KT recipients aged 65 and older at the time of transplantation (N = 30,207). MEASUREMENTS Mortality and death-censored graft loss ascertained through center report and linkage to Social Security Death Master File and to Medicare. RESULTS Older adults currently account for 18.4% of KT recipients, up from 3.4% in 1990; similar increases were noted for deceased donor (5.4 times percentage increase) and live donor (9.1 times percentage increase) transplants. Current recipients are not only older, but also more likely to be female and African American, have lengthier pretransplant dialysis, have diabetes mellitus or hypertension, and receive marginal kidneys. Mortality for older deceased donor recipients between 2009 and 2011 was 57% lower (hazard ratio (HR) = 0.43, 95% confidence interval (CI) = 0.33-0.56, P < .001) than between 1990 and 1993; mortality for older live donor recipients was 50% lower (HR = 0.50, 95% CI = 0.36-0.68, P < .001). Death-censored graft loss for older deceased donor recipients between 2009 and 2011 was 65% lower (HR = 0.35, 95% CI = 0.29-0.42, P < .001) than between 1990 and 1993; death-censored graft loss for older live donor recipients was 59% lower (HR = 0.41, 95% CI = 0.24-0.70, P < .001). CONCLUSION Despite a major increase in number of older adults transplanted and an expanding window of transplant eligibility, mortality and graft loss have decreased substantially for this recipient population. These trends are important to understand for patient counseling and transplant referral.
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Affiliation(s)
- Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University Baltimore, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University Baltimore, Baltimore, Maryland
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99
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Vajapey R, Rini D, Walston J, Abadir P. The impact of age-related dysregulation of the angiotensin system on mitochondrial redox balance. Front Physiol 2014; 5:439. [PMID: 25505418 PMCID: PMC4241834 DOI: 10.3389/fphys.2014.00439] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/27/2014] [Indexed: 12/13/2022] Open
Abstract
Aging is associated with the accumulation of various deleterious changes in cells. According to the free radical and mitochondrial theory of aging, mitochondria initiate most of the deleterious changes in aging and govern life span. The failure of mitochondrial reduction-oxidation (redox) homeostasis and the formation of excessive free radicals are tightly linked to dysregulation in the Renin Angiotensin System (RAS). A main rate-controlling step in RAS is renin, an enzyme that hydrolyzes angiotensinogen to generate angiotensin I. Angiotensin I is further converted to Angiotensin II (Ang II) by angiotensin-converting enzyme (ACE). Ang II binds with equal affinity to two main angiotensin receptors—type 1 (AT1R) and type 2 (AT2R). The binding of Ang II to AT1R activates NADPH oxidase, which leads to increased generation of cytoplasmic reactive oxygen species (ROS). This Ang II-AT1R–NADPH-ROS signal triggers the opening of mitochondrial KATP channels and mitochondrial ROS production in a positive feedback loop. Furthermore, RAS has been implicated in the decrease of many of ROS scavenging enzymes, thereby leading to detrimental levels of free radicals in the cell. AT2R is less understood, but evidence supports an anti-oxidative and mitochondria-protective function for AT2R. The overlap between age related changes in RAS and mitochondria, and the consequences of this overlap on age-related diseases are quite complex. RAS dysregulation has been implicated in many pathological conditions due to its contribution to mitochondrial dysfunction. Decreased age-related, renal and cardiac mitochondrial dysfunction was seen in patients treated with angiotensin receptor blockers. The aim of this review is to: (a) report the most recent information elucidating the role of RAS in mitochondrial redox hemostasis and (b) discuss the effect of age-related activation of RAS on generation of free radicals.
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Affiliation(s)
- Ramya Vajapey
- School of Medicine, Northeast Ohio Medical University Rootstown, OH, USA
| | - David Rini
- Division of Cellular and Molecular Medicine, Art as Applied to Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Jeremy Walston
- Division of Geriatrics Medicine and Gerontology, Department of Medicine, Johns Hopkins University Baltimore, MD, USA
| | - Peter Abadir
- Division of Geriatrics Medicine and Gerontology, Department of Medicine, Johns Hopkins University Baltimore, MD, USA
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100
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Walston J, Zellars RC. Racial differences in radiation-induced toxicity and cytokine expression levels. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jeremy Walston
- The Johns Hopkins University School of Medicine, Baltimore, MD
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