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Zhang D, Eckhardt CM, McGroder C, Benesh S, Porcelli J, Depender C, Bogyo K, Westrich J, Thomas-Wilson A, Jobanputra V, Garcia CK. Clinical Impact of Telomere Length Testing for Interstitial Lung Disease. Chest 2024:S0012-3692(24)00808-0. [PMID: 38950694 DOI: 10.1016/j.chest.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Shortened telomere length (TL) is a genomic risk factor for fibrotic interstitial lung disease (ILD), but its role in clinical management is unknown. RESEARCH QUESTION What is the clinical impact of TL testing on the management of ILD? STUDY DESIGN AND METHODS Patients were evaluated in the Columbia University ILD clinic and underwent Clinical Laboratory Improvement Amendments-certified TL testing by flow cytometry and fluorescence in situ hybridization (FlowFISH) as part of clinical treatment. Short TL was defined as below the 10th age-adjusted percentile for either granulocytes or lymphocytes by FlowFISH. Patients were offered genetic counseling and testing if they had short TL or a family history of ILD. FlowFISH TL was compared with research quantitative polymerase chain reaction (qPCR) TL measurement. RESULTS A total of 108 patients underwent TL testing, including those with clinical features of short telomere syndrome such as familial pulmonary fibrosis (50%) or extrapulmonary manifestations in the patient (25%) or a relative (41%). The overall prevalence of short TL was 46% and was similar across clinical ILD diagnoses. The number of short telomere clinical features was independently associated with detecting short TL (OR, 2.00; 95% CI, 1.27-3.32). TL testing led to clinical treatment changes for 35 patients (32%), most commonly resulting in reduction or avoidance of immunosuppression. Of the patients who underwent genetic testing (n = 34), a positive or candidate diagnostic finding in telomere-related genes was identified in 10 patients (29%). Inclusion of TL testing below the 1st percentile helped reclassify eight of nine variants of uncertain significance into actionable findings. The qPCR test correlated with FlowFISH, but age-adjusted percentile cutoffs may not be equivalent between the two assays. INTERPRETATION Incorporating TL testing in ILD impacted clinical management and led to the discovery of new actionable genetic variants.
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Affiliation(s)
- David Zhang
- Department of Medicine, Columbia University Irving Medical Center, New York, NY.
| | | | - Claire McGroder
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Shannon Benesh
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | | | | | - Kelsie Bogyo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph Westrich
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | | | - Vaidehi Jobanputra
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY; New York Genome Center, New York, NY
| | - Christine K Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
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Francis M, Lindrose A, O'Connell S, Tristano RI, McGarvey C, Drury S. The interaction of socioeconomic stress and race on telomere length in children: A systematic review and meta-analysis. SSM Popul Health 2023; 22:101380. [PMID: 37065841 PMCID: PMC10102414 DOI: 10.1016/j.ssmph.2023.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Rationale Proposed mechanisms relating early life exposures to poor health suggest that biologic indicators of risk are observable in childhood. Telomere length (TL) is a biomarker of aging, psychosocial stress, and a range of environmental exposures. In adults, exposure to early life adversity, including low socioeconomic status (SES), is predictive of shorter TL. However, results in pediatric populations have been mixed. Defining the true relation between TL and SES in childhood is expected to enhance the understanding of the biological pathways through which socioeconomic factors influence health across the life span. Objective The aim of this meta-analysis was to systematically review and quantitatively assess the published literature to better understand how SES, race, and TL are related in pediatric populations. Methods Studies in the United States in any pediatric population with any measure of SES were included and identified through the following electronic databases: PubMed, EMBASE, Web of Science, Medline, Socindex, CINAHL, and Psychinfo. Analysis utilized a multi-level random-effects meta-analysis accounting for multiple effect sizes within a study. Results Thirty-two studies were included with a total of 78 effect sizes that were categorized into income-based, education-based, and composite indicators. Only three studies directly tested the relation between SES and TL as the primary study aim. In the full model, there was a significant relation between SES and TL (r = 0.0220 p = 0.0286). Analysis by type of SES categorization identified a significant moderating effect of income on TL (r = 0.0480, 95% CI: 0.0155 to 0.0802, p = 0.0045) but no significant effect for education or composite SES. Conclusions There is an overall association between SES and TL that is predominately due to the association with income-based SES measures implicating income disparities as a key target for efforts to address health inequity across the life span. Identification of associations between family income and biological changes in children that predict life-span health risk provides key data to support public health policies addressing economic inequality in families and presents a unique opportunity to assess the effect of prevention efforts at the biologic level.
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Affiliation(s)
- Mariza Francis
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
| | - Alyssa Lindrose
- Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Samantha O'Connell
- Office of Academic Affairs and Provost, Tulane University, New Orleans, LA, USA
| | - Renee I. Tristano
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Cecile McGarvey
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
| | - Stacy Drury
- Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane Brain Institute and School of Science and Engineering, Tulane University, 6823 St. Charles Ave., New Orleans, LA, USA
- Corresponding author. Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
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Slavich GM. Social Safety Theory: Understanding social stress, disease risk, resilience, and behavior during the COVID-19 pandemic and beyond. Curr Opin Psychol 2022; 45:101299. [PMID: 35219156 PMCID: PMC8769662 DOI: 10.1016/j.copsyc.2022.101299] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
Many of life's most impactful experiences involve either social safety (e.g., acceptance, affiliation, belonging, inclusion) or social threat (e.g., conflict, isolation, rejection, exclusion). According to Social Safety Theory, these experiences greatly impact human health and behavior because a fundamental goal of the brain and immune system is to keep the body biologically safe. To achieve this crucial goal, social threats likely gained the ability to activate anticipatory neural-immune responses that would have historically benefited reproduction and survival; the presence of social safety, in turn, likely dampened these responses. Viewing positive and negative social experiences through this lens affords a biologically based evolutionary account for why certain stressors are particularly impactful. It also provides an integrated, multi-level framework for investigating the biopsychosocial roots of psychopathology, health disparities, aging, longevity, and interpersonal cognition and behavior. Ultimately, this work has the potential to inform new strategies for reducing disease risk and promoting resilience.
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Slavich GM. Social Safety Theory: A Biologically Based Evolutionary Perspective on Life Stress, Health, and Behavior. Annu Rev Clin Psychol 2020; 16:265-295. [PMID: 32141764 PMCID: PMC7213777 DOI: 10.1146/annurev-clinpsy-032816-045159] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Social Safety Theory hypothesizes that developing and maintaining friendly social bonds is a fundamental organizing principle of human behavior and that threats to social safety are a critical feature of psychological stressors that increase risk for disease. Central to this formulation is the fact that the human brain and immune system are principally designed to keep the body biologically safe, which they do by continually monitoring and responding to social, physical, and microbial threats in the environment. Because situations involving social conflict, isolation, devaluation, rejection, and exclusion historically increased risk for physical injury and infection, anticipatory neural-immune reactivity to social threat was likely highly conserved. This neurocognitive and immunologic ability for humans to symbolically represent and respond to potentially dangerous social situations is ultimately critical for survival. When sustained, however, this multilevel biological threat response can increase individuals' risk for viral infections and several inflammation-related disease conditions that dominate present-day morbidity and mortality.
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Affiliation(s)
- George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California 90095-7076, USA;
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Rentscher KE, Carroll JE, Mitchell C. Psychosocial Stressors and Telomere Length: A Current Review of the Science. Annu Rev Public Health 2020; 41:223-245. [DOI: 10.1146/annurev-publhealth-040119-094239] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A growing literature suggests that exposure to adverse social conditions may accelerate biological aging, offering one mechanism through which adversity may increase risk for age-related disease. As one of the most extensively studied biological markers of aging, telomere length (TL) provides a valuable tool to understand potential influences of social adversity on the aging process. Indeed, a sizeable literature now links a wide range of stressors to TL across the life span. The aim of this article is to review and evaluate this extant literature with a focus on studies that investigate psychosocial stress exposures and experiences in early life and adulthood. We conclude by outlining potential biological and behavioral mechanisms through which psychosocial stress may influence TL, and we discuss directions for future research in this area.
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Affiliation(s)
- Kelly E. Rentscher
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California 90095, USA;,
| | - Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California 90095, USA;,
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48106, USA
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Bürgin D, O'Donovan A, d'Huart D, di Gallo A, Eckert A, Fegert J, Schmeck K, Schmid M, Boonmann C. Adverse Childhood Experiences and Telomere Length a Look Into the Heterogeneity of Findings-A Narrative Review. Front Neurosci 2019; 13:490. [PMID: 31191214 PMCID: PMC6541108 DOI: 10.3389/fnins.2019.00490] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 04/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Adverse childhood experiences (ACEs) have been associated with poor mental and somatic health. Accumulating evidence indicates that accelerated biological aging-indexed by altered telomere-related markers-may contribute to associations between ACEs and negative long-term health outcomes. Telomeres are repeated, non-coding deoxyribonucleic acid (DNA) sequences at the end of chromosomes. Telomeres shorten during repeated cell divisions over time and are being used as a marker of biological aging. Objectives: The aim of the current paper is to review the literature on the relationship between ACEs and telomere length (TL), with a specific focus on how the heterogeneity of sample and ACEs characteristics lead to varying associations between ACEs and TL. Methods: Multiple databases were searched for relevant English peer-reviewed articles. Thirty-eight papers were found to be eligible for inclusion in the current review. Results: Overall, the studies indicated a negative association between ACEs and TL, although many papers presented mixed findings and about a quarter of eligible studies found no association. Studies with smaller sample sizes more often reported significant associations than studies with larger samples. Also, studies reporting on non-clinical and younger samples more often found associations between ACEs and TL compared to studies with clinical and older samples. Reviewing the included studies based on the "Stressor Exposure Characteristics" recently proposed by Epel et al. (2018) revealed a lack of detailed information regarding ACEs characteristics in many studies. Conclusion: Overall, it is difficult to achieve firm conclusions about associations of ACEs with TL due to the heterogeneity of study and ACE characteristics and the heterogeneity in reported findings. The field would benefit from more detailed descriptions of study samples and measurement of ACEs.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Clinic, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Aoife O'Donovan
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Delfine d'Huart
- Child and Adolescent Psychiatric Clinic, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Alain di Gallo
- Child and Adolescent Psychiatric Clinic, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Neurobiological Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Jörg Fegert
- Child and Adolescent Psychiatry/Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Clinic, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Clinic, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Clinic, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
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